University of Ghana http://ugspace.ug.edu.gh 
 
 
 
 
FATHERS’ KNOWLEDGE, ATTITUDES AND PRACTICES CONCERNING YOUNG 
CHILD FEEDING AND NUTRITIONAL STATUS OF CHILDREN 0-24 MONTHS IN 
THE LA NKWANTANANG MUNICIPAL DISTRICT 
 
 
 
BY 
 
CHARITY NAA FOFO ANANG 
(REG. NO. 10876328) 
 
 
 
 
 
THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON 
IN PARTIAL FUFILLMENT OF THE REQUIREMENT FOR THE AWARD 
OF MPHIL NUTRITION DEGREE 
 
 
JANUARY, 2023 
 
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DECLARATION 
I Charity Naa Fofo Anang, author of this thesis, do hereby declare that this work was done wholly 
by me in the Department of Nutrition and Food Science, University of Ghana, under the 
supervision of Dr. Agartha Ohemeng and Dr. Gloria-Ethel Otoo. All references cited in this work 
have been fully acknowledged. 
 
 
 
         _______________________________                                                  _______________________________ 
Charity Naa Fofo Anang         Date 
(Student) 
 
 
 
 
 
 
                    
____________________________                                                          June 06, 2023  
Dr. Agartha Ohemeng         Date 
(Principal Supervisor) 
 
 
 
 
 
 
 
 
__________________________                                       ___________________________                          
Dr. Gloria-Ethel Otoo        Date 
     (Co-supervisor) 
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ABSTRACT 
Introduction: Optimal Infant and Young Child Feeding (IYCF) during the first 1000 days is 
critical for the growth and development of children. Research in this area focuses on the input 
mothers make in the feeding of the child. The efforts of fathers, although under reported, are just 
as important in determining the nutritional status of a child. The main objective of this study was 
to assess fathers’ knowledge, attitudes and practices in IYCF in the La Nkwantanang Madina 
Municipal District (LaNMMA) and how this relates to children’s nutritional status. 
Methods: A cross-sectional study design was employed for this study. Convenience sampling was 
used select the health facilities and recruit 180 fathers and their children aged 0-24 months. Data 
were collected on the sociodemographic characteristics of participants, the knowledge, attitudes 
and practices of fathers (KAP) and the anthropometric measurements of the children. A qualitative 
aspect was introduced to explore fathers’ roles and barriers of fathers’ involvement. This was 
conducted by means of a focus group discussion and in-depth interviews.. 
Results: The mean age of fathers was 34.16 ± 5.63 years. The average age for children was 7.28 
 
± 5.50 months and females were slightly more than males (51.7% and 48.3% respectively). Fathers 
of children 0-5 months and 6-24 months had high knowledge (55.1% and 57.1% respectively) but 
poor practice scores (44.9% and 48.4% respectively). The prevalence of stunting, wasting and 
underweight amongst the children was 18%, 8% and 7% respectively. There was no significant 
association between the KAP of fathers and the nutritional status of children. 
From the focus group discussion and in-depth interviews, fathers identified their roles in IYCF as 
providing support to mothers. Support from fathers was either financial, physical or emotional. 
Fathers reported that they received information on IYCF from their wives, the grandmothers of 
their children and the health centers. The fathers indicated that cultural perception of men’s roles, 
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tiredness from work and financial difficulties were barriers to their involvement in infant feeding. 
Fathers believed being available for their children, education in schools, advertisements, 
improvement of services at health centers and policy change would help in overcoming their 
barriers towards IYCF involvement. 
Conclusion: All fathers had good knowledge and poor practices towards infant feeding. Fathers 
provided support for their wives and were aware that their involvement in infant feeding was 
necessary. There is the need to create interventions that specifically address fathers’ barriers 
towards infant feeding. 
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DEDICATION 
I dedicate this work to my mother, Mrs. Ruby Korkor Anang, the rest of my family and all those 
who played a part in this journey. I cannot thank you all enough. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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ACKNOWLEDGEMENT 
 
I would like to thank the Almighty God for holding my hand throughout this journey. There 
were times I wanted to give up, but he kept me standing. 
My heartfelt gratitude goes to my family; the team of 22 and counting. Thank you for being an 
amazing support system especially to my mother Mrs. Ruby Korkor Anang, my brother George 
Anang and my sister Sharon Anang-Aseweh. 
Special thanks go to my dear friend Akosua Afrah Arhin, thank you for being there, your 
support is deeply appreciated. Again to Theresa Andoh, for all the help you offered during my 
data collection. 
To all the fathers who provided information for this study, I am sincerely grateful. Thank you 
for being available to contribute to this study. This thesis has come to fruition because of your 
efforts. To Mrs. Emelia Awude and all the other students of Dr. Ohemeng’s Graduate Lab, I 
appreciate all the input you made in shaping my thesis right from the onset. To all my course 
mates and my roommate Prospera Sungzie Sungpoor, thank you for keeping me on my toes 
throughout this study. Most importantly to my supervisors Dr Agartha Ohemeng and Dr. Gloria 
Ethel Otoo. I could not have asked for better supervisors. Thank you for dedicating your 
precious time to make my work stand out. I am extremely grateful. 
 
 
 
 
 
 
 
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 TABLE OF CONTENTS 
 
DECLARATION ............................................................................................................................. i 
ABSTRACT .................................................................................................................................... ii 
DEDICATION ............................................................................................................................... iv 
ACKNOWLEDGEMENT .............................................................................................................. v 
LIST OF FIGURES ........................................................................................................................ x 
LIST OF TABLES ......................................................................................................................... xi 
LIST OF ACCRONYMS AND ABBREVIATIONS ................................................................... xii 
CHAPTER ONE ............................................................................................................................. 1 
1.0 INTRODUCTION ..................................................................................................................... 1 
1.1 Background ............................................................................................................................... 1 
1.2 Rationale ................................................................................................................................... 3 
1.3 Objectives ................................................................................................................................. 4 
1.3.1 Main objective .................................................................................................................... 4 
1.3.2 Specific objectives .............................................................................................................. 4 
1.4 Hypotheses ................................................................................................................................ 5 
1.4.1 Null hypotheses .................................................................................................................. 5 
1.4.2 Alternate hypotheses .......................................................................................................... 5 
1.5 Significance of study ................................................................................................................. 5 
CHAPTER TWO ............................................................................................................................ 6 
2.0 LITERATURE REVIEW ......................................................................................................... 6 
2.1 The first 1000 days.................................................................................................................... 6 
2.2 Infant and young child feeding ................................................................................................. 7 
2.3 Breastfeeding ............................................................................................................................ 7 
2.3.1 Early initiation of breastfeeding ......................................................................................... 8 
2.3.2 Exclusive breastfeeding ...................................................................................................... 9 
2.4 Complementary feeding .......................................................................................................... 11 
2.4.1 Timely initiation ............................................................................................................... 11 
2.4.2 Adequacy .......................................................................................................................... 12 
2.4.3 Safety ................................................................................................................................ 13 
2.4.4 Responsive feeding .......................................................................................................... 14 
2.5 Nutritional status ..................................................................................................................... 15 
2.6 Undernutrition ......................................................................................................................... 16 
2.6.1 Stunting ............................................................................................................................ 16 
2.6.2 Wasting ............................................................................................................................. 17 
2.6.3 Underweight ..................................................................................................................... 18 
2.7 Social perspective of fatherhood ............................................................................................. 19 
2.8 Support for mothers during infant feeding.............................................................................. 20 
2.9 Fathers’ involvement in infant feeding ................................................................................... 21 
2.10 Fathers’ knowledge on infant feeding................................................................................... 22 
2.11 Fathers’ attitudes towards infant feeding .............................................................................. 22 
2.12 Fathers’ practices towards infant feeding ............................................................................. 23 
2.13 Factors that affect fathers’ involvement ............................................................................... 24 
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CHAPTER THREE ...................................................................................................................... 25 
3.0 METHODOLOGY ................................................................................................................. 25 
3.1 Study area................................................................................................................................ 25 
3.2 Study design ............................................................................................................................ 25 
3.3 Study population ..................................................................................................................... 26 
3.4 Criteria for participant selection ............................................................................................. 26 
3.4.1 Inclusion criteria ............................................................................................................... 26 
3.4.2 Exclusion criteria .............................................................................................................. 26 
3.5 Sample size determination ...................................................................................................... 26 
3.6 Sampling technique ................................................................................................................. 27 
3.6.1 Quantitative phase ............................................................................................................ 27 
3.6.2 Qualitative phase .............................................................................................................. 27 
3.7 Data collection and tools ......................................................................................................... 28 
3.7.1 Quantitative .......................................................................................................................... 28 
3.7.1.1 Fathers’ information ...................................................................................................... 28 
3.7.1.2 Anthropometric measurements...................................................................................... 29 
3.7. 2 Qualitative ........................................................................................................................... 29 
3.7.2.1 Focus group discussion ................................................................................................. 29 
3.8 Data Management ................................................................................................................... 30 
3.9 Study variables ........................................................................................................................ 30 
3.10 Data analysis ......................................................................................................................... 31 
3.10.1 Quantitative ........................................................................................................................ 31 
3.10.1.1 Knowledge .................................................................................................................. 31 
3.10.1.2 Attitudes ...................................................................................................................... 31 
3.10.1.3 Practices ...................................................................................................................... 32 
3.10.1.4 Anthropometric measurements .................................................................................... 32 
3.10.2 Qualitative .......................................................................................................................... 32 
3.11 Ethical consideration ............................................................................................................. 33 
CHAPTER FOUR ......................................................................................................................... 34 
4.0 RESULTS ............................................................................................................................... 34 
4.1 Background characteristics of participants ............................................................................. 34 
4.2 Fathers’ knowledge on exclusive breastfeeding ..................................................................... 37 
4.3 Fathers’ knowledge on complementary feeding ..................................................................... 39 
4.4 Fathers’ attitudes towards exclusive breastfeeding................................................................. 40 
4.5 Fathers’ attitudes towards complementary feeding ................................................................ 41 
4.6 Fathers’ practices concerning exclusive breastfeeding ........................................................... 43 
4.7 Fathers’ practices towards complementary feeding ................................................................ 45 
4.8 Overall knowledge attitudes and practice scores of fathers with children 0-5 months .......... 47 
4.9 Overall knowledge, attitudes and practice of fathers of children 6-24 months ...................... 48 
4.10 Nutritional status of children ................................................................................................ 49 
4.11 Overall nutritional status of children .................................................................................... 50 
4.12 Association between the fathers’ KAP and the nutritional status of children 0-5 months ... 51 
4.13 Predictors of children’s nutritional status 0-5 months .......................................................... 53 
4.14 Predictors of children’s nutritional status 6-24 months ........................................................ 55 
4.15 Focus group discussion and in-depth interviews .................................................................. 57 
4.16 Infant feeding practices ......................................................................................................... 59 
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4.18 Fathers’ roles in infant feeding ............................................................................................. 59 
4.18.1 Financial support ............................................................................................................ 59 
4.18.2 Physical support ............................................................................................................. 60 
4.18.3 Emotional support .......................................................................................................... 60 
4.19 Sources of information .......................................................................................................... 61 
4.20 Barriers to fathers’ involvement in infant feeding ................................................................ 62 
4.21 Overcoming barriers ............................................................................................................. 63 
CHAPTER FIVE .......................................................................................................................... 65 
5.0 DISCUSSION ......................................................................................................................... 65 
5.1 Background characteristics ..................................................................................................... 65 
5.2 Fathers’ knowledge on exclusive breastfeeding ..................................................................... 66 
5.3 Fathers’ knowledge on complementary feeding ..................................................................... 67 
5.4 Fathers attitude towards the feeding of children 0-5 months .................................................. 67 
5.5 Fathers’ attitudes towards the feeding of children 6-24 months ............................................. 68 
5.6 Fathers practice towards infant feeding of children 0-5 months............................................. 69 
5.7 Fathers practice towards infant feeding of children 6-24 months........................................... 69 
5.8 Nutritional status of children .................................................................................................. 70 
5.9 Association between fathers’ KAP and the nutritional status of children .............................. 70 
5.10 Predictors of the nutritional status of children ...................................................................... 71 
5.11 Fathers’ roles in infant feeding ............................................................................................. 72 
5.12 Sources of information on infant feeding ............................................................................. 72 
5.13 Barriers to fathers’ involvement in infant feeding ................................................................ 73 
5.14 Overcoming Barriers ............................................................................................................. 73 
5.15 Strengths and limitations of the study ................................................................................... 74 
CHAPTER SIX ............................................................................................................................. 76 
6.0 CONCLUSIONS AND RECOMMENDATIONS ................................................................. 76 
6.1 Conclusions ............................................................................................................................. 76 
6.2 Recommendations ................................................................................................................... 76 
REFERNCES ................................................................................................................................ 77 
APPENDIX ................................................................................................................................... 89 
Appendix 1- Questionnaire ........................................................................................................... 89 
Appendix II- Discussion and interview guide ............................................................................... 99 
Appendix III- Consent form........................................................................................................ 100 
Appendix IV- ECBAS approval letter ........................................................................................ 103 
Appendix V- Approval letter from Greater Accra Regional Health Directorate and the La 
Nkwantanang Madina District Assembly ................................................................................... 104 
 
  
 
