International Journal of MCH and AIDS (2015),Volume 4, Issue 1, 13-21

INTERNATIONAL JOURNAL
of MCH and AIDS
ISSN 2161-864X (Online)
ISSN 2161-8674 (Print)
Available online at www.mchandaids.org

ORIGINAL ARTICLE
Exclusive Breastfeeding and Under-Five Mortality, 2006-2014:
A Cross-National Analysis of 57 Low- and-Middle Income
Countries
Romuladus E. Azuine, DrPH, RN;1 Janna Murray, BS;2 Noor Alsafi, MPS;3 Gopal K. Singh, PhD1
1
The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., P. O. Box 234, Riverdale, MD 20738, USA,
2
Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 1320 Bruce B. Downs Blvd, Tampa, FL 33612, USA,
3
American Institutes for Research, 1000 Thomas Jefferson Street, NW, Washington, DC 20007, USA

Corresponding author email: reazuine@globalhealthprojects.org

ABSTRACT
Background: Few studies have examined the long-term, cross-national, and population-level impacts of
exclusive breastfeeding on major global child health indicators. We investigated the overall and independent
associations between exclusive breastfeeding and under-five mortality in 57 low- and-middle-income
countries.
Methods: Data were obtained from the latest World Health Organization, United Nations, and
United Nations Children’s Fund databases for 57 low- and middle-income countries covering the periods
2006-2014. Multivariate linear regression was used to estimate the effects of exclusive breastfeeding on
under-five mortality after adjusting for differences in socioeconomic, demographic, and health-related factors.
Results: In multivariate models, exclusive breastfeeding was independently associated with under-five
mortality after adjusting for sociodemographic and health systems-related factors. A 10 percentage-points
increase in exclusive breastfeeding was associated with a reduction of 5 child deaths per 1,000 live births.
A one-unit increase in Human Development Index was associated with a decrease of 231 under-five child
deaths per 1,000 live births. A $100 increase in per capita health care expenditure was associated with a
decrease of 2 child deaths per 1,000 live births. One unit increase in physician density was associated with
2.8 units decrease in the under-five mortality rate.
Conclusions and Global Health Implications: Population-level health system and socioeconomic factors
exert considerable effect on the association between exclusive breastfeeding and under-five mortality. Given
that the health policy and socioeconomic indicators shown to influence exclusive breastfeeding and under-
five mortality are modifiable, policy makers could potentially target specific policies and programs to address
national-level deficiencies in these sectors to reduce under-five mortality in their countries.
Key words: Exclusive breastfeeding • Developing Countries • Under-five Mortality • Child Health • Health
Systems Policy • Low- and Middle-income countries • Human Development Index

Copyright © 2015 Azuine et al. This is an open-access article distributed under the terms of the creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.
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2015 Global Health and Education Projects, Inc.
Azuine et al.  International Journal of MCH and AIDS (2015), Vol. 4, No. 1, 13-21

