Table 2.
Characteristics of studies included in the review (n = 21)
| Study ref (study type; year data collected) | Setting | Country | Population | Study aim | Method | Drop out rate | Limitations |
|---|---|---|---|---|---|---|---|
| Abul‐Fadl et al. 2012 (Cross sectional; 2008) | Clinic based | Egypt | 1052 mothers, 61.7% urban, 30.2% rural, 8.1% slum. 53% ≥ 9 years education, 34.2% no/little education. 62.2% housewives, 37.8% employed. Infants aged 6–24 months, currently breastfeeding. | To evaluate the knowledge, attitudes and practice of Egyptian mothers towards the Ten Steps to Successful Breastfeeding. | Questionnaires and interviews | N/A | Study limited to convenience sampling method. |
| Adeyemi & Oyewole 2014 (Cross sectional; 2006) | Clinic based | Nigeria | 62 mothers (demographics not available as they were not separated for the mothers who defined EBF). | To furnish information that could be used to improve the delivery of nutrition education to mothers of young children attending a primary health care centre. | Pre‐tested semi‐structured self administered questionnaire | N/A | Possible reporting bias for BF practices. |
| Aksu et al. 2011 (RCT; 2008) | Hospital based | Turkey | 30 mothers (control group) mean age 23 ± 4.6 years. 43.3% primary education or less, 43.3% secondary education, 13.3% university graduates. 205 employed, 80% unemployed. Vaginal birth of 1 healthy infant born at 37 or > weeks. Aydin Resident, Turkish speaking. No drugs which may affect BM. Intention to BF, no history of chronic disease, non‐smoker. | To determine the effects of breastfeeding education/support offered at home on day 3 postpartum on breastfeeding duration and knowledge. | Questionnaires | 0% | Intervention was not blinded for those obtaining the outcomes. Small sample size. |
| Alade et al. 2013 (Cross sectional; N/R) | Household based | Nigeria | 410 mothers, mean age 27.4 years (range 13–49 years). Lactating with infants < 6 months 95.4% married, 59.3% Muslim; 94.9% Yoruba; 35.4% had only completed primary education; 39.5% were traders and 24.1% farmers, 3.9 % civil servants. | To investigate the antecedent factors for EBF among lactating mothers in Ayete, south‐east Nigeria. | Pre‐tested semi‐structured questionnaire (including a 14 point knowledge scale) | N/A | Low generalisability |
| Danso 2014 (Cross sectional: N/R) | Community based | Ghana | 1000 Professional working mothers aged 20–40 yrs, 71% aged 36–35 years, full time employment and high educational attainment. Infants 6–24 months. | To examine the practice of EBF among professional working mothers in Ghana. | Questionnaires | N/A | Did not state how question was asked/assessed, low generalisability to mothers not in full‐time employment, unsure if questionnaire is valid/reliable or was pre‐tested, did not state response rate. |
| Desai et al. 2014 (Cross sectional; 2011) | Clinic based | Zimbabwe | 295 mothers, mean age 26.1 ± 8.5 yrs, mean education 9.6 ± 1.9 years. 19.2% HIV +ve, 76.3 HIV −ve, 4.5% unknown HIV status. Infants <6 months. | To uncover barriers to breastfeeding exclusivity. | Survey questionnaire | N/A | Not representative as sample obtained from immunisation services. |
| Marais et al. 2010 (Cross sectional; 2005) | Clinic based | South Africa | 64 mothers, English/Afrikaans speaking. Infants < 6 months attending clinic ≥2 times, currently breastfeeding. | To investigate knowledge levels and the attitudes of health care workers and mothers alike and practices inhibiting the continuation of EBF by mothers attending private BF clinics. | Quantitative – Interviewer– administered questionnaires. | 49% | High subject attrition. Reasons for non‐participating subjects not determined therefore may bias results – related to non‐compliance to the 10‐steps. BF clinics from 1 private hospital group therefore not representative. |
| Murray et al. 2008 (Qualitative; NR) | Clinic based | South Africa | 89 Mothers with infants < 6 months. Afrikaans, English, Xhosa speaking. 52 from urban, 37 from rural. | To determine the comprehensibility of the preliminary PFBDG for infants younger than 6 months. | 20 × FGD | N/A | Convenience sampling – not representative |
| Nankunda et al. 2010 (Qualitative; 2005–2006) | Community based | Uganda | 11 mothers aged 18–45 years (mean 34 yrs) resident, good reputation within community, literate and numerate in local language, attained ≥ 7 years formal education, personal BF experience. | To describe the experience of establishing individual peer counselling including training and retaining peer counsellors for EBF in the Uganda site of the Promoting Infant Health and Nutrition in Sub‐Saharan Africa. | Questionnaires | N/A | No control group. Small sample size. Not realistic for population. No blinding – the training team also performed the evaluation. |
| Nduna et al. 2015 (Qualitative; N/R) | Community based | Zimbabwe | 10 mothers. Breastfeeding experience and breastfed ≥ 2 children. | To describe factors that enable and hinder EBF in a rural district of Zimbabwe based on mothers' own lived breastfeeding experiences. | Interviews | N/R | Small sample size. Low generalisability. |
