Exclusive Breastfeeding (EBF) and Child Mortality in West Africa: An Examination of the Differen

1. Exclusive Breastfeeding (EBF) and Child Mortality in West Africa:An Examination of the Difference in Rates in Burkina Faso and Ghana Emily A. Ramshur, BA, RN/BSN, MPH Candidate Johns Hopkins University Bloomberg School of Public Health Capstone Project, Fall 2009 Dr. William Brieger, Advisor

2. Goals of this Analysis • To understand EBF as compared to other IF methods • To illuminate EBF’s relationship to child undernutrition and mortality in West Africa • To compare lack of success in boosting EBF rate in Burkina Faso with success in Ghana • To recommend approaches and initiatives for raising EBF rate in Burkina

3. Breastfeeding and Child Mortalityin West Africa • 4th UN Millennium Development Goal (MDG) • Child mortality in SSA • EBF in West & Central Africa • Relationship between child mortality and suboptimal BF • Single most critical strategy to achieve MDG #4??

4. EBF versus Other Infant Feeding Methods • International consensus on superiority of EBF (WHO, UNICEF) • EBF definition • Extensive data on benefits • “Mixed feeding” • “Artificial feeding”

5. Burkina Faso: EBF Data • UNICEF 1993: 1-6% EBF UNICEF 2003: 3-8% EBF • DHS 2003: <2 month olds = 18% 2-3 month olds = 22% 4-5 month olds = 16% 6-7 month olds = 16% • 3-19% between 1990-2004 (24% Cameroon, 25% Mali, 34% Senegal, 53% Ghana)

6. Ghana: EBF Data • UNICEF 1988: 1-4% EBF UNICEF 2006: 75%  40% (4 mos)  10% (6 mos) • DHS 2003: <2 month olds = 62%, 2-3 month olds = 65%, 4-5 month olds = 39%, 6-7 month olds = 14% • DHS 2008: <2 month olds = 84%, 4-5 month olds = 49%, overall = 63% • Grew 4-53% from 1990-2004

7. Burkina Faso & Ghana:Child Mortality and Undernutrition *deaths per 1,000 live births • In Burkina, suboptimal BF responsible for 6,200 infant deaths, or 11% all-cause infant mortality • Many possible factors; low EBF may be one

8. Possible Factors in Differing Rates of EBF in Burkina Faso & Ghana • Sociocultural factors • Obstacle in both countries • Maternal formal education • Directly linked to EBF • Very low levels in Burkina • Practical education • Positive impact on EBF • Requires training of HCWs • Must boost out-of-hospital promotion by HCWs, particularly in Burkina Faso

9. Possible Factors in Differing Rates of EBF in Burkina Faso & Ghana • Community-level interventions? • Dearth of evidence in Burkina Faso • Broad-reaching, highly successful programs in Ghana • Level of poverty and availability of funding? • Fewer funds in Burkina • Ghana $34; Madagascar only $10/new acceptor • Can be affordable & sustainable • Reprioritization of goals & fund reallocation

10. Possible Factors in Differing Rates of EBF in Burkina Faso & Ghana • Baby-Friendly Hospital Initiative (BFHI)? • 19 Baby-Friendly facilities in Burkina; 192 in Ghana • Hospitals not requirements, but helpful • International policy? • Int’l Code of Marketing of Breastmilk Substitutes • Signature only in Burkina; concrete action in Ghana • National commitment? • Need reprioritization & true/demonstrated will

11. Summary: Recommendationsfor Burkina Faso to Boost EBF Rate • Practical education of mothers/families • Education of HCWs, in/outside hospitals • Expansion of BFHI • Monitoring, enforcement, and penalization for violations of current codes/laws/regulations • Shifting of national goals with fund reallocation • Enhanced large-scale, community-level programming • Coordination of stakeholders and collaboration with local and international agencies

12. THANK YOU! ANY QUESTIONS?

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