Thesis_ Literature Review on Some of the Practices Used by Nursing Mothers on Weaning

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Breastfeeding and weaning practices among mothers in Republic of ghana: A population-based cross-sectional report

• Hubert Amu,
• Eric Osei,
• Kennedy Diema Konlan,
• Iddris Hadiru Mumuni,
• Orish Ndudiri Verner,
• Raymond Saa-Eru Maalman,
• Eunji Kim,
• Siwoo Kim,
• Mohammed Bukari,
• Hajun Jung,
• Philip Kofie,
• Martin Amogre Ayanore,
• Gregory Kofi Amenuvegbe,
• Martin Adjuik,
• Elvis Enowbeyang Tarkang,
• Robert Kaba Alhassan,
• Ernestina Safoa Donkor,
• Francis Bruno Zotor,
• Margaret Kweku,
• Paul Amuna,
• John Owusu Gyapong,
•  [ ... ],
• So Yoon Kim
• [ view all ]
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Breastfeeding and weaning practices among mothers in Republic of ghana: A population-based cross-sectional study

• Prince Kubi Appiah,
• Hubert Amu,
• Eric Osei,
• Kennedy Diema Konlan,
• Iddris Hadiru Mumuni,
• Orish Ndudiri Verner,
• Raymond Saa-Eru Maalman,
• Eunji Kim,
• Siwoo Kim,
• Mohammed Bukari

x

• Published: November 12, 2021
• https://doi.org/ten.1371/journal.pone.0259442

Figures

Abstract

Background

Children need good diet to develop proper allowed mechanisms and psychosocial maturity, simply malnutrition can bear upon their ability to realize this. Autonomously from the national demographic and health survey, which is carried out every 5 years, there have not been plenty documented studies on kid breastfeeding and weaning practices of caregivers in the Volta Region. We, therefore, examined kid breastfeeding and weaning practices of mothers in the Volta Region of Republic of ghana.

Methods

A sub-national survey method was adopted and a semi-structured questionnaire was used to collect data from 396 mothers and their children. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and logistic regression were employed in analysing the information. We defined exclusive breastfeeding every bit given but breast milk to an baby from a mother or a wet nurse for six months of life except drops or syrups consisting of vitamins, minerals, supplements, or medicines on medical communication, and prolonged breastfeeding as breastfeeding up to 24 months of age.

Results

The prevalence of exclusive breastfeeding (EBF) was 43.7%. Mothers constituting 61.1% started breastfeeding within an 60 minutes of giving nativity. In addition to breast milk, 5.1% gave fluids to their children on the first twenty-four hour period of birth. About 66.4% started complementary feeding at 6 months, 22.0% breastfed for 24 months or across, while 40.four% fed their children on-demand. Child's age (AOR: 0.23, 95% CI:0.12–0.43, p<0.0001), prolonged breastfeeding (AOR: 0.41, 95%CI: 0.12–0.87, p = 0.001), female parent'south religion (AOR: 3.92, 95%CI: one.23–12.61, p = 0.021), feeding practices counselled on (AOR: 1.72, 95%CI: 1.96–3.09, p = 0.023), female parent ever heard virtually EBF (AOR: 0.43, 95%CI: 1.45–2.41, p = 0.039), child beingness fed from the canteen with a nipple (AOR: one.53, 95%CI: 1.94–2.48, p = 0.003), and age at which complementary feeding was started (AOR: 17.43, 95%CI: 3.47–87.55, p = 0.008) were statistically associated with EBF.

Conclusion

Breastfeeding education has been ongoing for decades, yet at that place are however gaps in the breastfeeding practices of mothers. To accelerate progress towards attainment of the sustainable evolution goal iii of ensuring healthy lives and promoting well-being for all at all ages by the twelvemonth 2030, nosotros recommend innovative policies that include extensive public teaching to improve upon the breastfeeding and weaning practices of mothers.

