Evidence Certainty

GRADE certainty was low for breastfeeding initiation and very low for continuation at 6 months. GRADE rated the overall certainty of evidence as very low. Risk of bias will be assessed with the revised Cochrane Risk of Bias tool. All included studies were cross-sectional. The certainty of evidence was low for every outcome. Evidence was downgraded because of inconsistency, publication bias, imprecision, and risk of bias from confounding management failures. All four outcomes showed substantial heterogeneity across studies and contexts. Cross-sectional studies were appraised with the Joanna Briggs Institute tool, while case-control and cohort studies were appraised with the Newcastle-Ottawa Scale. GRADE will be applied exploratively because it is not formally established for prevalence meta-analyses. Risk of bias will be assessed at the outcome level using the Cochrane Risk of Bias 2.0 tool. Certainty for all pooled outcomes was rated low or very low using an adapted GRADE approach. Evidence certainty will be rated as high, moderate, low, or very low. Evidence certainty for each comparison will be assessed using the CINeMA framework and web tool. Initial certainty will be rated low…