Maternal and Child Health Journal

, Volume 20, Issue 10, pp 2130–2141 | Cite as

The Influence of Infant Feeding Practices on Infant Mortality in Southern Africa

  • Lungile F. Motsa
  • Latifat Ibisomi
  • Clifford Odimegwu


Objective To examine the adjusted and unadjusted effects of infant feeding practices on infant mortality in Southern Africa. Methods A merged dataset from the most recent Demographic and Health Surveys for Lesotho, Swaziland, Zambia and Zimbabwe was analysed using the Cox Proportional Hazard Model. A total number of 13,218 infants born in 5 years preceding all the surveys with information on infant feeding practices constituted the study population. Infant mortality was the outcome variable and infant feeding practices categorised into; no breastfeeding, partial breastfeeding and exclusive breastfeeding were the main explanatory variables. Maternal demographic and socio-economic characteristics and infants’ bio-demographic characteristics were also studied. Results Although, exclusive breastfeeding was quite low (12 %), exclusively breastfed infants exhibited a 97 % lower risk of dying during infancy compared to infants not breastfed in the region. Variations existed by country in the levels and patterns of both infant mortality and infant feeding practices. Mother’s country, highest level of education and marital status; child’s sex, birth weight and preceding birth interval were the significant predictors of infant mortality in Southern Africa. Conclusions Any form of breastfeeding whether exclusive or partial breastfeeding greatly reduces the risk of infant mortality with the greatest mortality reduction effect observed among exclusively breastfed infants in Southern Africa. To reduce the upsurge of infant mortality, there is the need to step up the effectiveness of child nutrition programmes that promote breastfeeding and put emphasis on exclusive breastfeeding of infants in the region.


Infant mortality Feeding practices Southern Africa 



This paper is based on the first author’s Master of Arts research in Demography and Population Studies at the University of the Witwatersrand, Johannesburg, South Africa. Sincere gratitude to the William and Flora Hewlett Foundation, USA, through support to the interdisciplinary Demography and Population Studies Programme run through the Schools of Social Sciences and Public Health, University of the Witwatersrand, Johannesburg, South Africa, for the financial support.