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LIST OF FIGURES 
 
FIGURE TITLE PAGE  
Figure 4.1 Overall KAP scores of fathers of children 0-5 48 
months 
Figure 4.2 Overall KAP scores of fathers of children 6-24 49 
  months 
Figure 4.3 Nutritional status of children 50 
Figure 4.4 Overall nutritional status of children 51 
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LIST OF TABLES 
 
TABLE TITLE PAGE  
Table 3.1 List of independent and dependent variables 30 
Table 4.1 Background characteristics of participants 35 
Table 4.2 Fathers’ knowledge on exclusive breastfeeding for 38 
children 0-5 months 
 
Table 4.3 Fathers’ knowledge complementary feeding for 39 
children 6-24 months 
Table 4.4 Fathers’ attitudes concerning infant feeding of 40 
children less than 6 months 
Table 4.5 Fathers’ attitudes concerning complementary feeding 42 
Table 4.6 Fathers practice concerning infant feeding of 44 
children 0-5 months 
Table 4.7 Fathers practice concerning infant feeding of 46 
children 6-24 months 
Table 4.8 Association between fathers’ KAP and the 51 
nutritional status of children 0-5 months 
Table 4.9 Association between fathers’ KAP and the 52 
nutritional status of 
children 6-24 months 
Table 4.10 Predictors of children’s nutritional status of children 53 
0-5 months 
Table 4.11 Predictors of children’s nutritional status of children 55 
6-24 months 
Table 4.12 Qualitative participants’ sociodemographic 57 
characteristics 
Table 4.13 Themes and subthemes 58 
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LIST OF ACRONYMS AND ABBREVIATIONS 
 
WHO World Health Organization 
UNICEF Unite Nations Children’s Fund 
IYCF Infant and Young Child Feeding 
GDHS Ghana Demographic Health Survey 
MICS Multiple Indicator Cluster Survey 
LaNMMA La Nkwantanang Madina Municipal 
Assembly 
ME Margin of Error 
WLZ Weight for length z-score 
LAZ Length for age z-score 
WAZ Weight for age z-score 
FGD P Focus Group Discussion Participant 
IDI P In-depth Interview Participant 
EIB Early Initiation of Breastfeeding 
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CHAPTER ONE 
 
1.0 INTRODUCTION 
1.1 Background 
 
Undernutrition is a form of malnutrition that comprises of stunting, wasting and underweight. It 
also includes deficiencies in vitamins and minerals (WHO, 2021). From research, children are 
more likely to suffer from undernutrition, making them even more susceptible to diseases and 
death (Kandala et al., 2011; Ruwandasari, 2019; WHO, 2021, Mathiarasan & Huls, 2021). 
Globally, approximately 45% of child deaths occur due to undernutrition with majority of cases 
occurring in low to middle-income countries (WHO, 2021). As of 2016, it was estimated that 151 
million children were stunted, with 51 million suffering from wasting. Many of these children 
were from Africa, with varying levels amongst the different countries (WHO, 2017). Currently, 
140 million children are affected by stunting and 49.5 million are wasted. In Ghana, although 
progress has been made in reducing stunting to 17.5%, the prevalence of wasting although reduced 
(6.8%) remains higher than the prevalence for Africa (6.0%) (Global Nutrition Report, 2021). With 
the current figures, it is clear that the world is off course in achieving the 2025 WHO 
recommendations. 
According to the World Health Organization, optimal feeding practices serve as one of the most 
effective interventions targeted at improving child health and reducing undernutrition rates 
globally (WHO, 2009). The World Health Organization indicates that, optimal IYCF practices 
require that the breastfeeding of infants be initiated within the first hour of birth, followed with 
exclusive breastfeeding for the first 6 months of life. At 6 months complementary feeding must 
begin coupled with continued breastfeeding till the age of 2 and beyond. 
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Despite the implementation of interventions such as peer support groups and the baby-friendly 
initiative to reduce sub-optimal IYCF practices in Ghana, exclusive breastfeeding and appropriate 
complementary feeding rates continue to decline (Anin et al., 2020; Asare et al., 2018). The 
initiation of breastfeeding within the first hour of birth followed by exclusive breastfeeding for 6 
months reduces the risk of infant mortality and disease (UNICEF, 2019). Currently, in Ghana Early 
Initiation of Breastfeeding (EIB) has declined to 52% from the 56% recorded in 2014 (GDHS, 
2015, GNR, 2021). The Global Nutrition Report (2021) also indicates that only 42.9% of children 
are breastfed exclusively in Ghana. 
Transitioning from exclusive breastfeeding to the introduction of complementary foods is a 
vulnerable period and if not done properly could result in deficits in child growth and development. 
Complementary feeding must be initiated on time and be adequate in terms of nutritional 
composition. Foods given to infants must be prepared under safe conditions and given frequently 
based on the infant’s cues (WHO, 2009). In developing countries, complementary feeding is 
usually not initiated on time and foods given are of low nutritional content (Faber et al., 2016; Nti 
& Lartey, 2007). The poor nutrient composition of foods during this period of complementary 
feeding increases the risk of malnutrition in children, the risk of developing infections, and 
increased mortality (GDHS, 2014; Feng et al., 2022; Masuke et al., 2021). According to the 2021 
UNICEF conceptual framework on the determinants of maternal and child nutrition, optimal care 
practices and healthy diets contribute to positive maternal and child health outcomes. Adequate 
care and good diets lead to improved survival for women and children. The ideology of maternal 
care encompasses the emotional and physical support of the women and how this translates to 
optimal growth and development of children (Vogt et al., 2016). 
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Feeding of infants is usually regarded as a mother’s responsibility. However, studies have shown 
that family members such as significant others and grandmothers influence a mother’s decision 
concerning infant feeding (Witten et al., 2020; Aubel, 2011). It has been pointed out in several 
studies that the kind of support a mother receives helps to relieve stress, the feeling of isolation 
and boost a mother’s confidence in decisions related to the nutrition of the child (Martin et al., 
2021; Sear & Coall, 2011; Radzyminski & Callister et al., 2016). In situations where a mother’s 
support is limited during infant feeding, it could affect her caregiving abilities and mental health. 
This in turn could have a negative impact on child growth and development such as poor weight 
gain and slow cognitive development (Ickes et al., 2018). 
Previously, fathers were considered mainly as providers and protectors of the household. Men who 
exhibited a soft side were perceived as weak or feminine, having their masculinity questioned 
(Singh et al., 2014; Nkuoh et al., 2010). However, over the past few decades, there has been a re- 
orientation in family-gender roles with more men directly involved in the upbringing of their 
children (Anderson et al., 2010). 
 
 
1.2 Rationale 
In Sub-Saharan Africa, men hold the majority of power with regards to decisions taken at the 
household level (Nkuoh et al., 2010; Arthur-Holmes et al., 2020; Osei-Tutu & Ampadu, 2018). In 
Ghana, studies have proven that men’s roles in the home have profound implications on maternal 
health outcomes (Bougangue & Ling, 2022; Abiiro et al., 2022; Craymah et al., 2022; Ampim 
2013). Men usually have the final say concerning the number of children their wives should have 
or how much of the family’s budget should be allocated to health care (Ampim et al., 2021; Ganle 
et al., 2015; Cofie et al., 2015). However, studies in the Sub-Saharan region that have explored 
how fathers’ involvement in IYCF affects nutrition outcomes are limited. Some studies conducted 
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in the Sub-Saharan region deduced that fathers’ who had ample knowledge, offered support by 
doing household chores, or provided financially allowed mothers more time to concentrate on 
infant feeding. This in turn had a positive impact on the nutritional status of infants (Kumwenda, 
2017; Matare et al., 2019; Dafursa & Gebremedhin 2019). 
In Ghana, no study to the best of our knowledge has assessed the roles that fathers play in IYCF 
and its association with infants’ nutritional status, creating a gap in literature. This study therefore 
sought to find out directly from fathers about the depth of knowledge they possess concerning 
infant feeding, their attitudes and practices and how this is associated with the nutritional status of 
their children. 
 
 
1.3 Objectives 
 
1.3.1 Main objective  
 
The goal of this research was to assess fathers’ involvement in Infant and Young Child feeding in 
the La Nkwantanang Madina Municipal Assembly and how this relates to children’s nutritional 
status. 
1.3.2 Specific objectives 
 
1. To assess the knowledge, attitudes and practices of fathers of children 0 to 24 months 
 
2. To assess the nutritional status of children from 0 to 24 months within the La Madina 
Nkwantanang Municipal District. 
3. To assess the association between fathers’ knowledge, attitudes and practices and the 
nutritional status of children. 
4. To investigate the predictors of the nutritional status of study children. 
 
5. To explore and describe paternal roles during infant and young child feeding. 
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6. To explore and describe factors perceived to influence fathers’ attitudes and practices 
concerning infant and young child feeding. 
 
 
1.4 Hypotheses 
 
1.4.1 Null hypotheses 
 
Fathers’ knowledge, attitudes and practices concerning infant and young child feeding does not 
affect the nutritional status of children. 
1.4.2 Alternate hypotheses 
 
Fathers’ knowledge, attitudes and practices concerning infant and young child feeding affects the 
nutritional status of children. 
 
 
1.5 Significance of study 
 
The findings of this study contribute to understanding the ideas fathers in Ghana have about IYCF, 
as well as identify enhancers and challenges that they encounter in the feeding of their children. It 
also gives a better understanding on how the knowledge, attitudes and practices of fathers 
translates to the support they offer to the mothers of their young children and infant nutritional 
outcomes. The findings of the study also help to identify ways to encourage the involvement of 
fathers in infant and young child feeding. 
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CHAPTER TWO 
 
2.0 LITERATURE REVIEW 
 
2.1 The first 1000 days 
 
The first 1000 days of life is considered as the period from conception to the 24th month of child’s 
life. This is the stage of life where rapid growth and development occur and is highly dependent 
on the nutritional status of the mother (Cusick & Georgieff, 2016). Due to poor nutrition before 
and during pregnancy, the growth and development of the foetus is stifled right from the womb 
(Morrison and Regnault, 2016). Children born to nutritionally deficient mothers are affected by 
nutritional deficiencies and may suffer from poor cognitive development, defects, poor motor 
control, attention deficits, depressive symptoms and a host of other non-communicable diseases 
later in life (Schlotz & Philips,2009; Asindi & Al-Shehri, 2001; Li & Freedman 2020). A study in 
China showed that, exposure of infants in-utero to the 1950 China farming was significantly 
associated with hyperglycemia in adulthood with an odds ratio of 6.20 for adults with high socio- 
economic status and 1.68 for those with low socio-economic status (Li et al., 2010). Due to the 
impact of a mother’s health on the wellbeing of her child, it is important that women of 
reproductive age receive adequate care before and during pregnancy. Although a mother’s 
nutritional status before childbirth plays a pivotal role in infant growth and development, other 
factors also have an influence on the growth process (Pairman et al., 2011). Factors such as poor 
infant feeding practices, parental care and the environment could also affect the first 1000 days of 
a child’s life (Pem, 2015). Children in developing countries tend to be at a greater risk of 
developing nutritional deficiencies due to the inadequate intake nutrient rich foods as well as 
frequent infections thus inhibiting their growth potential (Adu-Afarwuah et al., 2017; Pem, 2016). 
In a bid to reduce the prevalence of malnutrition and improve infant nutrition, interventions 
such as Baby Friendly 
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Hospital Initiative and Growth Monitoring and Promotion have been implemented in various 
health facilities in Ghana (Ministry of Health, 2013). These measures have been put in place to 
reduce the burden of undernutrition, promote exclusive breastfeeding and complementary feeding 
during the first two years of a child’s life and give caregivers the necessary support they require in 
infant care (Tampah-Naah et al., 2019). 
 
2.2 Infant and young child feeding 
 
Optimal IYCF practices serve as one of the crucial points of intervention that shape the growth of 
individuals right from childhood to adulthood (WHO, 2009). Optimal nutrition during infancy 
coupled with other factors improves an individual’s chances of being productive in society (Prado 
et al., 2014). Optimal infant feeding encompasses early initiation of breastfeeding within the first 
hour of birth, exclusive breastfeeding for the first 6 months of life continues till the age of two and 
beyond as well as appropriate complementary feeding as recommended by WHO. According to 
Pelto et al (2003), infant feeding is basically defined as how, what and when infants should be fed. 
As indicated by Arabi et al (2012), these practices must be carried out during the state of wellness 
or disease in order to prevent the occurrence of undernutrition in children which could eventually 
lead to their death. 
 
 
2.3 Breastfeeding 
 
The World Health Organization in 2021 projected that optimal breastfeeding alone could save over 
820,000 lives of children under the age of five (WHO, 2022). The milk that infants receive from 
the mother’s breast is safe, abundant in nutrients that improve infant health and help to reduce the 
risk of common childhood killer diseases. In the long-term, infants who are exclusively breastfed 
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tend to have higher cognitive abilities than those who are not. In a prospective cohort study in 
Korea, it was discovered that infants that were exclusively breastfed for more than 3 months had a 
higher IQ compared to those breastfed for less than 3 months after 8 years (Kim & Choi, 2020). 
Breastfeeding also helps to reduce the risk of non-communicable diseases such as obesity and 
diabetes in adulthood (Branca et al., 2019; Rollins & Doherty, 2019; Owino, 2019). Breastmilk is 
not only safe but is also cheaper alternative to other milk substitutes. This makes it not only 
beneficial to the health of child, but to the finances of the household. The process of breastfeeding 
creates a bond between the mother and child. There is a reduction in anxiety and stress levels 
during breastfeeding due to the presence of the feel-good hormone oxytocin (Krol & Grossman, 
2018). The stimulation of the nipple-areolar complex by the suckling of the child stimulates the 
release of the hormone oxytocin from the posterior pituitary gland and then released into the 
bloodstream (Pillay & Davis, 2022). The presence of oxytocin in the blood stream during 
breastfeeding reduces the action of the stress causing hormone cortisol thus making a mother more 
relaxed during the process (Krol & Grossman, 2018; Heinrichs et al 2002, Nagel et al., 2021). 
 
