Breastfeeding Case Study 2022

Running head: CASP 1
CASP
Name
Institutional Affiliation

CASP 2
BREASTFEEDING
Introduction
The topic for this study is breastfeeding. Breastfeeding is important in cognitive
development of children and in the prevention of allergies and some diseases like asthma
amongst the children. Thus, this paper came up with an objective that related the effects of
breastfeeding on reduction of asthma cases amongst the children. The research questions was,
therefore, formulated as: “what is the effect of breastfeeding on children’s risks of getting
asthma?” This research question thus formed the basis of this paper. After the determination of
this research question, the search strategy formulation ensued to find the relevant three sources
which could be used to complete the assignment. The search strategy helped the researcher to get
the three articles that used different designs as RCT, prospective cohort study as well as case-
control study. These articles were subsequently appraised using different CASP tools patient to
each study design used in each of the three articles.
Methodology
The three articles for this study were obtained on the internet and libraries which are
credited using the known databases like PubMed and ProQuest databases. The search strategy
was developed via the key terms and concepts; truncation & wildcards; combining terms, and
phrases searching besides subject headings. The procedure proceeded the identification of the
concepts alongside terms and the relevant databases selections and resources. The Boolean
operators was then used to combine search terms and then running searches in the selected
resources. The review of the literature was performed and the search results were refined. The
research questions or the topic was used to identify key terms and key words within the topic.
Every constituent of the topic was then treated as separate concept and for every concept, the

CASP 3
researcher listed key words drawn from topic and other suitable synonyms alongside terms
acquired in preamble searches. Consequently, the researcher considered singular alongside plural
forms of acronyms, words, variant spelling and suitable index terms for the headings of the
subject. The systematic review of retrieved literature was then used to select the three articles
needed for this study based some exclusion criteria.
RESULTS
RCT
Straňák et al. (2016)
No. Question ANS. Justification
1. Did the trial address a clearly-focused
issue?
Yes Straňák et al., (2016) study
addressed the relationship effects of
restricted formula amount on
facilitation of breastfeeding
2. Was the assignment of patients to
treatments randomized?
Yes. Authors allotted partakers to
treatment group using randomized
method to enroll subjects.
3. Were all the patients who entered the
trial properly accounted for at its
conclusion?
Yes Player totaling to 104 healthy infants
were accounted for.
4. Were patients, health workers, and
study personnel “blind” to treatment?
Yes The participants got blinded in the
study which credibility of the data
gathered. Especially, a research

CASP 4
nurse was blinded to allocation in
the group who helped to assess the
results during personal interviews
(Straňák et al. (2016).
5. Were the groups similar at the start of
the trial?
Yes They stood matching at baseline
socio-demographic alongside
clinical variables
6. Aside from experimental intervention,
were the groups treated equally?
Yes. They got equal treatment in terms of
random selection and randomization
that avoided bias at selection.
7. How large was the treatment effects? No effects of treatment which as the
results showed no differences in the
groups existed.
8. How precise was the estimate of the
treatment effect?
Estimates stood precise and they
managed to reveal the differences in
the groups.
9. Can the results be applied to the local
population, or in your context?
No It used a small size of the sample
(104) infants that is not
demonstrative of the whole
population and hence cannot be
generalizable unless large size of
sample used in confirming the

CASP 5
outcomes.
10. Were all clinically important
outcomes considered?
Yes Every clinical significant results
stood considered as all statistical
comparison were anchored the
effects of limited formula on the
rates of breastfeeding.
11. Are the benefits worth the harms and
costs?
Yes The gains are worth the cost since
this study was the first to use RCT to
show that use of controlled limited
formula has no adverse effects on
breastfeeding rate in both long- and
short-tem.
Prospective Cohort Study

CASP 6
Lossius et al. (2018)
No. Questions ANS. Justification/ comments
1 Did the study address a clearly focused
issue?
YES Focused on establishing if period of
breastfeeding alongside time for
introducing a child to
complementary meals is linked to
risk of asthma in childhood (Lossius,
Magnus, Lunde & Størdal, 2018).
2 Was the cohort recruited in an
acceptable way?
Is it worth continuing?
YES Recruitment of cohort was
acceptable since it data was got from
Norwegian Mother and Child Study
(a countrywide prospective research)
which recruits expectant women
from crossways the nation beginning
1999-08 (Lossius, Magnus, Lunde &
Størdal, 2018).
3 Was the exposure accurately measured
to minimize bias?
YES Bias stood precisely minimized by
accurate measure of exposure.
4 Was the outcome accurately measured
to minimize bias?
YES The results measuring stood
precisely to minimalize bias based
on log-binomial regression models
which helped obtain RRs in

