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Meta-Analysis
. 2019 Nov 5;2019(11):CD007647.
doi: 10.1002/14651858.CD007647.pub2.

Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries

Zohra S Lassi  1 , Sophie Ge Kedzior  2 , Zulfiqar A Bhutta  3
Affiliations
Meta-Analysis

Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries

Zohra S Lassi et al. Cochrane Database Syst Rev. .

Abstract

Background: In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems.

Objectives: To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost).

Search methods: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.

Selection criteria: Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials.

Data collection and analysis: Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables.

Main results: We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33.

Authors' conclusions: This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.

PubMed Disclaimer

Conflict of interest statement

ZL has no interest to declare.

SK has no interest to declare.

ZB has no interest to declare.

Figures

1
1
Study flow diagram.
2
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Community health educational interventions versus control, outcome: 1.1 Neonatal mortality.
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Forest plot of comparison: 2 Community health educational one‐to‐one and group and both counselling (subgroup) versus control, outcome: 2.1 Neonatal mortality.
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Forest plot of comparison: 3 Community health educational ANC period and PNC period and both periods (subgroup) versus control, outcome: 3.1 Neonatal mortality.
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Forest plot of comparison: 4 Community health educational intervention for family members and mothers and for mothers only (subgroup) versus control, outcome: 4.1 Neonatal mortality.
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Forest plot of comparison: 1 Community health educational interventions versus control, outcome: 1.2 Early neonatal mortality.
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Forest plot of comparison: 2 Community health educational one‐to‐one and group and both counselling (subgroup) versus control, outcome: 2.2 Early neonatal mortality.
10
10
Forest plot of comparison: 3 Community health educational ANC period and PNC period and both periods (subgroup) versus control, outcome: 3.2 Early neonatal mortality.
11
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Forest plot of comparison: 4 Community health educational intervention for family members and mothers and for mothers only (subgroup) versus control, outcome: 4.2 Early neonatal mortality.
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Forest plot of comparison: 1 Community health educational interventions versus control, outcome: 1.3 Late neonatal mortality.
13
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Forest plot of comparison: 2 Community health educational one‐to‐one and group and both counselling (subgroup) versus control, outcome: 2.3 Late neonatal mortality.
14
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Forest plot of comparison: 3 Community health educational ANC period and PNC period and both periods (subgroup) versus control, outcome: 3.3 Late neonatal mortality.
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Forest plot of comparison: 4 Community health educational intervention for family members and mothers and for mothers only (subgroup) versus control, outcome: 4.3 Late neonatal mortality.
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Forest plot of comparison: 1 Community health educational interventions versus control, outcome: 1.4 Perinatal mortality.
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Forest plot of comparison: 2 Community health educational one‐to‐one and group and both counselling (subgroup) versus control, outcome: 2.4 Perinatal mortality.
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Forest plot of comparison: 3 Community health educational ANC period and PNC period and both periods (subgroup) versus control, outcome: 3.4 Perinatal mortality.
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Forest plot of comparison: 4 Community health educational intervention for family members and mothers and for mothers only (subgroup) versus control, outcome: 4.4 Perinatal mortality.
