The effect of unemployment and post-natal care on the exclusive breast-feeding practice of women in Ethiopia: a systematic review and meta-analysis.

Background: Promoting exclusive breastfeeding (EBF) is a major child survival strategy in developing countries like Ethiopia. Studies in EBF are found in a fragmented and inconclusive way in Ethiopia. Therefore, the aim of this study was to examine evidences on the effect of post natal care counseling and maternal employment status on exclusive breastfeeding practice of women in Ethiopia. Methods: A systematic literature search was conducted from PubMed (contains MEDLINE), CINAHL (EBSCO), Global Health, Food Science and Technology Abstracts (FSTA) (EBSCO) and Grey literature sources such as Google and Google scholar. All primary studies on the effects of employment status and/or post-natal care utilization on EBF practices of women in Ethiopia were included. Data analyses were performed using STATA software. Forest plot, I2 test and the Cochrane Q statistics were used to detect heterogeneity among studies. Heterogeneity was considered significant when the I2 value was ≥ 50%, with p-value < 0.05. Publication bias was checked by looking the asymmetry of funnel and confirmed by Egger's regression test at a 5% significant level. The pooled odds ratio (POR) with 95% confidence interval (CI) was used to report the measures of associations. Result: A total of 622 studies were identified in the initial search of which 42 articles were included this systematic review and meta-analysis. A meta-analysis of 24 studies indicated that maternal employment status was significantly associated (POR = 0.51, 95% CI 0.16, 0.86) EBF practice in that employed mother were less likely to practice to practice EBF. Post-natal care service utilization significantly increases (POR = 1.76, 95% CI 1.32, 2.34) the EBF practice in Ethiopia and it was computed using 25 eligible articles. Besides, the pooled estimates of EBF practice was found to be 62.58% (95% CI 56.98, 68.19, I2 = 96.4%, p < 0.001). Conclusion: This review found that post-natal care service utilization and maternal employment status has a significant effect on EBF practice. The findings from this review may be used to inform for better supportive and promotive strategies for EBF practice in Ethiopia. Plain Language summary: Promotion of EBF in developing countries including Ethiopia is very crucial strategy to improve the survival of children. Despite this, several factors prohibit women from practicing EBF of which post-natal care service utilization and employment status are the main determinants. The previous studies in Ethiopia are inconsistent and inconclusive to policy makers. Thus, this systematic review and meta-analysis underpinned the effects post-natal care service and maternal employment status on the EBF practice of women in Ethiopia. The findings of this study will be vital to forward recommendations on the duration of maternal leave and design promotion strategies of post-natal care, the most unaddressed maternal health care service in Ethiopia. The original studies were retrieved systematically from reputable databases and grey literature sources. The data were extracted using standardized data extraction sheet. Analyses were performed using STATA software. Fixed and random effect models were utilized to compute pooled estimates. Heterogeneities were computed and the sources of heterogeneities were explained. In the current study, the pooled prevalence of EBF was 62.6%. Likewise, post-natal care service utilization and employment status were found to have significant association with the EBF practice. Unemployed women had a better EBF practice as compared to the employed ones. This could be due to the fact that most employed women in Ethiopia are governmental employees where the maximum duration of maternal leave is four months after birth. This is before the due date of commencement of complementary feeding. Post-natal care should also be promoted to improve the EBF practice. [ABSTRACT FROM AUTHOR]