Barriers to Exclusive Breastfeeding Among Nursing Mothers at Tamale West Hospital: A Cross-Sectional Study

Barriers to Exclusive Breastfeeding Among Nursing Mothers at Tamale West Hospital: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Barriers to Exclusive Breastfeeding Among Nursing Mothers at Tamale West Hospital: A Cross-Sectional Study Gideon Adu Nyarko, Edward Kofi Sarfo, Frank Amoako, Simon Agongo Azuri, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6549105/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background: The World Health Organization recommends exclusive breastfeeding (EBF) as the primary nutritional requirement for the first six months of an infant’s life. However, various factors may influence whether mothers practice EBF effectively. The goal of this study is to evaluate the knowledge level, constraints, and maternal factors associated with exclusive breastfeeding practices among nursing mothers attending postnatal care at a tertiary teaching hospital in Ghana-West Africa. Methods: A facility-based cross-sectional study was conducted among nursing mothers at Tamale West Hospital, Ghana. Using Cochran’s formula, 382 participants were selected through simple random sampling. Data were collected using a structured questionnaire and analyzed with STATA. Descriptive statistics and inferential analyses were performed at a 5% significance level. Results: Mothers reported several constraints, notably insufficient breastmilk production (M = 4.82, SD = 3.43), cracked or sore nipples (M = 4.03, SD = 3.12), and shyness when breastfeeding in public (M = 3.61, SD = 3.01). Constraint scores did not differ significantly between exclusive and non-exclusive breastfeeding groups. Maternal age (χ² = 237.71; p < 0.001), educational status (χ² = 294.90; p < 0.022), employment status (χ² = 301.26; p < 0.000), parity (χ² = 404.37; p < 0.020), and mode of delivery (χ² = 298.45; p < 0.003) were significantly associated with EBF practices. Conclusion: Nursing mothers generally have good knowledge of exclusive breastfeeding yet face multiple constraints that can hinder its practice. Addressing these barriers and considering maternal factors such as age, education, and employment status are essential to improving exclusive breastfeeding rates and ensuring optimal infant nutrition. Biological sciences/Physiology Health sciences/Health care Health sciences/Health care/Nutrition Health sciences/Health care/Patient education Breastfeeding Exclusive breastfeeding Nursing mother Barriers Tamale West Hospital BACKGROUND Exclusive breastfeeding (EBF)—the practice of feeding infants only breast milk for the first six months of life—plays a pivotal role in promoting optimal infant growth, health, and survival. , Breast milk provides immunoglobulins that protect against infections and offers a safe, hygienic, and nutritionally complete food source for infants. , , Additionally, breastfeeding benefits mothers by reducing the risk of certain cancers and type 2 diabetes, while also being more cost-effective than formula feeding. , Despite these advantages, only 41% of infants under six months of age worldwide were exclusively breastfed in 2019, falling short of the global targets of at least 50% by 2025 and 70% by 2030. Just 37% of infants younger than six months old in low- and middle-income nations receive all their breast milk. Several nations have largely embraced the WHO's 6-month EBF policy. Nevertheless, most babies are not EBF at six months, especially in developed nations. In Ghana, infant mortality is strongly linked to suboptimal breastfeeding and infant feeding practices. Between 2006 and 2010, 63% of infants under six months were exclusively breastfed, a modest increase from 53.4% in 2003. Although progress has been attributed in part to increased maternal education, numerous barriers remain. Mothers often face conflicting advice, social pressure to introduce water or artificial feeds, and the belief that breast milk alone is insufficient (Diji et al., 2017). Furthermore, anecdotal evidence from Tamale West Hospital suggests some mothers perceive exclusively breastfed infants to have poorer appetites when transitioning to complementary foods compared to those who were not exclusively breastfed. Working mothers cite limited time and inadequate support after maternity leave as disincentives to continue exclusive breastfeeding. Research also indicates that close relationships, or cultural guardians can negatively influence breastfeeding decisions and the burden of household duties further complicates EBF. , , Several national policies and initiatives—such as the National Child Health Policy, the Baby-Friendly Hospital Initiative, and the National Nutrition Policy—have been introduced in Ghana to promote breastfeeding initiation and sustain EBF among infants under six months. While these efforts aim to reduce infant mortality and improve child health, exclusive breastfeeding rates remain below expectations (Agunbiade & Ogunleye, 2012; Ghana Health Service, 2018; Mohammed et al., 2023). , , A particular gap in the literature concerns the specific challenges mothers in the formal sector face, especially those receiving postnatal care at Tamale West Hospital, who may struggle to balance workplace demands with the recommended EBF duration. This study was designed to investigate the barriers to exclusive breastfeeding among nursing mothers attending postnatal care at Tamale West Hospital in Tamale. By examining maternal perceptions, workplace constraints, cultural influences, and the availability of support systems, the research seeks to identify key factors that hinder EBF practice. The findings will provide valuable insights for policymakers, healthcare providers, and employers, informing targeted interventions to improve exclusive breastfeeding rates. Ultimately, the findings will contribute to the broader literature on breastfeeding promotion, guiding policymakers and healthcare providers in developing context-specific solutions that ensure both mothers and infants reap the full benefits of exclusive breastfeeding. METHOD AND MATERIALS Study Design A facility-based cross-sectional study design using a survey method was used to design the study. The research used quantitative data approach to gather the primary data. The study population consisted of nursing mothers attending postnatal care (PNC) at Tamale West Hospital (TWH), focusing on those with babies less than a year old who were still breastfeeding. Inclusion criteria were nursing mothers aged 15–44 attending PNC at TWH, with at least one child under a year old who were still breastfeeding, and able to speak English or a local language. Exclusion criteria included nursing mothers outside the reproductive age range, those with terminal illnesses, and those who refused to sign the consent form. All methods were performed in accordance with the relevant guidelines set forth by the Ghana Health Service research regulations. Sampling Technique and Sample Size A simple random sampling method was used to collect quantitative data from nursing mothers attending postnatal care (PNC) at Tamale West Hospital (TWH). The sample size was determined using the Cochran formula, resulting in 382 participants. Data were gathered using a structured questionnaire adapted from a validated instrument, covering demographic characteristics, knowledge on exclusive breastfeeding practices, associated challenges, and influencing factors. The questionnaire's validity was ensured through peer review and pre-testing at Vitting Health Centre, achieving acceptable Cronbach Alpha values. Three trained research assistants collected data after obtaining ethical approval from the Ghana Health Service Ethics Review Committee and entry permission from relevant authorities. Data collection occurred at the PNC Unit over a period of six months. Consent was obtained from all participants prior to enrolling in this study. Data Analysis Data analysis was done shortly after data collection was completed. Then the Statistical Package for Service Solution (SPSS) software version 25.0 was used to analyze the data. SPSS Data was cleaned by screening for missing values, checking normality and outliers, as well as checking the homogeneity of the data using histogram, frequency and box plots respectively. As a statistical rule, missing variables were less than 5%, and they were deleted. Data analysis was done based on the themes drawn from the specific objectives. Descriptive analyses were done to ascertain the factors by knowledge and constrains of exclusive breastfeeding practices of the respondents. Chi-square analysis was used to establish the association between the categorical variables. The Mann-Whitney U test was used to compare the distributions of various factors (e.g., insufficient milk production, cracked or sore nipples, discomfort when breastfeeding in public) between two independent groups: exclusive breastfeeding (EBF) and non-exclusive breastfeeding (Non-EBF) mothers. All statistical tests that were performed used two-sided tests at the 0.05 level of significance. In the study, a knowledge index was created through the sum of binary input variables, where the highest and lowest values were selected for each underlying pointer. The enactment of individually pointer was articulated using a unit-free index between 0 and 1 in accordance with the structure technique of the Human Development Index (UNDP, 2005). Knowledge index = (Actual value – Minimum value) (Maximum value – Minimum value) The scores were created then categorized as the group labelled as poor and good knowledge (Oh et al., 2011; UNDP, 2005). Before measuring the level of knowledge using consistent or reliability of respondent’s answer. The knowledge score is poor at 0–4 and good at 5–9 (Oh et al., 2011). , In determining the constraints associated with exclusive breastfeeding practices, descriptive statistics, mean (M), standard deviation (SD), median (interquartile range) and chi-square were used. RESULTS Demographic Characteristics of Nursing Mothers In the study, 382 nursing mothers attending PNC services between July to December, 2023 were involved in the study. Majority (54.45%) of the nursing mothers were between the ages of 26 to 35, while 25.39% by those between the ages of 36 to 44, and 20.16% were between 15 to 25 years of age. Over half of the respondents (62.83%) were married, and the remaining 37.17% were unmarried. Nearly equal proportions identified as Christian (52.09%) or Muslim (47.91%). Several of the respondents (69.12%) practiced exclusive breastfeeding whereas the remaining ones (30.88%) could not do so (Table 1 ). In terms of breastfeeding practices, 69.12% reported practicing exclusive breastfeeding (EBF), whereas 30.88% did not. With respect to education, 17.02% had no formal education, 40.31% had basic education, 33.25% had secondary-level education, and 9.42% had tertiary education. About one-third (28.27%) of participants had no children prior to the current infant (parity 0), 35.86% had one child, 25.13% had 2–3 children, and 10.74% had more than three children. Regarding employment, 33.25% of respondents were unemployed, 55.50% were employed, and 11.25% were