CASP 7
mainstream analysis and further
adjusted for confounding variables
selected in the multivariate analyses
(Lossius, Magnus, Lunde & Størdal,
2018).
5 (a) Have the authors identified all
important confounding
factors?
(b) Have they take account of the
confounding factors in the
design and/or analysis?
No
Yes
Not all confounding variables were
identified and explained.
The RRs in mainstream examination
were obtained and adjusted correctly
for confounding variables in
multivariate examinations.
6 (a) Was the follow up of subjects
complete enough?
(b) Was the follow up of subjects
long enough?
YES The follow-up was both long and
complete enough. They followed up
babies with full data about
breastfeeding for 1.5 years and
present age more than seven years
who totaled to 41, 020 (Lossius,
Magnus, Lunde & Størdal, 2018).
7 What are the results of this study? For the period during breastfeeding,
5.90 percent of babies breastfed less
than half a year ([aRR]) 1.050,
0,930-1.190) as well as 4.60 percent
breastfed six to eleven months (aRR

CASP 8
0.960, 0.870-1.070) had already
dispensed medication for asthma at
seven years as opposed to 4.60
percent of babies breastfed greater or
equal to 12 months (P-trend 0.62
(Lossius, Magnus, Lunde & Størdal,
2018). The infants still did breastfeed
at six months, however, introduced
to complementary food less than four
months and four to six months, had
the aRR if 1.150 (0.980-1.360)
alongside 1.090 (0.940 -1.270) in
that order, as opposed to infants
completely breastfed for six months
(P-trend 0.09) (Lossius, Magnus,
Lunde & Størdal, 2018). The ages at
the start of solids or formula
distinctly stood insignificant
predictors (P-trend 0.16 and 0.08, in
that order) (Lossius, Magnus, Lunde
& Størdal, 2018).
8
How precise are the results? The outcome were accurate enough
and led to conclusion that there is a

CASP 9
link between breastfeeding period
and age of introducing an infant to
complementary foodstuffs and the
asthma at the age of seven years
(Lossius, Magnus, Lunde & Størdal,
2018).
9 Do you believe the results? Yes They remain credible since they are
consistent with other past study
outcomes.
10
Can the results be applied to the local
population?
YES The outcomes are applicable
because of its clinical strengths and
contribution to avoid asthma
amongst the locals.
11 Do the results of this study fit with
other available evidence?
YES The outcomes remain consistent
with the previous studies like the one
carried out by Huo et al. (2018) that
also found such associations.
12 What are the implications of this study
for practice?
Implication is that it supports and
confirms the importance of
breastfeeding the infants for long
rather than being introduced to
complementary foods at tender age
(Lossius, Magnus, Lunde & Størdal,

CASP 10
2018).
A case-control study
Huo et al. (2018).
NO. Question ANS. Justification
1. Did the study address a clearly focused
issue?
Yes It focused on determining
breastfeeding effects on asthma risk
amongst kids at increased risk (Huo,
Chu, Hua, Bao, Du, Xu & Zhang,
2018).
2. Did the author use an appropriate
method to answer their question?
Yes Appropriate method was employed
to respond to the query based on
case-control with adequate cases of
asthma and controls. The multiple
logistic regression was effective in
crude as well as adjusted odd ratios.
3. Were the case recruited in an
acceptable way?
Yes Case recruitment was acceptable
because the authors used large
amount of cases (697) from which
634 were selected (Huo, Chu, Hua,
Bao, Du, Xu & Zhang, 2018).
4. Were the controls selected in an
acceptable way?
Yes Control selection was acceptable
because it led to a total of 864 non-

CASP 11
asthma controls out of the potential
1099 after meeting exclusion and
inclusion criterion (Huo, Chu, Hua,
Bao, Du, Xu & Zhang, 2018).
5. Was the exposure accurately measured
to minimize bias?
Yes Exposure minimized bias based on
accurate measurements based Odds
ratio (Huo, Chu, Hua, Bao, Du, Xu
& Zhang, 2018).
6.a.
b.
Aside from the experimental
intervention were the groups treated
equally?
Have the authors taken account of the
potential confounding factors in design
and/or in their analysis?
Yes
Yes
All groups were treated equally in
the study without any bias or favor
on either case or control groups.
Both analysis and design considered
confounders. Exclusion criteria in
design was used to eliminate
confounding factors while in
analysis, multiple logistic regression
stood performed for the estimation of
both adjusted OR and crude ratio .
7. How large was treatment effect? Effect was large enough and were
measured based on OR which
showed that the children were not