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Forest plot of comparison: 1 Community health educational interventions versus control, outcome: 1.13 Timely initiation of breastfeeding.
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Forest plot of comparison: 2 Community health educational one‐to‐one and group and both counselling (subgroup) versus control, outcome: 2.9 Timely initiation of breastfeeding.
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Forest plot of comparison: 3 Community health educational ANC period and PNC period and both periods (subgroup) versus control, outcome: 3.6 Timely initiation of breastfeeding.
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Forest plot of comparison: 4 Community health educational intervention for family members and mothers and for mothers only (subgroup) versus control, outcome: 4.9 Timely initiation of breastfeeding.
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Persson 2013 {published data only}
    1. Persson LA, Nga NT, Malqvist M, Thi Phuong Hoa D, Eriksson L, et al. Effect of facilitation of local maternal‐and‐newborn stakeholder groups on neonatal mortality: cluster‐randomized controlled trial. PLoS Medicine 2013;10(5):e1001445. [DOI: 10.1371/journal.pmed.1001445; PUBMED: 23690755] - DOI - PMC - PubMed
    1. Wallin L, Målqvist M, Nga NT, Eriksson L, Persson LA, Hoa DP, et al. Implementing knowledge into practice for improved neonatal survival; a cluster‐randomised, community‐based trial in Quang Ninh province, Vietnam. BMC Health Services Research 2011;11:239. [DOI: 10.1186/1472-6963-11-239; PUBMED: 21951770] - DOI - PMC - PubMed
Soofi 2017 {published data only}
    1. Soofi S, Cousens S, Turab A, Wasan Y, Mohammed S, Ariff S, et al. Effect of provision of home‐based curative health services by public sector health‐care providers on neonatal survival: a community‐based cluster‐randomised trial in rural Pakistan. Lancet Global Health 2017;5(8):796–806. [DOI: 10.1016/S2214-109X(17)30248-6; PUBMED: 28716351] - DOI - PMC - PubMed
Srinivasan 1995 {published data only}
    1. Srinivasan V, Radhakrishna S, Sudha R, Malathi MV, Jabbar S, Ramakrishnan R, et al. Randomised controlled field trial of two antenatal care packages in rural South India. Indian Journal of Medical Research 1995;102:86‐94. [PUBMED: 8834820] - PubMed
Tripathy 2010 {published data only}
    1. Houweling TAJ, Tripathy P, Nair N, Rath S, Rath S, Gope R, et al. The equity impact of participatory women’s groups to reduce neonatal mortality in India: secondary analysis of a cluster‐randomised trial. International Journal of Epidemiology 2013;42(2):520‐32. [DOI: 10.1093/ije/dyt012; PUBMED: 23509239] - DOI - PMC - PubMed
    1. Tripathy P, Nair N, Barnett S, Mahapatra R, Borghi J, Rath S, et al. Effect of a participatory intervention with women's groups on birth outcomes in Jharkhand and Orissa, India: a cluster‐randomised controlled trial. Lancet 2010;375(9721):1182‐92. [DOI: 10.1016/S0140-6736(09)62042-0; PUBMED: 20207411] - DOI - PubMed
Tripathy 2016 {published data only}
    1. Sinha RK, Haghparast‑Bidgoli H, Tripathy P, Nair N, Gope R, Rath S, et al. Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India. Cost Effectiveness and Resource Allocation 2017;15:2. [DOI: 10.1186/s12962-017-0064-9; PUBMED: 28344517] - DOI - PMC - PubMed
    1. Tripathy P, Nair N, Sinha R, Rath S, Gope RK, Rath S, et al. Effect of participatory women’s groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster‐randomised controlled trial. Lancet Global Health 2016;4(2):119‐28. [DOI: 10.1016/S2214-109X(15)00287-9; PUBMED: 26823213] - DOI - PubMed
Waiswa 2015 {published data only}
    1. Waiswa P, Pariyo G, Kallander K, Akuze J, Namazzi G, Ekirapa‐Kiracho E, et al. Effect of the Uganda Newborn Study on care‐seeking and care practices: a cluster‐randomised controlled trial. Global Health Action 2015;8:24584. [DOI: 10.3402/gha.v8.24584; PUBMED: 25843498] - DOI - PMC - PubMed
    1. Waiswa P, Peterson SS, Namazzi G, Ekirapa EK, Naikoba S, Byaruhanga R, et al. The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community‐based intervention linked to health facilities ‐ study protocol for a cluster randomized controlled trial. Trials 2013;13:213. [DOI: 10.1186/1745-6215-13-213; PUBMED: 23153395] - DOI - PMC - PubMed
Wu 2011 {published data only}
    1. Wu Z, Viisainen K, Wang Y, Hemminki E. Evaluation of a community‐based randomized controlled prenatal care trial in rural China. BMC Health Services Research 2011;11(1):92. [DOI: 10.1186/1472-6963-11-92; PUBMED: 21542939] - DOI - PMC - PubMed

