Table 5

Quality assessment of studies measuring the association between suboptimal breastfeeding and selected outcomes

Directness


No of studies (ref)

Design

Limitations

Consistency

Generalizability to population of interest

Generalizability to intervention of interest


Diarrhea Incidence: moderate outcome-specific quality


5 [22,23,26-28]

Cohort/Cross-sectional

Reverse causality highly likely or likely for all 5 studies (-0.5)

Consistent and all studies showing benefit of EBF among infants 0-5 mos of age and benefit of any BF among children 6-23 mos of age (+1)

Mostly Latin America (-0.5)

EBF not reported for neonates alone


Diarrhea Prevalence (1-2 week): moderate outcome-specific quality


7 [21,22,27,30-32,34]

Cohort/Cross-sectional

Reverse causality highly likely or likely for all 7 studies (-0.5)

All but one study showing benefit of EBF among infants 0-5 mos of age; all studies showing benefit of any BF among children 6-23 mos of age (+1)

Mostly Asia (-0.5)

EBF not reported for neonates alone


Diarrhea Mortality: moderate outcome-specific quality


6 [15,19,20,25,33,35]

Cohort/Case-control

Reverse causality highly likely or likely for 5 of 6 studies (-0.5)

Consistent and all studies showing benefit of EBF among infants 0-5 mos of age and benefit of any BF among children 6-23 mos of age (+1)

Mostly Asia & Latin America (-0.5)

EBF not reported for neonates alone


All-Cause Mortality: moderate outcome-specific quality


4 [19-21,24]

Cohort

Reverse causality highly likely or likely for all 4 studies (-0.5)

All but one study showing benefit of EBF among infants 0-5 mos of age; all studies showing benefit of any BF among children 6-23 mos of age (+1)

Mostly Asia (-0.5)


Diarrhea Hospitalizations: moderate outcome-specific quality


2 [20,29]

Cohort/Case-control

Reverse causality highly likely or likely for both studies (-0.5)

Consistent and all studies showing benefit of EBF among infants 0-5 mos of age and benefit of any BF among children 6-23 mos of age (+1)

Equal amount of data from Asia, Latin America, Africa & Eastern Mediterranean

EBF not reported for neonates alone


Lamberti et al. BMC Public Health 2011 11(Suppl 3):S15   doi:10.1186/1471-2458-11-S3-S15

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