Introduction determinants and effects of exclusive breastfeeding

on specific health outcomes.[7,9-12] Given this interest,
Exclusive breastfeeding is the practice of feeding
many prior studies have focused on the benefits
infants only on breast milk without any additional
of exclusive breastfeeding in mitigating health care
food or drink, even water, for the first six months of
risks and preventing chronic and infectious diseases
life.[1,2] Exclusive breastfeeding enhances the overall
such as gastrointestinal problems, asthma, diabetes,
benefits of breast milk, which is widely recognized
obesity, leukemia, lymphoma, and reproductive-
as the ideal form of nutrition for infants. To achieve
aged cancers. There is a paucity of recent studies
optimal growth, development, and health of infants,
examining the long-term, cross-national, and
major national, global health, and professional
population-level impacts of exclusive breastfeeding
organizations recommend exclusive breastfeeding
on major global child health indicators such as
of infants for the first six months of life, and
under-five mortality rates. To our knowledge, the
continued breastfeeding along with appropriate
prior studies that examined the protective effects
complementary foods for up to two years of age
of exclusive breastfeeding on under-five mortality
or beyond.[1,3] In addition to exclusive breastfeeding,
were based in single sub-Saharan African countries
experts recommend that breastfeeding be initiated
and involved a sample of women.[13-16] Investing all
within the first hour of an infant’s life, it should be on
research examining increase in breastfeeding rates
demand—that is as often as the child wants—and
alone could be counterproductive given that, despite
without the use of bottles, teats, or pacifiers.[1]
concerted efforts, only modest improvements have
The short and long-term health benefits of been achieved in increasing exclusive breastfeeding
exclusive breastfeeding for infants and mothers rates in several decades globally.[7]
have been well-reported. These benefits include
In this study, we investigate the association
protection from infectious diseases, reduction in the
between exclusive breastfeeding and under-five
risks of chronic diseases, diabetes, asthma, lymphoma,
mortality, a leading child health indicator, using data
leukemia, Hodgkin’s disease, gastrointestinal tract
from 57 low- and middle-income countries.The aims
infection, atopic eczema, and improvement in
of our study were two-fold. First, we investigated
cognitive functioning.[4-6] Breast milk contains and
whether the rates of exclusive breastfeeding were
provides all the nutrients an infant needs for healthy
independently associated with under-five mortality.
development; it is safe and rich in antibodies that
Secondly, we investigated whether the associations,
protect infants from the two leading causes of
if any, identified in the above were attenuated
child mortality namely pneumonia and diarrhea
or otherwise in the presence of other health
worldwide; and breast milk is readily available and
systems-level factors in 57 countries in our study.
affordable.[6,7] Optimal breastfeeding of all children
We hypothesized an inverse relationship between
aged 0-23 months could lead to an annual savings
exclusive breastfeeding and under-five mortality
of about 800,000 under-five children’s lives around
rates. In other words, we expected that under-five
the world.[8] Exclusive breastfeeding has also been
mortality rates would be lower in countries with
associated with natural birth control for the first six
higher rates of exclusive breastfeeding. Understanding
months after birth, reduction in the risks of breast
how exclusive breastfeeding rates and under-five
and ovarian cancers among mothers later in life,
mortality rates are associated in the presence of
reduction in obesity rates, and faster return to their
other population-level and health-systems factors
pre-pregnancy weights.[6]
in countries that share similar socioeconomic,
National and global health efforts aimed at demographic, and health characteristics is important.
promoting exclusive breastfeeding have primarily This information would be useful for policy and
focused on increasing and tracking the number program planners in identifying areas of potential
of mothers around the world who exclusively intervention that will make a difference in the lives
breastfeed their infants and on individual-level of infants and mothers in their respective countries,

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 Exclusive Breastfeeding and Under-Five Mortality

and ultimately lead to increase in the uptake of representing the highest level.[19] GII is an aggregate
exclusive breastfeeding. measure that depicts gender-based disadvantages
based on three dimensions: reproductive health,
Methods empowerment, and the labor market.[19] GII values
To quantify the association between exclusive vary between 0 and 1, with 0 indicating equal
breastfeeding and under-five mortality, we obtained faring between men and women.[19] Healthcare
data on indicators from multiple global health data expenditure is the per capita total expenditure on
sources for the 57- low and middle-income countries health expressed in purchasing power parity (PPP)
included in our analyses spanning 2006 to 2014. The and is internationally-denominated to the United
data on exclusive breastfeeding were from the Global States dollar.[18] Improved drinking water usage is
Databases on Infant and Young Child Feeding.[17] measured as the percentage of the population using
Data on under-five mortality were from the World an improved drinking water source and improved
Health Statistics 2015 published by the World sanitation usage is measured as the percentage
Health Organization (WHO).[18] Data on the Human of the population using an improved sanitation
Development Index (HDI) and Gender Inequality facility.[18] Physician density is measured as the
Index (GII) were from the United Nations 2014 number of medical doctors per 10,000 population
Human Development Report,[19] while data on health- in a particular area.[18] Antenatal care coverage is the
related indicators namely improved drinking water percentage of women between the ages of 15 and
usage, sanitation usage, physician density, antenatal 49 with a live birth within a given time period that
coverage, births attended, and healthcare expenditure received four or more antenatal care visits during
were from the WHO’s 2015 World Health Statistics.[18] pregnancy.[18] Births attended is the percentage of
Where necessary, we augmented missing data on few births attended by skilled health personnel.[18]
countries with data from comparable countries as
Statistical analysis
determined by their Gross National Income (GNI).
Countries and study covariates were selected based Pearson correlation coefficients were computed to
on prior research, field experience, and the need to examine the bivariate associations between under-
examine countries with similar socioeconomic and five mortality, exclusive breastfeeding, and other
global health systems indicators.[20] covariates. Multivariate Ordinary Least Squares
(OLS) regression models were used to determine
Study variables
the independent effects of exclusive breastfeeding
Our dependent variable was under-five mortality which and other covariates on under-five mortality rates.
is defined as the probability of dying by age 5 per 1,000 Unstandardized regression coefficients (b’s) were
live births.[18] Our independent variable was exclusive used to estimate the effect on child mortality
breastfeeding greater than or equal to 6 months which associated with per unit change in exclusive
is defined as the percentage of infants 0 to 5 months breastfeeding and other independent variables.
of age who are fed exclusively with breast milk.[18] Our Standardized regression coefficients (β’s) were used
study covariates were eight national/health systems- to estimate the relative impacts of the predictors
level sociodemographic indicators: HDI, GII, improved on under-five mortality rates. Percentage variance
drinking water usage, sanitation usage, physician explained (R2) determined the goodness of fit of
density, antenatal coverage, births attended by trained the multivariate models. Statistical analyses were
health personnel, and health care expenditure. conducted using STATA version 12.[21]
HDI is a composite measure of three basic Results
human development indices, which includes a life
Descriptive statistics
expectancy index, an education index, and an income
index.[19] Values for HDI vary between 0 and 1, with 0 Table 1 presents the 57 countries included in the
representing the lowest level of development and 1 study, while Figure 1 presents the prevalence of

