THE EFFECTIVENESS OF CABBAGE LEAF APPLICATION ON THE IMPROVEMENT OF HEALTH OUTCOMES IN POSTNATAL MOTHERS WITH BREAST ENGORGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Breast engorgement is a distressing condition for postnatal mothers. Severe engorgement can result in mastitis and cessation of breastfeeding. With a low-cost and ease of use, cabbage leaf application is a feasible breast engorgement treatment for postnatal mothers. Yet, its effectiveness is poorly understood. Objective: To synthesize best available evidence and assess effectiveness of cabbage leaf application on breast pain and hardness in postnatal mothers with breast engorgement. Methods: Systematic searching was performed in seven electronic databases (Cochrane, Chinese National Knowledge Infrastructure, CINAHL, Embase, PubMed, Scopus and Web of Science). Published and unpublished randomized controlled trials (RCTs) and quasiexperimental studies were included. Two independent reviewers screened studies, appraised quality and extracted data. Cochrane Risk of Bias tool and JBI checklist for quasi-experimental studies were used to appraise studies. Quality of evidence was evaluated using JBI Levels of Evidence. Meta-analyses were conducted on Review Manager 5.4 using random effects model. Narrative synthesis was performed for studies which cannot be pooled into meta-analyses. Results: Meta-analysis of RCTs revealed significant effect of using cabbage leaf application on pain score (d = -0.56; 95% confidence interval (CI) -0.85 to -0.28; p = 0.0001). Metaanalysis of quasi-experimental studies showed an insignificant effect of cabbage leaf on pain score (d = 0.56; 95% confidence interval (CI) -0.95 to 2.06; p = 0.47). Narrative synthesis highlighted a significant effect of cabbage leaf application on breast hardness. Conclusion & Implications: This is the first systematic review on effectiveness of cabbage leaf that has pooled results via meta-analysis. The review found that effectiveness of cabbage leaf on pain and hardness due to breast engorgement was inconclusive. Further research with rigorous methodology is needed to evaluate cabbage leaf application and its effectiveness.