References to studies excluded from this review

Agboatwalla 1997 {published data only}
    1. Agboatwalla M, Akram DS. Impact of health education on mothers' knowledge of preventive health practices. Tropical Doctor 1997;27(4):199‐202. [DOI: 10.1177/004947559702700405; PUBMED: 9316359] - DOI - PubMed
Ahluwalia 2000 {published data only}
    1. Ahluwalia IB, Tessaro I, Grummer‐Strawn LM, MacGowan C, Benton‐Davis S. Georgia's breastfeeding promotion program for low‐income women. Pediatrics 2000;105(6):e86. [PUBMED: 10835098] - PubMed
Alexandre 2007 {published data only}
    1. Alexandre C, Bomy H, Bourdon E, Truffert P, Pierrat V. Lactation counselling support provided to mothers of preterm babies who intend to breastfeed. Evaluation of an educational intervention in a level III perinatal unit [Accompagnement des mères de nouveau‐nés prématurés dans leur projet d’allaitement maternel. Évaluation d'un programme de formation dans une unité périnatale de niveau III]. Archives de Pédiatrie 2007;14(12):1413–9. [DOI: 10.1016/j.arcped.2007.08.017; PUBMED: 17997289] - DOI - PubMed
Ayiasi 2015b {published data only}
    1. Ayiasi RM, Muhumuza C, Bukenya J, Orach CG. The effect of prenatal counselling on postpartum family planning use among early postpartum women in Masindi and Kiryandongo districts, Uganda. Pan African Medical Journal. 2015;21:1388. [DOI: 10.11604/pamj.2015.21.138.7026; PUBMED: 26327975] - DOI - PMC - PubMed
Bang 1990 {published data only}
    1. Bang AT, Bang RA, Morankar VP, Sontakke PG, Solanki JM. Pneumonia in neonates: can it be managed in the community?. Archives of Disease in Childhood 1993;68(5 Spec No):550‐6. [PUBMED: 8323354] - PMC - PubMed
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Bang 1999 {published data only}
    1. Bang AT, Bang RA, Baitule SB, Reddy HM, Deshmukh MD. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitating with mouth‐to‐mouth, tube‐mask or bag–mask. Journal of Perinatology 2005;25 Suppl 1:S82‐91. [DOI: 10.1038/sj.jp.7211275; PUBMED: 15791282] - DOI - PubMed
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Baqui 2015 {published data only}
    1. Baqui AH, Saha SK, Ahmed NU, Shahidullah M, Quasem I, Roth DE, et al. Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open‐label, equivalence trial. Lancet Global Health 2015;3(5):279–87. [DOI: 10.1016/S2214-109X(14)70347-X; PUBMED: 25841891] - DOI - PubMed
    1. Baqui AH, Saha SK, Ahmed NU, Shahidullah M, Quasem I, Roth DE, et al. Safety and efficacy of simplified antibiotic regimens for outpatient treatment of serious infection in neonates and young infants 0–59 days of age in Bangladesh. Pediatric Infectious Disease Journal 2013;32(9):S12–8. [DOI: 10.1097/INF.0b013e31829ff790; PUBMED: 23945570] - DOI - PMC - PubMed
Bartington 2006 {published data only}
    1. Bartington S, Griffiths LJ, Tate AR, Dezateux C, Millennium Cohort Study Child Health Group. Are breastfeeding rates higher among mothers delivering in baby friendly accredited maternity units in the UK?. International Journal of Epidemiology 2006;35(5):1178–86. [DOI: 10.1093/ije/dyl155; PUBMED: 16926214] - DOI - PubMed
Bhandari 2003 {published data only}
    1. Bhandari N, Bahl R, Mazumdar S, Martines J, Black ER, Bhan KM, Infant Feeding Study Group. Effect of community‐based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet 2003;361(9367):1418‐23. [DOI: 10.1016/S0140-6736(03)13134-0; PUBMED: 12727395] - DOI - PubMed
