{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:32:54Z","timestamp":1789475574995,"version":"build-2803163510"},"reference-count":50,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,1,9]],"date-time":"2022-01-09T00:00:00Z","timestamp":1641686400000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study analysed the association between breast feeding (BF) and birth interval (BI) (both succeeding and preceding) with neonatal mortality (NM), infant mortality (IM) and under-5 mortality (U5M).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This cross-sectional study used data from the Pakistan Demographic and Health Survey 2017\u20132018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Settings<\/jats:title><jats:p>All provinces, Islamabad and Federally Administered Tribal Areas were included in the analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total of 12\u2009769 children born to ever-married multiparous women aged 30\u201349 years who gave live birth within 5\u2009years preceding the interview. Multiple births are not included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data analysis<\/jats:title><jats:p>Multivariate logistic regression analysis was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found that BF was associated with nearly 98% lower risk of NM (OR 0.015; 95% CI: 0.01 to 0.03; p&lt;0.001), 96% lower risk of IM (OR 0.038; 95% CI: 0.02 to 0.06; p&lt;0.001) and 94% lower risk of U5M (OR 0.050; 95% CI: 0.03 to 0.08; p&lt;0.001). Compared with optimal preceding birth interval (PBI) (36+ months), short PBI (&lt;18 months) was associated with around six times higher risk of NM (OR 5.661; 95% CI: 2.78 to 11.53; p&lt;0.001), over five times risk of IM (OR 4.704; 95% CI: 2.70 to 8.19; p&lt;0.001) and over five times risk of U5M (OR 4.745; 95% CI: 2.79 to 8.07; p&lt;0.001). Disaggregating the data by child\u2019s gender, place of residence and mother\u2019s occupational status showed that being ever breast fed was associated with a smaller risk of NM, IM and U5M in all three disaggregations. However, the risk of smaller PBI &lt;18 months was generally more pronounced in female children (NM and U5M) or when the children lived in rural areas (NM, IM and U5M). PBI &lt;18 months was associated with greater risk of NM and IM, and smaller risk of U5M when mothers did a paid job.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study\u2019s significance lies in the fact that it has found BF and BI to be consistent protective factors against NM, IM and U5M. Given Pakistan\u2019s economic constraints, optimal BF and BI are the most cost-effective interventions to reduce child mortality.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-053196","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T18:33:45Z","timestamp":1641926025000},"page":"e053196","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Association of breast feeding and birth interval with child mortality in Pakistan: a cross-sectional study using nationally representative Demographic and Health Survey data"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4100-3382","authenticated-orcid":false,"given":"Rafi","family":"Amir-ud-Din","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz Zahid","family":"Mahmood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Abbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Muzammil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9701-3179","authenticated-orcid":false,"given":"Ramesh","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sathirakorn","family":"Pongpanich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"2022011108451479000_12.1.e053196.1","unstructured":"Hug L , Sharrow D , Zhong K . 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