Abstract
Objectives
Canadian Aboriginal infants experience poor health compared with other Canadian infants. Breastfeeding protects against many infant infections that Canadian Aboriginals disproportionately experience. The objective of our research was to estimate the proportion of select infant infection and mortality outcomes that could be prevented if all Canadian Aboriginal infants were breastfed.
Methods
We used Levin’s formula to estimate the proportion of three infectious outcomes and one mortality outcome that could be prevented in infancy by breastfeeding. Estimates were calculated for First Nations (both on- and off-reserve), Métis and Inuit as well as all Canadian infants for comparison. We extracted prevalence estimates of breastfeeding practices from national population-based surveys. We extracted relative risk estimates from published meta-analyses.
Results
Between 5.1 % and 10.6% of otitis media, 24.3% and 41.4% of gastrointestinal infection, 1 3.8% and 26.1 % of hospitalizations from lower respiratory tract infections, and 12.9% and 24.6% of sudden infant death could be prevented in Aboriginal infants if they received any breastfeeding.
Conclusion
Interventions that promote, protect and support breastfeeding may prevent a substantial proportion of infection and mortality in Canadian Aboriginal infants.
Key words: Aboriginal, breast feeding, communicable diseases, sudden infant death, epidemiology
Résumé
Objectifs
La santé des nourrissons autochtones canadiens est mauvaise par rapport à celle des autres nourrissons canadiens. L’allaitement maternel protège contre plusieurs infections infantiles que les Autochtones canadiens contractent de façon disproportionnée. L’objectif de notre recherche était d’estimer la proportion d’infections infantiles sélectionnées et la mortalité qui en résulte qui pourraient être évitée si tous les nourrissons autochtones canadiens étaient nourris au sein.
Méthodes
Nous avons utilisé la formule de Levin pour estimer la proportion de trois infections contractées et d’une mortalité qui aurait pu être évitées grâce à l’allaitement maternel. On a fait des estimations pour les Premières Nations (à l’intérieur comme à l’extérieur des réserves), les Métis et les Inuits, de même que pour tous les nourrissons canadiens à titre de comparaison. Nous avons extrait l’estimation de la prévalence des pratiques d’allaitement maternel à partir d’études nationales fondées sur la population. Nous avons extrait l’estimation du risque relatif des metaanalyses publiées.
Résultats
De 5,1 % à 10,6 % des otites moyennes, de 24,3 % à 41,4 % des infections gastro-intestinales, de 1 3,8 % à 26,1 % des hospitalisations dues aux infections des voies respiratoires inférieures et de 12,9 % à 24,6 % des morts subites de nourrissons auraient pu être évitées chez les nourrissons autochtones s’ils avaient été nourris au sein.
Conclusion
Les interventions qui favorisent, protègent et appuient l’allaitement maternel pourraient éviter une forte proportion des infections et des décès chez les nourrissons autochtones canadiens.
Mots Clés: Autochtone, allaitement maternel, maladies transmissibles, mort subite du nourrisson, épidémiologie
Footnotes
Acknowledgements: Kathryn Mclsaac is a CIHR Strategic Training Fellow in the ACHIEVE Research Partnership: Action for Health Equity Interventions; she gratefully acknowledges the support of the Canadian Institutes of Health Research Grant #96566 and the Ontario Ministry of Health and Long-Term Care.
Disclaimer: The views expressed in this publication are the views of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-Term Care.
Conflict of Interest: None to declare.