 
2.3.1 Early initiation of breastfeeding 
 
The World Health Organization defines early initiation of breastfeeding as the breastfeeding of a 
new-born within the first hour of birth (WHO, 2022). EIB stimulates the production of breastmilk, 
serves as a defence against infections and reduces the risk of infections (WHO, 2022). There is a 
40% risk of children dying if there is failure to initiate breastfeeding within the first hour after birth 
and an 80% risk if breastfeeding is delayed twenty-four hours after birth (Edmund et al., 2022). 
Similarly, Berkat and Sutan (2014) in their study reported that neonatal morbidity and mortality 
increased due to late initiation of breastfeeding. Results from a prospective cohort study conducted 
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in Ghana, Tanzania and India also proved that neonatal death was lower in children breastfed 
within the 1 hour of birth than those breastfed within 2-23 hours after delivery. Globally, it is 
estimated that only about 48% of new-borns are breastfed within the first hour of birth (UNICEF, 
2022). Several factors contribute to breastfeeding not being initiated on time (Ahinkorah et al, 
2021; Shobo et al., 2020; Boakye-Yiadom et al., 2021). From the study conducted by Ahinkorah 
and colleagues, it was found that EIB was practiced amongst mothers with 5 children or more and 
those who had vaginal birth, as compared to first-time mothers and mothers who had undergone 
caesarean sessions (aOR 1.51 [95% CI 1.07 to 2.12]; aOR 4.71 [95% CI 1.36 to 16.24]). They also 
found that EIB was practiced amongst non-working women, non-media exposed women and 
women with high socio-economic status with the odds 1.18, 1.37 and 1.58, respectively. In another 
mixed method study conducted by Shobo and colleagues, they reported that birth attendants’ 
unwillingness to allow mothers perform their religious practices like prayer during labour affected 
their likelihood to breastfeed within the first hour after birth (RR=4.5, 95% CI 1.2 to 17.1). Results 
from the qualitative arm showed that post-delivery pains and stress made it difficult for mothers 
to initiate breastfeeding. Mothers reported that they needed time to regain their strength before 
breastfeeding. Like Ahinkorah et al (2021), Boakye-Yiadom et al (2021), also found that 
attendance to antenatal care was significantly associated with early initiation of breastfeeding (p= 
0.006). Also, the odds of breastfeeding within the first hour were higher amongst women who 
were roomed with their children compared to those who were not (OR 106.9 (CI: 32.9–346.8)). 
 
 
2.3.2 Exclusive breastfeeding 
 
Exclusive breastfeeding is the process of giving infants only breastmilk for the first 6 months of 
life. However, exceptions are made for oral rehydration solution, vitamins in the form of drops 
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and syrup as well as minerals and medicines (WHO, 2019). Infants who are exclusively breastfed 
have a lower risk of developing gastrointestinal conditions, ear nose and throat diseases, 
pneumonia and other non-communicable diseases like obesity and diabetes (WHO, 2011; CDC, 
2021; Savino et al., 2013). A study conducted by Rito et al (2019), gave an analysis of the 
association between breastfeeding in 22 countries. From the study, Italy and Malta had the highest 
prevalence (21%) of obesity among children aged 6-9 years who had never been breastfed. In a 
meta-analysis carried out by Horta et al (2015), there was a reduced possibility of breastfed infants 
being overweight with an odds ratio of 0.74. Exclusive breastfeeding also offers benefits to the 
health of the mother. It acts as a natural contraceptive, reduces bleeding after birth, lowers the risk 
of developing breast and ovarian cancer and also helps in weight loss (Scoccianti et al., 2015; Sung 
et al., 2016; Sipsma et al., 2018; Chowdhary et al., 2015). According to Schwarz (2015), mothers 
who breastfeed have less visceral fat, tend to have a smaller waist circumference and a reduced 
risk of diabetes later in life. In systematic review of 55 studies, 36 found a significant association 
with breastfeeding and postpartum depression and anxiety whilst 29 showed a reduction maternal 
mental health outcome when breastfeeding was practiced (Yuen et al., 2022). Despite the benefits 
of the exclusive breastfeeding for both mother and child, the Global Nutrition Report indicates that 
only 49.2 % of children are breastfed exclusively in Ghana. This indicates a decline from the 52% 
recorded in 2014 (GDHS, 2014). According to a study conducted by Tettey et al (2016), shorter 
duration of exclusive breastfeeding resulted in children being either moderately or severely 
malnourished. Also, in a population cross-sectional survey conducted in Ghana, the prevalence of 
exclusive breastfeeding was 43.7% and only 22% of the mothers breastfed beyond the first two 
years (Appiah et al., 2021). Factors that affect the rate of exclusive breastfeeding include a 
mothers’ joining the workforce, level of education and cultural beliefs, family size, spousal support 
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(Dede et al., 2020; Nishirum et al., 2018; Mogre et al., 2016; Mekebo et al., 2022; Opoku Mensah, 
2011; Durmazoğlu et al., 2021). Mogre et al (2016) reported that although mothers have 
favourable attitudes towards exclusive breastfeeding, 42% of them did not practice it. Also, from 
their study, high education levels for mothers increased the chances of practicing exclusive 
breastfeeding (OR 5.9; 95 % CI 2.6, 13.3; p < 0.001) 
 
 
2.4 Complementary feeding 
 
After 6 months of breastfeeding exclusively, breastmilk becomes insufficient and does not meet 
the nutritional demands of infants (WHO, 2022). This is due to increased growth and development 
that occurs during this stage. Hence, other sources of food must be added to the child’s diet to 
maintain optimum growth and development (WHO, 2022). The introduction of complementary 
foods must be timely, responsive based on the infant’s hunger cues, safe and adequate. 
 
 
2.4.1 Timely initiation 
The World Health Organization defines timely initiation of complementary foods as the 
introduction of solid, semi solid or soft foods between 6-8 months (WHO, 2009). After six months, 
a child requires more than breastmilk to sustain growth and development (WHO, 2020). Timely 
initiation of complementary foods at 6 months has been shown to coincide with the physiological 
maturation of the infant’s renal system and gastrointestinal tract (D’Auria et al., 2020). Delay in 
the initiation of complementary foods elevates the risk of children becoming undernourished 
(Abiyu & Belachew, 2020). Notwithstanding, early initiation of complementary food is just as 
harmful to the child as when delayed. Early commencement of feeding could result in children 
being overweight (Shagaro et al., 2021). In addition, they are denied of all the protective factors 
they require for growth and development (Hadi et al., 2021). In the Soro District of Ethiopia, it 
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was found that only 34.3% of women initiated complementary feeding on time (Yohannes et al., 
2018). In another study conducted in Ethiopia, low maternal education and low household 
economic status were associated with untimely initiation of complementary foods (Chane et al., 
2018). In Ghana, one in every five children is not given complementary foods on time (UNICEF, 
2018). A study conducted in the Kumbungu district of northern Ghana showed that early initiation 
of complementary foods was significantly associated with children being underweight (p=0.04) 
(Badjaaba, 2015). Untimely initiation of complementary foods could have a negative impact on 
the dietary forming habits of infants and contribute to linear growth faltering (Hirvonen et al., 
2021). 
 
 
2.4.2 Adequacy 
 
Adequacy in complementary feeding refers to the provision of foods that contain nutrients to meet 
the nutritional needs of the child (WHO, 2022). Research has shown that often, children are not 
fed quantities of food the body requires (Scaglioni et al., 2018; WHO, 2022). Aside that, food is 
not given frequently thereby putting children at risk of being undernourished. Foods given are 
usually energy dense, devoid of essential micronutrients such as iron, zinc, calcium and vitamin A 
(Troesch et al., 2015). Thus, there is the need to strike the balance between quality and quantity to 
ensure that children grow healthily (WHO, 2009). Adu-Afarwuah and colleagues reported in their 
study that women and children in Ghana relied heavily on diets that were starch based (Adu- 
Afarwuah et al., 2017). Generally, in developing countries foods given to children are 
predominantly plant based with very little additions of animal source foods (Dasi et al., 2019; 
Adesogan et al., 2020). Phytic acid present in plant-based foods inhibit the absorption of certain 
essential micronutrients such as iron, zinc and calcium making them unavailable for bodily 
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processes (Gupta et al., 2015). Several interventions have been carried out to improve the 
nutritional composition of complementary foods. Interventions such as educating mothers on the 
need for diet diversification using locally produced foods, fortification and supplementation of 
these foods (Kuchenbecker et al., 2017; Adu-Afarwuah et al., 2017; Arikpo et al., 2018). A 
randomized control trial conducted by Adu-Afarwuah et al (2019), showed that supplementation 
did not improve the iron levels at 6months of age instead at 18 months. They proposed that this 
occurred because infants iron stores are dependent on the mother’s intake during pregnancy 
however, this ceases after the delivery of the baby. Another randomized control trial by Ghosh et 
al (2017), found that children who received fortified cereal had higher haemoglobin levels at the 
end phase of the study as compared to baseline levels. 
 
 
2.4.3 Safety 
 
Another requirement for complementary feeding is that foods given to infants must be hygienic 
and given in a clean environment (IYCF, 2009). According to the UNICEF conceptual framework 
on maternal and child health, the conditions of the environment in which food is prepared could 
compromise the wholesomeness of the food. This could eventually lead to the occurrence of 
disease, contributing further to increased morbidity and mortality in children (UNICEF, 2021). 
Unhygienic food preparation methods, poor storage of food and kitchenware make food unsafe to 
eat. Also, poor handwashing practices at designated times may lead to the contamination of food 
(Chidiwisano et al., 2020). Contaminated foods when consumed by infants often leads to diseases 
such as diarrhoea. Each year, it is estimated that about 1.7 billion diarrhoeal cases are reported in 
children under the age of five (WHO, 2022). In Africa, diarrhoea causes about 16% of deaths in 
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children under five and in Ghana, about 10000 deaths in children under 5 per year (Asamoah et 
al., 2016). 
 
 
2.4.4 Responsive feeding  
 
Responsive feeding addresses the feeding of complementary foods based on the caregiver’s 
sensitivity to an infant’s hunger cues and the actions taken to encourage the child to eat (WHO, 
2009). In responsive feeding, the child determines how much food will be eaten based on the cues 
that are given. On the other hand, it is the duty of the parent to determine what food is given, 
where and how the food is fed (Boswell, 2021). It is an activity that requires the effort of both 
parent and child. Studies have shown that responsive feeding is most effective when it is infant led 
(Chen et al., 2020; Brown et al., 2017; Lutter et al., 2021). When parent feed with coercion, a strict 
stance, forcefulness or offering rewards based on a child’s ability to eat, it affects the intake of 
food and could either lead to over or underfeeding (Boswell, 2021; Chen et al., 2020; Daniels et 
al., 2014; Magarey et al., 2016). According to Bentley (2011), responsive feeding influences food 
and dietary intake of infants and in turn affect growth and development. As such in responsive 
feeding, it is crucial that psychosocial care is applied by the caregiver (WHO, 2009). A prospective 
cohort study in Mexico among mothers and infant pairs found that application of force during 
feeding times was significantly associated with lower weight for length z scores and low body 
mass index (p=0.02) (Kim-Herrera et al., 2021). In a qualitative study carried out in Ghana, 
caregivers identified inadequate knowledge from health care providers and the lack of support 
from family, friends and community as some of the barriers to practicing responsive feeding 
(Sandow et al., 2022). With the right knowledge, caregivers will be more equipped to identify the 
hunger cues of their children and respond accordingly. In Kenya, it was also found that force 
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feeding of children was significantly associated with occurrence of undernutrition (Mutoro et al., 
 
2020). 
 
