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

Nancy Birungi, Lars T Fadnes, Isaac Okullo, Arabat Kasangaki, Victoria Nankabirwa, Grace Ndeezi, James K Tumwine, Thorkild Tylleskär, Stein Atle Lie, Anne Nordrehaug Åstrøm, Nancy Birungi, Lars T Fadnes, Isaac Okullo, Arabat Kasangaki, Victoria Nankabirwa, Grace Ndeezi, James K Tumwine, Thorkild Tylleskär, Stein Atle Lie, Anne Nordrehaug Åstrøm

Abstract

Background: Although 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.

Methods: Participants 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.

Results: Mean 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).

Conclusion: PROMISE 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 registration: ClinicalTrials.gov NCT00397150.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart.
Fig 1. Flowchart.
aSome had more than one inclusion criteria.
Fig 2. Mean caries (dmft) prevalence distribution…
Fig 2. Mean caries (dmft) prevalence distribution by tooth type (numbered) in maxilla (upper figures) and mandible (lower figures) in intervention (left figures) and control group (right figures).
Fig 3. Kaplan-Meier plot showing breastfeeding duration…
Fig 3. Kaplan-Meier plot showing breastfeeding duration in years.
* Dashed line indicates intervention group; complete line indicates control group.

References

    1. Kramer MS, Kakuma R (2012) Optimal duration of exclusive breastfeeding. The Cochrane Library.
    1. Staff WHO (2003) Global strategy for infant and young child feeding: World Health Organization.
    1. Victora CG, Smith PG, Vaughan JP, Nobre LC, Lombardi C, Teixeira AMB, et al. (1989) Infant feeding and deaths due to diarrhea a case-control study. American journal of epidemiology 129: 1032–1041.
    1. Masumo R, Bardsen A, Mashoto K, Astrom AN (2013) Feeding practice among 6–36 months old in Tanzania and Uganda: Reliability and relationship with early childhood caries, ECC. Acta Odontol Scand.
    1. Tylleskär T, Jackson D, Meda N, Engebretsen IMS, Chopra M, Diallo AH, et al. (2011) Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. The Lancet 378: 420–427. 10.1016/S0140-6736(11)60738-1
    1. Kramer MS, Kakuma R (2012) Optimal duration of exclusive breastfeeding (Review).
    1. Britton C, McCormick FM, Renfrew MJ, Wade A, King SE (2007) Support for breastfeeding mothers Cochrane Database Syst Rev 1.
    1. Chapman DJ, Morel K, Anderson AK, Damio G, Perez-Escamilla R (2010) Breastfeeding peer counseling: from efficacy through scale-up. J Hum Lact 26: 314–326.
    1. Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S (2001) Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics 108: e67–e67.
    1. Salone LR, Vann WF, Dee DL (2013) Breastfeeding: an overview of oral and general health benefits. The Journal of the American Dental Association 144: 143–151.
    1. AAPD (2004) Definition of Early Childhood Caries (ECC). Classifications, consequences, and preventive strategies Pediatr Dent 25: 31–32.
    1. Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH (1999) Diagnosing and reporting early childhood caries for research purposes: a report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. Journal of public health dentistry 59: 192–197.
    1. Health UDo, Services H (2000): Rockville: US Department of Health and Human Services.
    1. Stecksen-Blicks C, Sunnegardh K, Borssen E (2004) Caries experience and background factors in 4-year-old children: time trends 1967–2002. Caries Res 38: 149–155.
    1. Selwitz RH, Ismail AI, Pitts NB Dental caries. The Lancet 369: 51–59.
    1. Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP (2011) Impact of oral diseases and disorders on oral health‐related quality of life of preschool children. Community dentistry and oral epidemiology 39: 105–114. 10.1111/j.1600-0528.2010.00580.x
    1. Masumo R, Bardsen A, Mashoto K, Astrom AN (2012) Prevalence and socio-behavioral influence of early childhood caries, ECC, and feeding habits among 6–36 months old children in Uganda and Tanzania. BMC Oral Health 12: 24 10.1186/1472-6831-12-24
    1. Kiwanuka SN, Åstrøm AN, Trovik TA (2004) Dental caries experience and its relationship to social and behavioural factors among 3–5‐year‐old children in Uganda. International journal of paediatric dentistry 14: 336–346.
    1. Hallett KB, O'Rourke PK (2003) Social and behavioural determinants of early childhood caries. Australian dental journal 48: 27–33.
