Impact of Breast Feeding On Diarrhea and Pneumonia Among Vaccinated Children: Single Center Study

Impact of Breast Feeding On Diarrhea and Pneumonia


  • Shireen Qassim Bham Department of Pediatrics, Fazaia Ruth Pfau Medical College, AIR University, Karachi, Pakistan
  • Farhan Saeed Department of Pediatrics, Liaquat college of Medicine & Dentistry, Karachi, Pakistan
  • Umer Hayat Ahmed Sharif Dow University of Health Sciences, Karachi, Pakistan
  • Nighat Aijaz Department of Pediatrics, Memon Medical Institute, Karachi, Pakistan
  • Muhammad Faisal Rahim Department of Medical Education, Fazaia Ruth Pfau Medical College, AIR University, Karachi, Pakistan



Breast feeding, Diarrhea, Pneumonia, Vaccination


The best way to give babies the nutrition they need to grow and develop is through breast milk. Objective: To assess the combine effect of breast feeding, Rota virus vaccine and Pneumococcal vaccine on frequency of Diarrhea and Pneumonia in children less than 5 years of age. Methods: A descriptive cross-sectional study conducted at Department of Pediatrics at Darul sehat hospital, Karachi. Participants were selected by convenience sampling and interview-based questionnaire was used.   196 Participants were interviewed which included mothers of infant and children from 6 months to 5 years of age, who received complete or partial vaccination according to Expanded program of Immunization (EPI) schedule with   information on history of diarrhea and pneumonia.  Infant and children with bloody diarrhea were excluded. Results: Among the 196 participants, 152 (77.6%) children received breast feed,72(47.4%) children received two doses of Rota vaccine and 128 (84.2%) children received three doses of Pneumococcal vaccines. Significant impact was seen with breast feeding and Rota vaccine on the frequency of diarrhea with p value of 0.0001. Breastfeeding and the pneumococcal vaccine both had a similar potent effect on the prevalence of pneumonia, with a p-value of 0.006. Conclusions: Our study highlights the importance of breast feeding in vaccinated children, with incidence of diarrhea in breastfed, vaccinated children decreased to (32%), compared to 93% in non-breastfed, unvaccinated infants. Similarly, only 33% of breastfed, vaccinated children developed pneumonia, compared to 85% of unvaccinated, non-breastfed infants.


World Health Organization. Continued breastfeeding for healthy growth and development of children. Retrieved June. 2019 Jun; 17: 2021.

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The lancet. 2016 Jan; 387(10017): 475-90. doi: 10.1016/S0140-6736(15)01024-7

Steele AD, Victor JC, Carey ME, Tate JE, Atherly DE, Pecenka C, et al. Experiences with rotavirus vaccines: can we improve rotavirus vaccine impact in developing countries?. Human Vaccines & Immunotherapeutics. 2019 Jun; 15(6): 1215-27. doi: 10.1080/21645515.2018.1553593

Wright MJ, Mendez MA, Bentley ME, Adair LS. Breastfeeding modifies the impact of diarrhoeal disease on relative weight: a longitudinal analysis of 2–12 month‐old Filipino infants. Maternal & child nutrition. 2017 Apr; 13(2): e12312. doi: 10.1111/mcn.12312

Santos FS, Santos LH, Saldan PC, Santos FC, Leite AM, Mello DF. Breastfeeding and acute diarrhea among children enrolled in the family health strategy. Texto & Contexto-Enfermagem. 2016 Apr; 25. doi: 10.1590/0104-070720160000220015

Isyti’aroh Isyti’aroh SR and Widyastuti W. Breastfeeding and the Risk for Diarrhea Morbidity Among Children in Indonesia. Malaysian Journal of Medicine and Health Sciences. 2022; 18(SUPP18): 96-100.

Mulatu T, Yimer NB, Alemnew B, Linger M, Liben ML. Exclusive breastfeeding lowers the odds of childhood diarrhea and other medical conditions: evidence from the 2016 Ethiopian demographic and health survey. Italian Journal of Pediatrics. 2021 Dec; 47(1): 1-6. doi: 10.1186/s13052-021-01115-3

Shumetie G, Gedefaw M, Kebede A, Derso T. Exclusive breastfeeding and rotavirus vaccination are associated with decreased diarrheal morbidity among under-five children in Bahir Dar, northwest Ethiopia. Public health reviews. 2018 Dec; 39(1): 1-0. doi: 10.1186/s40985-018-0107-6

Troeger C, Forouzanfar M, Rao PC, Khalil I, Brown A, Reiner RC, et al. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet infectious diseases. 2017 Sep; 17(9): 909-48.

