Rifat M A, Chakrabarty Mahashweta, Alam Syeda Saima, Ali Masum, Nasrin Syeda Sumaiya, Sarkar Plabon, Singh Aditya, Saha Sanjib
Department of Global Public Health, Karolinska Institutet, Stockholm, 17176, Sweden.
Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India.
Int Breastfeed J. 2025 May 27;20(1):43. doi: 10.1186/s13006-025-00736-2.
Early initiation of breastfeeding, defined as breastfeeding within one hour of birth, halves the risk of neonatal mortality, establishing it as a crucial outcome component in various interventions implemented across South Asian countries. However, the overall effect of these interventions remain unexamined. Therefore, this study seeks to address this knowledge gap by evaluating the overall effect of these interventions on maternal early initiation of breastfeeding practice.
A systematic literature search was performed to identify randomised controlled trials conducted in South Asia focusing on early initiation of breastfeeding as an outcome variable. The interventions identified were categorized into behavioral, mobile health (mHealth), health system strengthening, and nutritional interventions. Random effects meta-analysis was conducted to estimate the pooled effect of interventions and effectiveness by intervention categories. Heterogeneity was explored by sub-group and meta-regression analyses. The risk of bias and strength of evidence were assessed by Cochrane's RoB2 assessment tool and GRADE criteria, respectively.
We included 22 articles published, representing 19 unique interventions, from a pool of 2,524 screened records for review and narrative synthesis. Among these, 19 articles were eligible for meta-analysis. The pooled relative risk (RR) of early initiation of breastfeeding among mothers in the intervention groups, as compared to their counterparts, was 1.55 (95% CI: 1.24, 1.95; I = 99.56; p < 0.001). Interventions targeted health system strengthening represented stronger effect than other types of interventions. The overall strength of evidence was moderate.
The overall intervention effect appeared efficacious in improving maternal early initiation of breastfeeding practice in South Asia, providing valuable insights for policymakers to develop contextually feasible strategies.
早期开始母乳喂养，即出生后一小时内开始母乳喂养，可将新生儿死亡风险减半，这使其成为南亚各国实施的各种干预措施中的一个关键结果指标。然而，这些干预措施的总体效果仍未得到检验。因此，本研究旨在通过评估这些干预措施对母亲早期开始母乳喂养行为的总体效果来填补这一知识空白。
进行了系统的文献检索，以确定在南亚进行的以早期开始母乳喂养为结果变量的随机对照试验。确定的干预措施分为行为干预、移动健康（mHealth）干预、卫生系统强化干预和营养干预。进行随机效应荟萃分析，以估计干预措施的合并效应以及按干预类别划分的有效性。通过亚组分析和荟萃回归分析探讨异质性。分别使用Cochrane的RoB2评估工具和GRADE标准评估偏倚风险和证据强度。
我们从2524条筛选记录中纳入了22篇已发表的文章，代表19种独特的干预措施，用于综述和叙述性综合分析。其中，19篇文章符合荟萃分析的条件。与对照组相比，干预组母亲早期开始母乳喂养的合并相对风险（RR）为1.55（95%CI：1.24，1.95；I² = 99.56；p < 0.001）。针对卫生系统强化的干预措施比其他类型的干预措施效果更强。证据的总体强度为中等。
总体干预效果在改善南亚母亲早期开始母乳喂养行为方面似乎是有效的，为政策制定者制定因地制宜的可行策略提供了有价值的见解。