Bhandari 2004 {published data only}
    1. Bhandari N, Mazumder S, Bahl B, Martines J, Robert EB, Bhan MK, Infant Feeding Study Group. An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. Journal of Nutrition 2004;134(9):2342‐8. [DOI: 10.1093/jn/134.9.2342; PUBMED: 15333726] - DOI - PubMed
Bhattacharya 1988 {published data only}
    1. Bhattacharya R, Kaur P, Reedy DC. Impact of education in the knowledge and practices of rural mothers and key family members on diarrhoea and its treatment at home. Journal of Diarrheal Diseases Research 1988;6(1):15‐20. [PUBMED: 3251936] - PubMed
Bhopal 2017 {published data only}
    1. Bhopal S, Verma D, Divan G, Hill Z, Barlow J, Roy R, et al. Early life stress of infants in the SPRING home visits intervention promoting child growth and development in rural India (SPRING‐ELS): development of stress measures for administration at scale. Lancet Poster 2017;389 Suppl 1:S26. [DOI: ]
Bhutta 2009 {published data only}
    1. Bhutta ZA, Rizvi A, Raza F, Hotwani S, Zaidi S, Hossain SM, et al. A comparative evaluation of multiple micronutrient and iron–folic acid supplementation during pregnancy in Pakistan: impact on pregnancy outcomes. Food and Nutrition Bulletin 2009;30(4):S496‐505. [DOI: 10.1177/15648265090304S404; PUBMED: 20120791] - DOI - PubMed
Bland 2008 {published data only}
    1. Bland RM, Little KE, Coovadiad HM, Coutsoudis A, Rollinse NC, Newella ML. Intervention to promote exclusive breast‐feeding for the first 6 months of life in a high HIV prevalence area. AIDS 2008;22(7):883‐91. [DOI: 10.1097/QAD.0b013e3282f768de; PUBMED: 18427207] - DOI - PubMed
Bolam 1998 {published data only}
    1. Bolam A, Manandhar DS, Shrestha P, Ellis M, Costello AM. The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial. BMJ 1998;316(7134):805–11. [PUBMED: 9549449] - PMC - PubMed
Boulvain 2004 {published data only}
    1. Boulvain M, Perneger TV, Othenin‐Girard V, Petrou S, Berner M, Iriona O. Home‐based versus hospital‐based postnatal care: a randomised trial. BJOG 2004;3(8):807–13. [DOI: 10.1111/j.1471-0528.2004.00227.x; PUBMED: 15270928] - DOI - PubMed
Carlo 2010 {published data only}
    1. Carlo WA, McClure EM, Chomba E, Chakraborty H, Hartwell T, Harris H, et al. Newborn care training of midwives and neonatal and perinatal mortality rates in a developing country. Pediatrics 2010;126(5):e1064. [DOI: 10.1542/peds.2009-3464; PUBMED: 20937659] - DOI - PubMed
Castrucci 2007 {published data only}
    1. Castrucci BC, Hoover KL, Lim S, Maus KC. Availability of lactation counselling services influences breastfeeding among infants admitted to neonatal intensive care units. American Journal of Health Promotion 2007;21(5):410‐5. [DOI: 10.4278/0890-1171-21.5.410; PUBMED: 17515004] - DOI - PubMed
Chapman 2004 {published data only}
    1. Chapman DJ, Damio G, Young S, Pe´rez‐Escamilla R. Effectiveness of breastfeeding peer counseling in a low‐income, predominantly Latina population. Archives of Pediatrics and Adolescent Medicine 2004;158(9):897‐902. [DOI: 10.4278/0890-1171-21.5.410; PUBMED: 17515004] - DOI - PubMed
Coombs 1998 {published data only}
    1. Coombs DW, Reynolds K, Joyner G, Son MB. A self‐help program to increase breastfeeding among low‐income women. Journal of Nutrition Education 1998;30(4):203‐9. [DOI: ]