housewives. Monthly income levels were split between those earning less than 1,000 GHS (42.93%) and those earning above 1,000 GHS (57.07%). Ethnically, over half of the sample identified as Gonja (51.04%), followed by Mamprusi (25.66%), Akan (8.64%), and other ethnic groups (14.66%). (Table 1 ) Table 1 Demographic Characteristics of participants Variables Category Frequency (N = 382) Percent Age (years) 15–25 77 20.16 26–35 208 54.45 36–44 97 25.39 Marital status Unmarried 142 37.17 Married 240 62.83 Religion Christianity 199 52.09 Islam 183 47.91 Breastfeeding practices EBF practices 264 69.12 Non-EBF practices 118 30.88 Educational status No formal education 65 17.02 Basic education 154 40.31 Secondary 127 33.25 Tertiary 36 9.42 Parity 0 108 28.27 1 child 137 35.86 2–3 children 96 25.13 3 + Children 41 10.74 Occupational status Unemployed 127 33.25 Employed 212 55.50 Housewife 43 11.25 Monthly income 1,000 GHS ( $ 65) 218 57.07 Ethnicity Gonja 195 51.04 Mamprusi 98 25.66 Akan 33 8.64 Others 56 14.66 Knowledge of Exclusive Breastfeeding among Nursing Mothers This study revealed that nursing mothers have good knowledge of exclusive breastfeeding practices. The knowledge score is poor at 0–4 and good at 5–9 (Ling et al., 2011). Individually, approximately 66% of nursing mothers aged 36–44 years had good knowledge of exclusive breastfeeding practices as compared to those between 15–25 years (53.25%). Majority of the married women (59.17%) had poor knowledge of exclusive breastfeeding practices while a large portion of the unmarried women (54.23%) had good knowledge of exclusive breastfeeding practices. Additionally, participants who identified as Christians (60.80%) exhibited good knowledge of exclusive breastfeeding practices as compared to Muslims (40.98%). In relation to nursing mother knowledge of exclusive breastfeeding practices and educational level, only few (27.69%) with no formal education had good knowledge of exclusive breastfeeding practices. However, almost all of the respondents with either basic/secondary (71.89%) and tertiary education (94.44%) showed very good knowledge of exclusive breastfeeding practices. The study, further, indicated that most nursing mothers had good knowledge of exclusive breastfeeding practices, and the knowledge level increases with parity. Those with one child (57.66%) had the least as compared to those with 2–3 children (68.46%) and above 3 children (72.92%). Both nursing mothers, either practicing exclusive or non-exclusive breastfeeding had good knowledge. Thus, those practicing non-exclusive breastfeeding recorded better knowledge score (68.64%) than their counterpart practicing exclusive breastfeeding (57.95%). In relation to employment status and knowledge of exclusive breastfeeding, several of the respondents reported poor knowledge of exclusive breastfeeding, those employed (37.26%) had the poorest followed by unemployed (40.16%) and housewife (48.84%). Also, nursing mothers with high monthly household income of > 1,000 GHS had good knowledge of exclusive breastfeeding practices whereas those with < 1,000 GHS (48.17%) had poor knowledge of exclusive breastfeeding practices. In addition, demographic variables such as age of nursing mothers, marital status, educational status, parity, and breastfeeding practices showed statistically a significant ( p < 0.05) relationship with knowledge of exclusive breastfeeding. However, religious affiliation, employment status and household income per month were the socio-demographic variables that had no significant relationship with knowledge on exclusive breastfeeding practices (Table 2 ). Table 2 Knowledge of Exclusive Breastfeeding Variables Categories Freq. (%) Knowledge about EBF Practices p -value Good Poor Age (years) 0.002 15–25 77 (20.16) 41 (53.25) 36 (46.75) 26–35 208 (54.45) 118 (56.73) 90 (43.27) 36–44 97 (25.39) 64 (65.98) 33 (34.02) Marital status 0.0001 Unmarried 142 (37.17) 77 (54.23) 65 (45.77) Married 240 (62.83) 98 (40.83) 142 (59.17) Religion 0.215 Christianity 199 (52.09) 121 (60.80) 78 (39.20) Islam 183 (47.91) 75 (40.98) 108 (59.02) Educational status 0.015 No formal education 65 (17.02) 18 (27.69) 47 (72.31) Basic/Secondary 281 (73.56) 202 (71.89) 79 (28.11) Tertiary 36 (9.42) 34 (94.44) 2 (5.56) Parity 0.000 1 child 137 (35.86) 79 (57.66) 58 (42.34) 2–3 children 149 (39.01) 102 (68.46) 47 (31.54) 3 + children 96 (25.13) 70 (72.92) 26 (27.08) Breastfeeding practices 0.002 EBF practices 264 (69.12) 153 (57.95) 111 (42.05) Non-EBF practices 118 (30.88) 81 (68.64) 37 (31.36) Employment status 0.122 Unemployed 127 (33.25) 51 (40.16) 76 (59.84) Employed 212 (55.50) 79 (37.26) 133 (62.74) Housewife 43 (11.25) 21 (48.84) 22 (51.16) Household income 0.205 1,000 GHS ( $ 65) 218 (57.07) 148 (67.89) 70 (32.11) Knowledge score 6.51 Constraints Associated with Exclusive Breastfeeding The top three constraints of exclusive breastfeeding were insufficient production of breastmilk (mean = 4.82, standard deviation = 3.43); cracked or sored nipple (mean = 4.03, standard deviation = 3.12); and shyness when breastfeeding in public (mean = 3.61, standard deviation = 3.01). However, there were other constraints to exclusive breastfeeding such as socio-cultural pressure to introduce water and artificial feeds, perception that breastmilk is insufficient for baby; tight work schedule, domestic duties and short maternity leave. These constraints recorded total means between 2.70 (SD = 2.44) – 3.03 (SD = 2.77). There was a significant difference between nursing mothers who practiced exclusive breastfeeding and those who did not in relation to the following constrains; insufficient breastmilk production (mean = 4.82, standard deviation = 3.43 at p = 0.035); cracked or sored nipple (mean = 4.03, standard deviation = 3.12, at p = 0.002); tight work schedule (mean = 2.98, standard deviation = 2.62, at p = 0.005); and short maternity leave (mean = 2.70, standard deviation = 2.44, at p = 0.003) (Table 3 ). However, no significant difference existed between the groups with the following constraints: shyness when breastfeeding in public, holding a perception that breastmilk is insufficient for baby, socio-cultural pressure to introduce water and artificial feeds and domestic duties. In addition, comparing the mean of the two groups (Table 3 ), there was a subtle difference between nursing mothers who practiced exclusive breastfeeding and those who practiced mixed feeding in relation to constraints to exclusive breastfeeding scores, although not statistically significant. Evidence suggested that the mean scores of the two groups were closely related and almost virtually the same. For instance, nursing mother who practiced exclusive breastfeeding had total mean of 3.31 (SD = 1.93) whereas those who practiced mixed feeding reported a mean of 3.83 (SD = 2.75). Table 3 Constraints Associated with Exclusive Breastfeeding Practices Variables Total M (SD) EBF M (SD) Non-EBF M (SD) EBF Median (IQR) Non-EBF Median (IQR) Mann-Whitney U p - value Insufficient milk production 4.82 (3.43) 3.31 (1.93) 3.83 (2.75) 3 (2–5) 3 (2–5) 165.50 0.035 Cracked or sore nipples 4.03 (3.12) 2.90 (1.74) 3..69 (2.55)) 3 (3–5) 3 (3–5) 155.00 0.002 Discomfort when breastfeeding in public 3.61 (3.01) 2.66 (1.72) 3.55 (2.48) 4 (3–4) 4 (3–5) 140.00 0.128 Socio-cultural pressure to introduce water and artificial feeds 3.12 (2.85) 2.38 (1.50) 3.54 (2.33) 3 (2–4) 3 (2–4) 350.50 0.055 Perception that breastmilk is insufficient for baby 3.03 (2.77) 2.11 (1.50) 3.38 (2.28) 4 (2–5) 4 (2–5) 350.00 0.051 Tight work schedule 2.98 (2.62) 2.09 (1.16) 3.18 (2.22) 3 (2–4) 3 (3–5) 330.00 0.005 Domestic duties 2.94 (2.53) 2.09 (1.16) 3. 04 (2.12) 3 (2–4) 3 (2–5) 310.00 0.400 Short maternity leave 2.70 (2.44) 2.04 (1.09) 2.85 (2.06) 4 (3–5) 4 (2–5) 300.50 0.003 M = Mean; SD = Standard deviation; IQR = Interquartile Range Maternal Factors associated with Exclusive Breastfeeding Practices Five maternal factors including maternal age, educational status, employment status, parity and mode of delivery, were significantly associated with exclusive breastfeeding practices. The maternal factors; maternal age (χ 2 = 237.71; p < 0.001); educational status (χ 2 = 294.90; p < 0.022); employment status (χ 2 = 301.26; p < 0.000); parity (χ 2 = 404.37; p < 0.020), and mode of delivery (χ 2 = 298.45; p < 0.003) were significantly associated with exclusive breastfeeding practices at Tamale West Hospital. However, marital status, breastfeeding initiation and duration, household income per month and HIV status had no significant association with exclusive breastfeeding practices (Table 4 ). Table 4 Maternal Factors associated with Exclusive Breastfeeding Practices Variables Categories N (%) Exclusive breastfeeding practices χ 2 Test statistic ( p -value) Poor N (%) Good N (%) Maternal age 237.71 0.001* 15–25 77 (20.16) 33 (42.86) 44 (57.14) 26–35 208 (54.45) 121 (58.17) 87 (41.83) 36–44 97 (25.39) 52 (53.61) 45 (46.39) Educational status 294.90 0.022* No formal education 65 (17.02) 48 (73.85) 17 (26.15) Basic/Secondary 281 (73.56) 112 (39.86) 169 (60.14) Tertiary 36 (9.42) 25 (69.44) 11 (30.56) Employment status 301.26 0.000* Unemployed 127 (33.25) 28 (22.05) 99 (77.95) Employed 212 (55.50) 41 (19.34) 171 (80.66) Housewife 43 (11.25) 40 (93.02) 3 (6.98) Marital status 137.84 0.109 Unmarried 142 (37.17) 92 (64.79) 50 (35.21) Married 240 (62.83) 67 (27.92) 173 (72.08) Breastfeeding initiation and duration 85.65 0.089 Early 200 (52.37) 84 (42.00) 116 (58.00) Late 182 (47.63) 81 (44.51) 101 (55.49) Parity 404.37 0.020* 0 108 (28.27) 18 (16.67) 90 (83.33) 1 child 137 (35.86) 27 (19.71) 110 (80.29) 2 + children 137 (35.87) 63 (49.99) 74 (54.01) Household income per month ( GH ¢) 283.09 0.163 1,000 GHS 218 (57.07) 87 (39.91) 131 (60.09) HIV status 201.09 0.521 Positive 0 (0.0) 0 (0.0) 0 (0.0) Negative 382 (100.0) 256 (67.02) 126 (32.98) Mode of delivery 298.45 0.003* Normal vaginal delivery 209 (54.71) 99 (47.37) 110 (52.63) Caesarean section (CS) 173 (45.29) 70 (40.46) 103 (59.54) * Statistically significant at p < 0.05 DISCUSSION This study revealed that nursing mothers attending postnatal care at Tamale West Hospital generally possess good knowledge of exclusive breastfeeding (EBF), as evidenced by a high overall knowledge score (6.51). This finding may be attributed to their levels of formal education—where many had at least basic or secondary education—and to the quality of postnatal education provided by the hospital. Comparable research in other Ghanaian settings and in various regions of Africa corroborates this result, indicating that awareness of EBF and its benefits is widespread. However, as other studies have shown, awareness does not necessarily translate into high rates of sustained EBF. Despite their strong knowledge base, participants reported multiple barriers that hindered continuous EBF. Insufficient breastmilk production emerged as the most common constraint, potentially influenced by factors such as postpartum stress, cesarean delivery, or the physiological delay in milk let-down. Cracked or sore nipples and discomfort with breastfeeding in public were also frequently mentioned, highlighting both physical and sociocultural challenges. These findings are consistent