title: Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To provide comprehensive evidence of the effect of interventions on early initiation, exclusive, continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above.
  
  
  METHODS
  Of 23977 titles identified through a systematic literature search in PUBMED, Cochrane and CABI, 195 articles relevant to our objective, were included. We reported the pooled relative risk and corresponding 95% confidence intervals as our outcome estimate. In cases of high heterogeneity, we explored its causes by subgroup analysis and meta-regression and applied random effects model.
  
  
  RESULTS
  Intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding rates, were seen when counselling or education were provided concurrently in home and community, health systems and community, health systems and home settings, respectively. Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding.
  
  
  CONCLUSIONS
  To promote breastfeeding, interventions should be delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors.forename: Bireshwar
authors.initials: B
authors.lastname: Sinha
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors.forename: Ranadip
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: Department of Pediatrics, Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M Jeeva
authors.initials: MJ
authors.lastname: Sankar
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway.
authors.forename: Jose
authors.initials: J
authors.lastname: Martines
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
authors.affiliation: Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: Nigel
authors.initials: N
authors.lastname: Rollins
authors.affiliation: Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Bahl
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors.forename: Nita
authors.initials: N
authors.lastname: Bhandari
mesh_terms: D001942:Breast Feeding; D003376:Counseling; D005260:Female; D006266:Health Education; D006293:Health Promotion / Q000379:methods*; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012944:Social Support; D014944:World Health Organization
keywords: Breastfeeding; Interventions; Meta Analysis