Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108, Kenya.
Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.
Int Breastfeed J. 2020 Nov 14;15(1):95. doi: 10.1186/s13006-020-00331-7.
The 2013 updated guidelines on management of severe acute malnutrition in infants and children recommends the support of exclusive breastfeeding. These guidelines are inconsistently applied in low and middle income countries (LMICs) due to barriers including unclear implementation guides, technical support and epidemiological factors. Peer support strategies have been used to offer psychological support to families with infants in NICU and improve mental health outcomes. Breastfeeding peer supporters (BFPS) have been shown to be effective in improving breastfeeding outcomes in community settings however, their success within hospital settings in LMICs is unknown. We conducted a scoping review to explore implementation of breastfeeding peer support strategies as have been applied to hospitalized infants globally and highlight their implementation strategies in order to guide future research and practice.
A scoping review of the literature was conducted using the Arksey and O'Malley framework. A search was conducted in five online databases (PubMed, Cochrane library, Hinari, Google Scholar and Open Grey library). Data were extracted and charted in data extraction tables to capture general characteristics, modes of peer support delivery, implementation details and evaluation procedures.
From the online search 276 articles were identified, however only 18 met the inclusion criteria for the study. The majority of these articles were reports on in-patient breastfeeding peer support interventions applied in Europe and the United States of America and only two were from LMICs. The articles described peer supporters' identification, training (n = 13) and supervision (n = 14). The majority of the BFPS were employed (n = 10) compared to volunteers (n = 3) and support was mainly one-to-one (n = 11) rather than group support. Process and impact evaluation (n = 13) reported positive breastfeeding outcomes associated with breastfeeding peer support.
Breastfeeding peer support strategies are applied in different hospital settings and can be used to improve breastfeeding outcomes. However, to achieve integration, scalability and comparability of impact and outcomes, there is a need to standardize training, develop consistent implementation and supervision plans of in-patient peer supporters' strategies. Further research to assess sustainability and evaluate cost-effectiveness of in-patient breastfeeding peer support strategies will improve uptake and scalability of these potentially lifesaving interventions.
2013 年更新的婴幼儿严重急性营养不良管理指南建议支持纯母乳喂养。由于实施指南不明确、技术支持不足和流行病学因素等障碍，这些指南在中低收入国家（LMICs）的应用并不一致。同伴支持策略已被用于为新生儿重症监护病房（NICU）的家庭提供心理支持，并改善心理健康结果。母乳喂养同伴支持者（BFPS）已被证明在改善社区环境中的母乳喂养结果方面是有效的，然而，它们在 LMIC 医院环境中的成功情况尚不清楚。我们进行了一项范围综述，以探讨在全球范围内应用于住院婴儿的母乳喂养同伴支持策略的实施情况，并强调其实施策略，以指导未来的研究和实践。
使用 Arksey 和 O'Malley 框架对文献进行了范围综述。在五个在线数据库（PubMed、Cochrane 图书馆、Hinari、Google Scholar 和 Open Grey 图书馆）中进行了搜索。数据在数据提取表中提取和图表化，以捕获一般特征、同伴支持传递模式、实施细节和评估程序。
从在线搜索中确定了 276 篇文章，但只有 18 篇符合研究标准。这些文章大多是关于在欧洲和美国实施的住院母乳喂养同伴支持干预的报告，只有两篇来自 LMICs。文章描述了同伴支持者的识别、培训（n=13）和监督（n=14）。大多数 BFPS 是受雇的（n=10），而不是志愿者（n=3），支持主要是一对一（n=11），而不是小组支持。过程和影响评估（n=13）报告了与母乳喂养同伴支持相关的积极母乳喂养结果。
母乳喂养同伴支持策略在不同的医院环境中得到应用，可以用来改善母乳喂养结果。然而，为了实现影响和结果的标准化、可扩展性和可比性，需要标准化培训，制定住院同伴支持者策略的一致实施和监督计划。进一步评估住院母乳喂养同伴支持策略的可持续性和成本效益的研究将提高这些潜在救生干预措施的采用率和可扩展性。
