支持策略對哺餵母乳之成效──系統性文獻回顧

Effect of the Strategies to Support Breastfeeding: a Systematic Review

目的：已知哺餵母乳對母親及嬰兒健康的益處，但能依照世界衛生組織的建議，採純哺餵母乳至產後六個月的比率卻很低。因此進一步探討提升純哺乳率至產後6個月的有效策略有其必要性。以嚴謹的系統性文獻回顧方法了解支持策略對哺餵母乳的成效，以作為提供以實證為基礎照護措施的參考。方法：搜尋六個電子資料庫，時間自1990年至2014年3月，依納入及排除條件篩選後，以Modified Jadad Scale評價文獻品質。結果：分析符合篩選標準之4篇隨機對照試驗研究，介入措施包括以電腦互動系統提供產婦哺乳諮詢、給予哺乳訓練計畫；介入時間從產前至產後。結果顯示支持策略對產婦之哺乳意願、哺乳態度、哺乳自我效能無顯著差異；但哺乳知識、哺乳問題處理則達到顯著差異。產後6個月的純哺乳率雖實驗組比對照組高，但仍然偏低，未達到世界衛生組織的建議標準。結論：本系統性文獻回顧顯示支持措施可有效提昇產婦哺乳知識及哺乳問題處理能力。但產後6個月的純哺乳率仍然偏低，建議持續發展更有效的支持策略。如從政策面制定鼓勵措施，加強產婦對哺乳的意願、態度及信心，以提升產後6個月的純哺乳率。

Purposes: Breastfeeding is known to benefit both mothers and infants, but the rate of exclusive breastfeeding for 6 months is low. To understand the effect of strategies to support breastfeeding by a rigid systematic review of studies whose aim was to promote nursing. Methods: We searched six electronic databases for relevant articles published between 1990 and March 2014. Data were collected based on inclusion and exclusion criteria. A modified Jadad Scale was used to evaluate the quality of the identified articles. Results: Four randomize controlled studies met our inclusion criteria. Interventions included the use of an interactive computer to support breastfeeding and an antenatal training program to improve breastfeeding. The duration of intervention was from antepartum to postpartum. The results showed no significant differences in breastfeeding intent, attitude, and self-efficacy, but there were significant differences in knowledge about breastfeeding and awareness of problems. The rates of exclusive breastfeeding for 6 months in the experiment groups were higher than those in the control groups, but they were still lower than the standard set by the World Health Organization. Conclusions: The systematic review showed that support for breastfeeding could improve mothers’ breastfeeding knowledge and ability to deal with problems. In view of the low rate of breastfeeding for 6 months, however, we suggest development of more supportive strategies such as policies to strengthen mothers’ breastfeeding intent, attitude and confidence, in order to increase the rate of exclusive breastfeeding for 6 months.