Exclusive breastfeeding policy, practice and influences in South Africa, 1980 to 2018: A mixed-methods systematic review


Autoři: Sara Jewett Nieuwoudt aff001;  Christian B. Ngandu aff002;  Lenore Manderson aff001;  Shane A. Norris aff002
Působiště autorů: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa aff001;  SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa aff002;  Institute at Brown for Environment and Society, Brown University, Providence, RI, United States of America aff003;  School of Social Sciences, Menzies Building, Clayton Campus, Monash University, Melbourne, Australia aff004;  School of Human Development and Health, and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224029

Souhrn

Background

In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health Organization recommendations. This was a marked shift from earlier policies, and with it, average EBF rates increased from less than 10% in 2011 to 32% by 2016.

Objectives

The aim of this mixed-methods systematic review was to describe EBF practices in South Africa and their multi-level influences over four policy periods.

Methods

We applied PRISMA guidelines according to a published protocol (Prospero: CRD42014010512). We searched seven databases [Africa-Wide, PubMed, Popline, PsychINFO, CINAHL, Global Health, and The Cochrane Library] and conducted hand searches for eligible articles (all study designs, conducted in South Africa and published between 1980–2018). The quality of articles was assessed using published tools, as appropriate. Separate policy analysis was conducted to delineate four distinct policy periods. We compared EBF rates by these periods. Then, applying a three-level ecological framework, we analysed EBF influences concurrently by method. Finally, the findings were synthesized to compare breastfeeding influences by policy period, maintaining an ecological framework.

Results

From an initial sample of 20,226 articles, 72 unique articles were reviewed, three of which contributed to both quantitative and qualitative analysis. Despite the large sample, several provinces were poorly represented (if at all) and many studies were assessed as low to moderate quality. Despite these limitations, our historical lens enabled us to explore why South African progress on increasing EBF practices has been slow. The review reflects a context that increasingly supports EBF, but falls short in accounting for family, community, and workplace influences. The findings also highlight the unintended damage caused by rapidly adopting and introducing global guidelines to an unsupported health workforce.

Conclusions

From a South African perspective, we identified geographic and methodological biases, as well as gaps in our understanding and potential explanations of inequities in EBF. Our recommendations relate to policy, programming, and research to inform changes that would be required to further improve EBF practice rates in South Africa. While our review is South Africa-specific, our findings have broader implications for investing in multi-level interventions and limiting how often infant feeding guidelines are changed.

Klíčová slova:

Breast feeding – HIV – HIV epidemiology – Infants – Mothers – Parenting behavior – Qualitative studies – South Africa


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PLOS One


2019 Číslo 10