Habtewold Tesfa Dejenie, Sharew Nigussie Tadesse, Alemu Sisay Mulugeta
Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia.
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
BMJ Open. 2019 May 30;9(5):e023956. doi: 10.1136/bmjopen-2018-023956.
The aim of this systematic review and meta-analysis was to investigate the association of gender of newborn, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breast feeding (TIBF) and exclusive breastfeeding (EBF) practices in Ethiopia.
Systematic review and meta-analysis.
To retrieve all available literature, PubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases were systematically searched and complemented by manual searches. The search was done from August 2017 to September 2018.
All observational studies including cross-sectional, case-control, cohort studies conducted in Ethiopia from 2000 to 2018 were included. Newcastle-Ottawa Scale was used for quality assessment of included studies.
Study area, design, population, number of mothers (calculated sample size and participated in the study) and observed frequency data were extracted using Joanna Briggs Institute tool. To obtain the pooled effect size, a meta-analysis using weighted inverse variance random-effects model was performed. Cochran's Q X test, τ and I statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity, respectively. Mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity. Egger's regression test at p value threshold ≤0.01 was used to examine publication bias. Furthermore, the trend of evidence over time was examined by performing a cumulative meta-analysis.
Of 523 articles retrieved, 17 studies (n=26 146 mothers) on TIBF and 24 studies (n=17 819 mothers) on EBF were included in the final analysis. ANC (OR=2.24, 95% CI 1.65 to 3.04, p<0.001, I=90.9%), PNC (OR=1.86, 95% CI 1.41 to 2.47, p<0.001, I=63.4%) and gender of newborn (OR=1.31, 95% CI 1.01 to 1.68, p=0.04, I=81.7%) significantly associated with EBF. ANC (OR=1.70, 95% CI 1.10 to 2.65, p=0.02, I=93.1%) was also significantly associated with TIBF but not with gender of newborn (OR=1.02, 95% CI 0.86 to 1.21, p=0.82, I=66.2%).
In line with our hypothesis, gender of newborn, ANC and PNC were significantly associated with EBF. Likewise, ANC was significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breast feeding. This meta-analysis study provided up-to-date evidence on breastfeeding practices and its associated factors, which could be useful for breastfeeding improvement initiative in Ethiopia and cross-country and cross-cultural comparison.
CRD42017056768.
本系统评价和荟萃分析旨在研究埃塞俄比亚新生儿性别、产前护理（ANC）和产后护理（PNC）与及时开始母乳喂养（TIBF）和纯母乳喂养（EBF）之间的关联。
系统评价和荟萃分析。
为检索所有可用文献，对PubMed、EMBASE、CINAHL、世界卫生组织全球健康图书馆、科学网和Scopus数据库进行了系统检索，并辅以手工检索。检索时间为2017年8月至2018年9月。
纳入2000年至2018年在埃塞俄比亚进行的所有观察性研究，包括横断面研究、病例对照研究和队列研究。采用纽卡斯尔-渥太华量表对纳入研究进行质量评估。
使用乔安娜·布里格斯研究所工具提取研究区域、设计、人群、母亲数量（计算样本量和参与研究的人数）以及观察到的频率数据。为获得合并效应量，采用加权逆方差随机效应模型进行荟萃分析。分别使用Cochran's Q X检验、τ和I统计量来检验异质性、估计总/残余异质性量以及测量归因于异质性的变异性。进行混合效应荟萃回归分析以确定可能的异质性来源。使用p值阈值≤0.01的Egger回归检验来检查发表偏倚。此外，通过进行累积荟萃分析来检查证据随时间的趋势。
在检索到的523篇文章中，最终分析纳入了17项关于TIBF的研究（n = 26146名母亲）和24项关于EBF的研究（n = 17819名母亲）。ANC（比值比[OR]=2.24，95%置信区间[CI]为1.65至3.04，p<0.001，I = 90.9%）、PNC（OR = 1.86，95%CI为1.41至2.47，p<0.001，I = 63.4%）和新生儿性别（OR = 1.31，95%CI为1.01至1.68，p = 0.04，I = 81.7%）与EBF显著相关。ANC（OR = 1.70，95%CI为1.10至2.65，p = 0.02，I = 93.1%）也与TIBF显著相关，但与新生儿性别无关（OR = 1.02，95%CI为0.86至1.21，p = 0.82，I = 66.2%）。
与我们的假设一致，新生儿性别、ANC和PNC与EBF显著相关。同样，ANC与TIBF显著相关。孕期和产后的最佳护理对于确保充足的母乳喂养很重要。这项荟萃分析研究提供了关于母乳喂养实践及其相关因素的最新证据，这可能有助于埃塞俄比亚的母乳喂养改善倡议以及跨国和跨文化比较。
CRD42017056768。