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Azuine et al.  International Journal of MCH and AIDS (2015), Vol. 4, No. 1, 13-21

exclusive breastfeeding and under-five mortality while Rwanda had the highest rate of exclusive
rates across the countries. Table 2 presents the breastfeeding (85%) followed by Cambodia (74%)
description of the study variables.The average under- and Malawi (71%). Although not shown here, data for
five mortality rate across the 57 countries was the study covariates varied across the countries. In
69.0 child deaths under age 5 per 1,000 live births. general, Asian countries had an HDI greater than 0.5,
Singapore had the lowest under-five mortality rate with Singapore having the highest HDI of 0.90 among
(2.8 deaths per 1,000 live births), while Angola had all 57 countries in our analysis. Sub-Saharan African
the highest under-five mortality rate (167.4). Majority countries of Niger Republic, the Democratic Republic
of sub-Saharan African countries had higher under- of Congo, and Central African Republic had the lowest
five mortality rates than their Asian counterparts. HDI at 0.34. The average HDI score was 0.54 for all
the 57 countries combined. All the 57 countries had
Exclusive breastfeeding rates varied among the
an average GII score of 0.51. Nigeria and Singapore
57 countries, with an average of 34.0%. Djibouti
had very low GII values of 0.07 and 0.09, respectively,
had the lowest exclusive breastfeeding rate of 1%
while Niger and Chad had the highest GII value
of 0.71. Singapore and Malaysia both had 100% of
Table 1. Countries Included in the Analysis, According to their populations using an improved drinking water
World Geographical Regiona (N = 57)
source, while the Democratic Republic of Congo
Regions N Country and Mozambique had the lowest improved drinking
Africa 44 Algeria, Angola, Benin, Botswana, Burkina Faso, water usage at 46% and 49%, respectively. Singapore
Burundi, Cameroon, Central African Republic, had the highest sanitation usage (100%) among all 57
Chad, Congo, Cote d’Ivoire, Democratic countries. Very low levels of sanitation usage were
Republic of Congo, Djibouti, Egypt,
observed among many of the sub-Saharan African
Ethiopia, Gabon, Gambia, Ghana, Guinea,
Guinea‑Bissau, Kenya, Lesotho, Liberia, Libya, countries; Niger Republic had the lowest percentage
Madagascar, Malawi, Mali, Mauritania, Morocco, at 9% followed by Malawi at 10%.All African countries
Mozambique, Niger, Nigeria, Rwanda, Senegal, except Algeria, Tunisia, Libya, and Egypt had physician
Sierra Leone, South Africa, Sudan, Swaziland, densities of less than 10, meaning that, for every
Togo, Tunisia, Uganda, United Republic of
10,000 persons in these countries, there were fewer
Tanzania, Zambia, Zimbabwe
than 10 available physicians. Many of the sub-Saharan
Asia 13 Brunei, Cambodia, China, India, Indonesia,
Lao People’s Democratic Republic, Malaysia, African countries had an even lower number of less
Myanmar, Philippines, Singapore, Thailand, than one available physician per 10,000 persons. Egypt
Timor‑Leste,Vietnam had the highest physician density at 28.3 among all
Notes: N = Number of countries. aBased on the United Nations’ geographical regions 57 countries, followed by Singapore at 19.5. Antenatal

