Effectiveness of breastfeeding support packages in low- and middle-income countries for infants under six months

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Research snapshot¹

Small and nutritionally at-risk infants under six months of age, defined as those with wasting, underweight or other forms of growth failure, are at high risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group but programmatic challenges are widely reported. At the core of these guidelines is support for breastfeeding. Previous systematic reviews have examined interventions to promote breastfeeding but most of these focused on the general infant population. This review aims to address the evidence gap on how to best support breastfeeding in a subpopulation of small and nutritionally at-risk infants under six months of age in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months of age.

The authors searched PubMed, CINAHL, Cochrane Library, EMBASE and Global Health databases from inception to 18 July 2018. Interventions of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Of 15,256 studies initially identified, 41 were eligible for inclusion, representing 22 geographically diverse LMICs. Interventions were mainly targeted at mother-infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices.

The identified breastfeeding support packages can serve as ‘primary prevention’ interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine the impacts of breastfeeding support on anthropometry and morbidity outcomes.