Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi
Abstract 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 attr...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-07-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-38455-5 |
| _version_ | 1797778900429832192 |
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| author | Shamsudeen Mohammed Emily L. Webb Clara Calvert Judith R. Glynn Bindu S. Sunny Amelia C. Crampin Estelle McLean Shekinah Munthali-Mkandawire Albert Lazarous Nkhata Dube Fredrick Kalobekamo Milly Marston Laura L. Oakley |
| author_facet | Shamsudeen Mohammed Emily L. Webb Clara Calvert Judith R. Glynn Bindu S. Sunny Amelia C. Crampin Estelle McLean Shekinah Munthali-Mkandawire Albert Lazarous Nkhata Dube Fredrick Kalobekamo Milly Marston Laura L. Oakley |
| author_sort | Shamsudeen Mohammed |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-12T23:24:12Z |
| format | Article |
| id | doaj.art-56c6846fe7714bea8a8b3159c2df2c9e |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-12T23:24:12Z |
| publishDate | 2023-07-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-56c6846fe7714bea8a8b3159c2df2c9e2023-07-16T11:15:42ZengNature PortfolioScientific Reports2045-23222023-07-0113111510.1038/s41598-023-38455-5Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in MalawiShamsudeen Mohammed0Emily L. Webb1Clara Calvert2Judith R. Glynn3Bindu S. Sunny4Amelia C. Crampin5Estelle McLean6Shekinah Munthali-Mkandawire7Albert Lazarous Nkhata Dube8Fredrick Kalobekamo9Milly Marston10Laura L. Oakley11Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineCentre for Global Health, Usher Institute, University of EdinburghDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineUnited Nations Educational, Scientific and Cultural OrganizationDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineDepartment of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineMalawi Epidemiology and Intervention Research UnitMalawi Epidemiology and Intervention Research UnitMalawi Epidemiology and Intervention Research UnitDepartment of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineDepartment of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineAbstract 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.https://doi.org/10.1038/s41598-023-38455-5 |
| spellingShingle | Shamsudeen Mohammed Emily L. Webb Clara Calvert Judith R. Glynn Bindu S. Sunny Amelia C. Crampin Estelle McLean Shekinah Munthali-Mkandawire Albert Lazarous Nkhata Dube Fredrick Kalobekamo Milly Marston Laura L. Oakley Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi Scientific Reports |
| title | Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi |
| title_full | Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi |
| title_fullStr | Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi |
| title_full_unstemmed | Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi |
| title_short | Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi |
| title_sort | effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13 year follow up study in malawi |
| url | https://doi.org/10.1038/s41598-023-38455-5 |
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