CASP 12
breastfed were highly allergic.
8. How precise was the estimate of the
treatment effect?
They were significantly was precise
based on OR which was made
possible by regression analysis.
9. Do you believe the results? Yes They were drawn from large data
and quality data source and were
correctly statistically analyze to
establish the link between
breastfeeding and asthma amongst
children which stood consistent with
previous studies
10. Can the results be applied to the local
population?
No They are applicable since the cases
alongside control were a good
representative of the population and
hence can help avoid the risk of
allergies and asthma amongst the
locals (Huo, Chu, Hua, Bao, Du, Xu
& Zhang, 2018).
11. Do the results of this study fit with
other available evidence?
Yes They fit with the existing evidence in
literature that have found association
of breastfeeding and reduction in
cases of asthma amongst the children

CASP 13
(Huo, Chu, Hua, Bao, Du, Xu &
Zhang, 2018).
Y = YES, N = NO, NC = NOT CLEAR
Discussion: Bias, Chance and Confounding Factors
RCT:
Straňák et al. (2016) was a RCT stud which used an appropriate design that eliminated
selection bias. According to this study, they effectively minimized bias since they blinded the
nurse who assessed the outcomes. Thus, it was effective when the authors blinded the research
nurse to group assignment. Thus, it is important that the future studies blinds all the subjects so
as to avoid any possible biases and the confounding factors (Straňák et al. (2016). The study
stood effective when the authors accounted for the confounding factors accurately by estimating
the adjusted RRs. This ensured that the results are believable and can be generalized in other
populations.
Prospective cohort study
Lossius et al. (2018) was a prospective cohort study which can also be appraised by on
the bias, chance and confounding factors. As reflected in the CASP table, it was not that most of
the questions were affirmed. This means that the authors used the correct design to answer the
question under the study (Lossius et al., 2018). The authors minimized the effects of the
confounders because they utilized regression models (log-binomial) to attain crude RRs in their
mainstream analyses and subsequently adjusted it for the confounding variables. However, the
limitations of the study was that the authors left chance for confounders since only selected few
were accounted for properly in the design and analysis (Lossius et al., 2018).
Case-Control Study

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Huo et al. (2018) is also discussed based on chance, bias and confounders. As seen from
the CASP table under the “result” section above, most of the questions were answered as “yes”
which means that this article met most of the criteria of appraisal. The authors correctly
accounted for the confounders and this led to minimization of errors in the results. This increased
the believability of the results (Huo et al., 2018). On the other hand, the authors minimized bias
in the study by ensuring that subjects were equally treated in the groups. This ensured that the
results remained consistent with the previous findings which further help support and defend the
need for breastfeeding amongst the children.
Conclusion
From the discussion above, it is clear that the three studies used different designs
including RCT, case-control and prospective cohort study which each fit the research questions,
problem and the issues being discussed. The three studies focused on the importance of
breastfeeding the children and the potential to reduce the asthma development amongst the
children. From this discussion, it is true and confirmed that there is a need to defend and support
breastfeeding for children to attain both better cognitive development and avoid the cases of
asthma. However, whereas most of the CASP questions per each design received a “Yes”
answered accompanied by effective justification, there were cases where the respective studies
were weak in terms of minimizing bias, accounting for confounding factors and chance. The
discussion has acknowledged these areas and has given recommendations on how such gaps can

CASP 15
be filled for effective results which can be implemented locally and generalized in the entire
population.
References

CASP 16
Huo, X., Chu, S., Hua, L., Bao, Y., Du, L., Xu, J., & Zhang, J. (2018). The effect of
breastfeeding on the risk of asthma in high-risk children: a case-control study in
Shanghai, China. BMC pregnancy and childbirth, 18(1), 341.
Lossius, A. K., Magnus, M. C., Lunde, J., & Størdal, K. (2018). Prospective Cohort Study of
Breastfeeding and the Risk of Childhood Asthma. The Journal of pediatrics, 195, 182-
189. https://www.ncbi.nlm.nih.gov/pubmed/29397158
Straňák, Z., Feyereislova, S., Černá, M., Kollárová, J., & Feyereisl, J. (2016). Limited amount of
formula may facilitate breastfeeding: randomized, controlled trial to compare standard
clinical practice versus limited supplemental feeding. PloS one, 11(2), e0150053.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150053