Peer support and exclusive breastfeeding duration in low and middle-income countries: a systematic review and meta-analysis

To examine the effect of peer support on duration of exclusive breastfeeding (EBF) in low and middle-income countries (LMICs). Medline, EMBASE, and Cochrane Central Register for Controlled Trials were searched from inception to April 2012. Two authors independently searched, reviewed, and assessed the quality of randomized controlled trials utilizing peer support in LMICs. Meta-analysis and metaregression techniques were used to produce pooled relative risks and investigate sources of heterogeneity in the estimates. Eleven randomized controlled trials conducted at 13 study sites met the inclusion criteria for systematic review. We noted significant differences in study populations, peer counselor training methods, peer visit schedule, and outcome ascertainment methods. Peer support significantly decreased the risk of discontinuing EBF as compared to control (RR: 0.71; 95% CI: 0.61-0.82; I(2) =92%). The effect of peer support was significantly reduced in settings with >10% community prevalence of formula feeding as compared to settings with