Coskun 2009 {published data only}
    1. Coskun AM, Karakaya E, Yaser Y. A safe motherhood education and counselling programme in Istanbul. European Journal of Contraception and Reproductive Health Care 2009;14(6):424‐36. [DOI: 10.3109/13625180903274460; PUBMED: 19929646] - DOI - PubMed
Davies‐Abetugbo 1996 {published data only}
    1. Davies‐Adetugbo AA. Promotion of breastfeeding in the community: impact of health education program in rural communities in Nigeria. Journal of Diarrhoeal Diseases 1996;14(1):5‐11. [PUBMED: 8708336] - PubMed
Dearden 2002 {published data only}
    1. Dearden K, Altaye M, Maza I, Oliva M, Stone‐Jimenez M, Burkhalter BR, et al. The impact of mother‐to‐mother support on optimal breast‐feeding: a controlled community intervention trial in peri‐urban Guatemala City, Guatemala. Revista Panamericana de Salud Publica 2002;12(3):193‐201. [PUBMED: 12396638] - PubMed
Dennis 2001 {published data only}
    1. Dennis CL. Breastfeeding initiation and duration: a 1990‐2000 literature review. Journal of Obstetric, Gynecologic and Neonatal Nursing 2002;31(1):12–32. [PUBMED: 11843016] - PubMed
Di Napoli 2004 {published data only}
    1. Napoli A, Lallo D, Fortes C, Franceschelli C, Armeni E, Guasticchi G. Home breastfeeding support by health professionals: findings of a randomised controlled trial in a population of Italian women. Acta Paediatrica 2004;93(8):1108‐14. [PUBMED: 15456204] - PubMed
Escobar 2001 {published data only}
    1. Escobar GJ, Braveman PA, Ackerson L, Odouli R, Coleman‐Phox K, Capra AM, et al. A randomized comparison of home visits and hospital‐based group follow‐up visits after early postpartum discharge. Pediatrics 2001;108(3):719–27. [PUBMED: 11533342] - PubMed
Flax 2009 {published data only}
    1. Flax VL, Negerie M, Ibrahim AU, Leatherman S, Daza EJ, Bentley ME. Integrating group counseling, cell phone messaging, and participant‐generated songs and dramas into a microcredit program increases Nigerian women's adherence to international breastfeeding recommendations. Journal of Nutrition 2009;144(7):1120–4. [DOI: 10.3945/jn.113.190124; PUBMED: 24812071] - DOI - PMC - PubMed
Foreit 1993 {published data only}
    1. Foreit KG, Foreit JR, Lagos G, Guzman A. Effectiveness and cost‐effectiveness of postpartum IUD insertion in Lima, Peru. International Family Planning Perspectives 1993;19(1):19‐33. [DOI: 10.2307/2133378] - DOI
Forster 2004 {published data only}
    1. Forster D, McLachlan H, Lumley J, Beanland C, Waldenstrom U, Amir L. Two mid‐pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial. Birth 2004;31(3):176‐82. [DOI: 10.1111/j.0730-7659.2004.00302.x; PUBMED: 15330879] - DOI - PubMed
Froozani 1999 {published data only}
    1. Froozani MD, Permehzadeh K, Dorosty AR, Golestan B. Effect of breastfeeding education on the feeding pattern and health of infants in their first 4 months in the Islamic Republic of Iran. Bulletin of the World Health Organization 1999;77(5):381‐5. [PUBMED: 10361754] - PMC - PubMed
Gill 2007 {published data only}
    1. Gill SL, Reifsnider E, Lucke JF. Effects of support on the initiation and duration of breastfeeding. Western Journal of Nursing Research 2007;29(6):708‐23. [DOI: 10.1177/0193945906297376; PUBMED: 17557933] - DOI - PubMed
