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Abstract

Exclusive breastfeeding in the first six months of life and complementary breastfeeding up to 24 months is encouraged to ensure optimal infant and young child nutrition and health. The WHO and UNICEF emphasize these optimal Infant and Young Child Feeding (IYCF) practices, especially for regions of the world where extensive child nutrition and healthcare support is lacking or inaccessible. This dissertation explores the epidemiology of IYCF practices and child health outcomes in sub-Saharan Africa. It also examines the status of IYCF policies and programs in this relatively less studied region of the world. I use publicly available data from the Nigerian Demographic and Health Survey (NDHS) and the WHO/UNICEF Breastfeeding Collective scorecard to answer important questions explored across three studies.The first study examines the long-term impact of different durations of breastfeeding on child health outcomes post-infancy. The second study investigates the relationships between household living environmental conditions and IYCF practices, and how this complex relationship impacts child health outcomes. The third and last study describes the status and implementation of IYCF programs and policies across countries in the region. This is to help policymakers understand the gaps and challenges that would need to be overcome if the region is to meet global and world health assembly (WHA) targets on child nutrition and health. Results from the first study suggest that longer durations of breastfeeding are associated with fewer reported acute illnesses post-infancy at 24 to 59 months; demonstrating the long-term protective effect of breast milk from illnesses that contribute to the high under-five mortality rates recorded for decades in sub-Saharan Africa. An important finding from the second study is that the relationship between exclusive breastfeeding, household living environmental conditions, and acute health outcomes in infancy is complex. The results suggest that the efficacy of exclusive breastfeeding in reducing recent incidents of diarrhea and acute respiratory illness is strongest for infants living in households with poor Water, Sanitation and Hygiene (WaSH) facilities and inadequate building materials respectively. Lastly, results from the third study indicate that sub-Saharan Africa as a region is yet to meet global and WHA targets on the implementation of many IYCF policies and programs. These findings have implications for child nutrition and health outcomes especially for a region already disproportionately impacted by high under-five mortality rates. The findings from this dissertation would help in the design of policies specifically tailored to deal with some of the challenges that are unique to this region of the world. Any policy prescription to improve child nutrition and health outcomes for the region must strategically include the promotion of long-term benefits of breastfeeding beyond infancy as well as targeting communities where sub-optimal conditions are pervasive.

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