Citation: Appiah PK, Amu H, Osei E, Konlan KD, Mumuni IH, Verner ON, et al. (2021) Breastfeeding and weaning practices among mothers in Ghana: A population-based cross-sectional report. PLoS I 16(11): e0259442. https://doi.org/10.1371/journal.pone.0259442

Editor: Marly A. Cardoso, Universidade de Sao Paulo Faculdade de Saude Publica, BRAZIL

Received: March 28, 2021; Accustomed: October 19, 2021; Published: November 12, 2021

Copyright: © 2021 Appiah et al. This is an open access article distributed under the terms of the Artistic Commons Attribution License, which permits unrestricted utilise, distribution, and reproduction in whatever medium, provided the original author and source are credited.

Information Availability: All relevant data are within the paper and its Supporting data files.

Funding: The authors received no specific funding for this piece of work.

Competing interests: The authors have declared that no competing interests exist.

1. Background

Globally, progress has been made over the past two decades to improve the nutritional status of all people, including children. Withal, malnutrition among children continues to be a public wellness challenge that threatens achievement of the Sustainable Development Goal 3, which is to ensure healthy lives and promote the well-being of all ages past the year 2030 [one]. Globally, well-nigh 22.2%, 7.v%, and 5.6% of children are stunted, wasted, and overweight respectively, inclusive of Ghana which has 18.viii% stunted, four.seven% wasted, and 2.6% overweighed children [i, two]. The consequences of malnutrition if not effectively addressed can have dire negative effects on the children including amplified risk of grave ailment and death, often resulting from infectious diseases [3]. This is mainly due to the impact that nutrient deficiencies accept on the hematopoietic and lymphoid organs which compromise the inborn and adaptive immune functions [4, v]. The effects of malnutrition not only touch children but the households, communities, and nations besides [1].

Although, the world is faced with a high prevalence of babyhood malnutrition and associated wellness, economic, and social consequences. There are cost-effective interventions including merely not express to exclusive breastfeeding (EBF), appropriate complementary feeding practices, and prolonged breastfeeding for 20-iv months to overcome the challenge of malnutrition [6–10]. Though these interventions are easy to execute, available data take shown that globally, 42.4% of infants started breastfeeding within an 60 minutes of nativity, while 40.7% exclusively breastfed for six months. Too, 68.5% started complementary feeding at the 6th month of birth, 45.i% breastfed for two years, and 25.4% had a diversity of five or more food groups [i]. In Ghana, previous studies take shown that 56% of infants were initiated to breastfeeding within an hour later birth and 52% exclusively breastfed. Once more, 73% started complementary feeding at the sixth month, fourteen% bottle-feed, and l% breastfeed for twenty-iv months [11, 12]. In sub-Sahara Africa, the overall prevalence of exclusive breastfeeding is 36.0%, with the highest and lowest prevalence reported in Rwanda and Gabon, respectively [13].

Many factors are influencing the early on initiation of breastfeeding and exclusive breastfeeding for six months in Africa. A report in Ethiopia indicated that rural residence, no antenatal follow up, caesarean nascence, and habitation delivery were factors associated with the late outset of breastfeeding [xiv]. Globally, studies have shown that demographics including rural residence, ethnicity, type of employment, richer household wealth quantile and religion, 4+ antenatal care visits, maternal education, knowledge on exclusive breastfeeding, socio-cultural, socioeconomic, nativity in a health facility, social support and psychosocial back up influence exclusive breastfeeding [thirteen, 15–18]. In developing countries, maternal employment, perceptions of inadequate chest milk supply, mother or infant illnesses, and breast problems are identified equally factors that prevent exclusive breastfeeding. Also, socio-cultural factors including, maternal and meaning other's beliefs about infant nutrition, always create barriers to exclusive breastfeeding [19].

