Effectiveness of Mobile Phone Interventions in Improving Breastfeeding: Systematic Review of Randomized Control Trials

Abstract

Background  

Current international best practice recommendations urge breastfeeding for infants to be exclusively breastfed until six months of age, with recognition that any breastfeeding for as long as possible affords benefits. Babies that are not exclusively breastfed are subject to infectious, atopic and metabolic diseases. In fact, several factors are associated with lack of exclusive breastfeeding such as nulliparity, delivery by caesarean section, the neonate not being put on the mother’s chest after delivery, multiple births, male gender, low birth weight and in case when neonate was resuscitated. Adequate interventions should be undertaken to overcome those barriers. This study reviewed the impact of mobile phone interventions in improve exclusive breastfeeding.

Objectives  

To assess the effectiveness of mobile phone in improving exclusive breastfeeding.

Search methods  

Randomized control trials were searched from January 2016 until February 2017. We searched through: CENTRAL, MEDLINE via PUBMED, CINHAL, Scorpus, Web of science, handsearches of journals and the proceedings of major conferences

Selection criteria  

We selected randomized controlled trials (RCTs) assessing mobile phone intervention for improving breastfeeding. There was no language restriction.

Data collection and analysis  

Two authors (JLT and LMM) independently identified and assessed all studies that met inclusion criteria. Study design, characteristics of study populations, interventions and controls and study results were extracted by JLT and LMM. Also, the risk of bias of included studies was assessed independently by two JLT and LMM. We reported the overall results for each outcome after meta-analysis. We reported the odds ratio with 95% confidence intervals for the different outcomes.

Main results  

Based on the exclusive breastfeeding results, within one month, mobile phone interventions increased exclusive breastfeeding by 52% compared to the standard care (OR 1.52, 95%CI 1.25 to 1.84, 2130 participants, 7 RCTs). This result was statistically significant (P < 0.0001). The evidence was graded as high. As well as in two to three months postpartum, mobile phone intervention improved highly exclusive breastfeeding by 49% compared to the control group (OR 1.49, 95%CI 1.28 to 1.74, 3519 participants, 12 RCTs, p< 0.00001). Therefore, mobile phone intervention did not impact on exclusive breastfeeding within six months (OR 1.11, 95%CI 0.99 to 1.29, 3978 participants, 8 studies, p=0.17).

In the other hand, formula feeding was more likely to be increased the standard care group compared to mobile phone intervention group in one month post-partum (OR 1.12 95%CI 0.85 to 1.47, 5 RCTs, 1358 participants, p-value=0.44). Even though, the result was not statistically significant. Therefore, within three months, formula feeding was significantly increased 27% compared to mobile phone group (OR 1.27 95%CI 1.05 to 1.54, 7 RCTS, 2359 participants, P=0.01). Lastly, formula feeding did not increase statistically after six months (OR 1.16 95%CI 0.99 to 1.35, 3066 participants, 5 RCTs, P = 0.06). Considering formula feeding, the overall evidence was moderate.

Authors' conclusions  

Our findings have shown the importance of mobile phone intervention in promoting exclusive breastfeeding. However, mobile phone intervention could not improve exclusive from four to six months. Further interventions should be studied to enforce exclusive breastfeeding within this specific period.