with earlier studies conducted in Ghana, Nigeria, and other regions, which point to the interplay of health issues, cultural norms, and personal discomfort in determining breastfeeding behavior (Tampah-Naah et al., 2019). Additionally, some participants noted that cultural beliefs around water or artificial feed introduction, heavy domestic workloads, and limited maternity leave further complicate EBF. These social and environmental factors often leave mothers feeling compelled to supplement breastmilk before the recommended six-month period. Similar trends have been observed in other Ghanaian research, suggesting that even in settings where mothers understand the benefits of EBF, systemic and cultural obstacles can undermine its practice (Diji et al., 2017. Addressing these constraints will require a multipronged approach—one that combines improved clinical support (e.g., lactation counseling, postpartum follow-ups) with broader structural reforms, such as extending maternity leave policies and creating more breastfeeding-friendly environments. The study also examined maternal factors influencing EBF. Results showed that maternal age, educational status, employment status, parity, and mode of delivery were significantly associated with EBF practices. These findings underscore that while knowledge is necessary, personal and demographic characteristics often shape whether that knowledge is acted upon. Women who are older or more educated may feel more confident in their ability to breastfeed and be more aware of its benefits. In contrast, younger or less educated mothers might require additional counseling and support to initiate and maintain EBF. Meanwhile, the lack of association with marital status, monthly income, or HIV status suggests that these variables may be less influential in this specific context, though they have been reported as important in other studies. Taken together, the results highlight the complexity of sustaining EBF in real-world settings. While knowledge is a critical first step, successful practice often depends on overcoming practical, cultural, and personal barriers. Strengthening postnatal care services—particularly lactation counseling and peer support networks—could further encourage mothers to persist with EBF despite the challenges they encounter. CONCLUSION Exclusive breastfeeding is integral to promoting infant growth, nutritional well-being, and reducing the risk of infant mortality. The present study affirms that nursing mothers at Tamale West Hospital generally have a good understanding of EBF, yet they face significant constraints such as insufficient breastmilk production, physical discomfort, and sociocultural pressures. Addressing these barriers will require coordinated efforts by healthcare providers, policymakers, and community stakeholders. Strategies that enhance postpartum support, extend maternity leave, and normalize public breastfeeding could help mitigate the physical and social obstacles identified in this research. The strong association of EBF with maternal age, educational level, employment status, parity, and mode of delivery points to the need for tailored interventions. Health education programs, workplace policies, and culturally sensitive outreach initiatives should focus on these demographic groups to maximize EBF uptake. By addressing both individual-level factors and structural barriers, public health efforts can strengthen exclusive breastfeeding practices, ultimately improving maternal and infant health outcomes. Future research may explore interventions that specifically target the most frequently cited challenges and assess their effectiveness in different socio-cultural settings. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ghana Health Service Ethics Review Committee. Informed consent was obtained from all subjects and their legal guardians. Participants could withdraw at any time. Participation was voluntary and confidential, with unique IDs ensuring anonymity. Consent for publication Not applicable Data Sharing Aside data gathered during this study, no external datasets were analyzed or utilized. Competing interests The authors declare no competing interests. Funding The authors declare no funding source for this study. Author Contribution A.N.G and P.O.A. designed the study. S.A.A. led data acquisition and analysis. E.K.S., P.O.A., A.N.G., and F.A. interpreted the data, wrote, and edited the manuscript. All authors reviewed and approved the manuscript. Acknowledgement The authors would like to thank the participants who volunteered their time for this study. Data Availability The datasets generated and analyzed in this current study are available upon request to the corresponding author. References United Nations Children’s Fund (UNICEF). (2023). Infant and young child feeding . https://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding World Health Organization (WHO). (2023). Infant and young child feeding . https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding Atyeo, C., & Alter, G. (2021). The multifaceted roles of breast milk antibodies. Cell , 184 (6), 1486–1499. https://doi.org/10.1016/J.CELL.2021.02.031 Hanson, L. Å. (1998). Breastfeeding Provides Passive and Likely Long-Lasting Active Immunity. Annals of Allergy, Asthma & Immunology , 81 (6), 523–537. https://doi.org/10.1016/S1081-1206(10)62704-4 Lokossou, G. A. G., Kouakanou, L., Schumacher, A., & Zenclussen, A. C. (2022). Human Breast Milk: From Food to Active Immune Response With Disease Protection in Infants and Mothers. Frontiers in Immunology , 13 , 849012. https://doi.org/10.3389/FIMMU.2022.849012 Stordal, B. (2022). Breastfeeding reduces the risk of breast cancer: A call for action in high‐income countries with low rates of breastfeeding. Cancer Medicine , 12 (4), 4616. https://doi.org/10.1002/CAM4.5288 Stuebe, A. (2009). The Risks of Not Breastfeeding for Mothers and Infants. Reviews in Obstetrics and Gynecology , 2 (4), 222. https://doi.org/10.3909/riog0093 WHO-UNICEF. (2019). INCREASING COMMITMENT TO BREASTFEEDING THROUGH FUNDING AND IMPROVED POLICIES AND PROGRAMMES . https://doi.org/10.1016/S0140-6736(16)00210-5 Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., Rollins, N. C., Allen, K., Dharmage, S., Lodge, C., Peres, K. G., Bhandari, N., Chowdhury, R., Sinha, B., Taneja, S., Giugliani, E., … Richter, L. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet , 387 (10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7 Mensah, K. A., Acheampong, E., Anokye, F. O., Okyere, P., Appiah-Brempong, E., & Adjei, R. O. (2017). Factors influencing the practice of exclusive breastfeeding among nursing mothers in a peri-urban district of Ghana. BMC Research Notes , 10 (1), 466. https://doi.org/10.1186/S13104-017-2774-7 Diji, A. K. A., Bam, V., Asante, E., Lomotey, A. Y., Yeboah, S., & Owusu, H. A. (2017). Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: A descriptive cross-sectional study. International Breastfeeding Journal , 12 (1), 1–7. https://doi.org/10.1186/S13006-017-0104-2/TABLES/3 Reinsma, K., Bolima, N., Fonteh Professor, F., Okwen Medical Doctor, P., Health District, B., West Health District, K., & Susanne Montgomery Director, C. (2013). Incorporating cultural beliefs in promoting exclusive breastfeeding. African Journal of Midwifery and Women’s Health , 6 (2), 65. https://doi.org/10.12968/AJMW.2012.6.2.65 Wanjohi, M., Griffiths, P., Wekesah, F., Muriuki, P., Muhia, N., Musoke, R. N., Fouts, H. N., Madise, N. J., & Kimani-Murage, E. W. (2017). Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya. International Breastfeeding Journal , 12 (1), 1–8. https://doi.org/10.1186/S13006-016-0092-7/FIGURES/1 Mogre, V., Dery, M., & Gaa, P. K. (2016). Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers. International Breastfeeding Journal , 11 (1), 1–8. https://doi.org/10.1186/S13006-016-0071-Z/TABLES/5 Nii Okai Aryeetey, R., & Antwi, C. L. (2013). Re-assessment of selected Baby-Friendly maternity facilities in Accra, Ghana. International Breastfeeding Journal , 8 (1), 1–6. https://doi.org/10.1186/1746-4358-8-15/TABLES/5 Agunbiade, O. M., & Ogunleye, O. V. (2012). Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: Implications for scaling up. International Breastfeeding Journal , 7 (1), 1–10. https://doi.org/10.1186/1746-4358-7-5/TABLES/5 Mohammed, S., Yakubu, I., Fuseini, A. G., Abdulai, A. M., & Yakubu, Y. H. (2023). Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana. BMC Public Health , 23 (1), 1–18. https://doi.org/10.1186/S12889-023-15758-W/TABLES/2 Ghana Health Service. (2018). CHILD HEALTH STANDARDS AND STRATEGY . Hanson, L. Å. (1998). Breastfeeding Provides Passive and Likely Long-Lasting Active Immunity. Annals of Allergy, Asthma & Immunology , 81 (6), 523–537. https://doi.org/10.1016/S1081-1206(10)62704-4 Rana, M. M., Islam, M. R., Karim, M. R., Islam, A. Z., Haque, M. A., Shahiduzzaman, M., & Hossain, M. G. (2020). Knowledge and practices of exclusive breastfeeding among mothers in rural areas of Rajshahi district in Bangladesh: A community clinic based study. PLOS ONE , 15 (5), e0232027. https://doi.org/10.1371/JOURNAL.PONE.0232027 Oh, A. L., Hassali, M. A., Al-Haddad, M. S., Sulaiman, S. A. S., Shafie, A. A., & Awaisu, A. (2011). Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia. Journal of Infection in Developing Countries , 5 (5), 338–347. https://doi.org/10.3855/JIDC.1502 UNDP. (2005). Technical note 1. Human Development Index . United Nations Children’s Fund (UNICEF). (2023). Infant and young child feeding . https://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding Yakubu, M. I., Odesanya, R. U., Abbas, M. Y., & Lawal, B. K. (2023). Exclusive breastfeeding knowledge and practice among nursing mothers in selected healthcare facilities in Kaduna Metropolis, Nigeria. African Health Sciences , 23 (2), 682. https://doi.org/10.4314/AHS.V23I2.78 Dun-Dery, E. J., & Laar, A. K. (2016). Exclusive breastfeeding among city-dwelling professional working mothers in Ghana. International Breastfeeding Journal , 11 (1), 1–9. https://doi.org/10.1186/S13006-016-0083-8/TABLES/3 Tampah-Naah, A. M., Kumi-Kyereme, A., & Amo-Adjei, J. (2019). Maternal challenges of exclusive breastfeeding and complementary feeding in Ghana. PLOS ONE , 14 (5), e0215285. https://doi.org/10.1371/journal.pone.0215285 Diji, A. K. A., Bam, V., Asante, E., Lomotey, A. Y., Yeboah, S., & Owusu, H. A. (2017). Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: A descriptive cross-sectional study. International Breastfeeding Journal , 12 (1), 1–7. https://doi.org/10.1186/S13006-017-0104-2/TABLES/3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviews received at journal 26 Nov, 2025 Reviewers agreed at journal 25 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviews received at journal 31 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviews received at journal 25 Aug, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviewers invited by journal 14 Aug, 2025 Editor assigned by journal 06 Aug, 2025 Editor invited by journal 12 May, 2025 Submission checks completed at journal 09 May, 2025 First submitted to journal 28 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6549105","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":502949674,"identity":"378ee3fd-063e-416f-864e-c990727ca840","order_by":0,"name":"Gideon Adu Nyarko","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYFCCBDBpwMDA2CABZMiBeAcekKLFGKwlgTgtDAwgLYkNCEHsgL89x+wxT809Y37+xY03PlTcSZ8fdvgh0BY7Od0G7FokzrwxN+Y5VmwmOeNhs+WMM89yN95OMwBqSTY2O4DDmhs5ZtI8bAk2BjcOtknzth3O3Tg7AaTlQOI2HFrkwVr+QbX8bTucbjg7/QNeLQYgLbxtCWYG5xvbpBnbDifIS+fgt8XwzLMyybl9CcaSMxibLXvOHDbcIJ1TcCDBALdf5I4nb5N48y3BsJ//+MMbPyoOy8vPTt/84UOFnRxO7wMBEw+IlEiAOhWs0gC3chBg/AEi+aGGyjfgVz0KRsEoGAUjDwAAMJlnlTtKHlAAAAAASUVORK5CYII=","orcid":"","institution":"University for Development Studies","correspondingAuthor":true,"prefix":"","firstName":"Gideon","middleName":"Adu","lastName":"Nyarko","suffix":""},{"id":502949675,"identity":"db8b2fa3-e499-4862-a882-2fe463ca8183","order_by":1,"name":"Edward Kofi Sarfo","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"prefix":"","firstName":"Edward","middleName":"Kofi","lastName":"Sarfo","suffix":""},{"id":502949676,"identity":"3305e868-40fb-4116-b247-7d478a2d8f56","order_by":2,"name":"Frank Amoako","email":"","orcid":"","institution":"Sunyani Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Amoako","suffix":""},{"id":502949677,"identity":"b22d1734-9ebe-4982-ad9d-5c768248947c","order_by":3,"name":"Simon Agongo Azuri","email":"","orcid":"","institution":"Department of Community Health, College of Health","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"Agongo","lastName":"Azuri","suffix":""},{"id":502949678,"identity":"65ed76ae-641a-4d50-93e3-af72642c8bee","order_by":4,"name":"Prince Owusu Adoma","email":"","orcid":"","institution":"University of Education Winneba","correspondingAuthor":false,"prefix":"","firstName":"Prince","middleName":"Owusu","lastName":"Adoma","suffix":""}],"badges":[],"createdAt":"2025-04-28 15:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6549105/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6549105/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89548105,"identity":"01de38ba-de53-41c5-b38b-b258f73499fd","added_by":"auto","created_at":"2025-08-21 07:43:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1229942,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6549105/v1/91b3106a-50d9-486d-8b5d-f665c39a3bf5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Barriers to Exclusive Breastfeeding Among Nursing Mothers at Tamale West Hospital: A Cross-Sectional Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eExclusive breastfeeding (EBF)\u0026mdash;the practice of feeding infants only breast milk for the first six months of life\u0026mdash;plays a pivotal role in promoting optimal infant growth, health, and survival.\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e Breast milk provides immunoglobulins that protect against infections and offers a safe, hygienic, and nutritionally complete food source for infants.\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e Additionally, breastfeeding benefits mothers by reducing the risk of certain cancers and type 2 diabetes, while also being more cost-effective than formula feeding.\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e Despite these advantages, only 41% of infants under six months of age worldwide were exclusively breastfed in 2019, falling short of the global targets of at least 50% by 2025 and 70% by 2030.\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e Just 37% of infants younger than six months old in low- and middle-income nations receive all their breast milk.\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e Several nations have largely embraced the WHO's 6-month EBF policy. Nevertheless, most babies are not EBF at six months, especially in developed nations.\u003c/p\u003e\u003cp\u003eIn Ghana, infant mortality is strongly linked to suboptimal breastfeeding and infant feeding practices. Between 2006 and 2010, 63% of infants under six months were exclusively breastfed, a modest increase from 53.4% in 2003.\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e Although progress has been attributed in part to increased maternal education, numerous barriers remain. Mothers often face conflicting advice, social pressure to introduce water or artificial feeds, and the belief that breast milk alone is insufficient (Diji et al., 2017).\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e Furthermore, anecdotal evidence from Tamale West Hospital suggests some mothers perceive exclusively breastfed infants to have poorer appetites when transitioning to complementary foods compared to those who were not exclusively breastfed. Working mothers cite limited time and inadequate support after maternity leave as disincentives to continue exclusive breastfeeding. Research also indicates that close relationships, or cultural guardians can negatively influence breastfeeding decisions and the burden of household duties further complicates EBF. \u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e\u003c/p\u003e\u003cp\u003eSeveral national policies and initiatives\u0026mdash;such as the National Child Health Policy, the Baby-Friendly Hospital Initiative, and the National Nutrition Policy\u0026mdash;have been introduced in Ghana to promote breastfeeding initiation and sustain EBF among infants under six months.\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e While these efforts aim to reduce infant mortality and improve child health, exclusive breastfeeding rates remain below expectations (Agunbiade \u0026amp; Ogunleye, 2012; Ghana Health Service, 2018; Mohammed et al., 2023).\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn17\" id=\"#FNLinkFn17\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn18\" id=\"#FNLinkFn18\"\u003e\u003c/a\u003eA particular gap in the literature concerns the specific challenges mothers in the formal sector face, especially those receiving postnatal care at Tamale West Hospital, who may struggle to balance workplace demands with the recommended EBF duration.\u003c/p\u003e\u003cp\u003eThis study was designed to investigate the barriers to exclusive breastfeeding among nursing mothers attending postnatal care at Tamale West Hospital in Tamale. By examining maternal perceptions, workplace constraints, cultural influences, and the availability of support systems, the research seeks to identify key factors that hinder EBF practice. The findings will provide valuable insights for policymakers, healthcare providers, and employers, informing targeted interventions to improve exclusive breastfeeding rates. Ultimately, the findings will contribute to the broader literature on breastfeeding promotion, guiding policymakers and healthcare providers in developing context-specific solutions that ensure both mothers and infants reap the full benefits of exclusive breastfeeding.\u003c/p\u003e"},{"header":"METHOD AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design\u003c/h2\u003e\n \u003cp\u003eA facility-based cross-sectional study design using a survey method was used to design the study. The research used quantitative data approach to gather the primary data. The study population consisted of nursing mothers attending postnatal care (PNC) at Tamale West Hospital (TWH), focusing on those with babies less than a year old who were still breastfeeding. Inclusion criteria were nursing mothers aged 15\u0026ndash;44 attending PNC at TWH, with at least one child under a year old who were still breastfeeding, and able to speak English or a local language. Exclusion criteria included nursing mothers outside the reproductive age range, those with terminal illnesses, and those who refused to sign the consent form. All methods were performed in accordance with the relevant guidelines set forth by the Ghana Health Service research regulations.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSampling Technique and Sample Size\u003c/h3\u003e\n\u003cp\u003eA simple random sampling method was used to collect quantitative data from nursing mothers attending postnatal care (PNC) at Tamale West Hospital (TWH). The sample size was determined using the Cochran formula, resulting in 382 participants. Data were gathered using a structured questionnaire adapted from a validated instrument, covering demographic characteristics, knowledge on exclusive breastfeeding practices, associated challenges, and influencing factors. The questionnaire\u0026apos;s validity was ensured through peer review and pre-testing at Vitting Health Centre, achieving acceptable Cronbach Alpha values. Three trained research assistants collected data after obtaining ethical approval from the Ghana Health Service Ethics Review Committee and entry permission from relevant authorities. Data collection occurred at the PNC Unit over a period of six months. Consent was obtained from all participants prior to enrolling in this study.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003eData analysis was done shortly after data collection was completed. Then the Statistical Package for Service Solution (SPSS) software version 25.0 was used to analyze the data. SPSS Data was cleaned by screening for missing values, checking normality and outliers, as well as checking the homogeneity of the data using histogram, frequency and box plots respectively. As a statistical rule, missing variables were less than 5%, and they were deleted. Data analysis was done based on the themes drawn from the specific objectives. Descriptive analyses were done to ascertain the factors by knowledge and constrains of exclusive breastfeeding practices of the respondents. Chi-square analysis was used to establish the association between the categorical variables. The Mann-Whitney U test was used to compare the distributions of various factors (e.g., insufficient milk production, cracked or sore nipples, discomfort when breastfeeding in public) between two independent groups: exclusive breastfeeding (EBF) and non-exclusive breastfeeding (Non-EBF) mothers. All statistical tests that were performed used two-sided tests at the 0.05 level of significance. In the study, a knowledge index was created through the sum of binary input variables, where the highest and lowest values were selected for each underlying pointer. The enactment of individually pointer was articulated using a unit-free index between 0 and 1 in accordance with the structure technique of the Human Development Index (UNDP, 2005).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth style=\"width: 50.0000%;\"\u003eKnowledge index =\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 50%;\"\u003e\n \u003cp\u003e(Actual value \u0026ndash; Minimum value)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"null; width: 50.0000%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 50%;\"\u003e\n \u003cp\u003e(Maximum value \u0026ndash; Minimum value)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe scores were created then categorized as the group labelled as poor and good knowledge (Oh et al., 2011; UNDP, 2005). Before measuring the level of knowledge using consistent or reliability of respondent\u0026rsquo;s answer. The knowledge score is poor at 0\u0026ndash;4 and good at 5\u0026ndash;9 (Oh et al., 2011). \u003csup\u003e,\u003c/sup\u003e In determining the constraints associated with exclusive breastfeeding practices, descriptive statistics, mean (M), standard deviation (SD), median (interquartile range) and chi-square were used.