Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana

INTRODUCTION: Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have consistently revealed a decline in EBF rates in Ghana. The World Food Programme implemented an intervention for Enhanced Nutrition and Value Chain (ENVAC) which was based on three pillars including pregnant women, lactating women, adolescent and children under two years old being beneficiaries of the third pillar since the first 1000 days are critical for averting malnutrition. The social behavior change communication (SBCC) interventions implemented as part of this project have a potential to increase EBF among beneficiaries but this has not been measured. Therefore, this study assessed the prevalence of EBF practice among mothers with children under two years old who were beneficiaries of the ENVAC project and its associated factors in northern Ghana. METHODS: This was a cross-sectional study involving 339 mother-child pairs in two districts of the northern region of Ghana. Participants were mother-child pairs who benefitted from the ENVAC project, which used SBCC strategies to promote good feeding and care practices as well as address other causes of malnutrition during antenatal care and child welfare clinic services among pregnant women, lactating mothers, and children under two years. We used WHO standard questionnaire to assess breastfeeding practices. Factors associated with EBF were modelled using multivariable logistic regression. RESULTS: Exclusive breastfeeding was 74.6% (95%CI = 69.5% -79.2%) in the ENVAC project areas, a 31.7% points higher than recent national levels. Adjusted analyses showed that EBF practice was associated with increasing maternal education: moderately educated women [aOR = 4.1 (95% CI = 2.17–7.66), P<0.001], and high [aOR = 9.15, (95% CI = 3.3–25.36), P<0.001], and access to pipe-borne water in households [aOR = 2.87, (95% CI = 1.11–7.43), P = 0.029]. CONCLUSION: A social behaviour change communication strategy implemented by ENVAC to lactating mothers likely improved exclusive breastfeeding practice in two districts of northern Ghana. EBF practices were higher among beneficiaries with high education and households with access to pipe-borne water. A combination of SBCC strategies and maternal and household factors are likely the best way to increase EBF rates in impoverished communities and warrants further investigation through future research.