Table 4

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


Pneumonia Incidence: moderate outcome-specific quality


1 [27]

Cohort

Reverse causality highly likely (-0.5)

Study shows benefit of EBF among infants 0-5 mos of age; study shows benefit of any BF among infants 6-23 mos of age (+1)

Only Asia (-0.5)

EBF not reported for neonates alone


Pneumonia Prevalence: moderate outcome-specific quality


1 [18]

Cohort

Reverse causality likely (-0.5)

Study shows benefit of EBF among infants 0-5 mos of age; study shows benefit of any BF among infants 6-23 mos of age (+1)

Only Latin America (-0.5)

EBF not reported for neonates alone


Pneumonia Mortality: moderate outcome-specific quality


5 [19-23]

Cohort/Case-control

Reverse causality highly likely or likely for 3 of 5 studies (-0.5)

All studies show benefit of EBF among infants 0-5 mos of age; all studies show benefit of any BF among infants 6-23 mos of age (+1)

Asia, Latin America, Africa, Western Pacific


All-Cause Mortality: moderate outcome-specific quality


4 [19,20,24,25]

Cohort

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

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

Asia, Latin America, Africa


Pneumonia Hospitalizations: moderate outcome-specific quality


2 [20,26]

Cohort/Case-control

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

All studies show benefit of EBF among infants 0-5 mos of age; studies show benefit of any BF among children 0-11 mos of age (+1)

Asia, Latin America, Africa

EBF not reported for neonates alone; BF not reported for children >11 mos


All-Cause Hospitalizations: moderate outcome-specific quality


1 [20]

Cohort

Reverse causality highly likely (-0.5)

Study shows benefit of EBF among infants 0-5 mos of age (+1)

Asia, Latin America, Africa

EBF not reported for neonates alone; BF not reported for children >6 mos


Lamberti et al. BMC Public Health 2013 13(Suppl 3):S18   doi:10.1186/1471-2458-13-S3-S18

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