Gill 2011 {published data only}
    1. Gill CJ, Phiri‐Mazala G, Guerina NG, Kasimba J, Mulenga C, MacLeod WB, et al. Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. BMJ 2011;342:346. - PMC - PubMed
Gross 2009 {published data only}
    1. Gross SM, Resnik AK, Cross‐Barnet C, Nanda JP, Augustyn M, Paige DM. The differential impact of WIC peer counseling programs on breastfeeding initiation across the state of Maryland. Journal of Human Lactation 2009;25(4):435‐43. [DOI: 10.1177/0890334409342070; PUBMED: 19652195] - DOI - PubMed
Grossman 2009 {published data only}
    1. Grossman X, Chaudhuri J, Feldman‐Winter L, Abrams J, Newton KN, Philipp BL, et al. Hospital Education in Lactation Practices (Project HELP): does clinician education affect breastfeeding initiation and exclusivity in the hospital?. Birth 2009;36(1):54‐9. [DOI: 10.1111/j.1523-536X.2008.00295.x; PUBMED: 19278384] - DOI - PubMed
Guise 2003 {published data only}
    1. Guise JM, Palda V, Westhoff C, Chan BK, Helfand M, Lieu TA. The effectiveness of primary care‐based interventions to promote breastfeeding: systematic evidence review and meta‐analysis for the US Preventive Services Task Force. Annals of Family Medicine 2003;1(2):70‐8. [PUBMED: 15040435] - PMC - PubMed
Haider 1996 {published data only}
    1. Haider R, Islam A, Hamadani J, Amin NJ, Kabir, Malek MA, et al. Breast‐feeding counselling in a diarrhoeal disease hospital. Bulletin of the World Health Organization 1996;74(2):173‐9. [PUBMED: 8706233] - PMC - PubMed
Haider 2000 {published data only}
    1. Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community‐based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000;356(9242):1643–7. [PUBMED: 11089824] - PubMed
Hannula 2008 {published data only}
    1. Hannula L, Kaunonen M, Tarkka MT. A systematic review of professional support interventions for breastfeeding. Journal of Clinical Nursing 2008;17(9):1132–43. [DOI: 10.1111/j.1365-2702.2007.02239.x; PUBMED: 18416790] - DOI - PubMed
Hoare 1999 {published data only}
    1. Hoare K, Hoare S, Rhodes D, Erinosos OH, Weaver LT. Effective health education in rural Gambia. Journal of Tropical Pediatrics 1999;45(4):208‐14. [DOI: 10.1093/tropej/45.4.208; PUBMED: 10467831] - DOI - PubMed
Hoddinott 2006 {published data only}
    1. Hoddinott P, Lee AJ, Pill R. Effectiveness of a breastfeeding peer coaching intervention in rural Scotland. Birth 2006;33(1):27‐36. [DOI: 10.1111/j.0730-7659.2006.00071.x; PUBMED: 16499529] - DOI - PubMed
Hotz 2005 {published data only}
    1. Hotz C, Gibson RS. Participatory nutrition education and adoption of new feeding practices are associated with improved adequacy of complementary diets among rural Malawian children: a pilot study. European Journal of Clinical Nutrition 2005;59(2):226‐37. [DOI: 10.1038/sj.ejcn.1602063; PUBMED: 15483634] - DOI - PubMed
Ickovics 2007 {published data only}
    1. Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H, et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics and Gynecology 2007;110(2 Pt 1):330–9. [DOI: 10.1097/01.AOG.0000275284.24298.23; PUBMED: 17666608] - DOI - PMC - PubMed
Ingram 2004 {published data only}
    1. Ingram J, Johnson D. A feasibility study of an intervention to enhance family support for breast feeding in a deprived area in Bristol, UK. Midwifery 2004;20(4):367‐79. [DOI: 10.1016/j.midw.2004.04.003; PUBMED: 15571885] - DOI - PubMed