Table 2. Descriptive Statistics of the Study Variables of all Countries (N = 57)

Variable N Minimum Maximum Median Mean±SD SE mean
Under‑five mortality rate 57 2.8 167.4 69.6 68.98±39.37 5.21
Exclusive breastfeeding 57 1 85 33 33.97±19.73 2.61
Human development index 57 0.34 0.90 0.50 0.54±0.13 0.02
Gender inequality index 57 0.07 0.71 0.55 0.51±0.15 0.02
Healthcare expenditure 57 20 3215 175 342.18±511.14 67.7
Drinking water usage 57 46 100 75 75.11±15.65 2.07
Sanitation usage 57 9 100 37 43.97±27.97 3.70
Physician density 57 0.1 28.3 1.4 4.14±5.98 0.79
Antenatal coverage 57 7 93 58 59.77±20.37 2.70
Births attended 57 10 100 65 65.88±23.65 3.13
Note: N=Number of countries, SE mean=Standard error of mean, SD=Standard deviation

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 Exclusive Breastfeeding and Under-Five Mortality

Exclusive Breastfeeding >=6 Months (%) Under five Mortality Rate per 1,000 Live Births
Angola 167.4
Sierra Leone 160.6
Rwanda 85 Chad 147.5
Cambodia 74 Central African Rep. 139.2
Malawi 71 Guinea-Bissau 123.9
Burundi 69 Mali 122.7
Uganda 63 Dem. Rep. Congo 118.5
Togo 62 Nigeria 117.4
Zambia 61 Niger 104.2
Lesotho 54 Guinea 100.7
Egypt 53 Cote D'Ivoire 100.0
Ethiopia 52 Lesotho 98.0
Timor-Leste 52 Burkina Faso 97.6
Madagascar 51 Cameroon 94.5
Tanzania 50 Mauritania 90.1
Guinea 48 Zimbabwe 88.5
Ghana 46 Zambia 87.4
India 46 Mozambique 87.2
Mauritania 46 Benin
Swaziland 85.3
44 Togo
Mozambique 43 84.7
Indonesia Burundi 82.9
42
Sudan 41 Swaziland 80.0
Senegal 39 Ghana 78.4
Burkina Faso 38 Sudan 76.6
Guinea-Bissau 38 Gambia 73.8
Dem. Rep. Congo 37 Laos 71.4
Central African Rep. 34 Liberia 71.1
Gambia 34 Kenya 70.7
Philippines 34 Djibouti 69.6
Benin 33 Malawi 67.9
Kenya 32 Uganda 66.1
Sierra Leone 32 Ethiopia 64.4
Morocco 31 Gabon 56.1
Zimbabwe 31 Madagascar 56.0
Liberia 29 Senegal 55.3
China 28 Timor-Leste 54.6
Laos 26 India 52.7
Myanmar 24 Rwanda 52.0
Niger 23 Tanzania 51.8
Botswana 20 Myanmar 50.5
Cameroon 20 Congo 49.1
Mali 20 Botswana 46.6
Brunei 19 South Africa 43.9
Congo 19 Cambodia 37.9
Vietnam 17 Morocco 30.4
Malaysia 15 Philippines
Nigeria 29.9
15 Indonesia
Singapore 15 29.3
Thailand Algeria 25.2
15
Cote D'Ivoire 12 Vietnam 23.8
Angola 11 Egypt 21.8
Libya 11 Tunisia 15.2
South Africa 8 Libya 14.5
Algeria 7 Thailand 13.1
Gabon 6 China 12.7
Tunisia 6 Brunei 9.9
Chad 3 Malaysia 8.5
Djibouti 1 Singapore 2.8

Figure 1. Exclusive Breastfeeding and Under-five Mortality in 57 Low-and-Middle-Income Countries. Data for Exclusive Breastfeeding
are for 2008-2012. Data for Under-five Mortality are for 2013. Sources: Global Databases on Infant and Young Child Feeding, 2015;
World Health Statistics, 2015.

