Effectiveness of interventions on early initiation of breastfeeding in South Asia: A systematic review and meta-analysis of randomized controlled trials

Abstract Background Early initiation of breastfeeding (EIBF) halves the risk of neonatal mortality, establishing it as a crucial outcome component in various interventions implemented across South Asian countries. However, the overall effect of these interventions remain unexamined. Therefore, this study seeks to address this knowledge gap by evaluating the overall effect of these interventions on maternal EIBF practice. Methods A systematic literature search was performed to identify randomised controlled trials (RCTs) conducted in South Asia focusing on EIBF as an outcome variable. The interventions identified were categorized into behavioral, mHealth, health system strengthening, and nutritional interventions. Random effects meta-analysis was conducted to estimate the pooled effect of interventions and effectiveness by intervention categories. Heterogeneity was explored by sub-group and meta-regression analyses. The risk of bias and strength of evidence were assessed by Cochrane’s RoB2 assessment tool and GRADE criteria, respectively. Results We included 22 articles published from 19 unique interventions from a pool of 2,524 screened records for review and narrative synthesis. Among these, 19 articles were eligible for meta-analysis. The pooled relative risk (RR) of EIBF among mothers in the intervention groups, as compared to their counterparts, was 1.55 (95% CI: 1.24, 1.95; I2 = 99.56; p < 0.001). Interventions targeted health system strengthening represented stronger effect than other types of interventions. The overall strength of evidence was moderate. Conclusion The overall intervention effect appeared efficacious in improving maternal EIBF practice in South Asia, providing valuable insights for policymakers to develop effective strategies.