Impact of early infant feeding practices on mortality in low birth weight infants from rural Ghana.

OBJECTIVE: To assess the impact of early infant feeding practices on low birth weight- (LBW) specific neonatal mortality in rural Ghana. STUDY DESIGN: A total of 11 787-breastfed babies were born between July 2003 and June 2004 and survived to day 2. Overall, 3411 (30.3%) infants had weight recorded within 48 h. Two hundred and ninety-six (8.7%) infants were <2.5 kg and 15 died in the neonatal period. Associations were examined using multivariate logistic regression. RESULT: Initiation of breastfeeding after day 1 was associated with a threefold increase in mortality risk (adjusted odds ratio (adjOR) 3.23, 95% confidence interval (95% CI) (1.07-9.82)) in infants aged 2 to 28 days. Prelacteal feeding was associated with a threefold significantly increased mortality risk (adjOR 3.12, 95% CI (1.19-8.22)) in infants aged 2 to 28 days but there was no statistically significant increase in risk associated with predominant breastfeeding (adjOR 1.91, 95% CI (0.60-6.09)). There were no modifications of these effects by birth weight. The sample size was insufficient to allow assessment of the impact of partial breastfeeding. CONCLUSION: Improving early infant feeding practices is an effective, feasible, low-cost intervention that could reduce early infant mortality in LBW infants in developing countries. These findings are especially relevant for sub-Saharan Africa where many LBW infants are born at home, never taken to a health facility and mortality rates are unacceptably high.