3. Did the reviewers try to identify all relevant studies?

The authors clearly stated the inclusion and exclusion criteria about the types of
participants and interventions. They searched the Cochrane Pregnancy and Childbirth
Group's Trials Register by contacting the Trials Search Co-ordinator including: 1.
quarterly searches of the Cochrane Central Register of Controlled Trials (CENTRAL);
2. weekly searches of MEDLINE; 3. handsearches of 30 journals and the proceedings
of major conferences; 4. weekly current awareness alerts for a further 44 journals
plus monthly BioMed Central email alerts. The Trials Search Co-ordinator searches
the register for each review using the topic list instead of keywords. The authors
also scanned reference lists of all relevant papers retrieved and searched SIGLE,
DHSS Data, and Dissertation Abstracts for grey literature. Furthermore, they
contacted original authors to clarify or obtain relevant details of individual
studies, particularly to request details of their randomisation processes. By
thoroughly search, it can reduce the chance of publication bias and a large of
possibly relevant studies could be identified.

4. Did the reviewers assess the quality of the included studies?

Empirical studies show that inadequate quality of trials may distort the results
from systematic reviews and meta�analyses (J�ni, et al., 2001). In this paper, the
validity assessment of each included study according to the criteria outlined in
the Cochrane Handbook was done by two authors, which can minimize errors. They
assessed selection bias on the basis of concealment of allocation: adequate;
unclear; or inadequate. Performance bias, attrition bias and detection bias were
rated as: adequate; unclear or partially adequate; or inadequate. The authors also
explained which were the studies exclude and the reasons of their exclusion.

5. If the results of the studies have been combined, was it reasonable to do so?
The five studies in the paper evaluating the efficacy of health education
interventions for increasing breastfeeding initiation rates combined by meta-
analysis showed the interventions were effective overall (risk ratio (RR) 1.57, 95%
confidence interval (CI) 1.15 to 2.15). Substantial statistical heterogeneity in
this analysis is suggested by the heterogeneity score above 50% (I2 = 53.4%). The
authors pointed out the studies were small, with the largest having 200
participants. All five evaluated studies were delivered in the USA to low-income
women with different feeding intentions and where baseline breastfeeding rates are
typically low. Moreover, programme components varied; however, all forms of health
education included in this review seem to have increased breastfeeding rates. But
these findings are based only on studies conducted in the USA; it raised some
questions regarding