Literature review for - Flourish Paediatrics

deficiency has also been associated with lower mean birth weight, increased infant mortality,
impaired hearing and motor skills.
Although salt iodization and iodine supplementation programmes have reduced the number
of countries where iodine deficiency remains a problem, about 1.9 billion people – 31% of
the world population – do not consume enough iodine. The most affected WHO regions are
South-East Asia and Europe (13). The direct sequelae of iodine deficiency, such as goitre,
cretinism and developmental disability, resulted in 3.5 million DALYs (0.2% of the total) in
2004.
Risks for child health
In 2004, 10.4 million children under 5 years of age died: 45% in the WHO African Region
and 30% in the South-East Asia Region. The leading causes of death among children under 5
years of age are acute respiratory infections and diarrhoeal diseases, which are also the
leading overall causes of loss of healthy life years. Child underweight is the leading
individual risk for child deaths and loss of healthy life years, causing 21% of deaths and
DALYs. Child underweight, together with micronutrient deficiencies and suboptimal
breastfeeding, accounted for 35% of child deaths and 32% of loss of healthy life years
worldwide. Unsafe water, sanitation and hygiene, together with indoor smoke from solid
fuels, cause 23% of child deaths. These environmental risks, together with the nutritional
risks and suboptimal breastfeeding, cause 39% of child deaths worldwide.
Suboptimal breastfeeding
We based our analysis on the methods of Black et al., who recently published an analysis of
the global burden of suboptimal breastfeeding (9). Black et al. provide data for breastfeeding
levels for 30 developing countries and 12 regions, mainly covering the developing world.
Data were limited for developed countries; therefore, prevalence estimates from the United
States of America (USA) and Australia were used (43, 44). The breastfeeding prevalence for
the USA was applied to all high-income countries that were not covered by Black and
colleagues and were not located in the WHO Western Pacific Region. Breastfeeding
prevalence from Australia was applied to all Western Pacific countries not covered by Black
and colleagues In this analysis, relative risks for diarrhoeal diseases, lower respiratory tract
infections and infectious perinatal conditions were calculated for children aged under 24
months. Relative risks were calculated for these conditions across four exposure categories
(exclusive, predominant, partial and non-breastfeeding) in the 0–5 months age group and two
(any and non-breastfeeding) in the 6–23 month age group. Relative risks and prevalence data
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