care coverage was highest for Thailand and Brunei relationship between under-five mortality rate and
(93%) and lowest for Djibouti (7%). The percentage GII (r = 0.41, P< 0.01). This indicated that a higher
of births attended by skilled health personnel was under-five mortality rate was associated with
100% for 5 of the 57 countries: Libya, Singapore, increased gender inequality. There was a significant
China, Thailand, and Brunei. Ethiopia had the lowest inverse relationship between under-five mortality
percentage of births attended by skilled personnel at rate and improved drinking water usage (r = -0.57,
10%. The per capita total expenditure on health was P<0.01), sanitation usage (r = -0.62, P<0.01),
lowest in Zimbabwe (PPP int. $20) and highest for physician density (r = -0.65, P<0.01), antenatal
Singapore (PPP int. $3,215). The average healthcare coverage (r = -0.51, P<0.01), and births attended
expenditure across the 57 countries was PPP int. (r = -0.61, P<0.01). A lower under-five mortality rate
$342.18. was associated with higher improved drinking water
usage, sanitation usage, physician density, and births
Bivariate analysis
attended. In addition, the correlation between HDI
Table 3 presents the results of our bivariate and the under-five mortality rate was very strong,
correlation analysis. There was a significant positive as indicated by the correlation coefficient of  -0.81.
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Azuine et al.  International Journal of MCH and AIDS (2015), Vol. 4, No. 1, 13-21

There was no significant linear relationship between births. Improved drinking water was inversely
under-five mortality rate and exclusive breastfeeding related to under-five mortality. One percentage
(r = 0.05, P > 0.05). point increase in improved drinking water source
was associated with 0.47 units decrease in under-five
Multivariate regression analysis
mortality. In multivariate Model 1, a comparison of
Table 4 presents the results of our multivariate β’s (standardized regression coefficients) indicated
regression analysis. In multivariate Model 1, one that HDI had the strongest effect on under-five
unit increase (i.e., one percentage point increase) mortality, followed by exclusive breastfeeding and
in exclusive breastfeeding was associated with improved drinking water. The child mortality impact
0.5 units decrease in under-five mortality rate. of HDI was 3.2 greater than that of exclusive
Equivalently, a 10 percentage-points increase in breastfeeding. In multivariate Model 2, a $100 US
exclusive breastfeeding was associated with a PPP increase in per capita health care expenditure
reduction of 5 child deaths per 1,000 live births. was associated with a decrease of 2 under-five child
A one unit increase in HDI was associated with a deaths per 1,000 live births. In multivariate Model 2,
decrease of 231 under-five deaths per 1,000 live physician density had the largest impact on child

Table 3. Bivariate Correlations Showing the Relationship between Exclusive Breastfeeding, Human Development,
Health Systems, and Socioeconomic Risk Factors and Under-Five Mortality in Selected Developing Countries,
2006-2014 (N=57 Countries)
Variables (Y) (X1) (X2) (X3) (X4) (X5) (X6) (X7) (X8) (X9)
Under‑five mortality rate (Y) 1.00
Exclusive breastfeeding (X1) 0.05 1.00
Human development index (X2) −0.81* −0.33* 1.00
Healthcare expenditure (X3) −0.54* −0.37* 0.77* 1.00
Gender inequality index (X4) 0.41* 0.25 −0.61* −0.51* 1.00
Drinking water usage (X5) −0.57* −0.24 0.56* 0.41* −0.36* 1.00
Sanitation usage (X6) −0.62* −0.33* 0.70* 0.52* −0.63* 0.59* 1.00
Physician density (X7) −0.65* −0.31* 0.76* 0.67* −0.52* 0.47* 0.69* 1.00
Antenatal coverage (X8) −0.51* −0.20 0.68* 0.49* −0.36* 0.52* 0.38* 0.52* 1.00
Births attended (X9) −0.61** −0.21 0.66* 0.55* −0.34* 0.62* 0.56* 0.57* 0.69* 1.00
Note: *Statistically significant at p<0.05 level

Table 4. Multivariate Regression Models Showing the Effects of Exclusive Breastfeeding, Health Systems and
Socioeconomic Risk Factors on Under‑five Mortality in Selected Low‑and‑Middle‑Income Countries, 2006‑2014
(N=57 Countries)
Model Variables b β t‑stat P‑value VIF R2 Adjusted R2
1 Exclusive breastfeeding + −0.498 −0.250 −3.33 0.002 1.12 73.6 72.1
Human development index + −230.685 −0.789 −8.98 0.000 1.55
Drinking water −0.474 −0.188 −2.20 0.32 1.47
2 Exclusive breastfeeding + −0.466 −0.233 −2.37 0.022 1.18 57.0 53.7
Healthcare expenditure + −0.016 −0.207 −1.62* 0.111 1.98
Drinking water + −0.869 −0.345 −3.30 0.002 1.32
Physician density −2.758 −0.419 −3.25 0.002 2.01
Notes: b = Unstandardized regression coefficient; β = Standardized regression coefficient; R2 = Percentage variance explained;VIF = Variance inflation factor; *P≈0.05 using
one‑tailed t‑test

