Table 4 Quality assessment of studies measuring the association between suboptimal breastfeeding and selected outcomes
| 听 | 听 | 听 | 听 | 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 | |||||
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 | 听 | |
All-Cause Mortality: moderate outcome-specific quality | |||||
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 | 听 | |
Pneumonia Hospitalizations: moderate outcome-specific quality | |||||
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 |