Exclusive Breastfeeding and Cognition, Executive Function, and Behavioural Disorders in Primary School-Aged Children in Rural South Africa: A Cohort Analysis

Abstract

BackgroundExclusive breastfeeding (EBF) is associated with early child health; its longer-term benefits for child development remain inconclusive. We examine the associations between EBF, HIV exposure, and other maternal/child factors and the cognitive and emotional-behavioural development of children aged 7–11 y.Methods and FindingsThe Vertical Transmission Study (VTS) supported EBF in HIV-positive and HIV-negative women; between 2012 and 2014, HIV-negative VTS children (332 HIV exposed, 574 HIV unexposed) were assessed in terms of cognition (Kaufman Assessment Battery for Children Second Edition [KABC-II]), executive function (Developmental Neuropsychological Assessment Second Edition [NEPSY-II]), and emotional-behavioural functioning (parent-reported Child Behaviour Checklist, [CBCL]). We developed population means by combining the VTS sample with 629 same-aged HIV-negative children from the local demographic platform. For each outcome, we split the VTS sample into scores above or at/below each population mean and modelled each outcome using logistic regression analyses, overall and stratified by child sex. There was no demonstrated effect of EBF on overall cognitive functioning. EBF was associated with fewer conduct disorders overall (adjusted odds ratio [aOR] 0.44 [95% CI 0.3–0.7], p ≤ 0.01), and there was weak evidence of better cognition in boys who had been exclusively breastfed for 2–5 mo versus ≤1 mo (Learning subscale aOR 2.07 [95% CI 1.0–4.3], p = 0.05). Other factors associated with better child cognition were higher maternal cognitive ability (aOR 1.43 [95% CI 1.1–1.9], p = 0.02, Sequential; aOR 1.74 [95% CI 1.3–2.4], p < 0.001, Planning subscales) and crèche attendance (aOR 1.96 [95% CI 1.1–3.5], p = 0.02, Sequential subscale). Factors positively associated with executive function were home stimulation (aOR 1.36 [95% CI 1.0–1.8], p = 0.04, Auditory Attention; aOR 1.35 [95% CI 1.0–1.8], p = 0.05, Response Set) and crèche (aOR 1.74 [95% CI 1.0–3.0], p = 0.05, Animal Sorting). Maternal mental health problems and parenting stress were associated with increased emotional-behavioural problems on the total CBCL (aOR 2.44 [95% CI 1.3–4.6], p = 0.01; aOR 7.04 [95% CI 4.2–11.9], p < 0.001, respectively). Maternal HIV status was not associated with any outcomes in the overall cohort. Limitations include the nonrandomised study design and lack of maternal mental health assessment at the child’s birth.ConclusionsEBF was associated with fewer than average conduct disorders and weakly associated with improved cognitive development in boys. Efforts to improve stimulation at home, reduce maternal stress, and enable crèche attendance are likely to improve executive function and emotional-behavioural development of children.

"Once the child is delivered, he is no more your baby," Exclusive Breastfeeding experiences of first-time mothers in Kassena-Nankana Municipality, Ghana - a qualitative study

“…As have been recognized in other studies (1,5), the current study among other benefits, revealed EBF as an act which served as an immunity for the child, an effective intervention against infections, and enhanced the immediate and future health of the infant. Again, the current study has also shown EBF as an effective measure for birth spacing as well as contributing to the personal wellbeing of the mothers, confirming previous research (6)(7)(8)(9)(10). First-time mothers who positively perceived EBF practice as beneficial were more likely to practice it.…”

“…Consequently, WHO and United Nations Children's Fund (UNICEF) recommend that all mothers should breastfeed their children exclusively for the first 6 months and thereafter continue to breastfeed for as long as the mother and child desire, with appropriate and sufficient weaning food included after 6 months of life (2,3). EBF is associated with multiple benefits ranging from cognitive to physical development over the life course of the infant (6)(7)(8). This practice is essential for good child health in the short term given its associated lower incidence and severity of diarrhea, reduced respiratory tract infections and lower incidence of allergic diseases among children at-risk (9,10).…”

Maternal alcohol consumption during pregnancy and child’s cognitive performance at 6–8 years of age in rural Burkina Faso: an observational study

“…In Africa, it has been used to study cognitive development and nutrition in Ethiopia (Bogale et al, 2013), Democratic Republic of Congo (Boivin et al, 2013; Bumoko et al, 2015) and South Africa (Taljaard et al, 2013; Rochat et al, 2016), among HIV infected children in Uganda (Boivin et al, 2010; Ruel et al, 2012; Brahmbhatt et al, 2017), and cerebral malaria in Senegal (Boivin, 2002), and Uganda (Bangirana et al, 2009). KABC-II has different sub-tests and is used in children aged 3–18 years.…”

Exclusive Breastfeeding Intention among Pregnant Mothers

“…[4][5][6] Skin-to-skin contact during breastfeeding also has a role on the development of infant's Intelligence Quotient and Emotional Intelligence. 7 Even though exclusive breastfeeding becomes a global health recommendation, but it only covers around 40% in the world. 8 In 2014, Center of Disease Control and Prevention reported that 80% of infants born in the United States did not get exclusive breastfeeding.…”