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 Exclusive Breastfeeding and Under-Five Mortality

mortality, followed by improved drinking water breastfeeding and under-five mortality rates in the
source, exclusive breastfeeding, and healthcare presence of several sociodemographic and health
expenditure. Covariates in the multivariate Models indicators in 57 low- and middle-income countries.
1 and 2 explained 72% and 54% of the cross-national
This study has limitations.This is an ecologic cross-
variance in under-five mortality, respectively.
sectional study; thus, the associations we observed in
Discussion the study may not be causally-related.[24] Some of the
observed associations at the cross-national level may
Using multiple global health databases, we have
not hold at the individual level. However, given that a
quantified the associations between under-five
health indicator such as under-five mortality cannot
mortality and exclusive breastfeeding in the
be subjected to a randomized controlled trial, due
presence of key socioeconomic and policy indicators
to ethical concerns, ecological studies remain one
in developing countries. Our findings support prior
of the most-robust methodologies for investigating
country-based studies in Ghana, India, and Tanzania
critical issue such as national variations in under-
that reported the protective effects of exclusive
five mortality rates. Further studies are needed to
breastfeeding on under-five mortality.[13-15,22] However,
investigate whether the associations observed in
our study adds upon these studies by providing
quantifiable evidence across multiple countries using this study hold for specific countries and for more
the latest cross-national sociodemographic, human advanced, industrialized countries. Subsequent
development, and health care data. Our findings on research should also explore the quantifiable link
the overwhelming effect of HDI on population-level between exclusive breastfeeding and other child
health indicators in general and under-five mortality health indicators such as infant mortality, stunting,
in particular are consistent with earlier findings.[20,22] and educational achievement.

Prior studies have identified some of the social Conclusions and Global Health
and economic barriers to exclusive breastfeeding in Implications
developing countries at the individual level including In conclusion, this study found that in the presence
unemployment, low income, lack of breastfeeding of enabling health systems and sociodemographic
friendly workplaces, and traditional practices.[11,23] indicators such as HDI, physician density, and
Our study goes beyond the individual-level barriers healthcare expenditure, the association between
and demonstrates the diversity of mediating macro- exclusive breastfeeding and the under-five mortality
socioeconomic policy factors that affect the ultimate rate in the 57 countries investigated becomes
benefit of exclusive breastfeeding in reducing under- substantial and statistically significant. These findings
five mortality. To the best of our knowledge, this suggest that the ability of exclusive breastfeeding to
is one of the first studies to empirically document impact the under-five mortality rate is determined,
the direct impact of macro socioeconomic factors in part, upon other sociodemographic and health
and exclusive breastfeeding on under-five mortality factors and, in the presence of these other factors,
across various developing countries. the effect that exclusive breastfeeding has on the
Under-five mortality rate is a key indicator under-five mortality rate is increased. Our findings
of infant and child health as well as reflection of support the importance of a health system as the
the socioeconomic and surrounding health and overall hub upon which health governance, financing,
healthcare conditions of a child’s environment. As service delivery, health workforce, information and
exclusive breastfeeding is thought to directly impact medicines and vaccines and other technologies
a child’s nutrition and subsequent survival, we work together in improving health outcomes for
performed a study to examine the possible effect of all citizens.[25] The results of this study indicate
exclusive breastfeeding on the under-five mortality that while exclusive breastfeeding is critical in
rate. The most recent global health statistics were improving child survival, its benefits to the overall
used to assess the relationship between exclusive improvement of child health, as measured by under-
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Azuine et al.  International Journal of MCH and AIDS (2015), Vol. 4, No. 1, 13-21

approval was required for this study, which is based

Key Messages on the secondary analysis of public-use global health
• Under-five mortality rate is a key indicator of databases. Financial Disclosure: None. Funding/
infant and child health as well as reflection of Support: None. Conflicts of Interest: None.
the socioeconomic and surrounding health References
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