Open AccessImproving exclusive breastfeeding in low and middle‐income countries: A systematic review
Author(s) -
Olufunlayo Tolulope Florence,
Roberts Alero Ann,
MacArthur Christine,
Thomas Neil,
Odeyemi Kofoworola Abimbola,
Price Malcolm,
Jolly Kate
Publication year - 2019
Publication title -
maternal and child nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 63
eISSN - 1740-8709
pISSN - 1740-8695
DOI - 10.1111/mcn.12788
Subject(s) - medicine , breastfeeding , psychological intervention , context (archaeology) , observational study , relative risk , randomized controlled trial , confidence interval , systematic review , meta analysis , pediatrics , medline , demography , nursing , paleontology , sociology , political science , law , biology
Exclusive breastfeeding (EBF) rates until 6 months in most low and middle income countries (LMICs) are well below the 90% World Health Organization benchmark. This systematic review sought to provide evidence on effectiveness of various interventions on EBF until 6 months in LMICs, compared with standard care. Experimental and observational studies with concurrent comparator promoting EBF, conducted in LMICs with high country rates of breastfeeding initiation, were included. Studies were identified from a systematic review and PUBMED, Cochrane, and CABI databases. Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for individual studies and pooled. High heterogeneity was explored through prespecified subgroup analyses for the primary outcome (EBF until 6 months) by context and by intervention for the randomized controlled trials. Prediction intervals were calculated for each effect estimate. Sixty‐seven studies with 79 comparisons from 30 LMICs were included. At 6 months, intervention group infants were more likely to be exclusively breastfed than controls (RR = 2.19, 95% CI [1.73, 2.77]; I 2 78.4%; 25 randomized controlled trials). Larger effects were obtained from interventions delivered by a combination of professional and laypersons (RR 3.90, 95% CI [1.25, 12.21]; I 2 46.7%), in interventions spanning antenatal and post‐natal periods (RR 2.40, 95% CI [1.70, 3.38]; I 2 83.6%), and when intensity was between four to eight contacts/sessions (RR 3.20, 95% CI [2.30, 4.45]; I 2 53.8%). Almost every intervention conducted in LMICs increased EBF rates; choice of intervention should therefore be driven by feasibility of delivery in the local context to reduce infant mortality.