Elsevier

Midwifery

Volume 27, Issue 4, August 2011, Pages 497-502
Midwifery

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

https://doi.org/10.1016/j.midw.2010.03.011Get rights and content

Abstract

Background

only about 25% of babies are exclusively breast fed until six months of age in developing countries and, given their greater risk of infection and infant mortality, there is a need to investigate ways of increasing this. The aim of this review is 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.

Methods

a systematic review of literature identified through searches of Medline, Global Health and CINAHL databases to identify randomised controlled trials of community-based interventions to improve the rate of exclusive breast feeding in low- and low–middle-income countries.

Findings

four studies, from four different countries, were included in the final review. Although they evaluated slightly different interventions, all showed a significant improvement in the rate of exclusive breast feeding with a pooled odds ratio of 5.90 (95% confidence interval 1.81–18.6) on random effects meta-analysis.

Conclusion

community-based interventions in low- and low–middle-income countries can substantially increase the rates of exclusive breast feeding and are therefore a viable option. The interventions included in the review varied, indicating that there are a number of ways in which this might be achieved; it is recommended that these are used as a starting point for determining the most appropriate intervention with regard to the setting. Given the importance of this issue, the lack of research in the area is surprising. The studies in the review demonstrate that good-quality randomised controlled trials of this area are possible and should encourage further research.

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.

References (18)

There are more references available in the full text version of this article.

Cited by (30)

  • Factors associated with low performance of Accredited Social Health Activist (ASHA) regarding maternal care in Howrah district, West Bengal, 2015–‘16: An unmatched case control study

    2018, Clinical Epidemiology and Global Health
    Citation Excerpt :

    CHWs can undertake actions that lead to improved health outcomes.4–8 CHWs have been used in maternal and child health care including reproductive health and family planning; malaria control; TB care; HIV/AIDS care and treatment of acute respiratory tract infections (ARI).4,6,9,10 India has a long history of small and large scale CHW programs.

  • Twenty-five years of breast-feeding research in Midwifery

    2011, Midwifery
    Citation Excerpt :

    Without this socio-cultural knowledge any intervention may fail due to contradictory cultural beliefs and/or constraints upon families in taking up or implementing designated changes. We also need to continue to improve support offered to breast-feeding mothers as the importance of high quality professional and peer support is now very clear (McInnes and Stone, 2000; Alexander et al., 2003; Dykes, 2005c; Britton et al., 2007; Spiby et al., 2009; Hall, in press). For this to happen we need to provide high quality professional education (Dykes, 2006b; McFadden et al., 2006; Renfrew et al., 2006) and secondly to improve the institutional ethos within maternity and neonatal units so that both midwives and, in turn, mothers will feel valued, cared for and able to `take time and touch base' (Dykes, 2005b; Dykes and Flacking, 2010).

  • Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission

    2018, The Lancet
    Citation Excerpt :

    Ideally, community health workers are drawn from the communities they serve, receive extensive training that enables them to diagnose and address multiple health conditions, and are compensated, supervised, and fully integrated into health systems. Integrating community health workers into health systems has been shown to increase immunisation rates, enhance access to diverse health services, and reduce childhood mortality.193–195 The financing of health care can have a major effect on the efficiency of health services.

View all citing articles on Scopus
View full text