 
 
2.5 Nutritional status 
 
Nutritional status is defined as the presence or the absence of malnutrition. Where malnutrition is 
defined as undernutrition or overnutrition (Huhmann, 2011). Todhunter (1970), also defines 
nutritional status as the health condition of an individual as influenced by the intake and utilization 
of nutrients. The assessment of nutritional status gives information on an individual’s health status 
such as potential nutritional deficiencies and excesses (Gurinović et al., 2017). Nutritional status 
can be determined by anthropometric measurements, biochemical tests, clinical assessments of 
signs and symptoms and by dietary assessments (Gibson, 2005). Biochemical tests tend to be 
expensive when conducted on large population sizes and clinical assessment usually require ample 
knowledge on signs and symptoms of various deficiencies (Bhattacharya et al., 2019; Sauberlich 
& Howerde, 2018). Dietary assessments give a fair idea of food or energy intake over a period 
however, it tends to be subject to recall biases (Bhattacharya et al., 2019). Anthropometry over the 
years has been the most frequently used assessment tool for nutritional surveys (Ferreira, 2020). 
This method of often preferred because it is much easier to perform compared to other assessment 
methods (Eaton-Evans, 2005; Thornton & Villamor, 2016). Nonetheless, minor errors in 
anthropometric measurements could lead to the misclassification of a person’s nutritional status 
(Eaton-Evans, 2005). Assessing nutritional status through surveys helps to give a snapshot of the 
health status of populations (Péter et al., 2015). This helps in the formulation of nutritional 
interventions that are channelled towards improving the health status of individuals 
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2.6 Undernutrition 
 
Undernutrition remains an issue of public health concern globally, stifling the economic growth of 
countries (WHO, 2021). Undernutrition in children could present itself as stunting, wasting and 
underweight. Stunting (low height-for-age) indicates chronic or long-term malnutrition, wasting 
(low weight-for-height) indicates acute retardation in nutrition (Sen et al., 2011). Although 
underweight, stunting, and wasting denote different facets of malnutrition in children, they are not 
mutually exclusive and rely on each other to coexist (Nandy et al., 2012). Undernutrition alone 
results in about 45% of deaths globally in children below the age of 5 with most cases occurring 
in low to middle income countries. The occurrence of undernutrition in children may be due to the 
interplay of several factors such as insufficient nutritious food, poor hygiene practices, lack of 
access to potable drinking water, poor parental knowledge, and low household socioeconomic 
status (Sulaiman et al., 2018; Murakar et al., 2020; Kassie & Workie, 2020). Undernutrition is 
considered critical by the World Health Organization when stunting prevalence exceeds 40% and 
wasting 15% (WHO, 2010). The severity of undernutrition in children is heightened if a child 
suffers from both stunting and wasting. It elevates the possibility of death in children and in turn 
affects the population wealth of countries (Fentahun et al., 2016). 
 
 
2.6.1 Stunting 
Linear growth is the best overall indicator of a child’s health status and provides an accurate 
marker of disparities in society (de Onis & Branca, 2016). This is evident in the millions of 
children worldwide who fall short in achieving linear growth potential due to sub-optimal nutrition 
and healthcare. They are also plagued with irreversible physical and cognitive damage that 
accompanies stunted growth (WHO, 2008). Severely stunted children face a four times higher risk 
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of dying by the age of 5 than normal children (Black et al., 2008). Stunted children enter adult 
hood with a higher propensity for developing obesity and chronic diseases (Hoffman et al., 2000). 
The condition is usually undetected in region where short stature is regarded as normal. The 
difficulty in visually identifying stunted children and the lack of routine assessment of linear in 
primary health care services explains why it has taken too long to recognize the magnitude of this 
scourge (WHO, 2012). As of 2019, UNICEF reported that every 1in 3 Ghanaian children suffer 
from stunting. Children after being weaned are unable to receive nutritious food that supports 
growth and cognitive development. In the Ghanaian Health system, growth monitoring session are 
centred on weight measurement of the child and making inferences on the child’s health based on 
that the child’s weight and age (UNICEF, 2008; Laar et al., 2018). Length measurement of children 
are often overlooked due to the lack of equipment and the time involved in taking the measurement 
in addition to the weight (Laar et al., 2018; Hamer et al., 2004). This makes it impossible to assess 
the child’s weight for length or length for age. Presently, stunting rates in the country have reduced 
from 18% in 2017/2018 to 17.5%. This percentage is less than the average of 30.7% recorded for 
Africa. In the Greater Accra region alone 13% of children are stunted lower than occurrences 
recorded for other regions in the country (GSS, 2018/2019). The Global Nutrition Report indicates 
that Ghana is making progress in achieving the 40% reduction in stunting in children below the 
age of 5 by the year 2025. 
 
2.6.2 Wasting 
 
Wasting in nutrition as defined by the World Health Organization is when a person is too thin for 
their height. Wasting or thinness in most cases indicates a recent and severe weight loss, which is 
often associated with acute starvation and or severe food shortage (WHO, 2019). Of all the forms 
of undernutrition, wasting has the highest tendency of resulting in infant death. According to Black 
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et al (2013), wasting is a form of nutritional deficiency that carries dire health consequences, the 
most immediate being a heightened risk of mortality. Children who are wasted in some situations 
may tend to be oedematose in the feet, all four limbs and in the worst-case scenario the entire body 
(UNICEF, 2022). Globally it is estimated that over 4.5 million children are wasted and close to 14 
million severely wasted (UNICEF, 2020). The continued high burden of child wasting globally 
represents an urgent policy priority (World Bank, 2016). The World Health Assembly’s target 
aims at reducing and maintaining child wasting below 5% globally by 2025 (WHO, 2014). Reports 
from the 2014 GDHS data indicate that children between that ages of 9-11 months were more 
likely to be wasted. Also, female children were more likely to be wasted by males (GDHS, 2014). 
Currently, the prevalence of wasting has increased from 5% in 2014 to 7% in 2018. 
 
 
2.6.3 Underweight 
 
Underweight (low weight-for-age) is a composite reflection of both stunting and wasting (WHO, 
2019). Over 45 countries in the world are bridled with the burden of this condition (Global 
Nutrition Report, 2021). Laar and colleagues (2018), in their study reported that during growth 
monitoring sessions, the indices for underweight are the most measured in Ghana. This is because 
it requires less time since it only involves the recording of the age of the child and taking weight 
measurements. Results from the 2014 GDHS showed that children born to mothers who had a 
body mass index less than 18.5kg/m2 were four times more likely to be underweight. The results 
also showed that, females were more likely to be underweight than males with a percentage of 
11.2 and 10.5 respectively. Again, children living in rural areas and those with mothers who had 
little or no education were more likely to be underweight than those in urban areas or those who 
had educated mothers (GDHS, 2014). 
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2.7 Social perspective of fatherhood 
 
Traditionally, a father is considered as the biological male parent of a child. Though this definition 
holds, a father may not always be a biological parent. He could be an adoptive father, a stepfather 
or even a male relative such as uncle or grandfather that plays an active role in the caregiving of a 
child whether directly or indirectly (Yogman & Eppel, 2022; Gogineni et al 2013). According to 
Richter and Morrell (2017), in some situations, a biological father may jilt his role in the life his 
child giving another man the chance to take responsibility. Also, with current technological 
advancements, a woman can get pregnant without direct participation from a man and thus 
eliminates the role of the ‘father’ in the child’s life (Baldwin, 2012). In the African context, the 
concept of fatherhood is expressed in the responsibilities a man takes on at home. It is considered 
as the father’s duty to provide financially, lead and protect his family (Osei & Ampadu, 2018; 
Whisson , 2012; Hunter; 2010; Abass et al., 2012). All other household activities such as cooking, 
cleaning and hands-on upbring of children is considered as a woman’s job (Annor,2014). It is not 
expected of a man to engage in such activities and men who usually do so are regarded as weak 
and feminine (Nkuoh et al., 2010). 
However, over the past three decades, gender roles in the world have seen a turn around with more 
women joining the active workforce (Wang &Bianchi, 2006; Raley et al., 2012). As a result of the 
change, more fathers have begun to contribute more at home by becoming involved in childcare 
activities, whilst women also offer financial support the household (Altintas et al., 2017). A study 
conducted by Ampim et al (2020), amongst young fathers in the rural and urban setting on their 
ideologies of manhood found that most men offered help at home with house chores to help ease 
the burden on their spouses. 
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2.8 Support for mothers during infant feeding 
 
The decisions a mother takes concerning the feeding of her child are largely dependent on the 
support she receives. Social support after birth reduces the stress a mother feels, boosts her self- 
esteem, improves her caring abilities and helps to eliminate the possibility of depression (Ni & 
Siew, 2011). In terms of support for mothers, fathers and grandmothers play a pivotal role in the 
IYCF journey of a child. In the African setting, grandmothers and older women are viewed as a 
well of knowledge and are key influencers at the household level (Michel et al., 2019; Jonasi, 
2007). They play a dominant role in decisions taken with regards to the health of the mother and 
her child (Thuita et al., 2015). Grandmothers not only run the affairs of their homes but offer help 
in the running of the homes of their children. Infants are often left in the care of their grandmothers 
to feed when the mother is either away on travel or at home (Thuita et al., 2015; Gupta, et al 2015). 
However, a partner’s support is often stronger than other relations (Thuita et al., 2015, Mitchell- 
Box et al., 2013, Rempell & Rempell, 2011, Tsai, 2014). The absence of support from family 
during the IYCF journey especially from the father of the child has shown to be an obstacle in 
efforts made to improve feeding practices (Aubel, 2011; Nankumbi & Muliira, 2015). In a 
prospective study conducted in Australia that sought to identify the determinants of breastfeeding 
initiation, it was found that partner support informed a mother’s decision to initiate breastfeeding. 
Women whose partners where pro-breastfeeding were more likely to initiate breastfeeding (AOR 
= 11.77, 95% CI 5.73, 24.15) (Arora et al., 2017). A study conducted by Coomson and colleagues 
(2016), in Accra deduced that women who received spousal support or encouragement from other 
relatives had higher tendencies to breastfeed their children in public (OR 3.99, 95% CI 1.50, 10.57; 
OR 3.27, 95% CI 1.31, 8.18). 
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2.9 Fathers’ involvement in infant feeding 
Optimal infant and young child nutrition is the responsibility of the parents of the child (Inbaraj et 
al., 2020). The role of a father in a child’s life is just as important as that of the mother although 
under-reported in studies (Clark, 2009). A father’s involvement is often seen from the time a child 
is born as this marks the onset of the fatherhood journey and may serve as a predictor for optimal 
involvement in the child’s life in the future (Bakermans-Kranenburg et al., 2019). Fathers’ 
involvement is classified as direct engagement with the child either through caretaking, or through 
playtime or leisure. Over the years, fathers’ involvement in the lives of their children have 
increased with more women acting as co-breadwinners in the household. Research conducted 
usually assesses a fathers’ involvement in infant nutrition based on maternal reports (Drysdale et 
al., 2021). This maybe a poor assessment of the support a father gives during the growth and 
development of his child. Often, fathers’ contribution towards nutrition is measured based on the 
wealth status of the father and its effect on infant health outcomes (Owaoje et al., 2014; Bimpong 
et al., 2020). Aside socioeconomic status, very little attention is given to other forms in which 
fathers involvement can impact the health of their children (Carlson &Magnuson, 2011). In a study 
concerning fathers engagement in infant feeding in Tanzania, majority of the fathers reported that 
their role in infant nutrition dwelt heavily on their ability to provide the necessary resources for 
needed infant feeding (Martin et al., 2021). Another study in Uganda showed that fathers were 
provided money for food and were helpful in buying food for their children however, they were 
less involved in taking decisions concerning the practice of exclusive breastfeeding, the onset of 
complementary feeding and accompanying the mothers of their children to the health facility 
(Kansiime et al., 2017). Contrarily, a study conducted in Kenya showed that fathers offered 
support by taking active part in decisions concerning infant feeding. This led to an improvement 
in the feeding frequency and dietary diversity of children (Aoko et al., 2018). Tohota and 
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colleagues found in their qualitative study that women appreciated it when their husbands offered 
support in handling the baby or carrying out some the household (Tohota et al., 2009). 
 
2.10 Fathers’ knowledge on infant feeding 
 
Knowledge received through education either influences a person’s behaviour positively or 
negatively (Saaka et al., 2021). Positive knowledge received and acted on has a high probability 
of improving the attitudes and practices of fathers towards infant feeding practices and in turn the 
nutritional status of their children (Nassanga et al., 2018). However, according to Bukusuba and 
colleagues (2010), there may be instances where positive knowledge may not cause the desired 
change in a particular behaviour. With the right knowledge fathers can help to improve exclusive 
breastfeeding rates and improve dietary diversity for children less than the age of 5 (Dinga et al., 
2018). In a randomized control trial in Australia known as the Father Feeding Initiative, it was 
found that women whose significant others received nutritional information during antenatal 
sessions were more likely to breastfeed than those who did not (Maycook et al., 2013). When men 
are exposed to information on infant feeding, it broadens their knowledge they already possess and 
improves the health outcomes for both mother and child (Piazalunga & Lamounier, 2009; Dinga 
et al., 2018; Palmqvist et al., 2013). An Ethiopian study found that fathers who had good 
knowledge and practice had children who had higher dietary diversity giving an odds ratio of 3.43 
(95% CI: 2.19–5.37) and 2.32 (95% CI:1.49–3.61), respectively (Bilal et al., 2015). 
 
 
2.11 Fathers’ attitudes towards infant feeding 
 
Attitudes are the perceptions and cognitive beliefs that influence the behavioural pattern of an 
individual. These perception and beliefs contribute to the emotional stance a person may have 
towards a particular phenomenon in addition to their preconceived ideas (Kaliyaperumal, 2004). 
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A father’s preconceived ideas about infant feeding may affect a mother’s feeding choice for their 
child. Positive attitudes exhibited by fathers concerning infant feeding practices is largely 
dependent on the information they receive. The attitudes that men have towards infant feeding are 
influenced by factors such as education and culture particularly in the African setting where 
males’ involvement in infant feeding labels them as weak (Nkuoh et al., 2010). Poor attitudes 
caused by poor knowledge could alter the trajectory of a child’s nutritional journey and could 
result in dire consequences on the child’s health and economic growth (Bilal et al., 2015). The 
attitudes of a man may not be influenced by the knowledge he possesses however, the have an 
impact on his practices concerning young child feeding. 
 
