The association of breastfeeding with cognitive development and educational achievement in sub-Saharan Africa: A systematic review

Mohammed, Shamsudeen; Oakley, Laura; Marston, Milly; Glynn, Judith R.; Calvert, Clara

doi:10.7189/jogh.12.04071

Cited by 6 publications

(11 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with existing literature on the association of breastfeeding with educational outcomes in sub-Saharan Africa [ 31 ]. For example, an analysis of data from the birth-to-twenty cohort study in South Africa found no effect of breastfeeding duration in infancy on subsequent educational outcomes among 17-year-olds [ 32 ].…”

Section: Discussionsupporting

confidence: 92%

“…Similarly, when Mitchell et al [ 33 ] studied 7–11-year-olds in rural KwaZulu-Natal, South Africa, they found no conclusive evidence of an association between exclusive breastfeeding and grade repetition. In addition, while our recent analysis of data from a Malawian cohort suggested an association between exclusive breastfeeding and age-for-grade attainment [ 34 ], in our earlier systematic review of data from sub-Saharan Africa, we found no effect of breastfeeding on cognitive development or educational achievement [ 31 ].…”

Section: Discussionmentioning

confidence: 69%

“…Each mother-child dyad was assigned a household wealth that was calculated from indicators collected around the time of the child’s birth. Potential confounders were selected based on previous literature [ 9 , 31 ] and our knowledge of the relationship between breastfeeding and educational attainment.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence from sub-Saharan Africa could clarify this association since the duration and pattern of breastfeeding are not strongly influenced by socioeconomic status in the region [ 14 , 29 , 30 ]. Our recent systematic review revealed that only two studies had investigated the breastfeeding-educational-outcomes relationship in sub-Saharan Africa [ 31 ], with no studies from Uganda. Neither of the two South African studies identified in the review demonstrated a clear association between breastfeeding and educational outcomes [ 32 , 33 ], although our recent analysis of data from Malawi found better grade progression among children exclusively breastfed for a longer duration [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study

Mohammed,

Calvert,

O Mugisha

et al. 2024

Global Health Action

Self Cite

View full text Add to dashboard Cite

Background Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. Objective This study investigated the association between breastfeeding duration and children’s educational attainment in rural Southwest Uganda. Methods We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. Results Most mothers breastfed for more than a year. Just over one-third breastfed for 18–23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7–12, 13–17, 18–23, and > 23 months compared to those breastfed for 0–6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. Conclusion Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children’s health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study

Mohammed,

Calvert,

O Mugisha

et al. 2024

Global Health Action

Self Cite

View full text Add to dashboard Cite

show abstract

“…In fact, Renee et al who studied the extent to which confounding explained the association between breastfeeding duration and cognitive development up to 14 years of age, reported that adjusting for SES tended to halve the effect sizes, while further adjustment for maternal cognitive scores explained the remaining association at 5 years of age, while there was still an effect at ages 7, 11 and 14 (Pereyra‐Elías et al, 2022 ). In line with this, a systematic review of 17 studies in Sub‐Saharan Africa concluded that much of the effect of breastfeeding that is, exclusive or prolonged breastfeeding on child development has to do with ‘who breastfeeds’ and that confounders are rarely adequately considered in analyses (Mohammed et al, 2022 ). In fact, prolonged breastfeeding in itself has been associated with undernutrition in several studies (Briend & Bari, 1989 ; Syeda et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Correlates of early child development among children with stunting: A cross‐sectional study in Uganda

Mbabazi,

Pesu,

Mutumba

et al. 2024

Maternal & Child Nutrition

View full text Add to dashboard Cite

Many children in low‐ and middle‐income countries are not attaining their developmental potential. Stunting is associated with poor child development, but it is not known which correlates of stunting are impairing child development. We explored potential socioeconomic, nutritional, clinical, and household correlates of early child development among 12–59‐month‐old children with stunting in a cross‐sectional study in Uganda. Development was assessed using the Malawi Development Assessment Tool (MDAT) across four domains of gross and fine motor, language, and social skills. Linear regression analysis was used to assess correlates of development in the four domains and total MDAT score. Of 750 children included, the median [interquartile range] age was 30 [23−41] months, 55% of the children resided in rural settings with 21% from female‐headed households and 47% of mothers had no schooling. The mean ± standard deviation height‐for‐age z‐score (HAZ) was −3.02 ± 0.74, 40% of the children had a positive malaria test and 65% were anaemic (haemoglobin < 110 g/L). One‐third had children's books at home, majority (96%) used household objects to play with and most of them (70%) used toys as pretence items like those to mimic cooking. After age, sex, and site adjustments, HAZ (0.24, 95% confidence interval [CI]: 0.14−0.33) and head circumference (0.07, 95% CI: 0.02−0.12) were positive correlates of total MDAT score, whereas weight‐for‐height z‐score (WHZ) was not. Current breastfeeding was associated with 0.41 (95% CI: 0.17−0.65) lower total MDAT score. Children from households with a single income earner had 0.22 (95% CI: 0.06−0.37) lower total MDAT score. Furthermore, severe food insecurity, inflammation and positive malaria test were associated with lower scores for motor development. All family care indicator subscales (FCIs) positively correlated with the total MDAT score and this association was independent of household's socioeconomic status. In conclusion, stunting degree, head circumference, number of household income earners and stimulation by improved FCIs correlate with early child development among stunted children. The negative association with prolonged breastfeeding is likely due to reverse causality. Identified correlates may inform initiatives to support children with stunting attain their development potential.

show abstract

Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi

Mohammed,

Webb,

Calvert

et al. 2023

Sci Rep

Self Cite

View full text Add to dashboard Cite

The benefits of exclusive breastfeeding (EBF) for infant health and survival are well documented. However, its impact on educational outcomes has been contested and poorly researched in Africa. It has been hypothesised that positive associations reported in high-income countries can be attributed to residual confounding by socioeconomic status (SES). Our study investigated whether EBF duration in infancy is associated with educational attainment and age-for-grade attainment trajectories at school-age in rural Malawi. Longitudinal data on 1021 children at the Karonga demographic surveillance site in Malawi were analysed. Breastfeeding data were collected 3 months after birth and again at age one. The school grade of each child was recorded each year from age 6 until age 13. We calculated age-for-grade based on whether a child was at, over, or under the official expected age for a grade. Generalised estimating equations estimated the average effect of breastfeeding on age-for-grade. Latent class growth analysis identified age-for-grade trajectories, and multinomial logistic regression examined their associations with EBF. Maternal-child characteristics, SES, and HIV status were controlled. Overall, 35.9% of the children were exclusively breastfed for 6 months. Over-age for grade steadily increased from 9.6% at age 8 to 41.9% at age 13. There was some evidence that EBF for 6 months was associated with lower odds of being over-age for grade than EBF for less than 3 months (aOR = 0.82, 95%CI = 0.64–1.06). In subgroup analyses, children exclusively breastfed for 6 months in infancy were less likely to be over-age for grades between ages 6–9 (aOR = 0.64, 95%CI = 0.43–0.94). Latent class growth analysis also provided some evidence that EBF reduced the odds of falling behind in the early school grades (aOR = 0.66, 95%CI = 0.41–1.08) but not later. Our study adds to the growing evidence that EBF for 6 months has benefits beyond infant health and survival, supporting the WHO's recommendation on EBF.

show abstract

The association of breastfeeding with cognitive development and educational achievement in sub-Saharan Africa: A systematic review

Cited by 6 publications

References 53 publications

Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study

Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study

Correlates of early child development among children with stunting: A cross‐sectional study in Uganda

Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi

Contact Info

Product

Resources

About