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Table 5 Quality assessment of studies measuring the association between suboptimal breastfeeding and selected outcomes

From: Breastfeeding and the risk for diarrhea morbidity and mortality

    

Directness

No of studies (ref)

Design

Limitations

Consistency

Generalizability to population of interest

Generalizability to intervention of interest

Diarrhea Incidence: moderate outcome-specific quality

5 [22, 23, 2628]

Cohort/Cross-sectional

Reverse causality highly likely or likely for all 5 studies (-0.5)

Consistent and all studies showing benefit of EBF among infants 0-5 mos of age and benefit of any BF among children 6-23 mos of age (+1)

Mostly Latin America (-0.5)

EBF not reported for neonates alone

Diarrhea Prevalence (1-2 week): moderate outcome-specific quality

7 [21, 22, 27, 3032, 34]

Cohort/Cross-sectional

Reverse causality highly likely or likely for all 7 studies (-0.5)

All but one study showing benefit of EBF among infants 0-5 mos of age; all studies showing benefit of any BF among children 6-23 mos of age (+1)

Mostly Asia (-0.5)

EBF not reported for neonates alone

Diarrhea Mortality: moderate outcome-specific quality

6 [15, 19, 20, 25, 33, 35]

Cohort/Case-control

Reverse causality highly likely or likely for 5 of 6 studies (-0.5)

Consistent and all studies showing benefit of EBF among infants 0-5 mos of age and benefit of any BF among children 6-23 mos of age (+1)

Mostly Asia & Latin America (-0.5)

EBF not reported for neonates alone

All-Cause Mortality: moderate outcome-specific quality

4 [1921, 24]

Cohort

Reverse causality highly likely or likely for all 4 studies (-0.5)

All but one study showing benefit of EBF among infants 0-5 mos of age; all studies showing benefit of any BF among children 6-23 mos of age (+1)

Mostly Asia (-0.5)

 

Diarrhea Hospitalizations: moderate outcome-specific quality

2 [20, 29]

Cohort/Case-control

Reverse causality highly likely or likely for both studies (-0.5)

Consistent and all studies showing benefit of EBF among infants 0-5 mos of age and benefit of any BF among children 6-23 mos of age (+1)

Equal amount of data from Asia, Latin America, Africa & Eastern Mediterranean

EBF not reported for neonates alone