Browsing by Author "Pérez-Escamilla, R."
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Item Factors associated with exclusive breastfeeding in Accra, Ghana(European Journal of Clinical Nutrition, 2005-07) Aidam, B.A.; Pérez-Escamilla, R.; Lartey, A.; Aidam, J.Objective: To assess factors associated with exclusive breast-feeding (EBF) in Accra, Ghana. Design, subjects, setting: Data on current and past infant feeding patterns, sociodemographic, biomedical and biocultural factors were collected using a cross-sectional design, from a sample of 376 women with infants 0-6 months, attending maternal and child health (MCH) clinics in Accra. EBF was defined in two ways: (a) based on a 24-h recall, and (b) based on a recall of liquids or foods given since birth. Results: Although 99.7% of mothers were currently breastfeeding (BF), only half (51.6%) of them EBF their infants. About 98% of participants had heard about EBF, and 85.6% of them planned to EBF on delivery. Based on 'since birth' EBF, planned EBF on delivery was associated with higher likelihood of EBF (OR=2.56; 95% CI, 1.06-6.17) and delivery at a hospital/polyclinic was associated with a two times higher likelihood of EBF (OR=1.96; 95% CI, 1.08-3.54). Women living in their own houses were more likely to EBF (OR=3.96; 95% CI, 1.02-15.49) than those living in rented accommodations and family houses. Those with a more positive attitude towards EBF were more likely to EBF (OR=2.0; 95% CI, 1.11-3.57) than their counterparts with more negative attitudes. The '24-h recall' EBF model yielded similar results. Conclusions: In this population, EBF was associated with delivery at hospital/polyclinic, having secondary school education, intention to EBF prior to delivery, owning a home and having a positive attitude to EBF. © 2005 Nature Publishing Group All rights reserved.Item Factors Influencing Dietary Practices Among Ghanaian Residents and Liberians Living in a Protracted Refugee Situation in Ghana(Journal of Nutrition Education and Behavior, 2019-05) Mandelbaum, J.; Pérez-Escamilla, R.; Sandow, A.; Gallego-Pérez, D.F.; Lartey, A.; Hromi-Fiedler, A.Objective Examine dietary practices among Liberian refugees living in a protracted refugee situation and Ghanaians living among them. Design Qualitative data were collected via audio-taped in-depth interviews as part of a larger mixed-methods cross-sectional study. Setting Buduburam Refugee Settlement and neighboring villages, Ghana. Participants Twenty-seven Liberian and Ghanaian women aged ≥16 years, who lived with ≥1 other female generation. Phenomenon of Interest Similarities and differences in factors influencing dietary practices among Liberian refugees living in Buduburam Refugee Settlement and Ghanaians living in and around this settlement. Analysis Domains, themes, and subthemes were confirmed through a highly iterative coding and consensus process. ATLAS.ti (version 7.5.10) was used to finalize coding and extract quotations. Results Seven domains emerged forming direct and indirect pathways influencing dietary patterns among Liberian refugees and Ghanaians: social support, food availability, nutrition knowledge, cultural food beliefs, food access, food preparation, and national identity. Conclusions and Implications Findings provide important insights into crucial factors driving dietary practices among refugees and local communities in and around a former protracted refugee settlement. Results strongly suggest that nutrition education, food availability, and access issues should be addressed with culturally sensitive programs targeting both the refugee and host communities.Item Factors influencing the implementation of the Becoming Breastfeeding Friendly initiative in Ghana(Maternal and Child Nutrition, 2019-01) Carroll, G.; Atuobi-Yeboah, A.; Hromi-Fiedler, A.; Aryeetey, R.; Safon, C.; Pérez-Escamilla, R.Becoming Breastfeeding Friendly (BBF) is an initiative designed to help countries assess their readiness to scale‐up breastfeeding programs and develop key recommendations to strengthen their breastfeeding environment. In 2016, Ghana was one of two countries to first pilot BBF. In applying BBF, a committee of 15 Ghanaian nutrition, health, and breastfeeding experts implemented the BBF toolbox over 8 months. Following implementation, semistructured interviews were conducted with 12 committee members (CMs) to (a) identify facilitators and barriers to implement BBF and (b) determine factors needed to strengthen the breastfeeding environment in Ghana. Using a grounded theory approach, five domains were identified. First, a dynamic committee of key stakeholders drove the implementation of BBF. Second, CMs faced some logistical and methodological challenges, including difficulty accessing data and the need for strong in‐country technical support for adhering to the BBF process. Third, CMs felt well positioned to facilitate and lead the dissemination and implementation of recommendations. Fourth, accountability would be essential to properly translate recommendations. Fifth, to move recommendations to action, advocacy would be a required first step, and BBF was proposed to facilitate this step. BBF provided an in‐depth analysis of Ghana's current breastfeeding environment to help Ghana strengthen its breastfeeding governance, policies, and programs while informing CMs' government and non‐governmental organizations' breastfeeding efforts.Item Food insecurity and perceived stress but not HIV infection are independently associated with lower energy intakes among lactating Ghanaian women(Maternal and Child Nutrition, 2011-01) Addo, A.A.; Marquis, G.S.; Lartey, A.A.; Pérez-Escamilla, R.; Mazur, R.E.; Harding, K.B.Human immunodeficiency virus (HIV) seropositive women