A systematic review of reviews on effective home, family and community based interventions from low- and middle-in-come countries to inform the breastfeeding action plan for South Africa

Abstract

Background and objectives: South Africa has one of the lowest breastfeeding rates globally and an exclusive breastfeeding (EBF) rate below 10%. If South Africa is to to reach the World Health Assembly target of 50% EBF rate by 2025 and reap the full benefits of breastfeeding, South Africa would need an evidence-in-formed action plan. We undertook a systematic review of reviews to i) summarise the evidence on the various community-based interventions for breastfeeding of infants aged 6-24 weeks in low- and middle-income countries (LMICs) and ii) produce an evidence-informed recommendation on the most appropriate interventions for South Africa. Methods: We searched six electronic databases for peer-reviewed reviews published between 2001 and 2017. To be included, systematic reviews had to: at least have 60% of their primary studies conducted in LMICs, report on community-based interventions compared to routine care, be aimed at pregnant or breastfeeding women and/or their families, and report on exclusive or any breastfeeding rates between 6 and 24 weeks as the primary outcome. Quality of the studies included for data extraction was appraised independently by two author pairs using the AMSTAR checklist. To assess quality of each study, we used the Cochrane risk of bias tool. Results: Title and abstract screening of 1037 references resulted in retaining three eligible systematic reviews, from which six primary studies in LMICs emerged. These six primary studies represented data collected from 1996 to 2008. To bridge this data and publication gap, citation searches of the six primary studies were performed which rendered four additional studies. Combined, these ten studies now presented data from 1996 to 2015 and the publication date ranged from 2005 to 2016. The evidence suggests that breastfeeding counselling, despite the wide range in number and frequency of breastfeeding counselling contact sessions, had a positive impact on breastfeeding duration and exclusivity at 24 weeks. Conclusions: There is a paucity of studies in LMICs. While our review of reviews suggests that breastfeeding counselling has the potential to improve EBF rates, scale-up and rigorous evaluation of community-based interventions to identify the pathways through which these effects can be sustained must be explored