 
2.12 Fathers’ practices towards infant feeding 
 
Practices can be defined as the behavioural pattern or actions a person takes that may affect their 
way of life. These actions are often performed on the premise usually based on the knowledge a 
person has concerning a particular situation. Poor behaviours towards infant feeding according to 
Baldwin et al (2021), is caused by misinformation on infant feeding and inadequate support for 
fathers from health professionals. At the household level, men consider it their responsibility to 
provide financially whilst women address the direct caregiving activities such as feeding (Martin 
et al., 2021; Allotey et al., 2022). Men’s actions during the gestation period affects the decisions 
the mothers of their children may take concerning infant feeding In Nigeria, fathers’ practices 
such as buying of food, offering encouragement and supporting mothers with household chores 
helped to improve mothers’ decisions concerning infant feeding (Allotey et al., 2022). Another 
study conducted by Flax et al (2022) showed that fathers may not be privy all the information 
concerning infant feeding but could still be good avenues of positive indirect support for mothers. 
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2.13 Factors that affect fathers’ involvement 
 
Culture encompasses the beliefs, values and norms that are shared by a group of people. Culture 
plays an integral role in society and goes a long way to influence ideologies on various expectations 
for gender roles. According to Ganle et al (2015), roles that men and women play in the home is 
influenced by long standing societal religious, economic, and political beliefs. The role of a father 
varies across societies globally and is dependent on family structures, kinship patterns and 
economic systems. 
The socioeconomic status of a man may affect his presence in the life of his child. A father’s need 
to earn an income to support his family may consume time needed to be spent with the child 
(Townsend & Townsend, 2002). This absence of the father leaves a greater portion of the direct 
care burden on the shoulders of the mother (Raley et al., 2012). 
In some situations, men may prefer not to attend antenatal sessions with their wives to cut down 
the cost of transportation in order to ease their financial burden (Leng et al., 2019). 
Insufficient information from health professionals is another factor that may affect fathers’ 
involvement in infant feeding. In some instances, fathers may want to do more than just provide 
financially but may not know how to help their spouses (Tohota et al., 2009). According to Tohota 
and in colleagues reported that fathers felt unprepared and lacked the necessary information to 
help their lactating spouses. A qualitative study by Bilal et al (2016), it was reported that there was 
a knowledge gap between mothers and fathers concerning childcare because of poor child-health 
education targeted at fathers at health facilities. According to Kisumu et al (2018), fathers are 
usually not targeted for information on optimal infant and young child feeding at health facilities. 
Due to insufficient knowledge, they are unable to give the needed support to the mothers of their 
children with regards to IYCF. 
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CHAPTER THREE 
3.0 METHODOLOGY 
3.1 Study area 
The study was conducted in the La-Nkwantanang Municipal District. La Nkwantanang is one of 
the 29 Metropolitan, Municipal and District Assemblies in the Greater Accra Region of Ghana. It 
is located in the northern part of the region and covers about 75 square kilometers of land 
(LaNMMA, 2019). To the west of the district is the Ga East Municipal, to the east the Adentan 
Municipal, to its south is the Accra Metropolitan and to the north is the Akwapim South Municipal. 
It is situated between latitude 50 81’3” N and latitude 50 67’7” N, between longitude 00 24’0” W 
and 0013’1” W. According the 2021 census, the population of the district is 244,676, with 120,846 
males and 123,830 females, respectively (LaNMMA, 2019). The district is predominantly urban 
with majority of the population engaging in commerce activities (LaNMMA, 2019). 
 
 
3.2 Study design 
 
The study was a cross-sectional survey. This survey measures both the exposure and outcome of a 
phenomenon at a single point in time (Setia, 2016). Cross-sectional surveys do not determine 
causality however they can be used to prove the association between the outcome and exposure 
(Gad, 2014). They can be used to generate hypothesis for prospective studies and also be used to 
determine the prevalence of either the outcome or exposure in a population (Olsen and St George, 
2004). Cross-sectional studies are devoid of follow-ups thus making them a cheaper alternative to 
other studies (Girolamo & Mans, 2019). 
The quantitative arm of the study required the use of a survey to collect data and a statistical tool 
for analysis. The qualitative aspect on the other hand, focused on the perceptions and the 
experiences the study participants (Guetterman & Creswell, 2015). 
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3.3 Study population 
 
The study was conducted among fathers of children aged between 0 to 24 months in the La- 
Nkwantanang District in the Greater Accra region of Ghana 
 
3.4 Criteria for participant selection 
3.4.1 Inclusion criteria 
 
• Fathers of children aged between 0 to 24 months who live within the La-Nkwantanang 
district. 
• Fathers of children whose mothers attended growth monitoring sessions at the selected 
health facilities. 
3.4.2 Exclusion criteria 
 
• Fathers who did not live with their family or had not visited at least 3 times a month within 
the past 6 months. 
• Fathers who did not offer any form of physical and financial support to the mother of their 
young child were not eligible to participate. 
 
3.5 Sample size determination 
 
The prevalence of chronic malnutrition with the Greater Accra region (12%) was used in the 
calculation of the sample size. The prevalence was derived from the 2017/2018 Ghana Multiple 
Indicator Cluster Survey (MICS 2017/2018). Using this prevalence in the Cochran sample size 
formula: n= z2 P (1-P)/ ME2 
Where: n= representative sample Using a confidence level (Z) of 95% 
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                 Margin of error (ME) of 5% (0.05) 
 
Prevalence of chronic malnutrition within the Greater Accra region (P) = 12.6 % 
 
N= (1.96)2 *0.126 (1-0.126) / (0.05)2 Therefore, the minimum sample size= 169 fathers. 
Considering a 5% non-response rate, the sample size was totaled at 180 fathers. 
 
 
3.6 Sampling technique 
 
3.6.1 Quantitative phase 
 
The district and the health facilities were selected conveniently due to their proximity to the 
researcher and high coverage of antenatal and postnatal care. The two polyclinics (Madina 
Polyclinic and Kekele Polyclinic) in the district had an average of 75 and 68 attendants per month. 
Hence, a proportion of 50% of participants was selected from each facility. Mothers whose 
significant others met the inclusion criteria for the study were eligible to participate. All mothers 
were approached at the health center and the purpose of the study was explain to them. Mothers 
who agreed to participate then gave the contact of the infant’s father. This process was repeated 
till the estimated sample size was reached. 
3.6.2 Qualitative phase 
 
Once a week from each of the health facilities, the researcher conveniently selected all mothers 
who were willing to participate in the study. These participants were different from those selected 
for the quantitative domain. The purpose of the study was explained to the mothers at the facility 
The mothers who consented gave the contact of the fathers of their children. The researcher 
contacted all fathers to seek their consent to participate in the study. A total of 17 fathers were 
recruited. Five fathers agreed to take part in a focus group discussion and 12 opted for in-depth 
interviews. 
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3.7 Data collection and tools 
 
3.7.1 Quantitative 
 
3.7.1.1 Fathers’ information 
 
A pretest was conducted on nine (9) fathers from each of the facilities. The questionnaire was 
administered online or over the phone based on the father’s preference of the father. The pretest 
was done to ensure the validity and accuracy of the questionnaire as well as the estimated time 
needed to answer the questions. Fathers who participated in the pretest were not included in the 
actual survey. After the pretest, fathers whose contacts were obtained from the mothers of their 
children were called to inform them about the study and ascertain their willingness to participate. 
The questionnaire was self- administered online using an electronic form or over the phone based 
on the preference of the father. On the other hand, fathers who visited the facility with their 
children were eligible to participate in the study. Fathers were approached directly and the 
purpose of the study was explained. Those who consented were recruited into the study. Data was 
collected on fathers’ socio-demographic characteristics. Knowledge, attitudes and practices 
(KAP) concerning IYCF were collected using the validated Food and Agriculture Organization 
(FAO) KAP questionnaire (FAO, 2014). The KAP questionnaire consists of 13 module 
questionnaires that cover an array of nutrition-related issues in society. This questionnaire was 
originally designed for mothers but can be modified for the purpose of other studies such as this, 
as demonstrated by Kumwenda (2017). These modifications included questions on fathers 
understanding of IYCF, the help they offer during feeding episodes, and the provision of financial 
support amongst others. 
 
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3.7.1.2 Anthropometric measurements 
 
Anthropometric measures were taken twice and recorded on the questionnaires. (WHO, 2008). For 
weight measurements, mothers stood barefooted on the scale after taking off all heavy objects. The 
scale was tarred and the child was handed over to the mother on the scale. The difference in weight 
was read and recorded on the questionnaire. The recumbent length of children was measured with 
an infantometer. The child was placed on the infantometer with his or her head against the head 
piece. An assistant held the head of the child in position by cupping the ears. The movable foot 
board was then pushed to the feet of the child by the measurer. Thereafter, the length of the child 
was recorded on the questionnaire 
 
3.7. 2 Qualitative 
 
3.7.2.1 Focus group discussion 
Due to the inability to get fathers to participate the qualitative arm of the study, only one focus 
group discussion was held. The discussion was held with five fathers aged 32-45 years over the 
weekend. The discussion was held at a convenient and comfortable location. The researcher 
functioned as the facilitator for the discussions. The discussion session was recorded and lasted 
for an hour and 5 minutes. An assistant researcher took notes and recorded non-verbal 
communication expressed during the discussion. With the use of a focus group discussion guide, 
the discussion session was centered on fathers’ attitudes and practices towards IYCF with more 
attention on factors that affect their involvement in terms of attitudes and practices. The 
participants were given beverage and pastries in appreciation of their contribution and time. 
3.7.2.1 In-depth Interviews 
Twelve in-depth interviews were conducted. This was because fathers found it difficult to make 
time during the week and over the weekend to participate in the focus group discussions. 
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Participants were more comfortable making time after work to offer the interview over the phone. 
The phone conversations with the fathers were recorded after fathers gave their consent. The 
interview guide followed the same pattern as the focus group discussion guide. Fathers who 
offered to be interviewed aged between 27-40 years and the sessions lasted for a maximum of 20 
minutes. The participants were compensated with airtime to show appreciation for their 
contribution and time. 
3.8 Data Management 
 
All the information provided for this study were treated with caution. Participants names were not 
mentioned in any report and identification codes were used for each participant. Hard copies of 
the questionnaire were locked in cabinets and questionnaires answered online were stored on a 
computer with a password 
 
3.9 Study variables 
 
Table 3.1: List independent and dependent variables 
Independent variables  Dependent variables 
Father’s Age  Wasting  
Occupation  Stunting  
Level of education  Underweight 
Income level   
Household size   
Child’s age   
Child’s sex  
Religion   
Ethnicity  
Number of children  
Number of children below 24 months   
Number of prenatal visits attended  
Number of postnatal visits attended  
Knowledge   
Attitudes   
Practices   
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3.10 Data analysis 
3.10.1 Quantitative 
The data was analyzed using IBM SPSS (Statistical Package for Social Sciences) version 20. 
Means and standard deviations were computed for continuous variables and frequencies and 
percentages for categorical variables. Chi-square analysis was also used to determine the 
association between the knowledge, attitudes and practices of fathers and the nutritional status of 
children between. Binary logistic regression was then used to determine the independent variables 
(fathers’ KAP and other covariates) that were associated with infant nutritional status (measured 
as wasting, stunting and underweight). 
3.10.1.1 Knowledge 
 
The knowledge of fathers was analyzed and put into binary classifications. The responses of the 
fathers were grouped as ‘knows’ for a correct answer and ‘does not know’ for a wrong answer. 
For the questions that required multiple correct answers, one correct answer given was classified 
as ‘knows.’ On the other hand, no correct answer for questions that required multiple correct 
answers were classified as does not know. Any correct answer attracted a score of one and a wrong 
answer was allocated a score of zero. The total score of each father was then calculated by 
summing up his scores. The knowledge scores of fathers were grouped into categories of high and 
low with cutoff points of >70% and ≤70% respectively (FAO, 2014). 
 3.10.1.2 Attitudes 
 
The attitudes of the respondents were also analyzed and grouped into binary classifications based 
on either a positive or negative attitude. A positive response of the fathers attracted a score of one 
and the negative, a score of zero. The total score of each father was then calculated by taking a 
sum of scores for each father. The scores of obtained were then grouped into categories of good 
and poor with cutoff points of >70% and ≤70% respectively (FAO, 2014). 
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 3.10.1.3 Practices 
 
Like the analysis of knowledge and attitudes, the binary classifications were used to analyze 
whether fathers had optimal feeding practices when it came to their younger children. Based on 
the questions asked about food type and frequency, fathers who had good practice skills were given 
a score of one and those with negative practices, a score of zero. Similar to the knowledge and 
attitudes of fathers, the total score of each father was then calculated by summing up his scores. 
The practice scores of fathers were then grouped into categories of good and poor with cutoff 
points of >70% and ≤70% respectively (FAO, 2014). 
3.10.1.4 Anthropometric measurements 
 
The average of the measurements was derived in SPSS and analyzed using the WHO Anthro 
software for weight for age, weight for length and length for age z-scores, respectively. The z- 
scores were then grouped into categories of undernourished and normal with the cut-off points <2 
and ≥ 2, respectively. A composite score for malnutrition was then created based on a child either 
being wasted, stunted, or underweight. A child having one or more of the conditions was given a 
score of one and labeled as undernourished. However, the absence of any of these conditions 
attracted a score of zero and labeled a child as normal. 
 
