Time trends in the prevalence and determinants of age-appropriate breast feeding among children aged 0–23 months in Ghana: a pooled analysis of population-based surveys, 2003–2017

OBJECTIVE: We assessed the sociodemographic and maternal–child characteristics associated with age-appropriate breast feeding among children aged 0–23 months in Ghana. METHODS: We pooled data on 12 743 children aged 0–23 months from three Demographic and Health Surveys (2003, 2008 and 2014) and three Multiple Indicator Cluster Surveys (2006, 2011 and 2017–2018). The outcome was age-appropriate breast feeding from birth to 23 months, with age-appropriate breast feeding defined as exclusive breast feeding at 0–5 months (ie, at less than 6 months) and breastfeeding alongside appropriate complementary feeding at 6–23 months. Potential determinants were maternal–child sociodemographic, obstetric and healthcare factors. Logistic regression was used to determine the factors associated with age-appropriate breast feeding. We accounted for the complex sampling design of the cross-sectional surveys in the analysis. RESULTS: Most children aged 0–3 months were exclusively breastfed. Among children aged 4–5 months, the most common feeding pattern was breastfeeding alongside water and/or solid foods. Exclusive breastfeeding prevalence in children less than 6 months peaked in 2008 at 62.8% and declined to 42.9% in 2017. For 6–11 month olds, the percentage experiencing age-appropriate breast feeding has been stable over the last four surveys, ranging from 79.3% in 2008 to 81.1% in 2017. Age-appropriate breast feeding in 12–23 month olds declined from 77.8% in 2003 to 61.2% in 2017. Rural residence, younger age, non-facility births and multiple births were associated with decreased odds of exclusively breast feeding. For 6–11 month olds, age-appropriate breast feeding was less likely if the woman did not receive postnatal care. Younger age, being unmarried, high income, wanting a child later and earlier birth order were associated with decreased odds of age-appropriate breast feeding in 12–23 month olds. CONCLUSION: Ghanaian children are now less likely to be exclusively breastfed than they were a decade ago. To succeed, breastfeeding promotion programmes should adopt approaches that address the predictors of suboptimal breast feeding at each age, as identified in this study.