PATH/Aurelio Ayala III Ayala PATH/Aurelio GHANA GHANA PROMOTION OF COMPLEMENTARY FEEDING PRACTICES PROJECT BASELINE SURVEY REPORT DECEMBER 2011 This document was produced through support provided by the US Agency for International Development under the terms of Cooperative Agreement No. GPO-A-00-06-00008-00. The opinions herein are those of the author(s) and do not necessarily reflect the views of the US Agency for International Development. Acknowledgments The Ghana Promotion of Complementary Feeding Practices Project would like to express our profound gratitude to the Regional Health Management Team of Brong Ahafo for their immense contributions and support. Thank you to the members of the District Health Management Teams of the nine districts—Sene, Jaman South, Asutifi, Atebubu-Amanten, Sunyani West, Kintampo South, Asunafo South, Nkoranza North, and Tain—for providing technical support and participating in the data collection process. iii Table of contents Acknowledgments.......................................................................................................................... iii Acronyms ....................................................................................................................................... vi Executive summary ....................................................................................................................... vii 1. Introduction ................................................................................................................................. 1 1.1 Background ........................................................................................................................... 1 1.2 Geographical focus ................................................................................................................ 1 1.3 Purpose of the baseline study ................................................................................................ 1 2. Methodology ............................................................................................................................... 2 2.1 Sampling................................................................................................................................ 2 2.2 Data collection methods ........................................................................................................ 2 2.3 Quality control....................................................................................................................... 3 2.4 Data analysis ......................................................................................................................... 3 3. Findings....................................................................................................................................... 4 3.1 Sociodemographic characteristics of study participants ....................................................... 4 3.2 Exclusive breastfeeding knowledge and practices ................................................................ 7 3.2.1 Beliefs and perceptions on exclusive breastfeeding ....................................................... 7 3.2.2 Initiation of breastfeeding ............................................................................................... 7 3.3 Exclusive breastfeeding practices ......................................................................................... 8 3.4 Complementary feeding knowledge and practices................................................................ 9 3.4.1 Initiation of complementary feeding .............................................................................. 9 3.4.2 Frequency of feeding .................................................................................................... 10 3.4.3 Amount of food per meal .............................................................................................. 10 3.4.4 Feeding a variety of foods to children 6-24 months ..................................................... 11 3.4.5 Use of commercially fortified complementary foods ................................................... 13 3.4.6 Nutrient density ............................................................................................................ 14 3.4.7 Responsive feeding ....................................................................................................... 15 3.5 Sources of health information for caregivers ...................................................................... 16 3.5.1 Membership of community-based groups .................................................................... 16 3.5.2 Access to infant and young child feeding information within community groups ...... 17 3.5.3 Access to infant and young child feeding information at health facilities ................... 17 3.5.4 Content of infant and young child nutrition information received at health facilities . 18 3.6 Media sources of infant and young child nutrition information.......................................... 19 3.6.1 Access to infant and young child nutrition information through the media ................. 20 3.6.2 Participation in radio discussions via call-in ................................................................ 21 3.7 In-depth interviews with health workers ............................................................................. 21 3.7.1 Counseling practices and knowledge on infant and young child nutrition................... 21 3.7.2 Knowledge on current recommendations on infant and young child feeding .............. 21 3.7.3 Prevalence of anemia in communities .......................................................................... 23 3.7.4 In-service training on infant and young child feeding .................................................. 23 3.7.5 Access to infant and young child nutrition information ............................................... 23 iv 4. Discussion ................................................................................................................................. 24 4.1 Group membership and discussion of infant and young child nutrition-related issues ...... 25 4.2 Positioning the findings in the literature ............................................................................. 25 5. Conclusions ............................................................................................................................... 27 6. Recommendations ..................................................................................................................... 28 7. References ................................................................................................................................. 29 Appendix 1. Selected study districts and communities ................................................................ 30 Appendix 2. Baseline study tools.................................................................................................. 31 Appendix 3. Data collectors .......................................................................................................... 52 Appendix 4. Supervisors/Team leaders for data collection .......................................................... 53 v Acronyms BCC behavior change communication FGD focus group discussion GAIN Global Alliance for Improved Nutrition GDHS Ghana Demographic and Health Survey IEC information, education, and communication PATH Program for Appropriate Technology in Health UNICEF United Nations Children‘s Fund WHO World Health Organization vi Executive summary Appropriate complementary feeding practices still remain a challenge in Ghana, and Brong Ahafo Region is no exception. The 2008 Ghana Demographic and Health Survey (GDHS) indicated that a large majority of young children in Ghana were not being fed appropriately; and overall, feeding practices met the minimum standards for only 36% of children aged 6-24 months. The most common problem was feeding nutritionally inadequate meals. Only 46% of children were fed the minimum number of times. Children aged 12-17 months (44%) were the most likely to be fed according to all three recommended infant and young child feeding practices, while those aged 6-8 months (28%) were the least likely to be fed according to recommended practices. In Brong Ahafo Region, 47% of children were put to the breast within one hour of delivery (GDHS 2008). Objective/Purpose of the study The United States Agency for International Development‘s Infant & Young Child Nutrition (IYCN) Project, the Ghana Health Service, the Global Alliance for Improved Nutrition (GAIN), and PATH conducted a baseline study in nine districts between June and July 2011. The objective was to provide an in-depth analysis of infant and young child feeding knowledge, practices, and behaviors as a baseline to guide the implementation of the Ghana Promotion of Complementary Feeding Practices Project, and to provide a basis for monitoring and evaluating the effectiveness of the behavior change communication campaign. Methods A mixed design involving qualitative and quantitative methods was used to conduct the study. Data were collected using a structured survey, in-depth interviews, and focus group discussions. The study participants were drawn from 45 communities within the nine project districts. The communities were selected based on the presence of mother support and/or church-based groups. Purposeful sampling was used to select the female caregivers of children 6-24 months. Fathers of children 6-24 months, health