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Characteristics of Nursing Mothers\u003c/h2\u003e\u003cp\u003eIn the study, 382 nursing mothers attending PNC services between July to December, 2023 were involved in the study. Majority (54.45%) of the nursing mothers were between the ages of 26 to 35, while 25.39% by those between the ages of 36 to 44, and 20.16% were between 15 to 25 years of age. Over half of the respondents (62.83%) were married, and the remaining 37.17% were unmarried. Nearly equal proportions identified as Christian (52.09%) or Muslim (47.91%). Several of the respondents (69.12%) practiced exclusive breastfeeding whereas the remaining ones (30.88%) could not do so (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn terms of breastfeeding practices, 69.12% reported practicing exclusive breastfeeding (EBF), whereas 30.88% did not. With respect to education, 17.02% had no formal education, 40.31% had basic education, 33.25% had secondary-level education, and 9.42% had tertiary education. About one-third (28.27%) of participants had no children prior to the current infant (parity 0), 35.86% had one child, 25.13% had 2\u0026ndash;3 children, and 10.74% had more than three children.\u003c/p\u003e\u003cp\u003eRegarding employment, 33.25% of respondents were unemployed, 55.50% were employed, and 11.25% were housewives. Monthly income levels were split between those earning less than 1,000 GHS (42.93%) and those earning above 1,000 GHS (57.07%). Ethnically, over half of the sample identified as Gonja (51.04%), followed by Mamprusi (25.66%), Akan (8.64%), and other ethnic groups (14.66%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables Category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;382)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBreastfeeding practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEBF practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-EBF practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBasic education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;3 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026thinsp;+\u0026thinsp;Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOccupational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonthly income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1,000 GHS (\u003cspan\u003e$\u003c/span\u003e65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1,000 GHS (\u003cspan\u003e$\u003c/span\u003e65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGonja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMamprusi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAkan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge of Exclusive Breastfeeding among Nursing Mothers\u003c/h2\u003e\u003cp\u003eThis study revealed that nursing mothers have good knowledge of exclusive breastfeeding practices. The knowledge score is poor at 0\u0026ndash;4 and good at 5\u0026ndash;9 (Ling et al., 2011). Individually, approximately 66% of nursing mothers aged 36\u0026ndash;44 years had good knowledge of exclusive breastfeeding practices as compared to those between 15\u0026ndash;25 years (53.25%). Majority of the married women (59.17%) had poor knowledge of exclusive breastfeeding practices while a large portion of the unmarried women (54.23%) had good knowledge of exclusive breastfeeding practices. Additionally, participants who identified as Christians (60.80%) exhibited good knowledge of exclusive breastfeeding practices as compared to Muslims (40.98%). In relation to nursing mother knowledge of exclusive breastfeeding practices and educational level, only few (27.69%) with no formal education had good knowledge of exclusive breastfeeding practices. However, almost all of the respondents with either basic/secondary (71.89%) and tertiary education (94.44%) showed very good knowledge of exclusive breastfeeding practices.\u003c/p\u003e\u003cp\u003eThe study, further, indicated that most nursing mothers had good knowledge of exclusive breastfeeding practices, and the knowledge level increases with parity. Those with one child (57.66%) had the least as compared to those with 2\u0026ndash;3 children (68.46%) and above 3 children (72.92%). Both nursing mothers, either practicing exclusive or non-exclusive breastfeeding had good knowledge. Thus, those practicing non-exclusive breastfeeding recorded better knowledge score (68.64%) than their counterpart practicing exclusive breastfeeding (57.95%). In relation to employment status and knowledge of exclusive breastfeeding, several of the respondents reported poor knowledge of exclusive breastfeeding, those employed (37.26%) had the poorest followed by unemployed (40.16%) and housewife (48.84%). Also, nursing mothers with high monthly household income of \u0026gt;\u0026thinsp;1,000 GHS had good knowledge of exclusive breastfeeding practices whereas those with \u0026lt;\u0026thinsp;1,000 GHS (48.17%) had poor knowledge of exclusive breastfeeding practices.\u003c/p\u003e\u003cp\u003eIn addition, demographic variables such as age of nursing mothers, marital status, educational status, parity, and breastfeeding practices showed statistically a significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) relationship with knowledge of exclusive breastfeeding. However, religious affiliation, employment status and household income per month were the socio-demographic variables that had no significant relationship with knowledge on exclusive breastfeeding practices (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge of Exclusive Breastfeeding\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFreq.\u0026nbsp;(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eKnowledge about EBF Practices\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (20.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (53.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36 (46.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e208 (54.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e118 (56.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90 (43.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97 (25.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (65.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (34.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e142 (37.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77 (54.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65 (45.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e240 (62.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98 (40.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e142 (59.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.215\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e199 (52.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (60.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78 (39.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e183 (47.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75 (40.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e108 (59.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (17.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (27.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47 (72.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBasic/Secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e281 (73.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e202 (71.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e79 (28.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (9.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (94.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (5.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137 (35.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79 (57.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58 (42.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;3 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e149 (39.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102 (68.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47 (31.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026thinsp;+\u0026thinsp;children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96 (25.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (72.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (27.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eBreastfeeding practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEBF practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e264 (69.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e153 (57.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e111 (42.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-EBF practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118 (30.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (68.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37 (31.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEmployment status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127 (33.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51 (40.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76 (59.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e212 (55.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79 (37.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e133 (62.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (11.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (48.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (51.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHousehold income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.205\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1,000 GHS (\u003cspan\u003e$\u003c/span\u003e65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164 (42.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79 (48.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85 (51.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1,000 GHS\u003c/p\u003e\u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e218 (57.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e148 (67.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70 (32.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e6.51\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eConstraints Associated with Exclusive Breastfeeding\u003c/h3\u003e\n\u003cp\u003eThe top three constraints of exclusive breastfeeding were insufficient production of breastmilk (mean\u0026thinsp;=\u0026thinsp;4.82, standard deviation\u0026thinsp;=\u0026thinsp;3.43); cracked or sored nipple (mean\u0026thinsp;=\u0026thinsp;4.03, standard deviation\u0026thinsp;=\u0026thinsp;3.12); and shyness when breastfeeding in public (mean\u0026thinsp;=\u0026thinsp;3.61, standard deviation\u0026thinsp;=\u0026thinsp;3.01). However, there were other constraints to exclusive breastfeeding such as socio-cultural pressure to introduce water and artificial feeds, perception that breastmilk is insufficient for baby; tight work schedule, domestic duties and short maternity leave. These constraints recorded total means between 2.70 (SD\u0026thinsp;=\u0026thinsp;2.44) \u0026ndash; 3.03 (SD\u0026thinsp;=\u0026thinsp;2.77).