Duration of exclusive breastfeeding and subsequent child feeding adequacy

Objective: Mothers of young children in Ghana believe that breastfeeding exclusively for six months impairs subsequent introduction of other foods. The current study was designed to determine whether feeding adequacy among 9-23 months old children is influenced by duration of exclusive  breastfeeding.Design: We surveyed 300 mother-infant pairs attending child-welfare-clinic at the University of Ghana Hospital, Accra. Data collected included  sociodemographic characteristics, morbidity, breastfeeding history, and maternal practices and perception on child feeding and temperament. Current child feeding was assessed using 24-hour dietary recall.  Adequately fed children were defined as 9-23 month old children meeting three basic feeding adequacy thresholds: 1) was fed complementary foods, at least three times in the last 24 hours, 2) was fed from at least three food groups, and 3) received breast milk in the last 24 hours. Multiple logistic regressions were used to identify independent predictors of child feeding adequacy.Results: About 66% of children were exclusively breastfed for six months and only 56% were adequately fed in the in the 24 hours preceding the survey. Child feeding adequacy was unrelated to duration of exclusive breastfeeding (OR=0.73; p=0.30). After controlling for child sex, age, and maternal education, the independent determinants of feeding adequacyincluded recent child morbidity (OR=0.41; p=0.03), number of caregivers who feed child (OR=1.33; p=0.03), and maternal perception that child does not like food (OR=0.25; p<0.01). Child temperament was unrelated to feeding adequacy.Conclusion: Child feeding adequacy is not affected by duration of exclusive breastfeeding. The study provides evidence to address misperceptions about exclusively breastfeeding for six months.Key words: Exclusive breastfeeding, child, dietary diversity, feeding adequacy, duratio

State of dietetics practice in Ghana

Objective: Prevalence of obesity and related diseases has increased in Ghana. Dietitians have essential skills to prevent and manage dietary diseases. However, little is known about dietetic practice in Ghana. This paper describes the history and current state of dietetics practice in Ghana.Methods: A questionnaire was administered to 13 dietitians and six dietetic interns in February 2012. The questionnaire collected data on perceptions about dietetics practice, career progression, and challenges in dietetics practice in Ghana. Key informant interviews (KII) on history of dietetics in Ghana were also held with four retired dietitians, and two dietetics  educators. Additional KII were conducted with the Chief dietitian, two officers of the Ghana Dietetic Association, and three other dietitians. Most KII were conducted faceto-face but a few were only possible via telephone.Some of the KII were audio-recorded, in addition to handwritten notes. Following transcription of audiorecorded interviews, all data were subjected to content analysis.Results: Dietetic practice in Ghana has evolved from low-skilled cadre (catering officers) offering hospitalbased meal services to the current era of available trained dietitians providing diet therapy in diverse settings. However, 80% of the 35 dietitians identified are working in Accra. In three regions of Ghana, there are no dietitians. There remain limited  opportunities for continuous learning and professional career advancement.Additionally, there are many unqualified dietitians in practice.Conclusion: A huge unmet need for dietitians exists in all regions of Ghana, except Greater Accra. Bridging this gap is essential to increase access to dietetic care throughout Ghana.Keywords: dietetics, professional practice, history, situational analysis, Ghan

Pathways Utilized for Antenatal Health Seeking Among Women in the Ga East District, Ghana

Background: Ghana’s maternal mortality ratio has been declining over the last two decades but at a rather slow pace. Poor access to effective maternity care is identified as one of the key challenges of maternity care. The current study mapped out the pathways to pregnancy care seeking among urban-dwelling adult women in a peri-urban district located in the Greater Accra region of Ghana.Methods: A total of 300 women who had a live birth in the last 12 months participated in a communitybased survey. They answered questions on care seeking behavior related to their last pregnancy. A multivariate Logistic regression model was used to identify factors associated with multiple care seeking behavior.Results: Almost all women in the survey (98%) reported accessing skilled antenatal care (ANC) from a biomedical provider, although 35% begun ANC later than the first trimester. About 45% of women simultaneously utilized both ANC and alternative care providers (ACP) including traditional birth attendants, herbalists, and spiritualists. A complex pathway to antenatal care seeking behavior involving shuttling between providers was observed. Controlling for household wealth, household size, and age, seeking care from multiple providers concurrently was associated with residence in Kwabenya sub-district OR=2.13 (95% CI: 1.28, 3.55) and previous abortion OR=2.08 (95% CI: 1.11, 3.91)Conclusions: Urban-dwelling women in Ga East District seek antenatal care concurrently from multiple sources. Health system interventions must seek ways to integrate alternative care providers into the existing biomedical health care system.Keywords: multiple care seeking, pregnancy, pathway, alternative care, antenata