Breast-feeding in sub-Saharan Africa: outlook for 2000

Breast-feeding in sub-Saharan Africa: outlook for 2000Sir, A recent paper in Public Health Nutrition reviewed the breast-feeding situation in Africa 1 .Although this review raised many important points, we disagree with its main message, that `the outlook for breast-feeding in African mothers in general is one of gloom'.The authors' opinion is that the rate and the duration of breast-feeding are declining in Africa, but their opinion is mostly based on small and not nationally representative surveys.A recent review of all available Demographic and Health Surveys from Africa, conducted by one of us, does not support this opinion 2 .As a matter of fact, the median duration of breast-feeding increased in two thirds of fifteen African countries from all regions where data were available.Furthermore, the rate of exclusive breast-feeding, a practice which is not common in African countries, is also increasing in eleven of the fifteen countries 3 .Giving other liquids to infants in addition to breastmilk, as well as introducing solid foods before 4 months, are widespread practices, as the authors rightly point out, but they are traditional and do not threaten prolonged breast-feeding as it is currently practised in most sub-Saharan countries 4 .The authors quote a review stating that `considerable responsibility' in the early cessation of breast-feeding `was attributed to the inadequacies of health services'.Although it is true that health professionals are overburdened and probably would need more training for the promotion of breast-feeding, there is evidence that the positive trends in breast-feeding are, at least in part, a result of their consistent promotion efforts.Although no Public Health Nutrition: 4(4), 929±932 q The Authors 2001 *Editor's note: In the Lancet on 26 May (357: 1651±5) the results from an RCT comparing mortality in infants of HIV positive mothers in Nairobi who were either breast or formula fed showed higher mortality in the children who had been breast fed.