Focused antenatal care (FANC) is timely and friendly personalized safe services and care given to a pregnant adult female. It focuses on the women'southward overall health condition, including preparation for childbirth and readiness for complications. Due to the limited number of midwives in Ghana, Community Health Nurses (CHN) and Enrolled Nurses (Auxiliary Nurses) are usually the health workforce during antenatal care visits. Though there is a shortage of midwives, some interventions have been implemented in Republic of ghana to ensure that children are breastfed exclusively for six months. These interventions include mother-to-mother support groups (MMSGs), infant-friendly hospital initiative (BFHI), the Kangaroo mother care programme, and community-based health planning and services (Fries) programme [20]. Although prospects are there during the antenatal visits, counselling mothers on breastfeeding is not done regularly [twenty], withal the recommendations that the prime emphasis of antenatal care intercessions should be on improving mother and infant health [21]. A study in fundamental Republic of ghana indicated that well-nigh one-half of significant women did not receive information on breastfeeding and concluded that the state of affairs is probable to affect the promotion and breastfeeding support [22]. Investigating cognition levels of health professionals, Nsiah-Asamoah [23] reported that counselling mothers on appropriate child feeding practices were a problem for these health professionals. Several obstacles affecting the effective commitment of nutritional care in the antenatal and postnatal intendance settings by health workers have been identified. These include inadequate confidence in nutrition care, bereft nutrition grooming during school, poor nutrition-related knowledge, and lack of resources and time [24–27].

Children demand practiced nutrition to develop proper allowed mechanisms and psychosocial maturity, merely malnutrition can affect their ability to realize this. However, apart from the national demographic and wellness survey, which is carried out every 5 years [12], there is a paucity of empirical studies on kid breastfeeding and weaning practices of caregivers in the Volta Region. Inspired by the pressing need to span the information gap, the study assessed breastfeeding and weaning practices of mothers in the Volta Region of Ghana.

ii. Methods and materials

two.1 Written report site

The study was carried out in the Volta Region, which is 1 of the 16 administrative regions in Republic of ghana. The region is located along the south-eastern part of the country, and shares boundaries with the Republic of Togo to the east, to the west with Greater Accra and Eastern regions, to the north with the Oti Region, and with the Gulf of Guinea to the south. The region has a total land area of about xx,570kmⁱⁱ; about 8.vii% of the total land area of the land [12]. The Volta Region has seventeen administrative districts with a total of five hundred and xx-half dozen health institutions (GHS Annual Report, 2019 [Unpublished]), serving an estimated population of 1,865,332, with children nether five years estimated to exist 261,147 (14.0%) [28]. The region is eighth populated region in Ghana [28] and the quaternary-lowest region, with 4 per cent of the population in the highest wealth quintile later on the Upper West (3.0%), Northern (2.0%), and Upper East (1.seven%) regions in descending order. These figures are lower than the national average of the highest wealth quintile (20.0%) [12]. The region has a 64.9% female literacy rate, 6th in the country but lower than the national average of 67.1% [12]. Almost 71.2% of people in Ghana are Christians, followed by Islam (17.half-dozen%) and Traditionalists (v.2%). Christianity dominates the southern part of Ghana, where the Volta region is, and the northern zone is more than of Islam [29].

2.ii Study population

The study population comprised of mothers who take children between 0 to 59 months and lived in the selected districts. With this, all mothers who were met in the selected households, who agreed to be part of the study, and signed the informed consent forms were recruited. Severely sick people were excluded from the study. Three hundred and xc-six (396) mothers with children less than v years were eligible for the report, and all participated in the written report.

2.3 Study design

This study was a customs-based descriptive cantankerous-sectional assessment of kid feeding practices and factors influencing the conditions of the do among mothers in iii districts (Hohoe, Ho W, and Ketu South) in the Volta Region, and adopted a population-based information gathering to employed participants.

two.iv Sampling and sample size determination

A sample size of 396 mothers and their children was determined based on one,306 households and children less than five years in the selected households in the iii administrative districts (Hohoe, Ketu S, and Ho West) randomly selected in the region. According to the 2010 Population and Health Census of Ghana, the total number of households in Hohoe, Ketu S, and Ho West were 43,329, 39,119, and 23,875 respectively. Yamane's (1998) formulae for population-based sample size decision was then practical [30], to decide the number of households for the districts every bit indicated beneath:

Formula: . Where due north is defined as the sample size to be adamant, Northward is report population, and e is the level of precision (0.05) at 95% confidence level. Using a 10% non-response charge per unit, the number of households required for each district were 436, 433, and 437 for Ketu S, Ho West, and Hohoe, respectively.