Ingram 2009 {published data only}
    1. Ingram J, Johnson D. Using community maternity care assistants to facilitate family‐focused breastfeeding support. Maternal and Child Nutrition 2009;5(3):276‐81. [DOI: 10.1111/j.1740-8709.2008.00175.x; PUBMED: 19531048] - DOI - PMC - PubMed
Jang 2008 {published data only}
    1. Jang GJ, Kim SH, Jeong KS. Effect of postpartum breast‐feeding support by nurse on the breast‐feeding prevalence. Taehan Kanho Hakhoe Chi 2008;38(1):172‐9. [PUBMED: 18323730] - PubMed
Johnson 2017 {published data only}
    1. Johnson D, Jurasb R, Rileyc P, Chatterji M, Sloanec P, Choid SK, et al. A randomized controlled trial of the impact of a family planning mHealth service on knowledge and use of contraception. Contraception 2017;95(1):90‐7. [DOI: 10.1016/j.contraception.2016.07.009; PUBMED: 27421767] - DOI - PubMed
Kadam 2005 {published data only}
    1. Kadam S, Binoy S, Kanbur W, Mondkar JA, Fernandez A. Feasibility of kangaroo mother care in Mumbai. Indian Journal of Pediatrics 2005;72(1):35‐8. [PUBMED: 15684446] - PubMed
Kafatos 1989 {published data only}
    1. Kafatos AG, Vlachonikolis IG, Codrington CA. Nutrition during pregnancy: the effects of an educational intervention program in Greece. American Journal of Clinical Nutrition 1989;50(5):979‐9. [DOI: 10.1093/ajcn/50.5.970; PUBMED: 2816804] - DOI - PubMed
Kafatos 1991 {published data only}
    1. Kafatos AG, Tsitoura S, Pantelakis SN, Doxiadis SA. Maternal and infant health education in a rural Greek community. Hygie 1991;10(1):32‐7. - PubMed
Kimani‐Murage 2015 {published data only}
    1. Kimani‐Murage EW, Kimiywe J, Kabue M, Wekesah F, Matiri E, Muhia N, et al. Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial. Trials 2015;16:431. [DOI: 10.1186/s13063-015-0935-3] - DOI - PMC - PubMed
    1. Maingi M, Kimiywe J, Iron‐Segev S. Effectiveness of Baby Friendly Community Initiative (BFCI) on complementary feeding in Koibatek, Kenya: a randomized control study. BMC Public Health 2018;18(1):600. [10.1186/s12889‐018‐5519‐1] - PMC - PubMed
Kools 2005 {published data only}
    1. Kools EJ, Thijs C, Kester ADM, Brandt PA, Vries H. A breast‐feeding promotion and support program: a randomised trial in the Netherlands. Preventive Medicine 2005;40(1):60‐70. [DOI: 10.1016/j.ypmed.2004.05.013; PUBMED: 15530582] - DOI - PubMed
Lin 2008 {published data only}
    1. Lin SS, Chien LY, Tai CJ, Lee CF. Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan. Journal of Clinical Nursing 2008;17(3):296–303. [DOI: 10.1111/j.1365-2702.2006.01927.x; PUBMED: 17931376] - DOI - PubMed
MacArthur 2009 {published data only}
    1. MacArthur C, Jolly K, Ingram L, Freemantle N, Dennis CL, Hamburger R, et al. Antenatal peer support workers and initiation of breastfeeding: cluster randomised controlled trial. BMJ 2009;338:b131. [DOI: 10.1136/bmj.b131; PUBMED: 19181730] - DOI - PMC - PubMed
Martens 2002 {published data only}
    1. Martens PJ. Increasing breastfeeding initiation and duration at a community level: an evaluation of Sagkeeng First Nation's community health nurse and peer counselor programs. Journal of Human Lactation 2002;18(3):236‐46. [DOI: 10.1177/089033440201800305; PUBMED: 12192958] - DOI - PubMed
Merewood 2003 {published data only}
