Effects of exclusive breastfeeding promotion interventions on child outcomes: a systematic review and meta-analysis

Introduction: Interventions promoting exclusive breastfeeding (EBF) may benefit infant health outcomes, but evidence is inconsistent. The objective of this review was to assess the effect of interventions promoting EBF on health outcomes in infants and children under 7 years of age. Methods: A literature search was conducted using EMBASE, MEDLINE, CINAHL, Cochrane Central, Cochrane Database of Systematic Reviews, and WHO International Clinical Trials Registry Platform from inception to April 2022. Inclusion criteria were randomized or cluster-randomized controlled trials aiming to increase EBF that reported effects on offspring growth, morbidity and/or mortality up to age 7 years. The primary outcome was infant/child growth. Secondary outcomes were infant morbidity and mortality and exclusive breastfeeding rates. Data were pooled using a random-effects model. Results: 32 studies (40 papers) were identified. No effect on infant/child growth was observed. EBF promotion interventions significantly improved EBF rates up to 6 months (n=25; OR 3.15; 95%CI 2.36,4.19) and significantly reduced the odds of respiratory illness at 0-3 months by 59% (n=2; OR 0.41; 95%CI 0.20,0.84) but not at later time-points. A borderline significant effect was observed for diarrhea (n=12; OR 0.84; 95%CI 0.70,1.00). Effects on hospitalizations or mortality were not significant. Discussion/Conclusion: EBF promotion interventions improve EBF rates and might yield modest reductions in infant morbidity without affecting infant/child growth. Future studies should investigate the cost-effectiveness of these interventions and examine potential benefits on other health outcomes.