Table 5.
Quality assessment of studies measuring the association between suboptimal breastfeeding and selected outcomes
| 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 [22,23,26-28] | 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 [21,22,27,30-32,34] | 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 [19-21,24] | 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 |