Studies reporting factors associated with exclusive breastfeeding are mostly quantitative. No study has performed a systematic qualitative summary to document the recurring constraints and facilitators to exclusive breastfeeding in sub-Saharan African countries from breastfeeding mothers’ perspective. This study systematically reviews the literature reporting barriers and facilitators to exclusive breastfeeding from the breastfeeding mothers’ perspective in sub-Saharan Africa to develop an educational intervention to optimize exclusive breastfeeding. A systematic literature review of qualitative studies such as phenomenological studies, followed by a risk of bias and methodological assessment of the included studies’ quality using the Critical Appraisal Skills Programme (CASP) tool was conducted. MEDLINE and Google Scholar were searched from January 1990 to October 2019 to retrieve studies of breastfeeding mothers who had infants aged between 0 and 12 months. Two authors independently carried out the review process and resolved disagreements through consensus. We analyzed the data thematically. After reviewing 92 studies, 20 studies involving 836 participants from 11 countries were eligible. Of the 72 studies excluded, 39 were not conducted in sub-Saharan Africa, and 33 included other participants such as fathers. Three themes emerged as barriers to exclusive breastfeeding (EBF) and five additional themes were identified with facilitators of maternal-infant factors being the most significant in both cases. Maternal employment and knowledge of the benefits of EBF were the most common maternal-infant factors that served as a barrier and a facilitator, respectively. The study’s limitations were that the review involved only primary research among breastfeeding mothers living in sub-Saharan Africa and excluded studies not available in the English language. The information synthesized from this review could be used to develop communication strategies employed during individual and group patient education in the hospitals to improve breastfeeding mothers’ understanding, acceptance, and practice of exclusive breastfeeding. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020133761. This review found that maternal-infant factors have the most significant influence over the practice of exclusive breastfeeding. Therefore, interventions targeted towards maternal-infant factors will improve and optimize exclusive breastfeeding significantly and, ultimately, improve maternal-child health outcomes.

中文翻译：

---

对撒哈拉以南非洲国家纯母乳喂养实践障碍和促进因素的定性研究的系统评价

报告与纯母乳喂养相关的因素的研究大多是定量的。没有研究进行系统的定性总结，以从母乳喂养母亲的角度记录撒哈拉以南非洲国家纯母乳喂养的反复出现的限制和促进因素。本研究从撒哈拉以南非洲母乳喂养母亲的角度系统地回顾了文献报道纯母乳喂养的障碍和促进因素，以制定教育干预措施以优化纯母乳喂养。对定性研究（如现象学研究）进行了系统的文献回顾，然后使用关键评估技能计划 (CASP) 工具对纳入研究的质量进行偏倚风险和方法学评估。在 1990 年 1 月至 2019 年 10 月期间对 MEDLINE 和 Google Scholar 进行了搜索，以检索对婴儿年龄在 0 到 12 个月之间的母乳喂养母亲的研究。两位作者独立进行审查过程并通过共识解决分歧。我们对数据进行了专题分析。在审查了 92 项研究后，有 20 项研究符合条件，涉及来自 11 个国家的 836 名参与者。在排除的 72 项研究中，39 项未在撒哈拉以南非洲进行，33 项包括其他参与者，例如父亲。三个主题成为纯母乳喂养（EBF）的障碍，另外五个主题被确定为母婴因素的促进因素在这两种情况下都是最重要的。母亲就业和对 EBF 益处的了解是最常见的母婴因素，分别是障碍和促进因素。该研究的局限性在于，该评价仅涉及生活在撒哈拉以南非洲的母乳喂养母亲的初步研究，而排除了英语中不可用的研究。从本综述中综合的信息可用于制定医院个人和团体患者教育期间采用的沟通策略，以提高母乳喂养母亲对纯母乳喂养的理解、接受和实践。该评价已在国际系统评价前瞻性注册库 (PROSPERO) 前瞻性注册，注册号 CRD42020133761。本综述发现母婴因素对纯母乳喂养的影响最为显着。因此，针对母婴因素的干预措施将显着改善和优化纯母乳喂养，并最终改善母婴健康结果。