Exclusive breastfeeding promotion and neuropsychological outcomes in 5-8 year old children from Uganda and Burkina Faso: Results from the PROMISE EBF cluster randomized trial

James K Tumwine, Victoria Nankabirwa, Hama Abdoulaye Diallo, Ingunn Marie Stadskleiv Engebretsen, Grace Ndeezi, Paul Bangirana, Anselme Simeon Sanou, Espérance Kashala-Abotnes, Michael Boivin, Bruno Giordani, Irene Bircow Elgen, Penny Holding, Angelina Kakooza-Mwesige, Vilde Skylstad, Joyce Nalugya, Thorkild Tylleskar, Nicolas Meda, James K Tumwine, Victoria Nankabirwa, Hama Abdoulaye Diallo, Ingunn Marie Stadskleiv Engebretsen, Grace Ndeezi, Paul Bangirana, Anselme Simeon Sanou, Espérance Kashala-Abotnes, Michael Boivin, Bruno Giordani, Irene Bircow Elgen, Penny Holding, Angelina Kakooza-Mwesige, Vilde Skylstad, Joyce Nalugya, Thorkild Tylleskar, Nicolas Meda

Abstract

Background: The beneficial effects from exclusive breastfeeding (EBF) have been widely acknowledged. We assessed the effect of exclusive breastfeeding promotion by peer counsellors in Uganda and Burkina Faso, on cognitive abilities, social emotional development, school performance and linear growth among 5-8 years old children.

Methods: Children in the PROMISE EBF trial (2006-2008) were re-enrolled in the follow-up PROMISE Saving Brains (SB) study (2013-2015). Caretaker interviews captured sociodemographic characteristics and social emotional development using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Overall cognition and working memory were assessed using the Kaufman Assessment Battery for Children, second edition (KABC2), cognitive flexibility was measured with the Child Category Test (CCT), and attention with the Test of Variables of Attention (T.O.V.A), while school performance was measured by a standardized test on arithmetic and reading. Country-pooled, age adjusted z-scores from each of the above outcomes were entered into a linear regression model controlling for confounders.

Results: The number of children re-enrolled in the intervention and control arms were: 274/396 (69.2%) and 256/369 (69.4%) in Uganda and 265/392 (67.6%) and 288/402 (71.6%) in Burkina Faso. Assessment of cognitive ability showed small and no significant differences, of which general cognition (z-scores, 95% CI) showed the largest mean difference: -0.17 (-0.40; 0.05). Social emotional symptoms were similar across arms. There were no differences in school performance or linear growth for age detected.

Conclusion: Peer promotion for exclusive breastfeeding in Burkina Faso and Uganda was not associated with differences at 5-8 years of age in a range of measures of child development: cognitive abilities, emotion-behaviour-social symptoms or linear growth. This study from sub Saharan Africa did not reconfirm findings elsewhere that have shown an association between exclusive breastfeeding and cognitive performance. This might be due to a number of methodological limitations inherent in the current study. For example since the majority of the children were breastfed, the benefits of the intervention could have been diluted. Other factors such as the mental and HIV status of the mothers (which were not assessed in the current study) could have affected our results. Hence regarding the effect of exclusive breastfeeding on measures of child neurocognitive development in sub Saharan Africa, the jury is still out.

Trial registration: ClinicalTrials.gov NCT01882335.

Conflict of interest statement

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

Figures

Fig 1. Study profile of the Saving…
Fig 1. Study profile of the Saving Brains study for Uganda and Burkina Faso.

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