Schuck-Paim C, Taylor RJ, Alonso WJ, Weinberger DM, Simonsen L. Effect of pneumococcal conjugate vaccine introduction on childhood pneumonia mortality in Brazil: a retrospective observational study. The Lancet Global Health. 2019 Feb; 7(2): e249-56. doi: 10.1016/S2214-109X(18)30455-8

Ujunwa FA and Ezeonu CT. Risk factors for acute respiratory tract infections in under five children in enugu Southeast Nigeria. Annals of medical and health sciences research. 2014; 4(1): 95-9. doi: 10.4103/2141-9248.126610

National Institute of Population Studies (NIPS) [Pakistan] and ICF. Pakistan demographic and health survey 2017-18. Pakistan demographic and health survey 2017–18. 2019 Jan.

Dadonaite B, Ritchie H, Roser M. Diarrheal diseases. Our World in Data. 2018 Nov 1.

WHO. IMCI Chart Booklet. 2014 [cited 2019 Feb 21]. Available from:

Prameela KK and Vijaya LR. The importance of breastfeeding in rotaviral diarrhoeas. Malaysian journal of nutrition. 2012 Mar; 18(1).

UNICEF, G.o.P., National Nutrition Survey 2018 - Key Findings Report. 2018

de Deus N, Chilaúle JJ, Cassocera M, Bambo M, Langa JS, Sitoe E, et al. Early impact of rotavirus vaccination in children less than five years of age in Mozambique. Vaccine. 2018 Nov; 36(47): 7205-9. doi: 10.1016/j.vaccine.2017.10.060

Shati AA, Khalil SN, Asiri KA, Alshehri AA, Deajim YA, Al-Amer MS, et al. Occurrence of diarrhea and feeding practices among children below two years of age in southwestern Saudi Arabia. International journal of environmental research and public health. 2020 Feb; 17(3): 722. doi: 10.3390/ijerph17030722

Das S, Sahoo GC, Das P, Singh UK, Jaiswal AK, Singh P, et al. Evaluating the impact of breastfeeding on rotavirus antigenemia and disease severity in Indian children. PLoS One. 2016 Feb; 11(2): e0146243. doi: 10.1371/journal.pone.0146243

Shen J, Zhang BM, Zhu SG, Chen JJ. No direct correlation between rotavirus diarrhea and breast feeding: A meta-analysis. Pediatrics & Neonatology. 2018 Apr; 59(2): 129-35. doi: 10.1016/j.pedneo.2017.06.002

Madhusudhan K, Sreenivasaiah B, Kalivela S, Nadavapalli SS, Babu RT, Jampana VR. Clinical and bacterial profile of pneumonia in 2 months to 5 years age children: A prospective study done in a tertiary care hospital. International Journal of Contemporary Paediatrics. 2017 Jan; 4(1): 90-5. doi:

Lamberti LM, Zakarija-Grković I, Fischer Walker CL, Theodoratou E, Nair H, et al. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC public health. 2013 Sep; 13: 1-8. doi: 10.1186/1471-2458-13-S3-S18

Boccolini CS, Carvalho ML, Oliveira MI, Boccolini PD. Breastfeeding can prevent hospitalization for pneumonia among children under 1 year old. Jornal de pediatria. 2011; 87: 399-404. doi: 10.2223/JPED.2136

Ásbjörnsdóttir KH, Slyker JA, Weiss NS, Mbori-Ngacha D, Maleche-Obimbo E, Wamalwa D, et al. Breastfeeding is associated with decreased pneumonia incidence among HIV-exposed, uninfected Kenyan infants. AIDS (London, England). 2013 Nov; 27(17): 2809. doi: 10.1097/01.aids.0000432540.59786.6d

Fathima P, Blyth CC, Lehmann D, Lim FJ, Abdalla T, De Klerk N, et al. The impact of pneumococcal vaccination on bacterial and viral pneumonia in Western Australian children: record linkage cohort study of 469589 births, 1996–2012. Clinical Infectious Diseases. 2018 Mar; 66(7): 1075-85. doi: 10.1093/cid/cix923

Mackenzie GA, Hill PC, Sahito SM, Jeffries DJ, Hossain I, Bottomley C, et al. Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies. The Lancet infectious diseases. 2017 Sep; 17(9): 965-73. doi: 10.1016/S1473-3099(17)30321-3




How to Cite

Qassim Bham, S. ., Saeed, F. ., Ahmed Sharif, U. H. ., Aijaz, N. ., & Faisal Rahim, M. . (2023). Impact of Breast Feeding On Diarrhea and Pneumonia Among Vaccinated Children: Single Center Study: Impact of Breast Feeding On Diarrhea and Pneumonia. Pakistan Journal of Health Sciences, 4(04), 95–99.



Original Article