\u003c/p\u003e\u003cp\u003eThere was a significant difference between nursing mothers who practiced exclusive breastfeeding and those who did not in relation to the following constrains; insufficient breastmilk production (mean\u0026thinsp;=\u0026thinsp;4.82, standard deviation\u0026thinsp;=\u0026thinsp;3.43 at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035); cracked or sored nipple (mean\u0026thinsp;=\u0026thinsp;4.03, standard deviation\u0026thinsp;=\u0026thinsp;3.12, at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002); tight work schedule (mean\u0026thinsp;=\u0026thinsp;2.98, standard deviation\u0026thinsp;=\u0026thinsp;2.62, at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005); and short maternity leave (mean\u0026thinsp;=\u0026thinsp;2.70, standard deviation\u0026thinsp;=\u0026thinsp;2.44, at p\u0026thinsp;=\u0026thinsp;0.003) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, no significant difference existed between the groups with the following constraints: shyness when breastfeeding in public, holding a perception that breastmilk is insufficient for baby, socio-cultural pressure to introduce water and artificial feeds and domestic duties.\u003c/p\u003e\u003cp\u003eIn addition, comparing the mean of the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), there was a subtle difference between nursing mothers who practiced exclusive breastfeeding and those who practiced mixed feeding in relation to constraints to exclusive breastfeeding scores, although not statistically significant. Evidence suggested that the mean scores of the two groups were closely related and almost virtually the same. For instance, nursing mother who practiced exclusive breastfeeding had total mean of 3.31 (SD\u0026thinsp;=\u0026thinsp;1.93) whereas those who practiced mixed feeding reported a mean of 3.83 (SD\u0026thinsp;=\u0026thinsp;2.75).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eConstraints Associated with Exclusive Breastfeeding Practices\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal M (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEBF M (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNon-EBF M (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEBF Median (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNon-EBF Median (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eMann-Whitney U\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep - value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsufficient milk production\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.82 (3.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.31 (1.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.83 (2.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e165.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCracked or sore nipples\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.03 (3.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.90 (1.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3..69 (2.55))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e155.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiscomfort when breastfeeding in public\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.61 (3.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.66 (1.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.55 (2.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e140.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocio-cultural pressure to introduce water and artificial feeds\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.12 (2.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.38 (1.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.54 (2.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e350.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception that breastmilk is insufficient for baby\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.03 (2.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.11 (1.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.38 (2.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e350.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTight work schedule\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.98 (2.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.09 (1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.18 (2.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e330.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDomestic duties\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.94 (2.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.09 (1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3. 04 (2.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e310.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.400\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShort maternity leave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.70 (2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.04 (1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.85 (2.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e300.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eM\u0026thinsp;=\u0026thinsp;Mean; SD\u0026thinsp;=\u0026thinsp;Standard deviation; IQR\u0026thinsp;=\u0026thinsp;Interquartile Range\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eMaternal Factors associated with Exclusive Breastfeeding Practices\u003c/h3\u003e\n\u003cp\u003eFive maternal factors including maternal age, educational status, employment status, parity and mode of delivery, were significantly associated with exclusive breastfeeding practices. The maternal factors; maternal age (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;237.71; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); educational status (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;294.90; p\u0026thinsp;\u0026lt;\u0026thinsp;0.022); employment status (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;301.26; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.000); parity (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;404.37; p\u0026thinsp;\u0026lt;\u0026thinsp;0.020), and mode of delivery (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;298.45; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.003) were significantly associated with exclusive breastfeeding practices at Tamale West Hospital. However, marital status, breastfeeding initiation and duration, household income per month and HIV status had no significant association with exclusive breastfeeding practices (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Factors associated with Exclusive Breastfeeding Practices\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eExclusive breastfeeding practices\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest statistic\u003c/p\u003e\u003cp\u003e(\u003cem\u003ep\u003c/em\u003e-value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePoor N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGood N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaternal age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e237.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (20.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (42.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44 (57.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e208 (54.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121 (58.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87 (41.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97 (25.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52 (53.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45 (46.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e294.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.022*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (17.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48 (73.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (26.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBasic/Secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e281 (73.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e112 (39.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e169 (60.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (9.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (69.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (30.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e301.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127 (33.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (22.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e99 (77.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e212 (55.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (19.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e171 (80.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (11.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (93.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (6.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e137.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e142 (37.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92 (64.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50 (35.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e240 (62.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 (27.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e173 (72.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBreastfeeding initiation and duration\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200 (52.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (42.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e116 (58.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e182 (47.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (44.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e101 (55.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e404.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.020*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (28.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (16.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90 (83.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137 (35.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (19.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e110 (80.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026thinsp;+\u0026thinsp;children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137 (35.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63 (49.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74 (54.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousehold income per month (\u003c/b\u003eGH \u0026cent;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e283.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1,000 GHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164 (42.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75 (45.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e89 (54.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1,000 GHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e218 (57.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (39.