A multi-phase cluster sampling method was applied to select the households for the study. The seventeen districts in the Volta region were categorized into 3 ecological zones (Northern, Middle, and Littoral zones). A uncomplicated random sampling process was so employed to selection a district each from the Northern (Hohoe), Center (Ho Due west), and the Coastal (Ketu South) zones. In each district, thirty communities were randomly selected, and proportionate allocation was practical to allocate the number of households to each community. The data collectors picked the first housing unit by moving clockwise from the centre of the community. After the first house, the team followed a specific direction to select the next housing unit. Upon entering a housing unit, the beginning household met was recruited. Where there was no child nether five years in the first household, the side by side household was entered until a targeted child was found in the housing unit. Where in that location were no targeted children in a housing unit, the next housing unit was entered and the same process followed to identify a targeted child for the study.

2.5 Data collection tools and procedure

A pre-tested semi-structured questionnaire was used to collect data from respondents. Data collectors were trained and the questionnaire used to collect data from caregivers with children 0–59 months on caregiver teaching, occupation, education on child care, breastfeeding and baby and young child feeding practices, and childcare practices. The research instrument was interviewer-administered using Computer Assisted Personal Interviews (CAPI) called "RedCap" installed on data collectors' smartphones and executed through face up-to-face interview technique in the homes of the participants. Data were nerveless on explanatory variables which comprised district, household size, age of both mother and child, mother's tribe, religion, educational status, occupation, healthcare services female parent received towards breastfeeding and care including whether the mother received education on childcare and breastfeeding during the post-natal visit, and whether mother was counselled on child feeding practices. We also collected data on the following variables: Time mothers started breastfeeding later on giving birth. In addition to chest milk, what else female parent gave to the kid on the outset twenty-four hour period afterward giving nascency. Whether female parent have ever heard nearly EBF. How many times mother breastfed the kid in a day. Whether the child ever fed from the bottle with a nipple. The appropriate age of a kid when mother call up can start complementary feeding, and months the child should breastfed before weaned off from chest. Our outcome variable of interest was EBF for six months. Probing and follow-upwards questions were used to limit recall bias. The written report was between 13^th October 2018 and eight^th Feb 2019.

2.6 Data analysis

Data collected were entered and cleaned with Statistical Package for Social Sciences (SPSS) V 27 and transported into STATA 14 version for analysis. Descriptive statistics (frequency, percentage) were used in analysing data and presented in frequency tables, cross-tabulations, and charts. Pearson's chi-square and binary logistic regression models were employed to assess associations between explanatory and issue variables (EBF). We used a 5% significance level for statistical assay. Exclusive breastfeeding (EBF) was classified equally apart from medicine prescribed by qualified health personnel female parent has given only breast milk to the child from nativity till 6 months later on nascency, and prolonged breastfeeding as breastfeeding up to 24 months of age.

2.7 Ethical issues

Ethical clearance for the report was provided by the Research Ethics Committee of the University of Health and Allied Sciences (UHAS) in Ghana (ID: UHAS-REC A.6[7] 17/18). Permission was obtained from the District Health Directorates and Community Leaders (including Chiefs and Assembly members) to bear out the written report in their jurisdictions. Participant consent was obtained through the signing/thumb-press of an informed consent course.

