Prolonged breastfeeding in Bangladesh: indicators of inadequate feeding practices or mothers' response to children's poor health?

The association between breastfeeding and diarrhoeal morbidity was examined in a prevalence study of 5502 children aged 6-71 months from rural and urban Bangladesh. Breastfeeding was found to be associated with reduced prevalence of diarrhoea. This association was most pronounced at the age of six months and declined linearly to zero at approximately 30 months of age; thereafter, breastfeeding was increasingly associated with diarrhoeal illness. The linear association was found only among those children who have no access to modern health services and information, when controlling for urban and rural differences. The literature provides two opposing explanations for the positive association of prolonged breastfeeding with diarrhoeal illness. The first explanation suggests that breastfeeding can be seen as mothers' response to children's poor health. The second explanation incriminates sub-optimal child feeding practices, characterised by prolonged breastfeeding and inadequate quality and quantity of complementary foods, as the cause of malnutrition and diarrhoea. Further studies are needed to identify which explanation is correct, given the public health implications in terms of children's survival, growth and development.