Abstract
IntroductionExclusive Breastfeeding (EBF) rates remain low in both low-income and high-income countries despite World Health Organization recommendations for EBF till 6 months. Breastfeeding has been shown to have a protective effect against gastrointestinal infections, among other benefits. Large-scale interventions focusing on educating mothers about breastfeeding have the potential to increase breastfeeding prevalence, especially EBF, up to recommended standards and also to decrease infant morbidity.MethodsA systematic literature search was conducted for RCTs and quasi-experimental studies comparing breastfeeding education or support to routine care. The effect of interventions was observed for exclusive, predominant, partial and no breastfeeding rates. The time intervals of interest were day 1, <1 month, and 1 to 5 months. Outcome-specific evidence was graded according to the Child Health Epidemiology Reference Group (CHERG) rules using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria and recommendations were made from studies in developing countries for inclusion into the Lives Saved Tool (LiST) model.ResultsAfter reviewing 4600 abstracts, 372 studies were selected for full text screening and 110 of these studies were finally included. Statistically significant increases in EBF rates as a result of breastfeeding promotion interventions were observed: 43% at day 1, 30% at <1 month, and 90% at 1-5 months. Rates of ‘no breastfeeding’ reduced by 32% at 1 day, 30% at <1 month, and 18% at 1-5 months. The effect of interventions on the rates of predominant and partial breastfeeding were non-significant.ConclusionBreastfeeding education and/or support increased EBF rates and decreased no breastfeeding rates at birth, <1 month and 1-5 months. Combined individual and group counseling appeared to be superior to individual or group counseling alone. Interventions in developing countries had a greater impact than those in developed countries.
Highlights
Exclusive Breastfeeding (EBF) rates remain low in both low-income and high-income countries despite World Health Organization recommendations for EBF till 6 months
We have reviewed and evaluated the quality of included studies according to the Child Health Epidemiology Reference Group (CHERG) adaptation of Grading of Recommendations, Assessments, Development and Education (GRADE) criteria [26]
78 had individual counseling, 14 had group counseling, and 19 studies had both individual and group counseling. 21 of these studies were done in community, 46 in facility while 43 were both community- and facility-based. 34 studies were conducted in developing countries and 76 in developed countries
Summary
Exclusive Breastfeeding (EBF) rates remain low in both low-income and high-income countries despite World Health Organization recommendations for EBF till 6 months. Large-scale interventions focusing on educating mothers about breastfeeding have the potential to increase breastfeeding prevalence, especially EBF, up to recommended standards and to decrease infant morbidity. The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) to infants till 6 months of age to achieve optimum growth [1]. EBF has protective effects against gastrointestinal infection [1] and the high incidence of morbidity and mortality from gastrointestinal infection in developing countries demands large-scale interventions to increase breastfeeding prevalence and exclusivity as evidence shows that “no breast feeding” is associated with a significant 165% increase in diarrhoea incidence in 0-5 month old infants and a 32% increase in 6-11 month old infants [7]. Pediatricians, nurses, midwives and lay counselors should actively promote and educate, while taking into account mothers’ situational limitations
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