Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA.
Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA.
Health Policy Plan. 2020 May 1;35(4):461-501. doi: 10.1093/heapol/czaa005.
Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research. Peer-reviewed and grey literature were systematically searched using a combination of index terms and relevant text words related to cost and the following breastfeeding interventions: breastfeeding counselling, maternity leave, the World Health Organization International Code of Marketing of Breastmilk Substitutes, the Baby-Friendly Hospital Initiative, media promotion, workplace support and pro-breastfeeding social policies. Data were extracted after having established inter-rater reliability among the first two authors. The quality of studies was assessed using an eight-item checklist for key costing study attributes. Forty-five studies met the inclusion criteria, with the majority including costs for breastfeeding counselling and paid maternity leave. Most cost analyses included key costing study attributes; however, major weaknesses among the studies were the lack of clarity on costing perspectives and not accounting for the uncertainty of reported cost estimates. Costing methodologies varied substantially, standardized costing frameworks are needed for reliably estimating the costs of implementing and scaling-up breastfeeding interventions at local-, national- or global-levels.
尽管有充分的证据表明母乳喂养可以改善母婴健康结果，但全球纯母乳喂养率仍然很低。成本估算可以让利益相关者了解扩大干预措施所需的财政资源，最终改善低收入、中等收入和高收入国家的母乳喂养结果。为了为制定全面的成本核算框架提供信息，本系统评价旨在：(1) 确定实施或扩大母乳喂养干预措施的成本核算研究；(2) 评估已确定的成本核算研究的质量；(3) 检查成本数据的可用性，以确定需要通过未来研究解决的差距。使用与成本和以下母乳喂养干预措施相关的索引术语和相关文本词的组合，对同行评议文献和灰色文献进行了系统检索：母乳喂养咨询、产假、世界卫生组织《国际母乳代用品销售守则》、爱婴医院倡议、媒体宣传、工作场所支持和支持母乳喂养的社会政策。在第一和第二作者之间建立了内部评估者间可靠性后，提取了数据。使用八项关键成本研究属性检查表评估研究的质量。有 45 项研究符合纳入标准，其中大部分包括母乳喂养咨询和带薪产假的成本。大多数成本分析都包含了关键的成本研究属性；然而，研究中的主要弱点是成本视角不明确，并且没有考虑报告的成本估算的不确定性。成本核算方法差异很大，需要标准化的成本核算框架，以便在地方、国家或全球各级可靠地估算实施和扩大母乳喂养干预措施的成本。
