Global Burden and Determinants of Puerperal Mastitis in Low- and Middle-Income Countries: A Systematic Review and metal analyzed
Year: 2026
Type: other
Abstract: Description Puerperal mastitis is an inflammatory condition of the breast occurring during the postpartum and breastfeeding period. It represents an important maternal health problem that can cause substantial physical discomfort, breastfeeding difficulties, premature breastfeeding cessation, and, in some cases, serious complications such as breast abscess and systemic infection. Although puerperal mastitis is a recognized complication of lactation, its reported prevalence varies considerably across populations and healthcare settings, partly because of differences in diagnostic criteria, case definitions, study designs, breastfeeding practices, and access to maternal healthcare services. Women living in low- and middle-income countries (LMICs) may experience additional challenges related to limited access to skilled lactation support, inadequate postpartum follow-up, delayed recognition of symptoms, and barriers to timely diagnosis and treatment. This systematic review and meta-analysis aims to comprehensively evaluate the burden and determinants of puerperal mastitis among postpartum and breastfeeding women in LMICs. Specifically, the study will estimate the pooled prevalence of puerperal mastitis, examine its distribution across geographical regions and healthcare settings, assess variations in reported prevalence according to diagnostic definitions and methodological characteristics, and identify maternal, obstetric, breastfeeding-related, socioeconomic, and healthcare-related factors associated with its occurrence. The review will systematically identify and synthesize relevant observational studies conducted in LMICs. Quantitative data on the occurrence of puerperal mastitis and its associated factors will be extracted using a standardized approach. Where sufficient clinical and methodological comparability exists, random-effects meta-analysis will be performed to estimate pooled prevalence and pooled measures of association with corresponding 95% confidence intervals. Between-study heterogeneity will be assessed using appropriate statistical measures, and subgroup analyses and meta-regression will be considered to explore potential sources of variability. Sensitivity analyses and assessments of publication bias will be conducted where appropriate. Methodological quality and risk of bias will be evaluated using suitable critical appraisal instruments. The review will also investigate potentially modifiable determinants, including breastfeeding frequency and technique, poor breast emptying, nipple trauma, breastfeeding difficulties, maternal knowledge, lactation support, delivery-related factors, and postpartum healthcare utilization, depending on the availability and consistency of evidence. The analysis will distinguish between factors supported by adjusted estimates and those reported only through unadjusted associations to improve the interpretability of the findings. The expected outcomes include a comprehensive estimate of the burden of puerperal mastitis in LMICs, identification of geographical and methodological variations in reported prevalence, and a consolidated assessment of maternal, obstetric, breastfeeding-related, and healthcare-related determinants. The findings are expected to identify populations at increased risk, highlight potentially preventable contributors to puerperal mastitis, and reveal important gaps in existing epidemiological evidence. By consolidating the available evidence, this review is expected to provide a useful scientific foundation for strengthening postpartum maternal care, improving breastfeeding education and practical lactation support, promoting early recognition of mastitis symptoms, and informing appropriate prevention and management strategies. The findings may also support maternal health policymakers, clinicians, midwives, nurses, lactation specialists, and public health practitioners in developing context-appropriate interventions to reduce the burden of puerperal mastitis and its consequences for maternal wellbeing and breastfeeding continuation in resource-limited settings.
Source: Open Science Framework
Author: Habtamu Fekadu Andeta
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7224865748