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Table 4 Quality assessment of studies measuring the association between suboptimal breastfeeding and selected outcomes

From: Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis

    

Directness

No of studies (ref)

Design

Limitations

Consistency

Generalizability to population of interest

Generalizability to intervention of interest

Pneumonia Incidence: moderate outcome-specific quality

1 [27]

Cohort

Reverse causality highly likely (-0.5)

Study shows benefit of EBF among infants 0-5 mos of age; study shows benefit of any BF among infants 6-23 mos of age (+1)

Only Asia (-0.5)

EBF not reported for neonates alone

Pneumonia Prevalence: moderate outcome-specific quality

1 [18]

Cohort

Reverse causality likely (-0.5)

Study shows benefit of EBF among infants 0-5 mos of age; study shows benefit of any BF among infants 6-23 mos of age (+1)

Only Latin America (-0.5)

EBF not reported for neonates alone

Pneumonia Mortality: moderate outcome-specific quality

5 [19–23]

Cohort/Case-control

Reverse causality highly likely or likely for 3 of 5 studies (-0.5)

All studies show benefit of EBF among infants 0-5 mos of age; all studies show benefit of any BF among infants 6-23 mos of age (+1)

Asia, Latin America, Africa, Western Pacific

 

All-Cause Mortality: moderate outcome-specific quality

4 [19, 20, 24, 25]

Cohort

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

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

Asia, Latin America, Africa

 

Pneumonia Hospitalizations: moderate outcome-specific quality

2 [20, 26]

Cohort/Case-control

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

All studies show benefit of EBF among infants 0-5 mos of age; studies show benefit of any BF among children 0-11 mos of age (+1)

Asia, Latin America, Africa

EBF not reported for neonates alone; BF not reported for children >11 mos

All-Cause Hospitalizations: moderate outcome-specific quality

1 [20]

Cohort

Reverse causality highly likely (-0.5)

Study shows benefit of EBF among infants 0-5 mos of age (+1)

Asia, Latin America, Africa

EBF not reported for neonates alone; BF not reported for children >6 mos

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BMC Public Health

ISSN: 1471-2458

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