3. Results

3.i Background information of participants

3 hundred and ninety-six (396) caregivers and their children under 5 years of age were involved in the study. The median age of the mothers was 29.0 years (IQR: 34.0–23.3), and that of the children was xviii months (IQR: 36.0–7.0). The comparative bulk (44.7%) of the caregivers were betwixt the ages of 20–29 years, while the children were 25–59 months (39.one%). A comparative bulk of the participants (37.6%) were from the Ketu-S district, followed past Ho-West (32.eight%) and Hohoe (29.6%) districts; households with 1–5 members formed the majority (sixty.nine%) in the study. More than one-half (54.8%) of the children were males; five indigenous groups were involved in the study with the bulk (91.9%) being Ewes. Most of the respondents were Christians (91.9%) and had attained bones education (72.2%). Mothers constituting 45.7% were involved in petty trading equally their main occupation (Tabular array ane).

iii.2 Healthcare services mothers received towards breastfeeding and child care

Comparative majority of the mothers (41.9%) received ante-natal care (ANC) during their final pregnancy from a public health centre. Also, 69.9% attended the kickoff ANC facility in the first three months of pregnancy. Although all the mothers went for ANC earlier given birth, 85.i% of them attended four or more times, whilst 3.5% did so once. Well-nigh six in ten (58.8%) received advice on baby care during the ANC visits. Of 63.4% who were counselled on EBF, nine.viii% did not remember the type of feeding practices they were advised on. Afterwards child birth, 45.2% made iv or more than mail service-natal intendance (PNC) visits, 33.3% made one visit, and 1.8% did not visit at all. Of those who went for post-natal care, 27.eight% were advised on baby care (Table ii).

3.3 Breastfeeding and weaning practices of mothers involved in the study

Virtually of the mothers (61.i%) started breastfeeding within an 60 minutes afterward birth. Also, 5.1% of the women gave fluids apart from chest milk to their babies on the offset day of nativity. Well-nigh 11% of the mothers said they have never heard of EBF, while 43.7% noted they had ever or were currently practising EBF. Also, 40.4% breastfed on-demand in a day, 25.three% feed nine or more times, nineteen.4% feed v to viii times, and 14.ix% feed one to four times per day. About half of the mothers (47.7%) ever fed their babies from a bottle with a nipple, while 66.4% remember advisable age to start complementary feeding is vi months. Nigh 56.8% of the mothers used a feeding bottle equally part of utensils used to feed their children. Of the children 0–24 months one-time, 30.3% had been weaned off breastfeeding, with 22.0% of all mothers prolonging breastfeeding for 24 months or beyond earlier weaning. About 48.5% and 63.9% of the children have completed vitamin A supplementation and immunization respectively required for their age (Table 3).

3.four Associations between groundwork characteristics and EBF

The bivariate assay showed pregnant associations between EBF and age of child (p < 0.001) and religion (p = 0.022). Besides, when the variables were adjusted for confounding effects using multivariable logistic regression assay, it further confirmed the associations and indicated that children age 7–12 months former (AOR: 0.93, 95%CI: 0.46–two.29, p = 0.029), xiii–24 months old (AOR: 0.28, 95%CI: 0.xiv–0.58, p = 0.001), and 25–59 months old (AOR: 0.23, 95%CI: 0.12–0.43, p < 0.001) were less likely to have been exclusively breastfed than children who were 0–6 months. Likewise, Islamic faith (AOR: 1.86, 95%CI: 1.54–5.42, p = 0.033) and Traditionalist (AOR: three.92, 95%CI: 1.29–v.78, p = 0.021) were more than likely to have exclusively breastfed their babies compared to Christians (Table iv).

3.five Associations between healthcare services mothers received towards breastfeeding and EBF

The study showed a pregnant association betwixt EBF and feeding practice mothers counselled on (p = 0.001). Furthermore, when a variable that had an association with EBF was adapted to eliminate misreckoning effects, the association was further confirmed and revealed that mothers counselled on complementary feeding (AOR: 0.35, 95%CI: 0.22–3.33, p = 0.003) and those who did not remember what they were counselled on (AOR: 0.36, 95%CI: 0.12–1.89, p = 0.023) were less probable to exclusively breastfeed their babies than those counselled on mixed feeding. Mothers who were counselled on EBF (AOR: 1.72, 95%CI: 1.26–3.09, p = 0.016) were more likely to exclusively breastfeed their babies compared with those counselled on mixed feeding (Table 5).

