Academic journal article Bulletin of the World Health Organization

Breastfeeding Rates in Central and Western China in 2010: Implications for Child and Population health/Taux D'allaitement Maternel En Chine Centrale et Occidentale En 2010: Implications Pour la Sante De L'enfant et De la population/Los Indices De Lactancia En El Centro Y Oeste De China En 2010: Implicaciones Para la Salud Infantil Y De la Poblacion

Academic journal article Bulletin of the World Health Organization

Breastfeeding Rates in Central and Western China in 2010: Implications for Child and Population health/Taux D'allaitement Maternel En Chine Centrale et Occidentale En 2010: Implications Pour la Sante De L'enfant et De la population/Los Indices De Lactancia En El Centro Y Oeste De China En 2010: Implicaciones Para la Salud Infantil Y De la Poblacion

Article excerpt

Introduction

In 2010, China had the world's fifth largest number of deaths among children younger than 5 years, despite child mortality rates in the country having fallen steadily over the last two decades. (1-4) Consequently, the timing and causes of death in children in China are different from those in countries where large numbers of children perish early in life. Globally, around two thirds of deaths in children younger than 5 years are caused by infection (5) and an estimated 35% are associated with poor nutrition. (6,7) By contrast, only 21.4% of comparable deaths in China in 2008 were infection-related: 16.5% were due to pneumonia; 3%, to diarrhoea and 1.9%, to neonatal sepsis. (2) However, child mortality rates are much higher in poor western provinces, where infectious diseases are more common; (2) the rate in children younger than 5 years in the poorest counties is more than six times higher than in large cities. (8) Children are more likely to die from pneumonia and diarrhoea in the western part of China. (2,4)

Breastfeeding has been shown to reduce child mortality and morbidity, especially from infectious diseases. (6,9-11) It may be possible, then, to reduce infection-associated child mortality and morbidity in poor rural areas in China by promoting good infant and young child feeding practices, particularly breastfeeding, and by discouraging the inappropriate use of breast-milk substitutes. Moreover, infant and young child feeding practices may be associated with the long-term incidence of noncommunicable diseases in both developing and developed countries, regardless of socioeconomic status. (12,13) Thus, improving breastfeeding practices may help reduce the future incidence of noncommunicable diseases both in China and elsewhere.

Currently, few data are available on infant and young child feeding practices in China. The aim of this study, therefore, was to describe these practices and associated variables by surveying a large geographical area in China's central and western provinces. Our survey was the first in the country to include the full range of globally recommended breastfeeding indicators, (11) enabling comparisons to be made between China and other countries. We also examined differences in infant and young child feeding practices between China and neighbouring countries in the context of increased consumption of breast-milk substitutes and rising noncommunicable disease rates.

Methods

We conducted a community-based, cross-sectional survey of infant and young child feeding practices in 26 counties, with a total population 11 000 000, in 12 central and western provinces of China: Chongqing, Gansu, Guangxi, Guizhou, Inner Mongolia, Jiangxi, Qinghai, Shaanxi, Shanxi, Sichuan, Tibet and Xinjiang. The counties were selected by staff at the United Nations Children's Fund (UNICEF) and the Chinese Ministry of Health as being representative of poor rural counties on the basis of their level of socioeconomic development and measures of maternal and child health. Child mortality was as high as 65 per 1000 live births in these counties, compared with a national rural average of 34 per 1000 live births in 2009, and the per capita gross domestic product ranged from 150 to 2210 United States dollars (US$), as calculated using the 2009 conversion rate from renminbi, compared with the national average of US$ 3680. The survey was conducted by Peking University School of Public Health and UNICEF staff working with local health authorities and was approved by Peking University's ethics committee.

Data collection

A multistage sampling technique was used to select townships and villages in the 26 counties. First, all townships in each county were ranked by hospital delivery rate in 2009 and divided into three approximately equal strata; one township was then randomly selected from each stratum, except in sparsely populated Tibet, in which two townships were selected from two equal strata in each county. …

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