    1. Yonezu T, Ushida N, Yakushiji M (2006) Longitudinal study of prolonged breast-or bottle-feeding on dental caries in Japanese children. The Bulletin of Tokyo Dental College 47: 157–160.
    1. Dye B, Shenkin J, Ogden C, Marshall T, Levy S, Kanellis M (2004) The relationship between healthful eating practices and dental caries in children aged 2–5 years in the United States, 1988–1994. J Am Dent Assoc 135: 55–66.
    1. Iida H, Auinger P, Billings R, Weitzman M (2007) Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 120: e944–952.
    1. Tanaka K, Miyake Y (2012) Association between breastfeeding and dental caries in Japanese children. J Epidemiol 22: 72–77.
    1. Dini EL, Holt RD, Bedi R (2000) Caries and its association with infant feeding and oral health‐related behaviours in 3–4‐year‐old Brazilian children. Community dentistry and oral epidemiology 28: 241–248.
    1. Mohebbi S, Virtanen J, Vahid-Golpayegani M, Vehkalahti M (2008) Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm. Community Dent Oral Epidemiol 36: 363–369.
    1. Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. (2001) Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. Jama 285: 413–420.
    1. Valaitis R, Hesch R, Passarelli C, Sheehan D, Sinton J (2000) A systematic review of the relationship between breastfeeding and early childhood caries. Can J Public Health 91: 411–417.
    1. Kramer MS, Vanilovich I, Matush L, Bogdanovich N, Zhang X, Shishko G, et al. (2007) The effect of prolonged and exclusive breast-feeding on dental caries in early school-age children. New evidence from a large randomized trial. Caries Res 41: 484–488.
    1. Lutter CK, Morrow AL (2013) Protection, promotion, and support and global trends in breastfeeding. Adv Nutr 4: 213–219. 10.3945/an.112.003111
    1. Ministry of local Government Uganda (2014) List of local Government districts.
    1. Statistics(UBOS) UBo (2012) Statistical Abstract.
    1. Engebretsen IM, Jackson D, Fadnes LT, Nankabirwa V, Diallo AH, Doherty T, et al. (2014) Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa: the cluster-randomised PROMISE EBF trial. BMC Public Health 14: 633 10.1186/1471-2458-14-633
    1. Howe LD, Hargreaves JR, Huttly SR (2008) Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg Themes Epidemiol 5: 3 10.1186/1742-7622-5-3
    1. World Health O (1992) Oral Health Surveys Basic Methods. Geneva: 1997. World Health Organization.
    1. Matee M, van't Hof M, Maselle S, Mikx F, van Palenstein Helderman W (1994) Nursing caries, linear hypoplasia, and nursing and weaning habits in Tanzanian infants. Community Dent Oral Epidemiol 22: 289–293.
    1. Hallonsten AL, Wendt LK, Mejare I, Birkhed D, Håkansson C, Lindvall AM, et al. (1995) Dental caries and prolonged breast‐feeding in 18‐month‐old Swedish children. International Journal of Paediatric Dentistry 5: 149–155.
    1. Sayegh A, Dini EL, Holt RD, Bedi R (2005) Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children. Journal of dentistry 33: 379–388.
    1. Scheiwe A, Hardy R, Watt RG (2010) Four-year follow-up of a randomized controlled trial of a social support intervention on infant feeding practices. Maternal & Child Nutrition 6: 328–337.
    1. Vachirarojpisan T, Shinada K, Kawaguchi Y (2005) The process and outcome of a programme for preventing early childhood caries in Thailand. Community Dent Health 22: 253–259.
    1. Feldens CA, Giugliani ER, Vigo A, Vitolo MR (2010) Early feeding practices and severe early childhood caries in four-year-old children from southern Brazil: a birth cohort study. Caries Res 44: 445–452. 10.1159/000319898
    1. Popkin BM (1998) The nutrition transition and its health implications in lower-income countries. Public Health Nutr 1: 5–21.
    1. Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics: 363–374.
    1. Huttly SR, Barros FC, Victora CG, Beria JU, Vaughan JP (1990) Do mothers overestimate breast feeding duration? An example of recall bias from a study in southern Brazil. Am J Epidemiol 132: 572–575.
    1. Gillespie B, d'Arcy H, Schwartz K, Bobo JK, Foxman B (2006) Recall of age of weaning and other breastfeeding variables. Int Breastfeed J 1: 4
    1. Launer LJ, Forman MR, Hundt GL, Sarov B, Chang D, Berendes HW, et al. (1992) Maternal recall of infant feeding events is accurate. J Epidemiol Community Health 46: 203–206.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner