Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

Breastfeeding Protection, Promotion, and Support in Humanitarian Emergencies: A Systematic Review of Literature

BACKGROUND

Infants, young children, and their mothers are vulnerable in humanitarian emergencies. The health benefits of optimal breastfeeding practices in emergency settings have been demonstrated by many researchers. Infant and Young Children Feeding in Emergency guidelines illustrate a series of interventions to protect, promote, and support breastfeeding, but unfortunately, these recommendations are still scarcely applied.

RESEARCH AIMS

(1) To review the literature describing the effectiveness of breastfeeding protection, promotion, and support interventions in humanitarian emergency contexts; (2) to describe the influence of interventions on breastfeeding initiation, exclusivity, and duration; and (3) to evaluate relevant mother and infant/child outcomes available in the literature.

METHODS

PubMed, CINAHL, Cochrane Library, Psychology Database, JSTOR, Web of Science, EMBASE, and Ovid were searched for articles that examined breastfeeding protection, promotion, or support interventions and the resulting outcomes without any time limits (N = 10). Articles that did not include the interventions and related outcomes were excluded (n = 1,391).

RESULTS

Improved breastfeeding outcomes were reported in four (40%) papers, and three (30%) highlighted a behavioral change in infant and young child feeding practices following the implementation of the interventions. Increased knowledge about appropriate infant and young child feeding practices among mothers and humanitarian/health staff was reported in eight (80%) papers. However, outcomes were sometimes only generically reported, and some of the included papers had a low strength of evidence.

CONCLUSION

In the literature, there is a great dearth of studies evaluating the influence of interventions aimed at improving breastfeeding in emergency settings. More evidence is urgently needed to encourage and implement optimal breastfeeding practices.

Informing infant and young child feeding programming in humanitarian emergencies: An evidence map of reviews including low and middle income countries

Around 200 million people were affected by conflict and natural disasters in 2015. Whereas those populations are at a particular high risk of death, optimal breastfeeding and complementary feeding practices could prevent almost 20% of deaths amongst children less than 5 years old. Yet, coverage of interventions for improving infant and young child feeding (IYCF) practices in emergencies is low, partly due to lack of evidence. Considering the paucity of data generated in emergencies to inform programming, we conducted an evidence map from reviews that included low- and middle-income countries and looked at several interventions: (a) social and behavioural change interpersonal and mass communication for promoting breastfeeding and adequate complementary feeding; (b) provision of donated complementary food; (c) home-based fortification with multiple micronutrient powder; (d) capacity building; (e) cash transfers; (f) agricultural or fresh food supply interventions; and (g) psychological support to caretakers. We looked for availability of evidence of these interventions to improve IYCF practices and nutritional status of infants and young children. We identified 1,376 records and included 28 reviews meeting the inclusion criteria. The highest number of reviews identified was for behavioural change interpersonal communication for promoting breastfeeding, whereas no review was identified for psychological support to caretakers. We conclude that any further research should focus on the mechanisms and delivery models through which effectiveness of interventions can be achieved and on the influence of contextual factors. Efforts should be renewed to generate evidence of effectiveness of IYCF interventions during humanitarian emergencies despite the challenges.

'It is me who eats, to nourish him': a mixed-method study of breastfeeding in post-earthquake Haiti

In Haiti, initiation of breastfeeding is high, but early mixed feeding is the norm. In a situation of crisis, mothers' worries about insufficiency of breast milk, disruption of social networks and free unmonitored distribution of breast milk substitutes impact feeding practices. This study was conducted to explore the attitudes, practices and understandings of breastfeeding in the post-earthquake situation in Haiti. A mixed-method study was conducted in Léogâne, Haiti, a town close to the epicentre of the 2010 earthquake. In a household survey, 1131 mothers of children under 24 months were interviewed about feeding practices. In the quantitative component, we conducted 25 in-depth interviews and seven focus group discussions with mothers, grandmothers, traditional birth attendants, fathers and health care professionals. Mothers described breastfeeding as a challenging responsibility to ensure the infants' health. They understood breast milk as a dynamic substance, the quality of which would deteriorate if the mother's diet was poor or if the mother was afflicted with a psychosocial condition called move san or colere, 'bad blood'. To protect the child in these situations, early supplementary feeding is introduced. Only 20% of informants exclusively breastfed infants under 6 months. Because of a lack of confidence in the quality of breast milk, Haitian mothers tend to wean children earlier. The abiding concerns of Haitian mothers over the quality of their breast milk suggest a number of ways - such as dietary advice - that post-earthquake aid agencies could enhance breastfeeding support.