References
- 1.Yorita KL, Holman RC, Sejvar JJ, Steiner CA, Schonberger LB. Infectious disease hospitalizations among infants in the United States. Pediatrics. 2008;121(2):244–52. doi: 10.1542/peds.2007-1392. [DOI] [PubMed] [Google Scholar]
- 2.Hauck FR, Tanabe KO. International trends in sudden infant death syndrome: Stabilization of rates requires further action. Pediatrics. 2008;122(3):660–66. doi: 10.1542/peds.2007-0135. [DOI] [PubMed] [Google Scholar]
- 3.Gracey M, King M. Indigenous health part 1: Determinants and disease patterns. Lancet. 2009;374(9683):65–75. doi: 10.1016/S0140-6736(09)60914-4. [DOI] [PubMed] [Google Scholar]
- 4.Smylie J, Adomako P. Indigenous Children’s Health Report: Health Assessment in Action. 2009. [Google Scholar]
- 5.Baxter JD. Otitis media in Inuit children in the Eastern Canadian Arctic-an overview-1968 to date. Int J Pediatr Otorhinolaryngol. 1999;49(S1):165–68. doi: 10.1016/S0165-5876(99)00154-8. [DOI] [PubMed] [Google Scholar]
- 6.Thomson M. Otitis media. How are First Nations children affected? Can Fam Physician. 1994;40:1943–50. [PMC free article] [PubMed] [Google Scholar]
- 7.Banerji A, Panzov V, Robinson J, Young M, Ng K, Mamdani M. The cost of lower respiratory tract infections hospital admissions in the Canadian Arctic. Int J Circumpolar Health. 2013;72:21585. doi: 10.3402/ijch.v72i0.21595. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Holman RC, Parashar UD, Clarke MJ, Kaufman SF, Glass RI. Trends in diarrhea-associated hospitalizations among American Indian and Alaska native children, 1980–1995. Pediatrics. 1999;103(1):11. doi: 10.1542/peds.103.1.e11. [DOI] [PubMed] [Google Scholar]
- 9.Harris SB, Glazier R, Eng K, McMurray L. Disease patterns among Canadian aboriginal children: Study in a remote rural setting. Can Fam Physician. 1998;44:1869–77. [PMC free article] [PubMed] [Google Scholar]
- 10.Luo Z-C, Wilkins R, Platt RW, Kramer MS. For the Fetal Infant Health Study Group of the Canadian Perinatal Surveillance System. Risks of adverse pregnancy outcomes among Inuit and North American Indian women in Quebec, 1985–97. Paediatr Perinat Epidemiol. 2004;18(1):40–50. doi: 10.1111/j.1365-3016.2003.00529.x. [DOI] [PubMed] [Google Scholar]
- 11.World Health Organization. The World Health Organization’s Infant Feeding Recommendation. 2001. [Google Scholar]
- 12.Health Canada, Canadian Paediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. A Joint Statement of Health Canada, Canadian Pediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. 2012. [DOI] [PubMed] [Google Scholar]
- 13.Hauck FR, Thompson JMD, Tanabe KO, Moon RY, Vennemann MM. Breastfeeding and reduced risk of sudden infant death syndrome: A meta-analysis. Pediatrics. 2011;128:103–10. doi: 10.1542/peds.2010-3000. [DOI] [PubMed] [Google Scholar]
- 14.Chien P, Howie P. Breast milk and the risk of opportunistic infection in infancy in industrialized and non-industrialized settings. Adv Nutr Res. 2001;10:69–104. doi: 10.1007/978-1-4615-0661-4_4. [DOI] [PubMed] [Google Scholar]
- 15.Bachrach V, Schwarz E, Bachrach L. Breastfeeding and the risk of hospitalization for respiratory disease in infancy: A meta-analysis. Arch Pediatr Adolesc Med. 2003;157(3):237–43. doi: 10.1001/archpedi.157.3.237. [DOI] [PubMed] [Google Scholar]
- 16.Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(S1):17–30. doi: 10.1089/bfm.2009.0050. [DOI] [PubMed] [Google Scholar]
- 17.Health Canada. Breastfeeding Initiation in Canada: Key Statistics and Graphics (2009-2010) 2012. [Google Scholar]