    1. Merewood A, Philipp BL, Chawla N, Cimo S. The baby‐friendly hospital initiative increases breastfeeding rates in a US neonatal intensive care unit. Journal of Human Lactation 2003;19(2):166‐71. [DOI: 10.1177/0890334403252475; PUBMED: 12744533] - DOI - PubMed
Moran 2006 {published data only}
    1. Moran AC, Sangli G, Dineen R, Rawlins B, Yaméogo M, Baya B. Birth‐preparedness for maternal health: findings from Koupéla District, Burkina Faso. Journal of Health, Population and Nutrition 2006;24(4):489‐97. [PUBMED: 17591346] - PMC - PubMed
Mottl‐Santiago 2008 {published data only}
    1. Mottl‐Santiago J, Walker C, Ewan J, Vragovic O, Winder S, Stubblefield P. A hospital‐based doula program and childbirth outcomes in an urban, multicultural setting. Maternal and Child Health Journal 2008;12(2):372‐7. [DOI: 10.1007/s10995-007-0245-9; PUBMED: 17610053] - DOI - PubMed
Murihead 2006 {published data only}
    1. Muirhead PE, Butcher G, Rankin J, Munley A. The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. British Journal of General Practice 2006;56(524):191‐7. [PUBMED: 16536959] - PMC - PubMed
Nabulsi 2014 {published data only}
    1. Nabulsi M, Hamadeh H, Tamim H, Kabakian T, Charafeddine L, Yehya N, et al. A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial. BMC Public Health 2014;14:36. [DOI: 10.1186/1471-2458-14-36; PUBMED: 24428951] - DOI - PMC - PubMed
Nair 2017 {published data only}
    1. Nair N, Tripathy P, Sachdev HS, Pradhan H, Bhattacharyya S, Gope R, et al. Effect of participatory women’s groups and counselling through home visits on children’s linear growth in rural eastern India (CARING trial): a cluster‐randomised controlled trial. Lancet Global Health 2017;5(10):1004–16. [DOI: 10.1016/S2214-109X(17)30339-X; PUBMED: 28911749] - DOI - PMC - PubMed
Nichols 2009 {published data only}
    1. Nichols J, Schutte NS, Brown RF, Dennis CL, Price I. The impact of a self‐efficacy intervention on short‐term breast‐feeding outcomes. Health Education & Behavior 2009;36(2):250‐8. [DOI: 10.1177/1090198107303362; PUBMED: 17893124] - DOI - PubMed
Petrova 2009 {published data only}
    1. Petrova A, Ayers C, Stechna S, Gerling JA, Mehta R. Effectiveness of exclusive breastfeeding promotion in low‐income mothers: a randomized controlled study. Breastfeeding Medicine 2009;4(2):63‐9. [DOI: 10.1089/bfm.2008.0126; PUBMED: 19239405] - DOI - PubMed
Philipp 2001 {published data only}
    1. Philipp BL, Merewood A, Miller LW, Chawla N, Murphy‐Smith MM, Gomes JS, et al. Baby‐friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics 2001;108(3):677‐83. [PUBMED: 11533335] - PubMed
Pobocik 2000 {published data only}
    1. Pobocik SR, Benaventea JC, Schwab AC, Boudreau N, Morris C, Houston MS. Effect of a breastfeeding education and support program on breastfeeding initiation and duration in a culturally diverse group of adolescents. Journal of Nutrition Education 2000;32(3):139‐45. [DOI: ]
Quinn 2005 {published data only}
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Schneider 2001 {published data only}
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References to studies awaiting assessment

Mazumder 2017 {published data only}
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References to other published versions of this review

Thaver 2009
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