Mai-Lei Woo Kinshella1, Sarina Prasad1, Tamanda Hiwa2, Marianne Vidler1, Alinane Linda Nyondo-Mipando3, Queen Dube2,4, David Goldfarb5, Kondwani Kawaza6,7. 1. Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada. 2. Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi. 3. School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi. 4. Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi. 5. Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada. 6. Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi. kkawaza@medcol.mw. 7. Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi. kkawaza@medcol.mw.
Abstract
BACKGROUND: Sub-Saharan Africa carries a disproportionate burden of under-five child deaths in the world and appropriate breastfeeding practices can support efforts to reduce child mortality rates. Health facilities are important in the promotion of early and exclusive breastfeeding. The purpose of this review was to examine facility-based barriers and facilitators to early and exclusive breastfeeding in Sub-Saharan Africa. METHODS: A systematic search was conducted on Medline, Web of Science, CINAHL, African Journals Online and African Index Medicus from database inception to April 29, 2021 and primary research studies on breastfeeding practices in health facilities in Sub-Saharan Africa were included in the review. We assessed qualitative studies with the Critical Appraisal Skills Programme Qualitative Checklist and quantitative studies using the National Heart, Lung, and Blood Institute tool. The review protocol was registered to Prospero prior to conducting the review (CRD42020167414). RESULTS: Of the 56 included studies, relatively few described health facility infrastructure and supplies-related issues (5, 11%) while caregiver factors were frequently described (35, 74%). Facility-based breastfeeding policies and guidelines were frequently available but challenged by implementation gaps, especially at lower health service levels. Facilitators included positive caregiver and health worker attitudes, knowledge and support during the postpartum period. Current studies have focused on caregiver factors, particularly around their knowledge and attitudes, while health facility infrastructure and supplies factors appear to be growing concerns, such as overcrowding and lack of privacy during breastfeeding counselling that lowers the openness and comfort of mothers especially those HIV-positive. CONCLUSION: There has been a dramatic rise in rates of facility births in Sub-Saharan Africa, which must be taken into account when considering the capacities of health facilities to support breastfeeding practices. As the number of facility births rise in Sub-Saharan Africa, so does the responsibility of skilled healthcare workers to provide the necessary breastfeeding support and advice to caregivers. Our review highlighted that health facility infrastructure, supplies and staffing appears to be a neglected area in breastfeeding promotion and a need to strengthen respectful maternity care in the delivery of breastfeeding counselling, particularly in supporting HIV-positive mothers within the context of Sub-Saharan Africa.
BACKGROUND: Sub-Saharan Africa carries a disproportionate burden of under-five childdeaths in the world and appropriate breastfeeding practices can support efforts to reduce childmortality rates. Health facilities are important in the promotion of early and exclusive breastfeeding. The purpose of this review was to examine facility-based barriers and facilitators to early and exclusive breastfeeding in Sub-Saharan Africa. METHODS: A systematic search was conducted on Medline, Web of Science, CINAHL, African Journals Online and African Index Medicus from database inception to April 29, 2021 and primary research studies on breastfeeding practices in health facilities in Sub-Saharan Africa were included in the review. We assessed qualitative studies with the Critical Appraisal Skills Programme Qualitative Checklist and quantitative studies using the National Heart, Lung, and Blood Institute tool. The review protocol was registered to Prospero prior to conducting the review (CRD42020167414). RESULTS: Of the 56 included studies, relatively few described health facility infrastructure and supplies-related issues (5, 11%) while caregiver factors were frequently described (35, 74%). Facility-based breastfeeding policies and guidelines were frequently available but challenged by implementation gaps, especially at lower health service levels. Facilitators included positive caregiver and health worker attitudes, knowledge and support during the postpartum period. Current studies have focused on caregiver factors, particularly around their knowledge and attitudes, while health facility infrastructure and supplies factors appear to be growing concerns, such as overcrowding and lack of privacy during breastfeeding counselling that lowers the openness and comfort of mothers especially those HIV-positive. CONCLUSION: There has been a dramatic rise in rates of facility births in Sub-Saharan Africa, which must be taken into account when considering the capacities of health facilities to support breastfeeding practices. As the number of facility births rise in Sub-Saharan Africa, so does the responsibility of skilled healthcare workers to provide the necessary breastfeeding support and advice to caregivers. Our review highlighted that health facility infrastructure, supplies and staffing appears to be a neglected area in breastfeeding promotion and a need to strengthen respectful maternity care in the delivery of breastfeeding counselling, particularly in supporting HIV-positive mothers within the context of Sub-Saharan Africa.
Entities:
Keywords:
Africa south of the Sahara; Barriers; Breastfeeding; Breastfeeding support; Facilitators; Health facilities
Authors: Gary L Darmstadt; Zulfiqar A Bhutta; Simon Cousens; Taghreed Adam; Neff Walker; Luc de Bernis Journal: Lancet Date: 2005 Mar 12-18 Impact factor: 79.321
Authors: Anne M Williams; Caroline Chantry; Eveline L Geubbels; Astha K Ramaiya; Aloisia I Shemdoe; Daniel J Tancredi; Sera L Young Journal: J Hum Lact Date: 2015-11-30 Impact factor: 2.219
Authors: Natalia V Bhattacharjee; Lauren E Schaeffer; Laurie B Marczak; Jennifer M Ross; Scott J Swartz; James Albright; William M Gardner; Chloe Shields; Amber Sligar; Megan F Schipp; Brandon V Pickering; Nathaniel J Henry; Kimberly B Johnson; Celia Louie; Michael A Cork; Krista M Steuben; Alice Lazzar-Atwood; Dan Lu; Damaris K Kinyoki; Aaron Osgood-Zimmerman; Lucas Earl; Jonathan F Mosser; Aniruddha Deshpande; Roy Burstein; Lauren P Woyczynski; Katherine F Wilson; John D VanderHeide; Kirsten E Wiens; Robert C Reiner; Ellen G Piwoz; Rahul Rawat; Benn Sartorius; Nicole Davis Weaver; Molly R Nixon; David L Smith; Nicholas J Kassebaum; Emmanuela Gakidou; Stephen S Lim; Ali H Mokdad; Christopher J L Murray; Laura Dwyer-Lindgren; Simon I Hay Journal: Nat Med Date: 2019-07-22 Impact factor: 53.440
Authors: Rune Nathaniel Philemon; Blandina T Mmbaga; John Bartlett; Jenny Renju; Tara B Mtuy; Innocent B Mboya; Sia E Msuya Journal: Patient Prefer Adherence Date: 2022-03-30 Impact factor: 2.711
Authors: Valerie L Flax; Abiodun Ipadeola; Courtney H Schnefke; Uche Ralph-Opara; Olatoun Adeola; Susan Edwards; Sujata Bose; Alice O Brower Journal: J Nutr Date: 2022-05-05 Impact factor: 4.687