MedicineDepartment of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
BMC Public Health. 2023 May 19;23(1):920. doi: 10.1186/s12889-023-15758-w.
Exclusive breastfeeding is a public health priority in sub-Saharan Africa. However, systematic reviews on its determinants in Ghana remain scarce. Therefore, we systematically reviewed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana.
We conducted systematic searches in Embase, Medline, and Africa-Wide Information from the databases' inception until February 2021 for studies that assessed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana. Random-effects meta-analysis was used to estimate the pooled prevalence of exclusive breastfeeding and narrative synthesis to summarise the determinants. We calculated the proportion of total variability that was due to between study heterogeneity using I² statistics, and Egger's test assessed publication bias. The review is registered with PROSPERO, CRD42021278019.
Out of the 258 articles identified, 24 met the inclusion criteria. Most of the included studies were cross-sectional and were published between 2005 and 2021. The pooled prevalence of exclusive breastfeeding (EBF) among children 0-6 months in Ghana was 50% (95%CI 41.0-60.0%). The prevalence was higher in rural areas (54%) than in urban areas (44%). Several factors were identified as facilitators of EBF, including older maternal age, self-employment, unemployment, living in a large house, being a house owner, giving birth in a health facility, non-caesarean delivery, adequate antenatal attendance, counselling services, participation in support groups, adequate knowledge about EBF, positive attitude towards EBF, and higher maternal education among rural dwellers. Additionally, having an average birthweight facilitated EBF. Barriers to EBF were also identified, including higher maternal education among urban dwellers, less than three months of maternity leave, maternal HIV-positive status, the experience of partner violence, lack of access to radio, inadequate breastmilk production, lack of family support, having a partner who wants more children, counselling on complementary feeding, healthcare worker recommendation of complementary feed, single marital status, and infant admission to neonatal intensive care units.
In Ghana, EBF rates are low, with only about half of all children aged 0-6 months breastfed exclusively. A multi-dimensional approach is required to tackle the diverse sociodemographic, obstetric, and infant-related issues that hinder EBF practice in Ghana.
在撒哈拉以南非洲地区，纯母乳喂养是一项公共卫生重点。然而，关于加纳母乳喂养决定因素的系统评价仍然很少。因此，我们系统地检索了 Embase、Medline 和 Africa-Wide Information 数据库，以评估加纳 0-6 个月儿童纯母乳喂养的流行率及其决定因素。我们采用随机效应荟萃分析来估计纯母乳喂养的汇总流行率，并采用叙述性综合法来总结决定因素。我们使用 I² 统计量来计算研究间异质性引起的总变异性比例，并采用 Egger 检验评估发表偏倚。该综述已在 PROSPERO 注册，注册号为 CRD42021278019。
在 258 篇文章中，有 24 篇符合纳入标准。纳入的研究大多为横断面研究，发表时间在 2005 年至 2021 年之间。加纳 0-6 个月儿童纯母乳喂养的汇总流行率为 50%（95%CI 41.0-60.0%）。农村地区的母乳喂养率（54%）高于城市地区（44%）。有几个因素被确定为促进纯母乳喂养的因素，包括母亲年龄较大、自营职业、失业、居住在大房子里、房屋所有者、在医疗机构分娩、非剖宫产分娩、充分的产前保健、咨询服务、参与支持小组、对纯母乳喂养有足够的了解、对纯母乳喂养的积极态度、农村地区母亲的教育程度较高等。此外，平均出生体重也促进了纯母乳喂养。还确定了纯母乳喂养的障碍，包括城市居民的母亲教育程度较高、产假不足三个月、母亲 HIV 阳性状态、经历伴侣暴力、无法收听广播、母乳分泌不足、缺乏家庭支持、伴侣想要更多孩子、关于补充喂养的咨询、保健工作者推荐补充喂养、单身婚姻状况以及婴儿被收入新生儿重症监护病房等。
在加纳，纯母乳喂养率较低，只有大约一半的 0-6 个月大的儿童进行纯母乳喂养。需要采取多维度的方法来解决加纳母乳喂养实践中存在的各种社会人口学、产科和婴儿相关问题。
