title: Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: a descriptive cross-sectional study.
abstract: BACKGROUND
  The challenges and predictors of exclusive breastfeeding (EBF) have been examined in many parts of the world. Considering the socio-cultural dynamics and the few research studies in Ghana, the factors that hinder and predict EBF practice in other countries may be different in the Ghanaian setting. The study therefore sought to assess the challenges and predictors of EBF among mothers attending a child welfare clinic at a regional hospital in Ghana.
  
  
  METHODS
  A descriptive cross-sectional study was carried out between January and March, 2015 to elicit information from 240 mothers who were sampled using simple random sampling technique. A validated structured questionnaire was used in collecting data on participants' socio-demographic characteristics and reported breastfeeding practices. Participants' breastfeeding challenges were rated on a Likert scale from 1 (not at all), 2 (mild), 3 (moderate), 4 (severe) to 5 (unbearable). In this study, EBF refers to birth of the infants up to six months.
  
  
  RESULTS
  The top three breastfeeding challenges of mothers were: belief that breast milk alone was not sufficient in meeting their babies' nutritional needs [mean 3.43 (standard deviation {SD} 1.35)], short maternity leave period [mean 3.41 (SD 1.29)], and socio-cultural pressure to introduce water and artificial feeds [mean 3.39 (SD 1.28)]. Independent predictors of EBF were: infant's age [Adjusted Odds Ratio (AOR) 0.82 (95% Confidence Interval [CI] 0.71, 0.95)], and self-employment [AOR 2.67 (95% CI 1.11, 6.41)].
  
  
  CONCLUSIONS
  Mothers are confronted with numerous EBF challenges both at the individual and societal levels, and stakeholders need to consider these in order to support breastfeeding mothers to maximize outcomes. Reviewing the labour laws on Ghana's maternity leave to accommodate an extended maternity leave in addition to the employee's annual leave could further improve EBF practice rates.
authors.affiliation: Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana.
authors.forename: Abigail Kusi-Amponsah
authors.initials: AK
authors.lastname: Diji
authors.affiliation: Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bam
authors.affiliation: Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Asante
authors.affiliation: Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana.
authors.forename: Alberta Yemotsoo
authors.initials: AY
authors.lastname: Lomotey
authors.affiliation: Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Yeboah
authors.affiliation: Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana.
authors.forename: Haim Acquah
authors.initials: HA
authors.lastname: Owusu
keywords: Breastmilk; Exclusive breastfeeding challenges; Exclusive breastfeeding predictors; Ghana; Infants; Mothers