  1. 1.
    Alam, M. U., Rahman, M., & Rahman, F. (2002). Effectiveness of baby friendly hospital initiative on the promotion of exclusive breastfeeding among the Dhaka city dwellers in Bangladesh. Mymensingh Medical Journal, 11, 94–99.PubMedGoogle Scholar
  2. 2.
    Bewick, V., Cheek, L., & Ball, J. (2004). Statistics review 12: Survival analysis. Critical Care, 8(5), 389–394.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Betran, A. P., de Onis, M., Lauer, J. A., & Villar, J. (2001). Ecological study of the effect of the breast feeding on the infant mortality in Latin America. BMJ, 323, 1–5.CrossRefGoogle Scholar
  4. 4.
    Broadfoot, M., Britten, J., Tappin, D. M., & Mackenzie, J. M. (2005). The baby friendly hospital initiative and breastfeeding rates in Scotland. Archives of disease in childhood. Fetal and Neonatal Edition, 90, F114–F116.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Buwembo, P. (2010). Factors associated with under-5 mortality in South Africa: Trends 1997–2002. Pretoria: Faculty of Humanities, University of Pretoria.Google Scholar
  6. 6.
    Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia, and Macro International Inc. (2009). Zambia demographic and health survey 2007. Calverton, MD: CSO and Macro International Inc.Google Scholar
  7. 7.
    Central Statistical Office (CSO) (Swaziland), and Macro International Inc. (2008). Swaziland demographic and health survey 2006–07. Mbabane: Central Statistical Office and Macro International Inc.Google Scholar
  8. 8.
    Central Statistical Office (CSO). (2010). Fertility, nuptiality, disability & mortality report on the 2007 Swaziland housing and population census. Mbabane: Central Statistical Office.Google Scholar
  9. 9.
    Coovadia, H. M., Rollins, N. C., Bland, R. M., Little, K., Coutsoudis, A., Bennish, M. L., & Newell, M. (2007). Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: An intervention cohort study. Lancet, 369, 1107–1116.CrossRefPubMedGoogle Scholar
  10. 10.
    Edmond, K. M., Zandoh, C., Quigley, M. A., Amenga-Etego, S., Owusu-Agyei, S., & Kirkwood, B. R. (2006). Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics, 117(3), e380.CrossRefPubMedGoogle Scholar
  11. 11.
    Hobcraft, J., McDonald, J., & Rutstein, S. (1984). Socio-economic factors in infant and child mortality. Population Studies, 39, 193–223.CrossRefGoogle Scholar
  12. 12.
    Humphrey, J. H. (2010). The risks of not breastfeeding. Journal of Acquired Immune Deficiency Syndromes, 53(1), 1–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Ministry of Health and Social Welfare (MOHSW) [Lesotho] and ICF Macro. (2010). Lesotho Demographic and Health Survey 2009. Maseru: MOHSW and ICF Macro.Google Scholar
  14. 14.
    Mihrshahi, S., Oddy, W. H., Peat, J. K., & Kabir, I. (2008). Association between infant feeding patterns and diarrhoeal and respiratory illness: A cohort study in Chittang, Bangladesh. International Breastfeeding Journal, 3, 28.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Molbak, K., Jensen, H., Ingholt, L., & Aaby, P. (1997). Risk factors for diarrheoal disease incidence in early childhood: A community cohort study from Guinea-Bissaua. American Journal of Epidemiology, 146, 273–282.CrossRefPubMedGoogle Scholar
  16. 16.
    Oche, M. O., & Umar, A. S. (2008). Breastfeeding of mothers in a rural community of Sokoto, Nigeria. The Nigerian Postgraduate Medical Journal, 15, 101–114.PubMedGoogle Scholar
  17. 17.
    Ogunlesi, T. A. (2010). Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi-urban setting. Maternal and Child Health Journal, 14, 459–465.CrossRefPubMedGoogle Scholar
  18. 18.
    Preston, S., Heuveline, P., & Guillot, M. (2001). Demography: Measuring and modelling population processes. Oxford: Blackwell Publishers.Google Scholar
  19. 19.
    Rossenkhan, R., Novitsky, V., Sebunya, T. K., Leidner, J., Hagan, J. E., Moyo, S., et al. (2012). Infant feeding practices were not associated with breast milk HIV-1 RNA levels in a randomized clinical trial in Botswana. AIDS and Behavior, 16, 1260–1264.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rutstein, S. O. (2000). Factors associated with trends in infant and child mortality in developing countries during the 1990s. Bulletin of the World Health Organization, 78, 1256–1270.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Sartorius, B. K. D., Sartorius, K., Chirwa, T. F., & Fonn, S. (2011). Infant mortality in South Africa-distribution, associations and policy implications, 2007: An ecological spatial analysis. International Journal of Health Geographics, 10, 61.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    UNICEF. (2008). The state of Africa’s children 2008. New York: United Nations Regional Groupings.Google Scholar
  23. 23.
    UNICEF. (2012). Infant and young child feeding. New York: IYCF Unit.Google Scholar
  24. 24.
    Walters, S. J. (2009). Statistics. What is a Cox model? (Vol. 1, No. 10, 2nd ed., pp. 1–7).
  25. 25.
    WHO. (2003). Global strategy for infant and young child feeding. Geneva: WHO.Google Scholar
  26. 26.
    WHO. (2012). WHO guidelines on HIV and infant feeding 2010: An updated framework for priority action. Geneva: World Health Organization.Google Scholar
  27. 27.
    WHO. (2013). Maternal, newborn, child and adolescent health. Geneva: World Health Organization.
  28. 28.
    WHO. (2013). Goal 4: Reduce child mortality. Geneva: World Health Organization.
  29. 29.
    Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International. (2012). Zimbabwe demographic and health survey 2010–11. Calverton, MD: ZIMSTAT and ICF International Inc.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Demography and Population StudiesUniversity of the WitwatersrandJohannesburgSouth Africa
  2. 2.Epidemiology and Biostatistics Division, School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa

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