In-depth Analysis of Mortality in Relation to Malnutrition in Children Under-five of Age in the Eastern Mediterranean Region

Abstract

Background:The Eastern Mediterranean region (EMR) countries are facing many challenges that influence the nutritional status of children under-five years of age (CU5) and increase early mortality rates (MRs). Few studies have considered using global data to analyze the protective effect of breastfeeding on reducing MRs in the EMR.Aim: To analyze regional mortality rates in relation to socio-demographic, nutritional indices and early feeding practices in CU5 in the EMR countries.Methods: Data from the WHO global data bank for nutritional status and MRs in the 22 countries in EMR were analyzed MRs included neonatal mortality rates (NMR), infant mortality rates (IMR), under-five mortality rates (U5MR), maternal mortality ratio (MMR). Data was analyzed by income group and correlated to obesity and underweight, early feeding practices including early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), breastfeeding rates at 12 (BR12) and 24 months (BR24) and selected indicators for development included illiteracy rates and total fertility rates (TFR).Results: MRs correlated with global data for country rates EIBF, EBF. Also BF12 and BF24 months correlated with stunting, wasting in the CU5, U5MR and overweight and obesity in adults. MRs correlated highly with stunting and wasting and poorly with overweight or obesity in CU5. Other variables as illiteracy, TFR, obesity and overweight in adults correlated significantly with MRs and with breastfeeding duration. At country level the low trends of shortened breastfeeding duration were associated with the high MRs and rate for obesity and stunting.Conclusions: Suboptimal early feeding practices leading to the double burden of malnutrition influence MR in the under-five mortality rates in children. Improving early initiation rates and prolonging the duration of intense breastfeeding can reduce early mortality. This cannot be attained without improving social indicators of literacy and birth spacing i.e. a comprehensive developmental approach to child survival.

Interventions and Programs to Promote Breastfeeding in Arabic-Speaking Countries: A Scoping Review

“…Low prevalence of exclusive breastfeeding in the Arab world is concerning; some countries in the Arab world approach the global average but prevalence is much lower in others including in Somalia (5.3%) and Tunisia (8.1%) (Al-Jawaldeh et al, 2018 ; United Nations Office of the High Commissioner for Human Rights, 2016 ). A comprehensive analysis reported that suboptimal BF was identified as a leading child health risk factor in several Arab States including Algeria, Egypt, Iraq, Libya and Morocco (Roberts et al, 2013 ).…”

Exclusive Breastfeeding

“…3 Nevertheless, the decline in early initiation (within one hour of birth)—87.1% and 82.0%—and the current low rate of EBF for the first six months (23.2%) are of concern not only in Oman but also in the region as a whole. 3 , 5 , 6 …”

“…3 Nevertheless, the decline in early initiation (within one hour of birth)-87.1% and 82.0%-and the current low rate of EBF for the first six months (23.2%) are of concern not only in Oman but also in the region as a whole. 3,5,6 A wide range of factors, including social and cultural attitudes, marketing of infant formula, health systems and workplace, community settings and individual attitudes, affect whether or not women initiate early breastfeeding and maintain exclusive and continued breastfeeding for up to two years. 2 Barrier analysis, based on the Health Belief Model and the Theory of Reasoned Action, has identified 12 determinants of behaviour: perceived selfefficacy, perceived social norms, perceived positive consequences, perceived negative consequences, perceived action efficacy, access, perceived susceptibility/risk, perceived severity, cues for action, policy, culture and perceived divine will.…”