Journal of Health Education Research & Development

ISSN: 2380-5439

Open Access

Effectiveness of Health Education in Increasing the Duration of Exclusive Breastfeeding in Low Income Countries: A Systematic Review


Paul Okyere, James Woodall and Emmanuel Appiah-Brempong

Background: The protective effects of exclusive breastfeeding (EBF) to the health of infants and mothers alike have been well documented. The rates of EBF remain low in spite of the recognized benefits and the persistent global call for infants to be breastfed exclusively on breast milk for the first six months of life. Health education has been widely suggested as one of the key intervention strategies for increasing the duration of EBF in low income countries.

Objective: To conduct a systematic review to assess the effectiveness of health education interventions in
increasing the duration of EBF in low income countries. A secondary objective of the review was to identify the theoretical bases of both effective/non-effective interventions and also to identify the educational methods that were utilized.

Methods: Systematic review of experimental and quasi-experimental studies of health education interventions that evaluated exclusive breastfeeding outcome. Studies not published in English language and studies not reporting exclusive breastfeeding outcome were excluded. A narrative synthesis was used.

Data Sources: Studies dating from 1980 – 2013 in English language were searched in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, Academic Search Complete. ScienceDirect and Google Scholar search engine.

Results: Twelve (12) studies were identified. Five were randomized controlled trials and additional three were before-after studies with control groups. The remaining four were non-randomized controlled trial. Only one study applied a theoretical framework in developing and implementing the intervention. EBF rate was significantly higher in the intervention groups compared with the control groups in ten (10) of the studies. The remaining two (2) studies reported no difference in EBF rates between the intervention groups and the control groups. Most of the studies reviewed had important methodological limitations.

Conclusion: Because of the methodological limitations of most of the included studies, firm conclusion on the effectiveness of health education interventions in increasing the duration of exclusive breastfeeding in low income countries cannot be made. Nonetheless there is a potential for this to be achieved if more methodologically rigorous health education interventions are developed and evaluated in low income countries.


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