Hello Helen,
Exclusive breastfeeding up to six months of age and breastfeeding up to 12 months was ranked number one, with complementary feeding starting at six months number three. These two interventions alone were estimated to prevent almost one-fifth of under-five mortality in developing countries
This is abstracted from::: http://www.unicef.org/nutrition/files/Final_IYCF_programming_guide_2011.pdf

Hi Helen, It is so important that the right questions are asked in this context. Breastfeeding is a physiological norm, so the report in fact needs to be looking instead for evidence that not breastfeeding does not contribute to wasting or stunting.

Dear Dr. Connolly:

You ask a very pertinent question. There is a growing body of literature, much of it with conflicting results, on the association between the WHO/UNICEF IYCF indicators and various types of malnutrition. Just search PubMed for IYCF indicators and stunting to find such publications. Several of these studies, mostly cross-sectional surveys, show a lack of association. I have personally assisted in several surveys which fail to demonstrate an association, and I have analyzed DHS datasets from Ethiopia and Guinea which showed that IYCF indicators are much more weakly related to stunting and wasting than many other variables, such as measures of socio-economic status or environmental sanitation and hygiene.

The reasons for this apparent lack of association are poorly understood. I don't think these studies prove that dietary diversity, exclusive breastfeeding, or the other IYCF indicators are truly unrelated to nutritional status in children 6-23 months of age; however, this possibility must be investigated. We cannot accept a hypothesis just because UN agencies say so or advocates believe it to be true. I suspect that the standard indicators are insufficiently precise and/or sensitive to be able to demonstrate an association in cross-sectional surveys, especially when the data are collected by overworked interviewers during a long interviews with tired respondents. Moreover, a cross-sectional survey collecting data from interviews, even if data collection is optimal, is a poor methodology to investigate associations between variables.

So, in short, you should not be too surprised at the lack of association in your report. Now we just need to find the funding and develop appropriate study designs to investigate this further.

Hi Helen,
Here are two references
- A 2-year integrated agriculture and nutrition and health behavior change communication program targeted to women in Burkina Faso reduces anemia, wasting, and diarrhea in children 3-12.9 months of age at baseline: a cluster-randomized controlled trial.
Olney DK; Pedehombga A; Ruel MT; Dillon A.
Journal of Nutrition. 145(6):1317-24, 2015 Jun.

-Behavioral Change Strategies for Improving Complementary Feeding and Breastfeeding.
Osendarp SJ; Roche ML.
World Review of Nutrition & Dietetics. 115:184-92, 2016

Dear Helen and all

this is a very important discussion. While I could not find specific Bangladesh articles, there are interesting ones, related to the topic that were recently published, please see below:

1. World Rev Nutr Diet. 2016;115:82-97. doi: 10.1159/000442075. Epub 2016 May 19.
The Role of Breastfeeding in the Prevention of Childhood Malnutrition.
Scherbaum V, Srour ML.

2. Cureus. 2016 Jan 7;8(1):e452. doi: 10.7759/cureus.452.
Feeding Patterns and Predictors of Malnutrition in Infants from Poor Socioeconomic Areas in Pakistan: A Cross-sectional Survey.
Nisar MU1, Anwar Ul Haq MM2, Tariq S3, Anwar M4, Khawar A2, Waqas A5, Nisar A6.

3. BMC Public Health. 2015 Nov 23;15:1157. doi: 10.1186/s12889-015-2494-7.
How well do WHO complementary feeding indicators relate to nutritional status of children aged 6-23 months in rural Northern Ghana?
Saaka M1, Wemakor A2, Abizari AR3, Aryee P4.

4. Paediatr Perinat Epidemiol. 2015 Nov;29(6):552-61. doi: 10.1111/ppe.12222. Epub 2015 Sep 1.
Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana.
Aheto JM1, Keegan TJ1, Taylor BM1, Diggle PJ1.

Regarding evidence of the effect of breastfeeding on growth you may also like to read:

Kuchenbecker J, Jordan I, Reinbott A et al. Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study. Paediatr Int Child Health. 2015;35(1):14-23. doi: 10.1179/2046905514Y.0000000134. Epub 2014 Jul 9. It's online accessible for free.