3.10.2 Qualitative 
 
Data was analyzed using thematic analysis. Data collected from the notes and audio tapes were 
transcribed verbatim by the researcher. The codes were grouped to form themes thereafter, 
subthemes were generated. The data analyzed from the discussions helped to validate the responses 
received from the quantitative aspect of the study and given a clearer picture of fathers’ 
involvement in IYCF. 
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3.11 Ethical consideration 
 
Ethical consideration for this study was sought from the Ethical Review Committee of the College 
of Basic and Applied Sciences (ECBAS) with the approval number, Ref. No: ECBAS 017/21-22 
(Appendix IV). Approval was also sought from the Greater Accra Regional Health Directorate and 
the District Directorate of the La Nkwantanang Madina Municipal District Assembly (Appendix 
V). Informed consent was also sought from all the participants after the purpose of the study was 
explained to them. Participants were made aware of confidentiality, the benefits and risk of the 
study as well as their freedom to withdraw at any point in time during the study. 
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CHAPTER FOUR 
4.0 RESULTS 
 
4.1 Background characteristics of participants 
 
A total number of 180 father-child pairs participated in the study. Table 4.1 shows that, the 
minimum age of the fathers was 22 years and the maximum was 52. Most fathers fell within the 
31 to 40 age group. More than half of the fathers (52.8%) lived in peri-urban areas and were 
married (88.9%). A little over half (51.1%) of them had completed secondary school and over a 
third owned their own businesses (42.2%). With regards to income, close to a third of the fathers 
(32.8%) earned between 1600-2000 monthly. Most of the participants recruited for the study were 
Christians (78.9%) and 39.4% belonged to the Akan ethnic group. Over two-thirds (68.3%) of the 
fathers belonged to a household with four to seven members. More than half of the fathers 
(57.2%) had only one child who was under the age of five. The minimum attendance to antenatal 
sessions was zero and the maximum ten. Most men (83.3%) had visited the health facility less 
than three times with the mothers of their children and 81.3% attended postnatal visits twice or 
less. The female children in this study (51.7%) were more than the males (48.3%). A little over half 
(50.6%) of the children fell within the 6-24 month’s category and 49.4% in the 0-5 months 
category. 
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Table 4.1: Background characteristics of participants 
 
 n % 
Fathers’ characteristics  
Age (years)  
≤30 48 (26.6) 
31-40 111 (61.7) 
>40 21 (11.7) 
Father’s age (years) x ± SD 34.16 ± 5.63 
 
Classification of residence 
Urban 116 (64.4) 
Peri-urban 64 (35.6) 
 
Marital status 
Married 160 (88.9) 
Single 20 (11.1) 
 
Education 
Primary 23 (12.8) 
Secondary 92 (51.1) 
Tertiary 65 (36.1) 
 
Occupation 
Business 76 (42.2) 
Office worker 25 (13.9) 
Service worker Other1,2,3 64 (35.5) 
15 (8.4) 
 
Income level (per month) 
600-1000 26 (14.4) 
1100-1500 46 (25.6) 
1600-2000 59 (32.8) 
>2000 49 (27.2) 
 
Religion 
Christianity 142 (78.9) 
Islam 38 (21.1) 
(Other 1= teacher/lecturer 11 (6.1%), 2=healthcare 3 (1.7%), 3=student 1(0.1%)) 
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Table 4.1: Continued 
 
 n (%) 
Ethnicity  
Akan 71 (39.4) 
Ga 39 (21.7) 
Ewe 36 (20.0) 
Northern 34 (18.9) 
 
Household number 
3 56 (31.1) 
4-7 124 (68.3) 
≥ 8 1 (0.6) 
 
Number of children under 5 
1 103 (57.2) 
2 67 (37.2) 
3 10 (15.6) 
 
Number of prenatal visits 
≤ 3 150 (83.3) 
4-7 22 (12.3) 
≥ 8 8 (4.4) 
 
Number of postnatal visits 
0 34 (18.9) 
1 77 (42.8) 
2 37 (20.6) 
3 20 (11.1) 
4 12 (6.7) 
 
Childs characteristics 
Age categories (months)  
0-5 89 (49.4) 
6-24 91 (50.6) 
Child’s age (months) x ± SD 7.28 ± 5.50 
 
Sex 
Male 87 (48.3) 
Female 93 (51.7) 
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4.2 Fathers’ knowledge on exclusive breastfeeding 
 
To evaluate the knowledge fathers of children below 5 months have about breastfeeding, a series 
of 10 questions were asked. In table 4.2 below, all the fathers (100%) knew that breastmilk is the 
only food a child new-born baby should receive. Most fathers had heard of and understood the 
term exclusive breastfeeding giving a percentage of 53.9 and 50.6, respectively. In relation to the 
length of breastfeeding a little over half of the fathers (53.9%) knew the required duration for 
exclusive breastfeeding. A significant number of fathers stated that babies had to be fed on demand 
and also knew that breastmilk alone was sufficient enough for babies (64.0% and 77.5% 
respectively). All the fathers who participated knew the benefits of exclusive breastfeeding to the 
child however, only 37.1% knew the benefits it offered to the mother. Almost all the participants 
(95.5%) knew how mothers could keep their milk supply. Also, more than two-thirds fathers knew 
how a mother could continue exclusive breastfeeding after resuming work and where she could 
seek help if she had any difficulties with feeding (62.9% and 71.9% respectively). 
Table 4.2: Fathers’ knowledge on exclusive breastfeeding for children 0-5 months (N=89) 
 
Knowledge on infant feeding n (%) 
First food a child should receive  
Breastmilk 89 (100) 
  
Heard of exclusive breastfeeding  
Yes 45 (50.6) 
 No 41 (49.4) 
  
Meaning of exclusive breastfeeding  
Child gets only breastmilk 48 (53.9) 
Do not know 41 (46.1) 
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Table 4.2: Continued 
 
Knowledge on infant feeding n (%) 
Length of exclusive breastfeeding     
Birth to six months 48 (53.9) 
 3 months 2 (1.1) 
4 months 5 (2.8) 
5 months 2 (1.1) 
Do not know     32 (36.0) 
  
Benefits of exclusive breastfeeding for  
the mother  
Knows 33 (37.1) 
Does not know 56 (62.9) 
  
Keeping up milk supply  
Knows 85 (95.5) 
Does not know   4 (4.5) 
  
Continuation of exclusive breastfeeding  
after resuming work  
Express breastmilk 56 (62.9) 
Formula 24 (27.0) 
Porridge 5 (5.6) 
Do not know 4 (4.5) 
  
Overcoming difficulties with  
breastfeeding  
Seek professional help    64 (71.9) 
 Talk to another woman 14 (15.7) 
 Do not know 11 (12.4) 
  
Frequency of exclusive breastfeeding  
On demand  57 (64.0) 
Does not know 32 (36.0) 
  
Sufficiency of breastmilk  
Knows 69 (77.5) 
Does not know 20 (22.5) 
  
Benefits of exclusive breastfeeding to   
the baby  
Knows 89 (100) 
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4.3 Fathers’ knowledge on complementary feeding 
 
In table 4.3 below, fathers of children above six months were asked five questions to determine 
the knowledge they possess in relation to complementary feeding. From the table, majority 
(60.4%) of the participating fathers knew the appropriate age to initiate complementary foods. 
Most of the participants (68.1%) were able to report correctly on the importance of adding other 
foods to breastmilk. All the fathers knew the kinds of food that can be used to enrich porridges and 
how to encourage children to eat. 
       Table 4.3: Fathers knowledge on complementary feeding for children 6-24 months (N=91) 
Knowledge on complementary feeding n (%) 
Recommended age for the continuation  
of breastfeeding  
24 months and more 25 (27. 5) 
 Do not know 66 (72.5) 
  
Age to start complementary feeding  
At six months 55 (60.4) 
 Do not know 36 (39.6) 
  
Importance of adding other food to  
breastmilk 
Breastmilk is insufficient 62 (68.1) 
Do not know 29 (31.9) 
  
Foods that enrich porridge  
Knows 91 (100) 
  
Ways to encourage children to eat  
Knows 91 (100) 
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4.4 Fathers’ attitudes towards exclusive breastfeeding 
 
Table 4.4 shows the attitude scores of the fathers of children below 6 months. From the table 
below, more the half of the fathers reported that exclusively breastfeeding children was good 
(52%). A high proportion did not think it was difficult for women to breastfeed on demand and 
were confident in the way the mothers of their children breastfed (73% and 87.6% respectively). 
Also, most men were confident in the mother expressing and storing her breastmilk (52.8%) 
Table 4.4 Fathers’ attitudes towards exclusive breastfeeding for infants 0-5 months (N=89) 
Attitude question n (%)  
Is exclusive breastfeeding good?   
Yes 52 (58.4) 
Not sure 35 (39.3) 
No 2 (2.2) 
  
Is exclusive breastfeeding good for your  
child? 
Yes 52 (58.4) 
Not sure 37 (41.6) 
  
Do you think it is difficult for mothers to  
breastfeed on demand? 
Yes 24 (27.0) 
No 65 (73.0) 
  
Are you confident in how the mother of  
your child breastfeeds? 
Confident 78 (87.6) 
Ok 11 (12.4) 
  
Are you confident in the mother of your  
child expressing and storing milk? 
Confident 47 (52.8) 
Ok 35 (39.3) 
Not confident 7 (7.9) 
 
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4.5 Fathers’ attitudes towards complementary feeding 
 
As shown in the table below, over half of the fathers (56.0%) were not confident in preparing 
meals for their children. More than two thirds of (74.7%) also reported that it was good to give 
children diverse types of food each day. Concerning the difficulty in giving children different foods 
in a day, 56.0% had a challenge in doing so however, the majority (85.7%) thought it was good to 
feed the child several times a day. More than half (62.6%) of the participant had difficulties in 
feeding their children several times a day and most (79.1%) of them thought it was good to 
breastfeed beyond 6 months of age. 
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Table 4.5: Fathers’ attitudes towards complementary feeding of children 6-24 months (n=91) 
 
Attitude question n (%) 
Are you confident in meal preparation?  
Confident 31(34.9) 
            Not confident 60 (65.1) 
  
How good it is to give children different  
types of food each day? 
Good  68 (74.7) 
Not good 23 (25.3) 
  
Do you find it difficult in giving different  
foods each day? 
Difficult 64 (70.3) 
Not difficult 40 (29.7) 
  
Is feeding your child several times a day  
good? 
Good  78 (85.7) 
Not sure 13(14.3) 
  
Do you find it difficult feeding child  
several times a day? 
Not difficult 30 (33.0) 
 Difficult 61(67.0) 
  
Is it good to continue breastfeed beyond  
6 months? 
Good  72 (79.1) 
Not sure  16 (17.6) 
Not good      3 (1.7) 
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4.6 Fathers’ practices concerning exclusive breastfeeding 
 
Fathers were assessed on their ability to help feed their children, participation in decision making 
and purchasing of food. In the table below, only 20% of fathers helped to feed their children below 
the age of six months. This was because majority of the women remained at home during this 
period (23%) or there were grandmothers (22.5%). With regards to what food was fed to the baby 
when the mother was away, most men (47.2%) reported that no other food was given since most 
women remained at home with the baby. When asked about the responsibility on deciding to 
breastfeed exclusively, more than half of the fathers reported that the mother of their child solely 
took the decision. Also, a substantial proportion of the fathers (61.8%) stated they encouraged the 
mothers of their children to breastfeed exclusively. 
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Table 4.6: Fathers’ practices towards exclusive breastfeeding of children 0-5 months (N=89) 
 
Practice question n (%) 
Whose responsibility is it to take  
decisions on exclusive breastfeeding?  
Mother 51 (57.3) 
Both mother and father 38 (42.7) 
  
Do you encourage the mother of your  
child to breastfeed exclusively? 
Yes 55 (61.8) 
No 34 (38.2) 
  
Who feeds the baby when the mother is  
not at home 
Father  18 (20.2) 
Grandmother 20 (22.5) 
Mother is always at home 42 (47.2) 
Other 9 (10.1) 
  
What type of food is fed to the baby when  
the mother is not around? 
Breastmilk by spoon cup or bottle 30 (33.7) 
Infant formula by spoon, cup or bottle 15 (16.9) 
Porridge  2 (2.2) 
Mother is always at home   42 (47.2) 
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4.7 Fathers’ practices towards complementary feeding 
 
Fathers practice towards complementary feeding was also assessed to determine the behaviours 
fathers possessed towards feeding their children. In table 4.7, a substantial number of fathers 
(75.8%) reported that they helped to feed their children at home. When asked about who was 
responsible for feeding the child close to half of the fathers (49.5 %) stated that it was the duty of 
the mother to feed the child and 71.4% reported that the mother of the child solely decided on 
when to start complementary feeding. Another 59.3% of the fathers said it was the responsibility 
of the mother to decide on when to initiate complementary feeding and 40.7% stated that it 
was a joint responsibility. All the participants (100%) interviewed stated that they bought food 
specifically for their children. Close to half (48.4%) of the fathers’ reported that both parents had 
the responsibility of buying food for the child however, only 46.2% participated in the decision- 
making process on that foods to buy. With regards to who bore the responsibility of deciding what 
foods to buy, 48.4% stated that it was the duty of the mother. Nevertheless, more than half of the 
fathers (67.0%) reported that both parents actually bought food for the child. 
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Table 4.7: Fathers’ practice concerning complementary feeding of children 6-24 months 
(N=91) 
 
