Effect of Breastfeeding Promotion on Early Childhood Caries and Breastfeeding Duration among 5 Year Old Children in Eastern Uganda: A Cluster Randomized Trial

Abstract

BackgroundAlthough several studies have shown short term health benefits of exclusive breastfeeding (EBF), its long term consequences have not been studied extensively in low-income contexts. This study assessed the impact of an EBF promotion initiative for 6 months on early childhood caries (ECC) and breastfeeding duration in children aged 5 years in Mbale, Eastern Uganda.MethodsParticipants were recruited from the Ugandan site of the PROMISE- EBF cluster randomised trial (ClinicalTrials.gov no: NCT00397150). A total of 765 pregnant women from 24 clusters were included in the ratio 1:1 to receive peer counselled promotion of EBF as the intervention or standard of care. At the 5 year follow-up, ECC was recorded under field conditions using the World Health Organization’s decayed missing filled tooth (dmft) index. Adjusted negative binomial and linear regression were used in the analysis.ResultsMean breastfeeding duration in the intervention and control groups (n=417) were 21.8 (CI 20.7–22.9) and 21.3(CI 20.7–21.9) months, respectively. The mean dmft was 1.5 (standard deviation [SD] 2.9) and 1.7 (SD 2.9) in the intervention and control groups, respectively. Corresponding prevalence estimates of ECC were 38% and 41%. Negative binomial regression analysis adjusted for cluster effects and loss-to-follow-up by inverse probability weights (IPW) showed an incidence-rate ratio (IRR) of 0.91 (95% CI 0.65–1.2). Comparing the effect of the trial arm on breastfeeding duration showed a difference in months of 0.48 (-0.72 to 1.7).ConclusionPROMISE EBF trial did not impact on early childhood caries or breastfeeding duration at 5 years of age. This study contributes to the body of evidence that promotion of exclusive breastfeeding does not raise oral health concerns. However, the high burden of caries calls for efforts to improve the oral health condition in this setting.Trial RegistrationClinicalTrials.gov NCT00397150

Assessing causal effects of early life‐course factors on early childhood caries in 5‐year‐old Ugandan children using directed acyclic graphs (DAGs): A prospective cohort study

“…Moreover, the intervention study was powered to evaluate effects on EBF and diarrhoea prevalence and not ECC and this could have led to type II errors, thus the nonsignificant findings of the intervention on ECC. 29 From a public health perspective, this study highlights the importance of early oral health intervention with caregivers both before and immediately after delivery, suggesting that those interventions should be included in primary health care in Uganda. Scaling up optimal early feeding practices and strengthening the policies to support their implementation could prevent ECC in Ugandan preschool children.…”

“…It may be argued that the EBF intervention could have had an effect on the ECC incidence and that the RCT groups should have been included in the models of this present study. Even though the primary outcome of the intervention was to evaluate effects on EBF and diarrhoea prevalence, the confidence intervals for the effect of the intervention on ECC described in another article 0.91 (95% CI 0.65-1.2), 29 suggests that if any effect at all, it was neither of statistical or clinical significance. Moreover, the intervention study was powered to evaluate effects on EBF and diarrhoea prevalence and not ECC and this could have led to type II errors, thus the nonsignificant findings of the intervention on ECC.…”

“…Details of the inter-rater and intrarater agreement between and within dental examiners have been reported previously. 29 Double data entry was carried out.…”

“…29 In the present study, we investigate how the practice of exclusive breastfeeding itself impacts on ECC in the context of a cohort study design.…”

Feeding frequency in infancy and dental caries in childhood: a prospective cohort study

“…Given the undisputed and critical role of breastfeeding in assuring maternal and infant health 27 , dental professionals should encourage mothers to initiate exclusive breastfeeding from birth, followed by continued breastfeeding as complementary foods are added to the diet. Promotion of exclusive breastfeeding early in life does not increase caries risk 28,29 . However, the results of the present study and others 25 suggest that frequent breastfeeding at later ages might have negative implications for dental health.…”