3.6 Associations between child feeding and weaning practices and 6 months EBF

The study showed significant associations between EBF and whether mother had ever heard virtually EBF (p = 0.043); babies ever fed from bottles with nipple (p = 0.001); prolong breastfeeding (p < 0.0001), and age starting complementary feeding (p < 0.001). Additionally, when variables that were having associations with EBF from the bivariate analysis were tested for confounding effects using multivariable logistic regression analysis, we plant that mothers who had never heard virtually EBF were less likely to exclusively breastfeed their babies (AOR: 0.46 95%CI: 0.27–4.18, p = 0.039) than those who had heard near EBF; babies never fed from the canteen with a nipple were more than likely to exist breastfed exclusively (AOR: 1.63, 95%CI: i.94–2.48, p = 0.003) than their peers who had always been fed from bottle with nipple. Mothers who think appropriate age to start complementary feeding is i–3 months (AOR: 3.40, 95%CI: i.51–4.83, p = 0.021), 4–5 months (AOR: 2.52, 95%CI: ane.47–iii.71, p = 0.028), 6 months (AOR: 7.43, 95%CI: three.47–7.55, p = 0.001), and mothers who exercise non know when to offset complementary feeding (AOR: 1.62, 95%CI: 1.36–4.76, p = 0.008) were more than probable to practice EBF than those who recollect appropriate age to start complementary feeding to exist less than a month. Also, children who did not do prolong breastfeeding were less likely to be associated with EBF (AOR: 0.41, 95%CI: 0.12–0.87, p = 0.001) than their peers who were still breastfeeding (i.e. practicing prolong breastfeeding) (Table 6).

4. Give-and-take

Preparations towards child care, including breastfeeding and all other feeding practices, are expected to begin during pregnancy. Pedagogy towards the achievement of the goal is given at health facilities when mothers visit for ANC services. However, 14.ix% of the mothers in this study did not attend the recommended four or more ANC visits for every significant woman and did non observe whatever association between ANC visits and EBF. Although ANC visits and services received including childcare and feeding practices are expected to influence child feeding, only 63.4% and 2.eight% of the mothers were counselled on EBF and complementary feeding during the ANC visits. A little over quarter (27.8%) of them were counselled on kid feeding and intendance during mail-natal care visits in apprehension that there will be an improved child intendance and feeding practices.

Improvement in kid care, including breastfeeding, requires that mothers, especially working mothers become support and encouragement from peers, close relatives, and non-family members. Studies take shown that child care and breastfeeding improves in areas where mothers do receive support, counselling, and regular visits from peers, family, and non-family members [31–33]. Evidence has shown that early initiation of breastfeeding and exclusive breastfeeding in the first month of life tin reduce about 23% of neonatal deaths [34]. A causal relationship between early babe feeding practices and infection specific neonatal bloodshed report showed that new-borns who started breastfeeding within i hour of birth were less likely to die of neonatal sepsis than those who did not [35]. Another systematic review study agrees with these finding and stated that infants who initiated breastfeeding 2–23 hours afterwards nascency had 33% greater risk of neonatal mortality, and infants who initiated breastfeeding ≥24 hours later on birth had virtually 2.2-fold greater risk of neonatal mortality compare to infants who initiated breastfeeding ≤one hour after birth [36]. Despite these dangers, only 61.i% of caregivers in the study initiated feeding within an hour of birth and 43.vii% of the mothers practised EBF. This is inconsistent with global figures, and what was reported in Ghana's demographic and health survey and in the Keta-North district in Ghana [1, 11, 12, 37]. A study notwithstanding has shown that many mothers are facing breastfeeding bug because their traditional source of learning has been reduced as extended families are gradually being replaced by nuclear families, providing little opportunities for caregivers to learning well-nigh appropriate breastfeeding [38]. Some other challenge has to practise with atmospheric condition such as formula feeding practices, breast engorgement, sore nipple, nipple trauma, and insufficiency of milk [39]. Hence, to enable a female parent to kickoff or proceed enjoying the lactation process, prevention and management of these challenges are significant.