Practice questions n (%) 
Do you help to feed your child?     
Yes    69 (75.8) 
  No 22 (24.2) 
  
Who is responsible for feeding the child? 
Mother 45 (49.5) 
 Both 37 (40.6) 
Mother, father, grandmother 5 (6.6) 
Mother and grandmother  2 (2.2) 
Mother and older daughter 1 (1.1) 
  
Who made the decision to start  
complementary feeding?  
Mother  65 (71.4) 
 Father   1 (1.1) 
Both   24 (13.3) 
mother and grandmother   1 (1.1) 
  
Whose responsibility is it to make decisions  
on when to introduce complementary foods?  
Mother    54 (59.3) 
Both 37 (40.7) 
  
Do you buy food specifically for the child?  
Yes 91 (100) 
  
Whose responsibility to buy food for the  
child? 
Mother 14 (15.4) 
 Father  12 (13.2) 
Both 65 (71.4) 
  
Participation in decision making to buy food  
for your child.  
Yes 42 (46.2) 
No 49 (53.8) 
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Table 4.7: Continued 
 
Practice questions n (%) 
Responsibility to make decisions on food      
purchase for child  
Mother     44 (48.4) 
 Father  5 (5.5) 
Both 42 (46.2) 
  
Who actually buys food for the child?  
Mother     13 (14.3) 
Father 17 (18.7) 
 Both 61 (67.0) 
 
 
 
 
4.8 Overall knowledge attitudes and practice scores of fathers with children 0-5 months  
Based on Figure 4.1 below, the majority (55.1%) of fathers had high knowledge about exclusive 
breastfeeding. A high proportion also had positive attitudes (53.9%). However, this did not 
translate into their practice, since only 44.9% had positive behaviours towards exclusive 
breastfeeding. 
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60
55.1  53.9 55.1
                     
50 good/ high  
44.9 46.1 44.9  
poor/bad  
40  
 
 
30
 
 
20  
 
 
10  
 
 
0
 
knowledge attitudes practices
 
 
 
Figure 4.1 Overall KAP scores of fathers of children 0-5 months 
 
 
 
 
4.9 Overall knowledge, attitudes and practice of fathers of children 6-24 months 
 
For fathers with children six months and above, more than half had high knowledge (57.1%) on 
complementary feeding. Although the fathers had high knowledge, a high proportion had low 
scores for attitudes and practices (46.2% and 48.4% respectively) as shown in Figure 4.2 
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Percentage 
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60 57.1
53.8 51.6 good/ high
48.4
50 46.2 poor/bad
42.9
40
30
20
10
0
knowledge attitudes practices
 
        Figure 4.2 Overall KAP scores of fathers of children 6-24 months 
 
 
 
4.10 Nutritional status of children 
 
Based on the WHO growth standards, weight and height of the children were measured for the 
calculation of their weight for age, weight for length and length for age status. Figure 4.3 below 
shows that majority of the children fell within the normal category however, 7% were underweight, 
8% were wasted and 18% stunted. 
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Percentage 
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100 93% 92%  
90 normal
82%
80
undernourished
70
60
50
40
30
18%
20
7% 8%
10
0
WAZ WLZ LAZ
 
Figure 4.3 Nutritional status of children 
 
 
 
4.11 Overall nutritional status of children 
 
Overall nutritional indicator that was created to serve as a proxy for undernutrition. If a child had 
one or more of the conditions, they were considered as undernourished. As such, from the figure 
below, 72% of the children fell within the normal category and 28% were undernourished. 
 
 
 50 
Percentage 
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28%
72%
normal undernourished
     
Figure 4.4: Overall nutritional status of children 
 
 
 
4.12 Association between the fathers’ KAP and the nutritional status of children 0-5 months 
 
A chi-square analysis was run to determine the association between KAP and the nutritional status 
of children. From the analysis there was no significant association at a p value set at <0.05 
Table 4.8 Association between the fathers’ KAP and the nutritional status of children 0-5 
months (N=89) 
 
Characteristic Normal Undernourished p-value 
n (%) n (%) 
Knowledge    
High 45 (91.8%) 4 (8.2%)  
Low 35 (87.5%) 5 (12.5%) 0.50 
 
Attitudes   
Good  44 (91.7%) 4 (8.3%)  
Poor 36 (87.8%) 5 (12.2%) 0.55 
Practices    
Good  38 (95.0%) 2 (5.0%)  
Poor 42 (85.7%) 7 (14.3%) 0.18 
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4.12 Association between fathers’ KAP and the nutritional status of children 6-24 months 
In table 4.9 below, there was no association between fathers’ KAP and the nutritional status of 
children from 6 to 24 months when the p-value was set at < 0.05 
Table 4.9: Association between fathers’ KAP and the nutritional status of children 6-24 
months (N=91) 
 
Characteristic Normal Undernourished p-value 
 n (%) n (%) 
Knowledge    
High 44 (84.6%) 8 (15.4%)  
 Low 31 (79.5%) 8 (20.5%) 0.525 
Attitudes    
Good  37 (88.1%) 5 (11.9%)  
Poor 38 (77.6%) 11 (22.4%) 0.188 
Practices    
Good 38 (86.4%) 6 (13.6%)  
Poor 37 (78.7%) 10 (21.3 %) 0.339 
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4.13 Predictors of children’s nutritional status 0-5 months 
 
In table 4.10 below, there was only a significant association between the sex of the child and the 
nutritional status of the child. The table showed that female children were more likely to be 
undernourished than males (AOR= 0.333 (0.126-0.879)). 
Table 4.10: Predictors of children’s nutritional status 0-5months (N=89) 
 Unadjusted odds p-value Adjusted p-value 
ratio  odds ratio  
Knowledge      
High 1  1  
Low  1.61 (0.40-6.43) 0.50 1.99 (0.43-9.37) 0.40 
     
Attitude      
Good  1  1  
Poor  1.53 (0.38-6.11) 0.55 2.05 (0.45-10.09) 0.38 
     
Practice      
Good  1   1  
Poor  3.17 (0.62-16.19) 0.15 3.32 (0.55-19.99) 0.19 
     
Residence     
Urban                1  1  
Peri-urban 1.25 (0.53-2.96) 0.66 1.38 (0.24-8.06) 0.72 
     
Fathers Age      
Above 35  1  1  
Below 35 1.68 (0.76 -3.21) 0.23 2.20 (0.33-14.63) 0.63 
     
Education     
Secondary  1  1  
Primary 0.92 (0.25-3.34) 0.90 1.76 (0.55-5.68) 0.41 
     
     
Marital status      
Married                 1                 1  
    Single  2.33 (0.77-7.12) 0.13 0.46 (0.18- 1.14) 0.35 
           Dependent Variable: overall nutritional status, criterion level: (*p<0.05) 
 
 
 
 
 
 
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Table 4.10: Continued 
 Unadjusted odds p-value Adjusted odds p-value 
ratio  ratio  
Occupation                           
Business             1                1      
Other  0.53 (0.22-1.23) 0.13 0.46 (0.19-1.14) 0.094 
     
Religion      
Christian 1                1  
Muslim  1.21 (0.45-3.29) 0.70 1.15 (0.20-6.52) 0.88 
     
Ethnicity      
Southern                1                 1  
Northern  1.09 (0.38-3.14) 0.89 1.20 (0.392-3.641) 0.75 
     
Income      
≥ 2000 1                1  
≤ 2000 0.62 (0.25-1.51) 0.28 0.697 (0.26-1.85) 0.47 
     
Household     
number                  
3 members               1                1  
Above 3  0.95 (0.39-2.36)       0.92 0.58 (0.08-4.00) 0.58 
     
Number of     
children      
1 1  1  
≥ 2  1.06 (0.45-2.48) 0.89 1.42 (0.30-6.69) 0.74 
     
Antenatal visits      
≥ 4 1  1  
≤ 4  1.55 (0.43-5.54) 0.50 0.55 (0.11-2.73) 0.21 
     
Postnatal visits      
3-4 1  1  
0-2 0.17 (0.02-1.28)  0.05* 0.16 (0.02-1.54) 0.07 
     
Sex of child      
Female              1  1  
     Male   0.31 (0.12-0.79)  0.01* 0.33 (0.13-0.88)  0.02* 
Dependent Variable: overall nutritional status, criterion level: (*p<0.05) 
 
 
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4.14 Predictors of children’s nutritional status 6-24 months 
 
Two variables had a statistically significant relationship with the nutritional status of children in 
the regression model. Marital status (AOR=7.030 (1.171-42.209)) and the sex of the child (0.176 
(0.043-0.714)) were the significant variables 
Table 4.11: Predictors of children’s nutritional status 6-24 months (N=91) 
 
 Unadjusted odds p-value Adjusted odds ratio p-value 
ratio 
Residence     
Urban 1  1  
Peri-urban 1.25 (0.53-2.96) 0.66 0.90 (0.24-3.45) 0.85 
    
Fathers Age 
Above 35 1  1  
Below 35 1.68 (0.76 -3.21) 0.23 1.37 (0.38-4.91) 0.63 
    
Education 
Secondary 1  1  
Primary 0.92 (0.25-3.34) 0.90 0.67 (0.06-7.00) 0.43 
    
Marital status 
Married 1  1  
Single 2.33 (0.77-7.12) 0.13 7.03 (1.17-42.21) 0.03* 
    
Occupation 
Business 1  1  
Other 0.53 (0.22-1.23) 0.13 0.69 (0.19-2.44) 0.56 
    
Religion 
Christian 1  1  
Muslim 1.21 (0.45-3.29) 0.70 2.62 (0.53-13.05) 0.24 
    
Ethnicity 
Southern 1  1  
Northern 1.09 (0.38-3.14) 0.89 2.84 (0.53-15.29) 0.23 
    
Income 
≥ 2000 1  1  
≤ 2000 0.62 (0.25-1.51) 0.28 0.88 (0.24-3.23) 0.85 
Dependent Variable: overall nutritional status, criterion level: (*p<0.05) 
 
 
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Table 4.11: Continued 
 
 Unadjusted odds p-value Adjusted odds p-value 
ratio ratio 
Household     
number     
3 members 1  1  
Above 3 0.95 (0.39-2.36) 0.92 1.22 (0.35-4.30) 0.54 
    
Number of 
children     
1 1  1  
≥ 2 1.06 (0.45-2.48) 0.89 1.30 (0.38-4.50) 0.68 
    
Antenatal visits 
≥ 4 1  1  
≤ 4 1.55 (0.43-5.54) 0.50 2.78 (0.31-24.59) 0.36 
    
Sex of child 
Female 1  1  
Male 0.31 (0.12-0.79) 0.01 0.18 (0.04-0.71) 0.04 
    
Knowledge 
High 1  1  
Low 1.42 (0.48-4.19) 0.53 1.32 (0.39-4.48) 0.50 
    
Attitudes 
Good 1  1  
Poor 2.142 (0.68-6.77) 1.88 1.91 (0.56-6.52) 0.54 
    
Practices 
Good 1  1  
Poor 1.71 (0.57-5.19) 0.34 1.46 (0.44-4.81) 0.18 
        Dependent Variable: overall nutritional status, criterion level: (*p<0.05) 
 
 
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4.15 Focus group discussion and in-depth interviews 
 
The FGD was held in-person and all the in-depth interviews were conducted over the phone. The 
discussions and interviews were centered on fathers’ responsibilities during infant feeding, 
perceived factors that affect involvement and any other responsibilities fathers could take on in the 
home to help mothers. Table 4.12 shows the sociodemographic characteristics and table 4.13 
shows that major themes and subthemes that were derived from the focus group discussion and 
the in-depth interviews respectively. 
Table 4.12: Qualitative participants’ sociodemographic characteristics (N=17) 
 
Interview type No of participants Age range 
Focus group discussion 5 32-45 
In-depth interviews 12 27-40 
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Table 4.13: Theme and sub-themes 
 
General theme Theme Sub-themes 
Infant feeding Breastfeeding and • Duration of 
practices complementary feeding breastfeeding 
of infants • Inadequate 
knowledge of the 
term 
complementary 
feeding 
• Types of foods 
children should 
receive 
Fathers’ roles in Providing support • Financial support 
infant feeding • Physical support 
• Emotional 
   
Information Sources of information • Internet 
• Health centers 
• Wives 
• Grandmothers 
   
Barriers Barriers to fathers’ • Cultural 
involvement • Finances 
problems 
• Tiredness from 
work 
   
   
Overcoming barriers Improving fathers’ • Making extra 
participation effort to be 
present 
• Education in 
schools 
• Advertisements 
on media 
platforms 
• Improving 
services at health 
centers 
• Policy changes 
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4.16 Infant feeding practices 
 
From the focus group discussion and interviews fathers were asked what they understood by proper 
infant feeding. From the responses, most fathers had heard about exclusive breastfeeding. They 
were able to explain the term exclusive breastfeeding and identify the duration. However, some of the 
fathers did not know the term complementary feeding. Although they could not identify the term, 
they were able to indicate certain foods children could have as complementary foods. These some of 
the views the fathers expressed when asked, what is proper complementary feeding? 
 “What I know is it's feeding the baby from just zero age to maybe 6 months, just giving them 
breastmilk” 
 