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e131 (60.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHIV status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e201.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.521\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e382 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e256 (67.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e126 (32.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMode of delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e298.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal vaginal delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e209 (54.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99 (47.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e110 (52.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaesarean section (CS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e173 (45.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (40.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103 (59.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study revealed that nursing mothers attending postnatal care at Tamale West Hospital generally possess good knowledge of exclusive breastfeeding (EBF), as evidenced by a high overall knowledge score (6.51). This finding may be attributed to their levels of formal education\u0026mdash;where many had at least basic or secondary education\u0026mdash;and to the quality of postnatal education provided by the hospital. Comparable research in other Ghanaian settings and in various regions of Africa corroborates this result, indicating that awareness of EBF and its benefits is widespread.\u003ca class=\"FNLink\" href=\"#Fn22\" id=\"#FNLinkFn22\"\u003e\u003c/a\u003e However, as other studies have shown, awareness does not necessarily translate into high rates of sustained EBF.\u003ca class=\"FNLink\" href=\"#Fn23\" id=\"#FNLinkFn23\"\u003e\u003c/a\u003e\u003c/p\u003e\u003cp\u003eDespite their strong knowledge base, participants reported multiple barriers that hindered continuous EBF. Insufficient breastmilk production emerged as the most common constraint, potentially influenced by factors such as postpartum stress, cesarean delivery, or the physiological delay in milk let-down. Cracked or sore nipples and discomfort with breastfeeding in public were also frequently mentioned, highlighting both physical and sociocultural challenges. These findings are consistent with earlier studies conducted in Ghana, Nigeria, and other regions, which point to the interplay of health issues, cultural norms, and personal discomfort in determining breastfeeding behavior (Tampah-Naah et al., 2019).\u003ca class=\"FNLink\" href=\"#Fn24\" id=\"#FNLinkFn24\"\u003e\u003c/a\u003e\u003c/p\u003e\u003cp\u003eAdditionally, some participants noted that cultural beliefs around water or artificial feed introduction, heavy domestic workloads, and limited maternity leave further complicate EBF. These social and environmental factors often leave mothers feeling compelled to supplement breastmilk before the recommended six-month period. Similar trends have been observed in other Ghanaian research, suggesting that even in settings where mothers understand the benefits of EBF, systemic and cultural obstacles can undermine its practice (Diji et al., 2017.\u003ca class=\"FNLink\" href=\"#Fn25\" id=\"#FNLinkFn25\"\u003e\u003c/a\u003e Addressing these constraints will require a multipronged approach\u0026mdash;one that combines improved clinical support (e.g., lactation counseling, postpartum follow-ups) with broader structural reforms, such as extending maternity leave policies and creating more breastfeeding-friendly environments.\u003c/p\u003e\u003cp\u003eThe study also examined maternal factors influencing EBF. Results showed that maternal age, educational status, employment status, parity, and mode of delivery were significantly associated with EBF practices. These findings underscore that while knowledge is necessary, personal and demographic characteristics often shape whether that knowledge is acted upon. Women who are older or more educated may feel more confident in their ability to breastfeed and be more aware of its benefits. In contrast, younger or less educated mothers might require additional counseling and support to initiate and maintain EBF. Meanwhile, the lack of association with marital status, monthly income, or HIV status suggests that these variables may be less influential in this specific context, though they have been reported as important in other studies.\u003c/p\u003e\u003cp\u003eTaken together, the results highlight the complexity of sustaining EBF in real-world settings. While knowledge is a critical first step, successful practice often depends on overcoming practical, cultural, and personal barriers. Strengthening postnatal care services\u0026mdash;particularly lactation counseling and peer support networks\u0026mdash;could further encourage mothers to persist with EBF despite the challenges they encounter.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eExclusive breastfeeding is integral to promoting infant growth, nutritional well-being, and reducing the risk of infant mortality. The present study affirms that nursing mothers at Tamale West Hospital generally have a good understanding of EBF, yet they face significant constraints such as insufficient breastmilk production, physical discomfort, and sociocultural pressures. Addressing these barriers will require coordinated efforts by healthcare providers, policymakers, and community stakeholders. Strategies that enhance postpartum support, extend maternity leave, and normalize public breastfeeding could help mitigate the physical and social obstacles identified in this research. The strong association of EBF with maternal age, educational level, employment status, parity, and mode of delivery points to the need for tailored interventions. Health education programs, workplace policies, and culturally sensitive outreach initiatives should focus on these demographic groups to maximize EBF uptake. By addressing both individual-level factors and structural barriers, public health efforts can strengthen exclusive breastfeeding practices, ultimately improving maternal and infant health outcomes. Future research may explore interventions that specifically target the most frequently cited challenges and assess their effectiveness in different socio-cultural settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e Ethical approval was obtained from the Ghana Health Service Ethics Review Committee. Informed consent was obtained from all subjects and their legal guardians. Participants could withdraw at any time. Participation was voluntary and confidential, with unique IDs ensuring anonymity.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eData Sharing\u003c/h2\u003e\u003cp\u003eAside data gathered during this study, no external datasets were analyzed or utilized.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe authors declare no funding source for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.N.G and P.O.A. designed the study. S.A.A. led data acquisition and analysis. E.K.S., P.O.A., A.N.G., and F.A. interpreted the data, wrote, and edited the manuscript. All authors reviewed and approved the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the participants who volunteered their time for this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed in this current study are available upon request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e United Nations Children\u0026rsquo;s Fund (UNICEF). (2023). \u003cem\u003eInfant and young child feeding\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding\u003c/span\u003e\u003cspan address=\"https://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e World Health Organization (WHO). (2023). \u003cem\u003eInfant and young child feeding\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Atyeo, C., \u0026amp; Alter, G. (2021). The multifaceted roles of breast milk antibodies. \u003cem\u003eCell\u003c/em\u003e, \u003cem\u003e184\u003c/em\u003e(6), 1486\u0026ndash;1499. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/J.CELL.2021.02.031\u003c/span\u003e\u003cspan address=\"10.1016/J.CELL.2021.02.031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Hanson, L. \u0026Aring;. (1998). Breastfeeding Provides Passive and Likely Long-Lasting Active Immunity. \u003cem\u003eAnnals of Allergy, Asthma \u0026amp; Immunology\u003c/em\u003e, \u003cem\u003e81\u003c/em\u003e(6), 523\u0026ndash;537. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1081-1206(10)62704-4\u003c/span\u003e\u003cspan address=\"10.1016/S1081-1206(10)62704-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Lokossou, G. A. G., Kouakanou, L., Schumacher, A., \u0026amp; Zenclussen, A. C. (2022). Human Breast Milk: From Food to Active Immune Response With Disease Protection in Infants and Mothers. \u003cem\u003eFrontiers in Immunology\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 849012. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/FIMMU.2022.849012\u003c/span\u003e\u003cspan address=\"10.3389/FIMMU.2022.849012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Stordal, B. (2022). Breastfeeding reduces the risk of breast cancer: A call for action in high‐income countries with low rates of breastfeeding. \u003cem\u003eCancer Medicine\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(4), 4616. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/CAM4.5288\u003c/span\u003e\u003cspan address=\"10.1002/CAM4.5288\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Stuebe, A. (2009). The Risks of Not Breastfeeding for Mothers and Infants. \u003cem\u003eReviews in Obstetrics and Gynecology\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(4), 222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3909/riog0093\u003c/span\u003e\u003cspan address=\"10.3909/riog0093\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e WHO-UNICEF. (2019). \u003cem\u003eINCREASING COMMITMENT TO BREASTFEEDING THROUGH FUNDING AND IMPROVED POLICIES AND PROGRAMMES\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(16)00210-5\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(16)00210-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Victora, C. G., Bahl, R., Barros, A. J. D., Fran\u0026ccedil;a, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., Rollins, N. C., Allen, K., Dharmage, S., Lodge, C., Peres, K. G., Bhandari, N., Chowdhury, R., Sinha, B., Taneja, S., Giugliani, E., \u0026hellip; Richter, L. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003e387\u003c/em\u003e(10017), 475\u0026ndash;490. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(15)01024-7\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(15)01024-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Mensah, K. A., Acheampong, E., Anokye, F. O., Okyere, P., Appiah-Brempong, E., \u0026amp; Adjei, R. O. (2017). Factors influencing the practice of exclusive breastfeeding among nursing mothers in a peri-urban district of Ghana. \u003cem\u003eBMC Research Notes\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(1), 466. