摘要：Objectives. We studied reasons for cessation of breastfeeding before the age of 15 months, replacement feeding modes, and child mortality in West Africa. Methods. Data were gathered for 12208 children born between 1987 and 1997 in a rural area of Senegal. Interviews were conducted with caregivers of early-weaned children, and child mortality risks were assessed. Results. Fewer than 1% of children had been weaned early. The main reasons for early weaning were maternal death and new pregnancy (in 41% and 27% of cases, respectively). Twenty percent of children had been relactated by a wet nurse, and 16% had received formula. Many early-weaned children died before the age of 2 years (26%), particularly those weaned early as a result of the mother’s death (hazard ratio = 5.1; 95% confidence interval [CI] = 1.74, 15.0). Girls had a lower hazard ratio than boys (0.16; 95% CI=0.05, 0.41). Conclusions. Our results showed that early cessation of breastfeeding was rare but that associated mortality was high, especially when the mother had died. Breastfeeding is practiced by a vast majority of mothers in sub-Saharan Africa, often for long durations. 1 Results from all 34 countries for which Demographic and Health Survey data are available show that, since 1975, more than 95% of children have been initially breastfed, and the median age of the child at breastfeeding cessation has been more than 18 months in all 13 countries surveyed after 1990. 2 Although the prevalence and duration of breastfeeding decreased in some African countries between 1975 and 1990 owing to increased rates of urbanization and female employment, prevalence levels have remained stable or even increased when these factors are taken into account. 3 Breastfeeding has a beneficial effect on mothers by decreasing risks of new pregnancies and thus increasing mean birth intervals, 4 and it is considered an essential component of motherhood in African populations. 5 Studies have shown that breastfeeding reduces the risk of diarrhea and of death from diarrhea and respiratory infectious diseases among African children 1 to 2 years of age. 6 , 7 In Asia and South America, its protective effect has been shown to be strongest during infancy, but hazard ratios associated with lack of breastfeeding during infancy have not yet been estimated for African populations because virtually all children are breastfed for more than 1 year, particularly in rural areas. 7 , 8 Recent studies have emphasized the importance of reasons for early breastfeeding cessation in interpreting the protective effect of lactation on survival. Indeed, children may be weaned earlier than normal as a result of conditions increasing mortality risk per se. 8 , 9 In the present study, we sought to estimate the prevalence of early maternal breastfeeding cessation (or noninitiation of breastfeeding) in a rural West African society and to describe reasons and alternative feeding options. Also, we assessed mortality rates before the age of 2 years in relation to reasons for weaning and to postweaning feeding modes.