Several approaches can exist employed to promote exclusive breastfeeding in the Volta region. For instance, an intervention report to explore the influence of peers on sectional breastfeeding in sub-Saharan Africa concluded that depression-intensity private breastfeeding peer counselling methods could effectively increment the prevalence of EBF in the sub-region [40]. Another intervention study in South Africa indicated that self-efficacy significantly predicted breastfeeding initiation and elapsing. It concluded that supporting breastfeeding behaviour through programmes that include both individual-level and multi-systems modules aiming the office of healthcare providers, family and customs may craft environments that value and support EBF behaviour [41].

The study revealed that 66.4% of the caregivers started complementary feeding at six months. This finding disagrees with the global information, Ghana Demographic and Wellness Survey, and the Keta-Due north district study [1, 11, 12, 37]. Yet, from six months afterwards nascency, breastmilk alone is not enough to meet all nutritional needs leading to increased risk of malnutrition among infants. Therefore, acceptable and appropriate complementary feeding needs to be started at the 6th month to supplement the breast milk [42]. A study has also shown that the tardily introduction of complementary feeding can lead to agin health consequences, including deficiencies of zinc, protein, fe, and the B-vitamins and vitamin D that will lead to growth suppression and cause and rickets [43, 44]. Hence, children need a thoughtful developed who will not merely select and offer appropriate foods but also assist and encourage them to swallow these foods in sufficient quantities to run into their nutritional needs. This report also indicated that caregivers who started complementary feeding in the sixth month after birth, have a higher take chances of practising EBF than caregivers who started complementary feeding before the sixth month, this is non surprising because sectional breastfeeding should last for at least six months.

Early on termination of breastfeeding seems to pose a huge claiming in Africa. This report has shown that xxx.three% of the mothers did not proficient prolong breastfeeding, while another study in Southward Africa reported that 20% of HIV-negative women stopped breastfeeding their children by the third month of birth and called for an urgent need to improve antenatal breastfeeding counselling [45]. Although teaching and counselling on child feeding and care start from pregnancy and given during ANC visits. The child breastfeeding reported in this study and other parts of Africa could have arisen because caregivers do not attend ANC during pregnancy, and those who do attend practice not nourish oft and regularly [32]. For instance, simply 69.9% of the mothers attended ANC within the first trimester of gestation. A study however showed that 72.7% of mothers do not even know the right gestation age at which a pregnant woman should start attention antenatal care [46]. This could exist due to the availability of health facilities in terms of geographical and fiscal accessibility as may exist corroborated by a study in Nigeria confirming that affordability and proximity of wellness intendance facility influences significant women's pick of wellness establishment they attend [47]. Hence, it was not surprising that this study showed that caregivers who terminated breastfeeding before 24 months were less probable to have practised exclusive breastfeeding. Interventions targeted at extending the duration of breastfeeding in populations need to focus on enhancing caregiver's self-confidence concerning breastfeeding [48].

To enhance breastfeeding practices, caregivers are encouraged not to utilize pacifiers and canteen-feeding because supplementary feedings, irrespective of the method use (loving cup or bottle), have a detrimental effect on breastfeeding duration [49]. Nevertheless, 47.vii% of caregivers take ever fed their babies from a canteen with a nipple, and 56.eight% were still practising bottle-feeding. Meanwhile, only 4.ii% of caregivers are known to follow all the five steps to ensure bottle-feeding is safe [l]. However, canteen-feeding is a known leading cause of diarrhoea [51]. Some other report has shown that children need to be protected from common cold temperatures because they are at increased risk from cold stress, especially those with depression weights [52]. A written report reported that infants experience warmer during breastfeeding than bottle-feeding [53].