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S13104-017-2774-7\u003c/span\u003e\u003cspan address=\"10.1186/S13104-017-2774-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Diji, A. K. A., Bam, V., Asante, E., Lomotey, A. Y., Yeboah, S., \u0026amp; Owusu, H. A. (2017). Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: A descriptive cross-sectional study. \u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S13006-017-0104-2/TABLES/3\u003c/span\u003e\u003cspan address=\"10.1186/S13006-017-0104-2/TABLES/3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Reinsma, K., Bolima, N., Fonteh Professor, F., Okwen Medical Doctor, P., Health District, B., West Health District, K., \u0026amp; Susanne Montgomery Director, C. (2013). Incorporating cultural beliefs in promoting exclusive breastfeeding. \u003cem\u003eAfrican Journal of Midwifery and Women\u0026rsquo;s Health\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(2), 65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12968/AJMW.2012.6.2.65\u003c/span\u003e\u003cspan address=\"10.12968/AJMW.2012.6.2.65\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Wanjohi, M., Griffiths, P., Wekesah, F., Muriuki, P., Muhia, N., Musoke, R. N., Fouts, H. N., Madise, N. J., \u0026amp; Kimani-Murage, E. W. (2017). Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya. \u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S13006-016-0092-7/FIGURES/1\u003c/span\u003e\u003cspan address=\"10.1186/S13006-016-0092-7/FIGURES/1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Mogre, V., Dery, M., \u0026amp; Gaa, P. K. (2016). Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers. \u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S13006-016-0071-Z/TABLES/5\u003c/span\u003e\u003cspan address=\"10.1186/S13006-016-0071-Z/TABLES/5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Nii Okai Aryeetey, R., \u0026amp; Antwi, C. L. (2013). Re-assessment of selected Baby-Friendly maternity facilities in Accra, Ghana. \u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1), 1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1746-4358-8-15/TABLES/5\u003c/span\u003e\u003cspan address=\"10.1186/1746-4358-8-15/TABLES/5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Agunbiade, O. M., \u0026amp; Ogunleye, O. V. (2012). Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: Implications for scaling up. \u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(1), 1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1746-4358-7-5/TABLES/5\u003c/span\u003e\u003cspan address=\"10.1186/1746-4358-7-5/TABLES/5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Mohammed, S., Yakubu, I., Fuseini, A. G., Abdulai, A. M., \u0026amp; Yakubu, Y. H. (2023). Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 1\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S12889-023-15758-W/TABLES/2\u003c/span\u003e\u003cspan address=\"10.1186/S12889-023-15758-W/TABLES/2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Ghana Health Service. (2018). \u003cem\u003eCHILD HEALTH STANDARDS AND STRATEGY\u003c/em\u003e.\u003c/span\u003e\u003cdiv id=\"Par35\" class=\"Para\"\u003eHanson, L. \u0026Aring;. (1998). Breastfeeding Provides Passive and Likely Long-Lasting Active Immunity. \u003cem\u003eAnnals of Allergy, Asthma \u0026amp; Immunology\u003c/em\u003e, \u003cem\u003e81\u003c/em\u003e(6), 523\u0026ndash;537. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1081-1206(10)62704-4\u003c/span\u003e\u003cspan address=\"10.1016/S1081-1206(10)62704-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/div\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Rana, M. M., Islam, M. R., Karim, M. R., Islam, A. Z., Haque, M. A., Shahiduzzaman, M., \u0026amp; Hossain, M. G. (2020). Knowledge and practices of exclusive breastfeeding among mothers in rural areas of Rajshahi district in Bangladesh: A community clinic based study. \u003cem\u003ePLOS ONE\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(5), e0232027. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/JOURNAL.PONE.0232027\u003c/span\u003e\u003cspan address=\"10.1371/JOURNAL.PONE.0232027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Oh, A. L., Hassali, M. A., Al-Haddad, M. S., Sulaiman, S. A. S., Shafie, A. A., \u0026amp; Awaisu, A. (2011). Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia. \u003cem\u003eJournal of Infection in Developing Countries\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(5), 338\u0026ndash;347. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3855/JIDC.1502\u003c/span\u003e\u003cspan address=\"10.3855/JIDC.1502\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e UNDP. (2005). \u003cem\u003eTechnical note 1. Human Development Index\u003c/em\u003e.\u003c/span\u003e\u003cdiv id=\"Par45\" class=\"Para\"\u003eUnited Nations Children\u0026rsquo;s Fund (UNICEF). (2023). \u003cem\u003eInfant and young child feeding\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding\u003c/span\u003e\u003cspan address=\"https://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/div\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Yakubu, M. I., Odesanya, R. U., Abbas, M. Y., \u0026amp; Lawal, B. K. (2023). Exclusive breastfeeding knowledge and practice among nursing mothers in selected healthcare facilities in Kaduna Metropolis, Nigeria. \u003cem\u003eAfrican Health Sciences\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(2), 682. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4314/AHS.V23I2.78\u003c/span\u003e\u003cspan address=\"10.4314/AHS.V23I2.78\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Dun-Dery, E. J., \u0026amp; Laar, A. K. (2016). Exclusive breastfeeding among city-dwelling professional working mothers in Ghana. \u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S13006-016-0083-8/TABLES/3\u003c/span\u003e\u003cspan address=\"10.1186/S13006-016-0083-8/TABLES/3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Tampah-Naah, A. M., Kumi-Kyereme, A., \u0026amp; Amo-Adjei, J. (2019). Maternal challenges of exclusive breastfeeding and complementary feeding in Ghana. \u003cem\u003ePLOS ONE\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(5), e0215285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0215285\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0215285\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Diji, A. K. A., Bam, V., Asante, E., Lomotey, A. Y., Yeboah, S., \u0026amp; Owusu, H. A. (2017). Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: A descriptive cross-sectional study. \u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S13006-017-0104-2/TABLES/3\u003c/span\u003e\u003cspan address=\"10.1186/S13006-017-0104-2/TABLES/3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breastfeeding, Exclusive breastfeeding, Nursing mother, Barriers, Tamale West Hospital","lastPublishedDoi":"10.21203/rs.3.rs-6549105/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6549105/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eThe World Health Organization recommends exclusive breastfeeding (EBF) as the primary nutritional requirement for the first six months of an infant\u0026rsquo;s life. However, various factors may influence whether mothers practice EBF effectively. The goal of this study is to evaluate the knowledge level, constraints, and maternal factors associated with exclusive breastfeeding practices among nursing mothers attending postnatal care at a tertiary teaching hospital in Ghana-West Africa.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA facility-based cross-sectional study was conducted among nursing mothers at Tamale West Hospital, Ghana. Using Cochran\u0026rsquo;s formula, 382 participants were selected through simple random sampling. Data were collected using a structured questionnaire and analyzed with STATA. Descriptive statistics and inferential analyses were performed at a 5% significance level.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eMothers reported several constraints, notably insufficient breastmilk production (M\u0026thinsp;=\u0026thinsp;4.82, SD\u0026thinsp;=\u0026thinsp;3.43), cracked or sore nipples (M\u0026thinsp;=\u0026thinsp;4.03, SD\u0026thinsp;=\u0026thinsp;3.12), and shyness when breastfeeding in public (M\u0026thinsp;=\u0026thinsp;3.61, SD\u0026thinsp;=\u0026thinsp;3.01). Constraint scores did not differ significantly between exclusive and non-exclusive breastfeeding groups. Maternal age (χ\u0026sup2; = 237.71; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), educational status (χ\u0026sup2; = 294.90; p\u0026thinsp;\u0026lt;\u0026thinsp;0.022), employment status (χ\u0026sup2; = 301.26; p\u0026thinsp;\u0026lt;\u0026thinsp;0.000), parity (χ\u0026sup2; = 404.37; p\u0026thinsp;\u0026lt;\u0026thinsp;0.020), and mode of delivery (χ\u0026sup2; = 298.45; p\u0026thinsp;\u0026lt;\u0026thinsp;0.003) were significantly associated with EBF practices.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eNursing mothers generally have good knowledge of exclusive breastfeeding yet face multiple constraints that can hinder its practice. Addressing these barriers and considering maternal factors such as age, education, and employment status are essential to improving exclusive breastfeeding rates and ensuring optimal infant nutrition.\u003c/p\u003e","manuscriptTitle":"Barriers to Exclusive Breastfeeding Among Nursing Mothers at Tamale West Hospital: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 07:27:24","doi":"10.21203/rs.3.rs-6549105/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-03T15:21:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T18:32:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-26T09:22:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42834341045868375155281250576849022656","date":"2025-11-26T04:15:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270271679308147935902793005201485663773","date":"2025-11-18T03:33:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T04:29:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314508414842750212024568533424456378799","date":"2025-10-06T09:56:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-25T12:09:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"216971556457981614392846539665419062641","date":"2025-08-15T10:02:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-14T04:47:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-07T03:20:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-12T15:58:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-09T11:21:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-28T15:02:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"25f9af34-24d8-4add-b92c-eea17c69a30c","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":53427093,"name":"Biological sciences/Physiology"},{"id":53427094,"name":"Health sciences/Health care"},{"id":53427095,"name":"Health sciences/Health care/Nutrition"},{"id":53427096,"name":"Health sciences/Health care/Patient education"}],"tags":[],"updatedAt":"2026-04-01T10:57:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-21 07:27:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6549105","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6549105","identity":"rs-6549105","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}