Improving exclusive breastfeeding in low and middle-income countries: A systematic review

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Improving exclusive breastfeeding in low and middle-income countries : A systematic review. / Olufunlayo, Tolulope; Roberts, Alero Ann ; MacArthur, Christine; Thomas, G Neil; Odeyemi, Kofoworola Abimbola ; Price, Malcolm; Jolly, Kate.

In: Maternal and Child Nutrition, Vol. 15, No. 3, e12788, 21.01.2019.

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@article{b54a388a62834da891cc30d6d075d018,
title = "Improving exclusive breastfeeding in low and middle-income countries: A systematic review",
abstract = "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. ",
keywords = "Exclusive breastfeeding, breastfeeding, , intervention effectiveness, developing countries, systematic review, meta-analysis",
author = "Tolulope Olufunlayo and Roberts, {Alero Ann} and Christine MacArthur and Thomas, {G Neil} and Odeyemi, {Kofoworola Abimbola} and Malcolm Price and Kate Jolly",
year = "2019",
month = jan,
day = "21",
doi = "10.1111/mcn.12788",
language = "English",
volume = "15",
journal = "Maternal and Child Nutrition",
issn = "1740-8695",
publisher = "Wiley",
number = "3",

}

RIS

TY - JOUR

T1 - Improving exclusive breastfeeding in low and middle-income countries

T2 - A systematic review

AU - Olufunlayo, Tolulope

AU - Roberts, Alero Ann

AU - MacArthur, Christine

AU - Thomas, G Neil

AU - Odeyemi, Kofoworola Abimbola

AU - Price, Malcolm

AU - Jolly, Kate

PY - 2019/1/21

Y1 - 2019/1/21

N2 - 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.

AB - 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.

KW - Exclusive breastfeeding

KW - breastfeeding

KW - , intervention effectiveness

KW - developing countries

KW - systematic review

KW - meta-analysis

UR - http://www.scopus.com/inward/record.url?scp=85062326512&partnerID=8YFLogxK

U2 - 10.1111/mcn.12788

DO - 10.1111/mcn.12788

M3 - Review article

VL - 15

JO - Maternal and Child Nutrition

JF - Maternal and Child Nutrition

SN - 1740-8695

IS - 3

M1 - e12788

ER -