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Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis.

ABSTRACT: BACKGROUND:Exclusive breastfeeding rates in many high-income countries are considerably lower than the World Health Organization recommendations. Younger mothers are less likely than older mothers to exclusively breastfeed or to exclusively breastfeed for a long duration. This systematic review explores interventions to increase the rate of exclusive breastfeeding among young mothers in high-income countries. METHODS:A systematic search of the following databases was completed in August 2020: CINAHL, PubMed, MEDLINE, ProQuest, PsychInfo, Web of Science, Cochrane, Scopus and Embase. A manual search of the reference lists of all the included studies and published systematic reviews was also performed. The Cochrane Collaboration Risk of Bias Tool was used to assess the quality of the included studies. A random effects model meta-analyses was applied. Heterogeneity of outcomes between the studies was assessed using both the ?² test and the I² statistic. RESULTS:Of 955 records identified in the search, 392 duplicates were removed, and nine studies met the inclusion criteria. Seven studies were randomised controlled trial (RCTs) and two were quasi-experimental in design. Eight were conducted in the United States. The interventions included peer counselling, telephone support, massage, gift packs, financial incentive and antenatal education. Most studies included a combination of strategies, peer counselling being the most common. A meta-analysis of four of nine included studies did not detect a difference in rate of exclusive breastfeeding to 3 months postpartum (RR 1.44; 95% CI 0.82, 2.55; p?=?0.204). This review is limited by the relatively few studies which met the inclusion criteria and the small sample sizes of most included studies. High rates of attrition and formula supplementation among the participants made it difficult to detect a statistically significant effect. Consistency in follow up times would enable more studies to be included in a meta-analysis. CONCLUSIONS:Peer counselling was the most promising strategy associated with higher rates of exclusive breastfeeding. However, further studies are needed to understand the breastfeeding experiences of young mothers. Young mothers should be targeted specifically in intervention studies.

SUBMITTER: Buckland C

PROVIDER: S-EPMC7706026 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis.

Buckland Christa C Hector Debra D Kolt Gregory S GS Fahey Paul P Arora Amit A

International breastfeeding journal 20201201 1

<h4>Background</h4>Exclusive breastfeeding rates in many high-income countries are considerably lower than the World Health Organization recommendations. Younger mothers are less likely than older mothers to exclusively breastfeed or to exclusively breastfeed for a long duration. This systematic review explores interventions to increase the rate of exclusive breastfeeding among young mothers in high-income countries.<h4>Methods</h4>A systematic search of the following databases was completed in ...[more]

PMID: 33256788

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Project description: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.

Project description:BackgroundExclusive breastfeeding is defined as the practice of providing only breast milk for an infant for the first 6 months of life without the addition of any other food or water, except for vitamins, mineral supplements, and medicines. Findings are inconsistent regarding the prevalence of exclusive breastfeeding in Ethiopia. Full-time maternal employment is an important factor contributing to the low rates of practice of exclusive breastfeeding. Empowering women to exclusively breastfeed, by enacting 6 months' mandatory paid maternity leave can increase the rate of exclusive breastfeeding in the first 6 months of life up to 50%. The purpose of this review was to estimate the pooled prevalence of exclusive breastfeeding and its association with full-time maternal employment in the first 6 months of life for infants in the context of Ethiopia.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. All observational studies reporting the prevalence of exclusive breastfeeding and its association with maternal employment in Ethiopia were considered. The search was conducted from 6 November 2020 to 31 December 2020 and all papers published in the English language from 1 January 2015 to 31 December 2020 were included in this review.ResultsForty-five studies were included in the final analysis after reviewing 751 studies in this meta-analysis yielding the pooled prevalence of EBF 60.42% (95% CI 55.81, 65.02) at 6 months in Ethiopia. Those full-time employed mothers in the first 6 months were 57% less likely to practice exclusive breastfeeding in comparison to mothers not in paid employment in Ethiopia (OR 0.43; 95% CI 0.31, 0.61).ConclusionsFull-time maternal employment was negatively associated with the practice of exclusive breastfeeding in comparison to unemployed mothers. The prevalence of exclusive breastfeeding in Ethiopia is low in comparison to the global recommendation. The Ethiopian government should implement policies that empower women. The governmental and non-governmental organizations should create a conducive environment for mothers to practice exclusive breastfeeding in the workplace.

Project description:Background:Many infants worldwide are not breastfeeding according to WHO recommendations and this impacts on the health of women and children. Increasing breastfeeding is identified as a priority area supported by current policy targets. However, interventions are complex and multi-component and it is unclear which elements of interventions are most effective to increase breastfeeding in which settings. Breastfeeding counselling is often part of complex interventions but evidence is lacking on the specific effect of counselling interventions on breastfeeding practices. The aim of this systematic review is to examine evidence on effectiveness of breastfeeding counselling to inform global guidelines. Methods:A systematic search was conducted of six electronic databases in January 2018. Randomised controlled trials comparing breastfeeding counselling with no breastfeeding counselling or different formulations of counselling were included if they measured breastfeeding practices between birth and 24?months after birth. Results:From the 5180 records identified in searches and a further 11 records found by hand searching, 63 studies were included. Of these, 48 were individually-randomised trials and 15 were cluster-randomised trials. A total of 69 relevant comparisons were reported involving 33,073 women. There was a significant effect of counselling interventions on any breastfeeding at 4 to 6 weeks (Relative risk [RR] 0.85, 95% CI 0.77, 0.94) and 6 months (RR 0.92, 95% CI 0.87, 0.94). Greater effects were found on exclusive breastfeeding at 4 to 6 weeks (RR 0.79, 95% CI 0.72, 0.87) and 6 months (RR 0.84, 95% CI 0.78, 0.91). Counselling delivered at least four times postnatally is more effective than counselling delivered antenatally only and/or fewer than four times. Evidence was mostly of low quality due to high or unclear risk of bias of the included trials and high heterogeneity. Conclusions:Breastfeeding counselling is an effective public health intervention to increase rates of any and exclusive breastfeeding. Breastfeeding counselling should be provided face-to-face, and in addition, may be provided by telephone, both antenatally and postnatally, to all pregnant women and mothers with young children. To inform scale-up globally there is a need to further understand the elements of breastfeeding interventions such as counselling and their effectiveness in different contexts and circumstances. Study registration:This systematic review was registered in Prospero (CRD42018086494).

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Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis.

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Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis.

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