BREASTFEEDING AND ACUTE RESPIRATORY INFECTION (ARI) IN INFANTS: ASYSTEMATIC REVIEW IN NIGERIA

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A. George¹, S. Bonne², E.N. Ekpenyong³, E.N. Edem⁴, S. Ajayi¹

1. The Oxford Vaccine Group, Department of Paediatrics, University of Oxford, England.
2. Faculty of Medicine, McGill University, Canada.
3. Department of Haematology and Blood Bank, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
4. Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, University of Uyo, Nigeria.

Abstract

Background: Acute Respiratory Infections (ARIs) significantly contribute to infant morbidity and mortality worldwide, especially in developing countries like Nigeria, where factors such as inadequate nutrition, poor environmental conditions, and partial immunization increase their incidence, while exclusive breastfeeding (EBF) offers immune protection that can reduce their incidence and severity. Therefore this review assessed the role of breastfeeding, especially exclusive breastfeeding, in reducing the risk and severity of ARIs in Nigerian infants, while also evaluating factors influencing breastfeeding practices.

Methods: A systematic review was conducted following PRISMA guidelines, involving a comprehensive search of databases such as PubMed, Scopus, Science Direct, Google Scholar, and African Journals Online. Twelve studies conducted between 2004 and 2024 focusing on breastfeeding practices and their impact on ARIs in Nigerian infants aged 0-6 months were selected. The review focused on primary studies with observational and cohort designs.

Results: The review found that exclusive breastfeeding significantly reduces the risk of ARIs in infants, with non-exclusively breastfed infants facing a fourfold increase in ARI risk. Breast milk contains immunologically active components like secretory IgA, lactoferrin, and lysozyme, which enhance immune defenses and reduce the severity of ARIs such as pneumonia. However, only 25-40% of infants in Nigeria are exclusively breastfed for six months due to cultural beliefs, maternal employment, lack of education etc.

Conclusion: Exclusive breastfeeding significantly protects Nigerian infants against ARIs, but cultural misconceptions, socioeconomic barriers, insufficient maternal education etc hinder optimal practices, necessitating targeted public health initiatives and policy interventions to improve infant health outcomes.

Keywords: Exclusive breastfeeding, Acute respiratory infections, Infant health, Breastfeeding practices, Public health strategies

Introduction

Infectious diseases have constituted a great menace to public health.¹ Some of these infectious diseases such as respiratory tract infections (RTIs) are a leading cause of morbidity and hospitalization in infants, children and adults.^2,3 The RTIs encompass a range of infections including Acute Respiratory Infections (ARIs), which can be caused by either viruses, fungi or bacteria. The ARIs can affect the upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs) or both respiratory tracts.⁴ The URTIs encompass conditions like laryngitis, the common cold, pharyngitis, acute rhinitis, tonsillitis, acute rhinosinus­itis, and otitis media,⁵ while the LRTIs include acute bronchiolitis, bronchitis, tracheitis, and pneumonia.^6,7 The ARI is characterized by varying symptoms depending on whether the upper or lower respiratory tract is affected, and can include conges­tion in the nasal sinuses or lungs, a runny nose, coughing, sore throat, body aches, and fatigue.² Globally, ARIs are responsible for about 12 million morbidities and 1.3 million fatalities in infants and under-five years of age children,⁸ with three-fourths occurring in Sub-Saharan Africa (SSA).^9.10 The likelihood of children under five in West Africa experiencing a higher ARI symptoms compared to those in East Africa, is notably high.¹¹ In Nigeria, the prevalence of ARI symptoms among children under five has shown some variation over the years. As of 2018, about 2.6% of children in Nigeria had symptoms of ARI in the two weeks preceding the survey.² The prevalence is higher in the North East region, with 8.2% of children affected, while the South West region has the lowest prevalence.¹¹ The underlying factors contributing to the high incidence of ARIs in children include unfavourable environmental conditions (such as poor ventilation and exposure to cigarette smoke), partial immunizations, low birth weight, low parental education, underdeveloped immune system, and inadequate nutrition (non-exclusive breastfeeding).¹²

Breastfeeding is perhaps the oldest practice in human history, healthiest, simplest and least expensive means of meeting the nutritional needs of newborns and infants. Breast milk contains arrays of essential nutrients including carbohydrates, essential fats, proteins, minerals, and immunological factors etc, required for the optimal growth and development of infants; hence, making it the ideal meal for them.¹³ In addition to the nutrients, it also has a great array of ‘bioactive factors’ which strengthens their immune systems thereby protecting them against the risk and impact of neonatal infections.¹⁴ For instance, infants that are not breastfed are at a higher risk of hospitalization in their early life in relation to a wide range of common infections including digestive and respiratory tract infections. Based on this, breastfeeding had been recognized by World Health Organization (WHO) and UNICEF for its essential role in infants, hence recommending exclusive breastfeeding for the first six months of life.¹⁵ Infants who are not exclusively breastfed have a 4.96- fold higher incidence of ARI compared to those who are exclusively breastfed.¹⁶

According to the World Health Organization (WHO), exclusive breastfeeding (EBF) means that an infant receives only breast milk, without any additional food or drink, not even water, for the first six months of life to ensure optimal growth, development, and health.¹⁷ EBF has proven that poor breastfeeding, mostly non-exclusive breastfeeding in the first six months of life, is estimated to have led to 1.4 million mortality and 10% of diseases among under-fives including ARI prevalence.¹⁸ This review aims to summarize the role of breastfeeding and the composition of breast milk in reducing the risk and severity of ARIs in infants in Nigeria, while also examining factors that influence breastfeeding practices in the country. This review will enhance understanding of breastfeeding trends on ARIs in Nigeria.