Effective community-based interventions to improve exclusive breast feeding at four to six months in low- and low–middle-income countries: a systematic review of randomised controlled trials
Section snippets
Background
On the basis of evidence from a systematic review of the optimal duration of exclusive breast feeding (WHO, 2001), the World Health Organization (WHO) recommends exclusive breast feeding for the first six months of life (WHO, 2003). This recommendation is based on evidence of the importance of good nutrition in the early months of life and of the crucial role that appropriate feeding practices play in achieving optimal health outcomes:
Lack of breastfeeding – and especially lack of exclusive
Aim
This review seeks to assess the effectiveness of community-based interventions to improve the rates of exclusive breast feeding at four to six months in infants in low- and low–middle-income countries compared with standard care.
Exclusive breast feeding at four to six months was chosen as the outcome because this is the recommendation of WHO. This is not to suggest that interventions that do not focus on exclusive breast feeding or that operate on a shorter time scale are not worthwhile, but
Search strategy
The search was conducted in March 2010 and three databases were searched. Medline was included because of its wide coverage of medical journals, the Global Health/Global Health Archive for its international perspective and coverage of public health issues, and CINAHL Plus for its comprehensive, international coverage of nursing and midwifery topics.
In Medline, MeSH terms of community health services, community health aides, maternal health services (exploded) and health promotion were searched,
Findings
Table 3 shows the results for exclusive breast feeding in the intervention group compared with the control group for the four studies. As not all the studies reported at six months, the lowest common denominator of four months was taken; however, Haider et al. (2000) only reported at five months so this was used for that study. As breast feeding declines with time, this should result in an underestimate of the true effect as the rate of exclusive breast feeding at four months would have been
Discussion and interpretation
This review has demonstrated that in low- and low–middle-income countries, community-based interventions can improve exclusive breast feeding at four to five months: pooled OR 5.80 (95%CI 1.81–18.6). As this was calculated on an intention-to-treat basis, this is likely to be an underestimate. These findings are consistent with the Cochrane review which also found that support increased the rates of exclusive breast feeding (Dyson and Renfrew, 2005).
Given the differences between the studies, it
Implications for practice
The findings of this review show the positive effect that community-based interventions can have on improving the levels of exclusive breast feeding at four to five months in low- and low–middle-income countries. Community-based interventions can therefore be seen as a viable way of improving exclusive breast feeding in settings where hospital births are less common. This benefit was found despite the variation in settings and interventions, which would seem to suggest that there are a number
Competing interests
None.
Author’s contributions
Sole author.
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