Timing of breastfeeding initiation has no impact on day 1 deaths.

1. 4,000 lives EUROPE 27% deaths 179,000 lives E MED 33% deaths 26,000 lives AMERICAS 28% deaths 147,000 lives W PACIFIC 31% deaths 274,000 lives AFRICA 25% deaths 487,000 lives SE ASIA 34% deaths Meeting the child survival MDG: How many newborn lives could we save by improving coverage of early initiation of breastfeeding? Karen M Edmond, Ellie C Bard, Betty R Kirkwood (LSHTM) Early BF initiation: Current Coverage Background • 36% of childhood deaths occur during the first month of life: reducing neonatal deaths is essential if the child survival MDG is to be met. • 2005 Lancet Neonatal Series identified 16 interventions with proven efficacy for neonatal survival including exclusive breastfeeding. • Early initiation of breastfeeding was not on this list. • Recent results have become available from a large birth cohort study in Ghana demonstrating that delayed initiation of breastfeeding is associated with increased risk of neonatal mortality (Edmond et al, Pediatrics, in press). • This increased risk is additional to those associated with predominant and partial as compared to exclusive breastfeeding. CONCLUSIONS AND RECOMMENDATIONS • Coverage rates of early initiation of breastfeeding are low (see Figure); only about a third of babies are breastfed within the 1st hour of birth, and for more than a fifth initiation is delayed until after the first day. The countries • 60 UNICEF priority countries: these are countries with • No. of under-five deaths ≥ 50,000 or • U5MR ≥ 90/1000 live-births • We used the numbers of neonatal deaths in each country as reported in the World Health Report 2005. • These 60 countries account for 91% of the approx. 4 million newborns that die each year. • DHS data on current coverage levels of early initiation were available for 38 of the 60 countries. • Regional averages were used for the 22 countries with no coverage data. The model • Timing of breastfeeding initiation has no impact on day 1 deaths. • Early initiation can only reduce the risk of neonatal deaths that happen between days 2 & 28. • We assume this is 65% of all neonatal deaths (mid-point of range given in Paper 1 of the Lancet neonatal series). • The increased risks associated with delayed breastfeeding found in the Ghana study can be applied to all countries. • These increased risks (ORs) reflect a causal relationship & all the excess is attributable to delayed breastfeeding. • Babies who never breastfeed have the same risk as those who start after the first day; this is a conservative estimate. Ghana: Risk of Newborn Death after 1st day * AR = (OR-1)/OR * 100% • Two intervention models: A: breastfeeding initiated within 1st hour B: breastfeeding initiated within 1st day (but not necessarily 1st hour) • Lives saved estimated for: • Univeral coverage (defined as 99%) • 90% coverage RESULTS • The model is based on a single dataset; Similar data from other countries should be collated/collected as a priority. • If risks from Ghana are confirmed EARLY BF initiation should be added to key child survival interventions & monitored. • Potentially about 30% of newborn deaths (10% of U5 deaths) might be prevented with universal coverage of BF initiation within the 1st hour