living in low-income communities may have difficulty meeting the increased energy requirements that are associated with both lactation and HIV infection. Data on household food security and maternal socio-demographic characteristics, perceived stress, anthropometry, reported illness, dietary intakes and preferences, and exposure to nutrition education were collected from 70 lactating women [16 seropositive (HP), 27 seronegative (HN), and 27 who refused to be tested and had unknown HIV status (HU)]. Diet was assessed with three 24-h recalls (one market day, one weekend day, and one non-market weekday). Data were collected at 8.4 (SD = 4.7) months postpartum. Most women (74.3%) reported being in good health at the time of study. Three-day mean energy intakes did not differ by HIV status [HP: 12 000 kJ (SD = 3600), HN: 12 600 kJ (SD = 5100), and HU: 12 300 kJ (SD = 4800); P = 0.94]. Protein, fat, vitamin A, thiamin, riboflavin, niacin, vitamin C, calcium, iron, and zinc intakes also did not differ by group (P > 0.10). There was a higher proportion of women with high stress levels in food insecure households compared with food secure households (55.6% vs. 26.5%; P = 0.01). Energy intake was independently negatively associated with food insecurity [high: 11 300 kJ (SD = 3500) vs. low: 13 400 kJ (SD = 5400), respectively; P = 0.050] and stress [high: 10 800 kJ (SD = 2800) vs. low: 13 400 kJ (SD = 5300), P = 0.021]. These results suggest the need to integrate multi-dimensional interventions that address economic and mental health constraints which may limit some women's ability to meet their dietary needs. © 2010 Blackwell Publishing Ltd.Item HIV-negative status is associated with very early onset of lactation among ghanaian women(Journal of Human Lactation, 2010-05) Otoo, G.E.; Marquis, G.S.; Sellen, D.W.; Chapman, D.J.; Pérez-Escamilla, R.This is a longitudinal cohort study investigating the association between maternal HIV status and the reported onset of lactation. The Research to Improve Infant Nutrition and Growth project recruited 442 mothers from 3 antenatal clinics in the eastern region of Ghana, based on positive, negative, and unknown HIV status. Onset of lactation was assessed by maternal perception and validated with 2 subsamples: measurement of infant breast milk intake (n = 40) and daily infant weight measurement for 2 weeks (n = 150). Multivariate logistic regression was used to identify predictors of very early onset of lactation (onset of lactation < 6 hours). Predictors of very early onset of lactation include HIV-negative status (odds ratio = 2.68; P =.014), multiparity (odds ratio = 2.93; P =.009), vaginal delivery (odds ratio = 2.55; P =.035), and having a male child (odds ratio = 1.86; P =.032). The findings indicate an association between maternal HIV status and very early onset of lactation. © 2010 International Lactation Consultant Association.Item Lactation counseling increases exclusive breast-feeding rates in Ghana(Journal of Nutrition, 2005-07) Aidam, B.A.; Pérez-Escamilla, R.; Lartey, A.Exclusive breast-feeding (EBF) rates remain low despite numerous health benefits associated with this behavior. We conducted a randomized trial on the effect of lactation counseling on EBF, which controlled for the Hawthorne effect while also varying the timing of the intervention. Pregnant women attending prenatal clinics in Tema were randomly assigned to 1 of 2 intervention groups (IG) or to a control group (C), as follows: 1) EBF support given pre-, peri-, and postnatally (IG1; n = 43); 2) EBF support given only peri- and postnatally (IG2; n = 44); or 3) nonbreast-feeding health educational support (C; n = 49) that had an equal amount of contact with lactation counselors. Two educational sessions were provided prenatally, and 9 home follow-up visits were provided in the 6-mo postpartum period. Infant feeding data were collected monthly at the participant's home. The 3 groups did not differ in sociodemographic characteristics. At 6 mo postpartum, 90.0% in IG1 and 74.4% in IG2 had exclusively breast-fed during the previous month. By contrast, only 47.7% in C were doing so (P = 0.008). Similarly, the percentage of EBF during the 6 mo was significantly higher (P = 0.02) among IG1 and IG2 (39.5%) than among C (19.6%). The 100% increase in EBF rates can be attributed to the lactation counseling provided. Additional prenatal EBF support may not be needed within a context of strong routine prenatal EBF education. © 2005 American Society for Nutritional Sciences.Item Perceived incentives and barriers to exclusive breastfeeding among periurban ghanaian women(Journal of Human Lactation, 2009-02) Otoo, G.E.; Lartey, A.A.; Pérez-Escamilla, R.Focus group discussions were conducted to elicit the perceived incentives and barriers to exclusive breastfeeding in Ghana. Thirty-five breastfeeding women were recruited from the Manya and Yilo Krobo districts of the eastern region. Participants had a mean age of 27.5 years and had at least one child < 4 months old. Almost all of the participants believed that exclusive breastfeeding is the superior infant feeding method and should be practiced for the first 6 months postpartum. However, there was widespread belief that infants can be given water if it is clean. Mothers reported that exclusive breastfeeding was easier when breast milk began to flow soon after delivery. The main obstacles to exclusive breastfeeding identified were maternal employment, breast and nipple problems, perceived milk insufficiency, and pressure from family. Addressing the concerns put forward by these participants can be used to enhance exclusive breastfeeding promotion in this region. © Copyright 2009 International Lactation Consultant Association.