Health didactics and health promotion have shown quite substantial effects on behaviour alter. Nonetheless, learning principles including rewards and feedback, that accept shown increase effectiveness, are frequently not adequately applied [54]. This agrees with the present report finding, which revealed that caregivers counselled on kid feeding practices was associated with EBF. Another study in North-western Ethiopia, also reported that mothers who received breastfeeding counselling during ANC were more probable to practice EBF than their counterparts [55]. Nonetheless, a study underscores the need to develop more than effective individual interventions than providing wide-based and community-wide health education programmes [56].

Child age was also associated with EBF, with studies in Southern Brazil and South-western Ethiopia which both correlate with the fact that child age is indeed associated with EBF [57, 58]. The associations showed that as a kid grows, the rate of exclusive breastfeeding reduces, which may be that caregivers are tempted to give nutrient to children as they require for nutrient. However, a report has shown that EBF for six months has the potential to reduce child mortality [35]. The study in Brazil [56] agrees with the present study that feeding a child with a pacifier (bottle with nipple) is associated with EBF. A written report revealed that children never fed with pacifiers were having a greater chance of being exclusively breastfed, and concluded that children fed with pacifiers are at higher adventure of getting an infection than those not fed with pacifiers [51].

Knowledge and awareness of breastfeeding recommendations may greatly influence breastfeeding practices, and this was revealed in this report, which indicated that caregivers who take never heard near EBF are less probable to practise EBF than caregivers who have ever heard. This finding agrees with another study, which indicated that women without the knowledge and awareness of exclusive breastfeeding had a higher run a risk of ceasing breastfeeding early compared with women who know about breastfeeding [59]. Hence, public health officials need to continue childcare and feeding education unceasingly and involve personalities who matter in maternal and child health issues in the communities in the breastfeeding and child care processes.

Religious interest can influence several health outcomes as indicated in this study, which revealed that religion was associated with EBF. This further agrees with both the results of the Fragile Families and Kid Wellbeing and the United State of America studies [60, 61]. Therefore, agreement religious differences in breastfeeding could enable public health professionals to more finer handle susceptible populations.

4.1 Written report limitation

The study could not assess the nutritional status of the children to compare with the feeding and weaning practices to decide the effect of the practices on the nutritional outcomes. We also recollect a cross-sectional quantitative study may not be plenty to explore the actual picture of EBF and the associated factors. Again, recall bias could also affect the written report outcome. Notwithstanding, we believe that the limitation cannot invalidate the findings of the study.

five. Conclusion

Childcare and breastfeeding educational activity has been going on in the written report surface area and Ghana for decades, notwithstanding mothers' knowledge and practices of breastfeeding revealed in the study are not promising. We, therefore, recommend innovative policies that include all-encompassing public instruction to improve the breastfeeding and weaning practices of mothers.

Supporting information

Acknowledgments

The authors limited their appreciation to the staff of the University of Health and Allied Sciences (UHAS) and Yonsei University who played various roles in the projection, also the community leaders and students of UHAS for the support and role they played in this work. Not to forget Professor Fred N. Binka, the former Vice-Chancellor of the University of Wellness and Allied Sciences (UHAS), who initiated the collaboration between the Yonsei University and UHAS.

The study was part of a partnership project between the University of Health and Allied Sciences (UHAS) in Ghana, and the Yonsei Academy in South korea. The 4-year Public Health Educational Capacity Development collaborative project financed by the National Research Foundation of Korea (NRF) started between the two universities in April 2017 and aimed at empowering UHAS to train health care professionals who tin contribute to the advancement of healthcare in Ghana. The specific objectives of the Yonsei-UHAS project include the development of faculty educational activity and research chapters, remodelling of educational curriculum, and reorganizing of vocational preparation of UHAS. The School of Public Health (SPH), School of Nursing and Midwifery (SONAM), and Schoolhouse of Medicine (SOM) were schools that participated in the project out of the six schools in UHAS. This manuscript emanated from the community wellness needs assessment conducted betwixt 13th October 2018 and 8th February 2019 to understand the health needs of the Volta Region, Ghana.

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