| Nor et al. 2012 (Qualitative; 2006) | Community based | South Africa | 17 mothers, mean age 24 years, 7 HIV +ve, 9 HIV −ve, 1 unknown HIV status. | To explore mothers' perceptions and experiences of infant feeding within a community based peer‐counselling intervention promoting exclusive breast or formula feeding. | Qualitative – semi‐structured interviews | N/A | Research quality dependent on the individual skills of researcher and possibly more easily influenced by researcher's personal biases. |
| Oche et al. 2011 (Cross sectional; N/R) | Community based | Nigeria | 179 Mothers, semi‐urban, mean age 29 ± 10.3 yrs, 34% formal education, 5% tertiary education, 61% housewives, 12% civil servants. Breastfeeding or stopped BF ≤2 years. | To gather information about the knowledge and others factors that influence the practice of EBF in Kware, Nigeria. | Pre‐tested structured interview‐administered questionnaire | N/A | Did not explore other cultural determinants of BF, which may have had influence on EBF. A score of >50% was graded as adequate knowledge of EBF. |
| Ogbonna & Daboer 2007 (Cross sectional; N/R) | Household based | Nigeria | 470 mothers, mean age 27.5 ± 5.1 yrs. 47.2% secondary education, 21.3 tertiary. 40% housewives, 28.1% traders. Infants 6–12 months. | To determine the current level of knowledge and practice of nursing mothers on EBF and the factors that influence them. | Pre‐tested structured interview‐administered questionnaire | N/A | Did not state how question was asked/assessed, low generalisability. |
| Onah et al. 2014 (Cross sectional; 2012) | Clinic based | Nigeria | 400 mothers, lower SES, no more than secondary education, with healthy infants ≤ 6 months. | To describe the feeding practices of infants below months of age and determine maternal and socio‐demographic factors that influences the practice of EBF among mothers in South‐east Nigeria. | Pre‐tested interviewer administered questionnaire | N/A | May be subjective to recall bias and miss reporting by participants and interviewers. |
| Ostergaard & Bula 2010 (Qualitative; 2008–2009) | Hospital and clinic based | Malawi | 21 mothers aged 18–40 yrs with infants 7–12 months. Intention to practice EBF for 6 months. | To explore the challenges which HIV positive women in Malawi face when they have to decide how to feed their infants. | Individual in‐depth interviews and observation | N/A | Low generalisability |
| Otoo et al. 2009 (Qualitative; 2006) | Clinic based | Ghana | 35 mothers aged 19–49, 7.2 ± 3.6 yrs formal education, with infants' ≤ 4 months. 32 employed, 3 unemployed, 17 were traders. | To explore Ghanaian women's knowledge and attitudes toward EBF. | 4 × FGD | N/A | FGDs conducted in peri‐urban community so results may vary from mothers in rural and urban communities. Low generalisability |
| Petrie et al. 2008 (Cross sectional; 2004) | Clinic based | South Africa | 36 mothers. 30.6 % < 25 years, 22.2% 25–29 years, 47.2% > 30 years (18–39 age range). 55.6% < 6 months postpartum 44.4 5 pregnant. 63.9% unemployed. 47.2% education level between grades 11 and 12, 8.3% reported no education, 8.3% tertiary education. | To determine the knowledge, attitudes and practices of women regarding the PMTCT programmes at Vangaurd Community Health Centre. | Questionnaires | N/R | Low generalisability |
| Uchendu et al. 2009 (Cross sectional; 2006) | Clinic based | Nigeria | 184 mothers. Infants ≥6 months, born after 1992 in hospital where EBF promoted. | To evaluate mothers' perceptions of EBF and determine the relationship between such views and their practices. | Structured questionnaires | 8% | Low generalisability |
| Ukegbu & Ukegbu 2010 (Cross sectional; N/R) | Community based | Nigeria | 353 rural mothers, 34.3% aged 20–24, 28.5% aged 30–34, 2.27% aged 35–39 years. 67% secondary education, 35.8% farmers, 30.1% housewives, 9.7% traders. Currently breastfeeding. | To determine the knowledge, attitude and practice of breastfeeding and identify factors associated with introduction of others foods within the first 6 months of life. | Pre‐tested questionnaire | N/A | Did not state how question was asked/assessed, low generalisability. |
| Ukegbu et al. 2011 (Qualitative; 2006–2007) | Clinic based | Nigeria | 35 mothers | To identify the factors influencing breastfeeding practices among mothers in Anambra State, Nigeria. | 4 × FGD | N/R | No description of inclusion criteria. |
| Ukegbu & Anyikaelekeh 2013 (Cross sectional; N/R) | Clinic based | Nigeria | 240 urban mothers, 71.3% aged 26–35, 7.9% primary education, 42.9% secondary, 49.2% tertiary, 37.5% employed in civil service, 21.7% housewives. Vaginal delivery of healthy full term babies' ≥2.5 kg. | To assess knowledge, attitude and practice of EBF and maternal factors associated with its practice in an urban area in southeast Nigeria. | Questionnaires | 9.40% | Sample size not equal to sample size initially calculated therefore inability to generalise data. |
N/R = not reported; N/A = not applicable; EBF = exclusive breastfeeding; BF = breastfeeding; FGD = focus group discussions; PFBDG = Paediatric food based dietary guidelines; PMTCT = prevention of mother‐to‐child transmission.