- 18.Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998;88(1):15–19. doi: 10.2105/AJPH.88.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Steenland K, Armstrong B. An overview of methods for calculating the burden of disease due to specific risk factors. Epidemiology. 2006;17(5):512–19. doi: 10.1097/01.ede.0000229155.05644.43. [DOI] [PubMed] [Google Scholar]
- 20.Gargiullo PM, Rothenberg RB, Wilson HG. Confidence intervals, hypothesis tests, and sample sizes for the prevented fraction in cross-sectional studies. Stat Med. 1995;14(1):51–72. doi: 10.1002/sim.4780140107. [DOI] [PubMed] [Google Scholar]
- 21.Statistics Canada. Health Indicator Profile, by Aboriginal Identity and Sex, Age-standardized Rate, Four Year Estimates, Canada, Provinces and Territories. 2013. [Google Scholar]
- 22.First Nations Information Governance Centre. First Nations Regional Health Survey (RHS) Phase 2 (2008/2010) National Report on Adults, Youth and Children Living in First Nations Communities. 2012. [Google Scholar]
- 23.Statistics Canada. Canadian Community Health Survey - Annual Component Definition, Data Sources and Methods. 2013. [Google Scholar]
- 24.Li R, Scanlon KS, Serdula MK. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev. 2005;63(4):103–10. doi: 10.1111/j.1753-4887.2005.tb00128.x. [DOI] [PubMed] [Google Scholar]
- 25.Darrow LA, Steenland NK. Confounding and bias in the attributable fraction. Epidemiology. 2011;22(1):53–58. doi: 10.1097/EDE.0b013e3181fce49b. [DOI] [PubMed] [Google Scholar]
- 26.Daly LE. Confidence limits made easy: Interval estimation using a substitution method. Am J Epidemiol. 1998;147(8):783–90. doi: 10.1093/oxfordjournals.aje.a009523. [DOI] [PubMed] [Google Scholar]
- 27.American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776–89. doi: 10.1542/peds.108.3.776. [DOI] [PubMed] [Google Scholar]
- 28.Public Health Agency of Canada. HIV/AIDS Among Aboriginal People in Canada. 2010. [Google Scholar]
- 29.Chalmers B B u i C. Can Med Assoc J. 2013;185(5):375–76. doi: 10.1503/cmaj.121309. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Chalmers B, Levitt C, Heaman M, O’Brien B, Sauve R, Kaczorowski J. Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women. Birth. 2009;36(2):122–32. doi: 10.1111/j.1523-536X.2009.00309.x. [DOI] [PubMed] [Google Scholar]
- 31.Nickel NC, Labbok MH, Hudgens MG, Daniels JL. The extent that noncompliance with the ten steps to successful breastfeeding influences breastfeeding duration. J Human Lact. 2013;29(1):59–70. doi: 10.1177/0890334412464695. [DOI] [PubMed] [Google Scholar]
- 32.Muhajarine N, Ng J, Green K, Bowen A, Cushon J, Johnson S, et al. Understanding the Impact of the Canada Prenatal Nutrition Program: A Quantitative Evaluation. 2009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Statistics Canada. Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. Ottawa: Statistics Canada; 2013. [Google Scholar]
- 34.Public Health Agency of Canada. Tuberculosis in Canada 2007. Ottawa: Minister of Public Works and Government Services Canada; 2009. [Google Scholar]
- 35.Jackson KM, Nazar AM. Breastfeeding, the immune response, and long-term health. J Am Osteopath Assoc. 2006;106(4):203–7. [PubMed] [Google Scholar]
- 36.Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet. 2006;367(9524):1747–57. doi: 10.1016/S0140-6736(06)68770-9. [DOI] [PubMed] [Google Scholar]
- 37.Mehio-Sibai A, Feinleib M, Sibai TA, Armenian HK. A positive or a negative confounding variable? A simple teaching aid for clinicians and students. Ann Epidemiol. 2005;15(6):421–23. doi: 10.1016/j.annepidem.2004.10.004. [DOI] [PubMed] [Google Scholar]