healthy development, and the economicproductivity of individuals and societies1 . Undernutrition in childrenincludes stunting, wasting, and deficiencies in Vitamins and Minerals. In 2011, in a jointlyconducted survey by WHO, UNICEF and World Bank globally, described 165 million (25.7%) children younger than 5 years ofage had a height for-age Z score (HAZ) of –2 or lower (stunted) based on theWHO Child Growth Standards1 .
In High Income Countries (HIC), the prevalencewas 7.2% while in Low-income and Middle-income countries (LMIC) the prevalencewas 28.0%1. Overweight and obesity can exist in the same setting, representingwhat has been called the “double burden” of malnutrition. The global prevalenceof overweight, defined as a weight-for-height Z score (WHZ) of +2 or higherbased on the WHO Child Growth Standards2 , was 7% for children younger than 5years in 2011, and is projected to increase in most world regions1 . Althoughprevalence is higher in HIC, the most overweight children younger than 5 years(32 million in 2011) live in LMICs; over half of these children (17 million)live in Asia1 .. Globally, 70% of deficits in height are due to faltering inthe first “1000 days” after conception7,8.
The association betweenbreastfeeding and long-term effects on linear growth is not well-established9,however, infectious disease in early childhood has been associated withlong-term effects on linear growth1,9, with diarrhea1 representing the mostimportant determinant. Strong evidence also exists for the link between breastfeedingand protection against infectious morbidity10-12, particularly fordiarrhea13,14. In one meta-analysis, the risk of diarrhea incidence was higherfor partial (RR=3.
04; 95% CI=1.32, 7.00) and non-breastfed infants (RR=3.65;95% CI=1.69, 7.88) compared to exclusively breastfed infants13.
Breast milkcontains non-nutrient factors that promote intestinal adaptation and maturationand protect against infection and inflammatory disorders15-17, which may be onepathway through which breastfeeding protects infants from infection and allowsenergy to be directed toward growth and development. 15 Risk of overweight alsohas many potential determinants, including breastfeeding patterns. One recentmeta-analysis showed a pooled adjusted odds ratio (AOR) of 0.78 (95% CI: 0.74,0.81)18 while another demonstrated a 12% reduction in the risk of overweight orobesity1 associated with breastfeeding. Exclusive breastfeeding in the firstsix months along with continued breastfeeding has been identified as the singlemost effective preventive intervention for improving the survival and health ofchildren19. Two systematic literature reviews of breastfeeding promotioninterventions identified counseling and education as two methods tosignificantly increase exclusive breastfeeding rates in various HIC and LMICsettings20,21, but potential for scaling up was unclear.
In addition, no trialswere found in either of the breastfeeding promotion reviews nor in a. Althoughbreastmilk is well known to be economically and physiologically crucial tochild survival13, breastfeeding promotion also faces a competition from other feed usually regarded as prelacteal23