A systematic review of qualitative research on barriers and facilitators to exclusive breastfeeding practice in sub-Saharan African countries

Abstract

Background Studies reporting factors associated with exclusive breastfeeding are mostly quantitative. No study has performed a systematic qualitative summary to document the recurring constraints and facilitators to exclusive breastfeeding in sub-Saharan African countries from breastfeeding mothers’ perspective. This study systematically reviews the literature reporting barriers and facilitators to exclusive breastfeeding from the breastfeeding mothers’ perspective in sub-Saharan Africa to develop an educational intervention to optimize exclusive breastfeeding. Methods A systematic literature review of qualitative studies such as phenomenological studies, followed by a risk of bias and methodological assessment of the included studies’ quality using the Critical Appraisal Skills Programme (CASP) tool was conducted. MEDLINE and Google Scholar were searched from January 1990 to October 2019 to retrieve studies of breastfeeding mothers who had infants aged between 0 and 12 months. Two authors independently carried out the review process and resolved disagreements through consensus. We analyzed the data thematically. Results After reviewing 92 studies, 20 studies involving 836 participants from 11 countries were eligible. Of the 72 studies excluded, 39 were not conducted in sub-Saharan Africa, and 33 included other participants such as fathers. Three themes emerged as barriers to exclusive breastfeeding (EBF) and five additional themes were identified with facilitators of maternal-infant factors being the most significant in both cases. Maternal employment and knowledge of the benefits of EBF were the most common maternal-infant factors that served as a barrier and a facilitator, respectively. The study’s limitations were that the review involved only primary research among breastfeeding mothers living in sub-Saharan Africa and excluded studies not available in the English language. The information synthesized from this review could be used to develop communication strategies employed during individual and group patient education in the hospitals to improve breastfeeding mothers’ understanding, acceptance, and practice of exclusive breastfeeding. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020133761. Conclusions This review found that maternal-infant factors have the most significant influence over the practice of exclusive breastfeeding. Therefore, interventions targeted towards maternal-infant factors will improve and optimize exclusive breastfeeding significantly and, ultimately, improve maternal-child health outcomes.

Potential Determinants and Effects of Exclusive Breastfeeding Among Infants at a Tertiary Care Center, Kerala, India

“…This finding is similar to a study done in Somali [ 10 ]. Moreover, a systematic review of qualitative studies from Sub-Saharan Africa also identified maternal employment as the major barrier to EBF [ 11 ]. One of the reasons could be inadequate maternity leave.…”

“…A randomized control trial from Pakistan showed that mothers who were counseled antenatally were significantly more likely to initiate breastfeeding early and continue EBF for six months [ 19 ]. Similarly, the systematic review from Sub-Saharan Africa demonstrated that knowledge of the benefits of EBF was the most common facilitator towards EBF [ 11 ]. Therefore, other factors such as postnatal lactation support may play a role.…”

Sustainability of breastfeeding interventions to reduce child mortality rates in low, middle-income countries: A systematic review of randomized controlled trials

“…Earlier reviews have discovered and categorized various facilitators and barriers that affect the sustainability of interventions (55,61,63,66,67) utilizing different frameworks such as Stirman's influences on sustainability (innovation, organizational context, capacity, and processes) (61), Mays's General Theory of Implementation (capability, capacity, contribution, and potential) (68), Lennox's Consolidated Framework for Sustainability Constructs in Healthcare (initiative design and delivery, negotiating initiative processes, the people involved, resources, organizational setting, and external environment) (69), and Schell's nine domain framework (political support, funding stability, partnerships, organizational capacity, program evaluation, program adaption, communications, public health impacts, and strategic planning) (70). Moreover, few reviews identified facilitators and barriers of breastfeeding interventions (71,72), but we are unaware of any that particularly assessed those combined, relating to the sustainability of breastfeeding interventions. We categorized facilitators and barriers of interventions in this review by Scheirer and Dearing's factors affecting sustainability (intervention characteristics, organizational setting factors, and community environmental factors) (34), of which other reviews have utilized as well but in different aspects such as youth peer health education network in primary schools (73) and in a school-based bullying prevention program (74).…”

Women’s awareness and practices regarding papanicolaou smear in the selected regional hospital of Limpopo Province, South Africa

“…The health seeking behaviour is related to lack of awareness of infection as Pap smear is the only procedure of detecting cancer of the cervix. The study 16 conducted in sub-Saharan Africa revealed lack of awareness of the disease. The literature 17 indicated that lack of awareness of the diseases, perceptions and cultural beliefs also hinders respondent's practises towards cancer of the cervix screening through Pap smear.…”