Peer Support and Exclusive Breastfeeding Duration in Low and Middle-Income Countries A Systematic Review and Meta-Analysis 英文参考文献.docVIP
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Peer Support and Exclusive Breastfeeding Duration in Low and Middle-Income Countries A Systematic Review and Meta-Analysis 英文参考文献
PeerSupportandExclusiveBreastfeedingDurationin
LowandMiddle-IncomeCountries:ASystematicReview
andMeta-Analysis
ChristopherR.Sudfeld1*,WafaieW.Fawzi1,2,3,ChandrakantLahariya4
1DepartmentofEpidemiology,HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica,2DepartmentofNutrition,HarvardSchoolofPublic
Health,Boston,Massachusetts,UnitedStatesofAmerica,3DepartmentofGlobalHealthandPopulation,HarvardSchoolofPublicHealth,Boston,Massachusetts,United
StatesofAmerica,4DepartmentofCommunityMedicine,G.R.MedicalCollege,Gwalior,MP,India
Abstract
Objective:Toexaminetheeffectofpeersupportondurationofexclusivebreastfeeding(EBF)inlowandmiddle-income
countries(LMICs).
DataSources:Medline,EMBASE,andCochraneCentralRegisterforControlledTrialsweresearchedfrominceptiontoApril
2012.
Methods:Twoauthorsindependentlysearched,reviewed,andassessedthequalityofrandomizedcontrolledtrialsutilizing
peer support in LMICs. Meta-analysis and metaregression techniques were used to produce pooled relative risks and
investigatesourcesofheterogeneityintheestimates.
Results:Elevenrandomizedcontrolledtrialsconductedat13studysitesmettheinclusioncriteriaforsystematicreview.We
noted significant differences in study populations, peer counselor training methods, peer visit schedule, and outcome
ascertainmentmethods.PeersupportsignificantlydecreasedtheriskofdiscontinuingEBFascomparedtocontrol(RR:0.71;
95% CI: 0.61–0.82; I2=92%). The effect of peer support was significantly reduced in settings with .10% community
prevalenceofformulafeedingascomparedtosettingswith,10%prevalence(p=0.048).Therewasnoevidenceofeffect
modificationbyinclusionoflowbirthweightinfants(p=0.367)andnodifferenceintheeffectofpeersupportonEBFat4
versus6monthspostpartum(p=0.398).
Conclusions:PeersupportincreasesthedurationofEBFinLMICs;however,theeffectappearstobereducedinformula
feeding cultures. Future studies are needed to determine the optimal timing of peer visits, how to best integrate peer
support into packaged intervention st
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