“So, when a child is given only breastmilk to drink and the mother doesn’t add any other 
thing yeah that’s it, till the child is six months” (FGD, P1) 
“…errm, I have no idea but what I know is that after the six months they are supposed to 
start eating some food like Koko or other foods that you eat at home.” (IDI, P3) 
 
 
4.18 Fathers’ roles in infant feeding 
 
Fathers stated that their main role in infant feeding was to provide support to the mother of their 
child. Support from fathers was either given financially, physically or emotionally. 
4.18.1 Financial support 
With regards to financial support, most fathers stated that they gave money to the mothers to buy 
food for the children. Some stated that they also gave money to cater for the transportation to 
monthly growth monitoring sessions. 
“I always make sure that I send her money so that she can buy food for the house. Most of 
the time I am not at home so the money must always be sent so that they have enough to buy 
food….” (IDI, P4) 
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“…if anything comes up and I can’t go with her for weighing I will leave money so that she 
can go. (IDI, P5) 
4.18.2 Physical support 
 
For physical support, fathers helped mothers with some of the chores at home to allow them time 
to take care of the child. A proportion of fathers mentioned that they helped to bathe and clean up 
the children after they had used the toilet. Again, some indicated that they helped in meal 
preparation and in feeding the children. A few fathers also stated that they were responsible for 
shopping for food items. Lastly, physical support from fathers also came in the form of attending 
growth monitoring sessions with the mothers. 
“So, to support in that angle, it is either you are boiling some hot water to put the feeing 
bottles in, the spoons, whatever you will use to feed the child you follow that procedure to 
make it hygienic.” (FGD, 4) 
“When the mother is not around and he has pooped I can’t wait for her to come back before I 
change him, so I do it myself and if I have to bath him too I do it.” (IDI, 1) 
“…you should be able to prepare some food for the baby. When the mother is not there, you 
should be able to take care of the baby and feed the baby as well.” (FGD, P3) 
“…because she just gave birth, I have to help with the shopping, so she will make the list for 
me and then I’ll out and buy the things…” (IDI, P12) 
“I take her to the hospital for the weighing too… My wife she always wants me to go because 
if I do, they will attend to her early then she can leave and go and open her shop.” (IDI, P5) 
4.18.3 Emotional support 
 
Emotional support from fathers came in four forms. Some fathers stated that there were times when 
they stayed up at night to keep the mother company while she breastfed. Fathers also mentioned 
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that they reminded the mothers to breastfeed and offered words of encouragement. In some 
situations, fathers helped to carry and comfort children when they were crying. 
“…when the baby wakes up in the night to feed sometimes if I am not too tired, I also wake 
up so that I keep her company whilst she is feeding…at times too it is like she doesn’t want 
feed the child because she is also tired but I have to encourage her to do it because I also 
want what is best for the child. If it happens like that, I take the baby from her when she has 
finished then she too she can sleep” (IDI, 8) 
“I think one thing that happens to the mothers is when after 6 months, they get to adding 
other stuff, they tend to reduce the breastmilk. So maybe one thing that I do is to remind her 
or tell her that the breastmilk is also very important in addition to the other foods” (FGD, 
P1) 
“…there are times where for no reason the baby will just be crying and the mother cannot 
handle it so I just take the child from her and be walking outside, then she too can look after 
the other children” (IDI, 6) 
 
4.19 Sources of information 
 
Findings from the study showed that fathers received their information from various sources. The 
respondents stated that they received information about infant feeding from their wives, the health 
centers, the internet and other female relatives. The information they received helped to shape their 
thoughts concerning infant feeding. These were some of the responses that were given when asked, 
where do you receive information on infant feeding? 
“I usually get it from my wife. When she comes home from the hospital, she tells me and then 
we discuss. Secondly, I get it from grandma. You know they also come with a lot of knowledge 
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and several years of experience. You know it is grandma who takes care of the children, so 
she will say do a, b, c…” (FGD, P4) 
 
 
“I learnt that from my mother, sometimes too grandmother and aunties, I'm the eldest of my 
siblings so I have been doing that for them when they were kids.” (IDI, P1) 
 
 
“… I think essentially from the hospital. So, when you accompany your wife for the ANC 
visits, usually there is the antenatal clinics where they teach you some of these things and 
even the ANC book that they give has a lot of information on how to feed children…” 
(FGD,3) 
 
 
4.20 Barriers to fathers’ involvement in infant feeding 
 
With regards to the factors that hindered the active participation of fathers in infant feeding, fathers 
stated that they would have loved to be involved more in the feeding of their children. However, 
they reported that culture, tiredness from work, and financial problems influenced their levels of 
participation in the feeding of their children. The following responses illustrate the views that were 
shared on how these barriers affects their involvement 
“One thing is that men have ego, every man has an ego. Our culture too does not make it 
easy. It is not easy. That is why I said that it is a difficult task for some of the men. Because 
me, I met someone holding his wife’s bag and someone said ‘now you are carrying women’s 
bags’. Ask yourself how many men can take of their children when their wives are not 
around. Even to bath their children in the house is difficult for them because they feel big.” 
(FGD, P5) 
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“It’s about you being the head of the house. You must make sure that there is food on the 
table. So, you go to work but when you come you are tired, mother too is tired, you want to 
sleep but chale you can hear the baby crying but you just want to sleep. You know that kind 
of thing.” (FGD, P1) 
 
 
“…some of us are really suffering. You work and you don’t even know where the money goes 
to. I work hard but I can’t even save like how I want to. The bills are so many. Things are 
not like how they used to be before…even to give chop money has become a problem” (IDI, 
P10) 
 
 
4.21 Overcoming barriers 
 
After stating the barriers that affected their involvement, fathers also stated possible ways to 
overcome these barriers. From the discussion and interviews fathers raised the need to put more 
effort into being present for their children, education in schools, advertising on television and 
radio, improving services at health centers and policy changes. From the discourse, these were 
some of the points that were raised when the question ‘how do you overcome the barriers you have 
mentioned?’ was asked. 
“You have to be there for your child. For some of us and I think most people our fathers’ 
provided money, but they did not play active roles in our lives, so I think it is time to correct 
that behaviour. As a father it is the responsibility of you and the mother to take care of the 
child, not just her own so you too you have to be there for the child.” (IDI, P7) 
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“…so it can be on TV, it can be on radio, newspapers because there are people who like 
watching TV for news, there are others who for instance like reading and there are others 
who will not like reading at all so they will prefer listening” (IDI, P2) 
 
 
“I think that is boils down to education because culture and religion have a very strong hold 
on our lives and whether we like it or not, it is with us. But as you advance in your education 
and in your economic status, some of these things begin to change. We have, to start 
involving the adolescent boys right from their primary school education. I think that is the 
way to go. If we begin to involve them right from school and teach them to appreciate that 
childbearing, is the responsibility of both parents, then as they grow, they will begin to 
appreciate that it is not only for women.” (FGD, P2) 
 
“If you go to our hospitals eh, the maternal wards, the antenatal sessions there are 
televisions there. In specialized hospitals, you will see them show videos of the reproductive 
system. But go to our main general hospitals and it is on the local tv stations, when they can 
show something educational the mother will benefit from.” (1DI, P4) 
 
“Okay so I think that the courtesies that are given to women should also be extended to men 
and I will use paternity leave as an example. So, when the woman delivers, she gets between 
2 and 6 months in some organizations, the man doesn’t get anything. In my organization 
they gave me only one week for paternity leave and some men don’t even get at all. We need 
to begin to look at some of these policies in our organizations. So maternity leave and 
paternity leave should be looked at.” (FGD, P3 
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CHAPTER FIVE 
5.0 DISCUSSION 
5.1 Background characteristics 
 
Close to two-thirds of the fathers (61.7%) were within the 31-40 age group. This age range is 
below the period where male fertility begins to decline (Chan et al., 2015). Over half (64.4.%) of 
the participants captured in the study resided in urban areas and engaged in commerce activities 
(42.2%). This was expected since majority of areas within the district are urban with few sects of 
rural areas (GSS, 2021). Most of the participants in the study were married, similar to a study 
conducted by Ayam et al., 2020 within the district. Although the study area is within the Greater 
Accra region, most of the participants were Akans (39.4%). 
All the participants had received some form of education however the about half (51.2%) had 
attained their secondary school education. This coincides with reports from GDHS (2014), where 
50% of men had received some form of secondary education. A study conducted in South Africa 
showed that fathers who had attained secondary or tertiary education had better knowledge 
(p=0.001) on exclusive breastfeeding than those who had lower levels of education (Mabele et al., 
2022). 
Most of the fathers had been for prenatal visits less than three times and only once for postnatal 
visits with the mother of their child. A study conducted in Ghana found that only 16.5% of men 
attended antenatal clinics sessions with their wives (Owusu, 2021). Nonetheless, 33.5% influenced 
their wives to attend (Owusu, 2021). This was similar to some of the feedback of the qualitative 
arm of the study where most fathers stated that they were unable to attended prenatal sessions with 
their wives due to the nature of their jobs. In a study by Kyei-Arthur et al (2021), fathers’ 
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attendance to antenatal sessions increased the likelihood of a mother practicing exclusive 
breastfeeding (AOR = 1.08; CI 95%: 1.00–1.16; p = 0.04). 
 
 
5.2 Fathers’ knowledge on exclusive breastfeeding 
 
All the fathers were aware that breastmilk was the first food children had to receive after birth. 
Other studies conducted in Ethiopia and Malawi also reported that fathers had high knowledge on 
the first food a baby should receive (Shitu et al., 2021; Kumwenda, 2017). Fathers also knew about 
the duration and sufficiency of breastmilk. This differed from a study conducted by in South 
Africa, where less than half of the fathers knew the duration for exclusive breastfeeding and 
whether breastmilk was sufficient for the first six months of life (Mabele et al 2021). Inadequate 
knowledge on the benefits of breastfeeding to the mother was expected. This is because, 
information on the benefits of breastfeeding is usually targeted at children with little emphasis on 
the advantages to the mother (Dieterich et al., 2013; Spiro, 2017; Del Ciampo & Del Ciampo, 
2018). On the other hand, there was receptiveness to mothers expressing their milk as they resumed 
work to encourage exclusive breastfeeding. The expression of breastmilk may have been accepted 
widely by the fathers in this study since it offered mothers the opportunity to continue 
breastfeeding exclusively after returning to work. Expression of milk may have also helped to 
improve to the bond between fathers and their children since they could also help in feeding with 
the bottle or the cup and spoon. Fathers also reported that women had to seek help from health 
professionals when it came to breastfeeding. Fathers may have considered themselves inadequate 
in providing solutions to breastfeeding problems. In Ghana, nurses and midwives are known to 
support mothers by giving information on infant feeding during antenatal and growth monitoring 
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sessions (Kyei-Arthur et al., 2019; Acheampong, 2020; Dubik et al., 2021; Adjei-Ampofo et al., 
2020, Zhang et al., 2018). 
 
5.3 Fathers’ knowledge on complementary feeding 
 
Most fathers of children 6-24 months did not know the recommended age for the continuation of 
breastfeeding. Fathers’ poor knowledge on the continuation of breastfeeding may have been as a 
result of their poor attendance to antenatal and postnatal sessions with the mothers of their children. 
A study conducted by Sachdeva & Gupta (2022), showed that fathers’ high knowledge in infant 
feeding was significantly associated with attendance to antenatal sessions. Although fathers had 
inadequate knowledge on the duration for continued breastfeeding, they were informed on the 
recommended age for the onset of complementary feeding. Similar to the FGD and IDI’s most 
fathers knew when complementary feeding was supposed to begin. Positive knowledge on the 
recommended age for complementary feeding influences the timely introduction of appropriate 
complementary foods (Flax et al, 2022). Fathers’ awareness on positive ways to feed children 
agreed with the WHO’s stance on positive encouragement during feeding times for the proper 
development of a child’s relationship with food (WHO, 2021). 
 
 
5.4 Fathers attitude towards the feeding of children 0-5 months 
 
From this study, fathers were certain that exclusive breastfeeding was the best choice for their 
children. This is buttressed by several studies, where fathers agreed that breastmilk was adequate 
for their children till they reached the age of six months (Shiota et al., 2019, Hansen et al., 2018; 
Kumwenda, 2018; Rempel & Rempel; 2018). Fathers’ stance on the exclusive breastfeeding could 
be explained by their high knowledge levels on the benefits of breastmilk for infants. Fathers 
opposed the perception that breastfeeding was a challenging task for women. This could imply 
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that since fathers offered encouragement to mothers, they assumed that breastfeeding was not 
stressful. Conversely, in other studies, men reported that breastfeeding on demand seemed like a 
challenging task for women since it required a lot of attention (Hansen et al., 2018; Tohotoa et al., 
2009). Although fathers knew expressing milk helped mothers continue exclusive breastfeeding 
after resuming work, they were not confident in the expressing and storage of milk. Fathers may 
have had this sentiment due to the risk of infants being infected from unhygienic utensils or 
transference, as opposed to mothers feeding right from the breast. Similar to this study, a Malawian 
study showed that fathers were concerned that the nutrient composition and safety of the milk will 
be compromised if expressed and stored (Kumwenda, 2018). 
 
 
5.5 Fathers’ attitudes towards the feeding of children 6-24 months 
 
Fathers in both the quantitative and qualitative arms of the study stated that food preparation was 
usually the mothers’ responsibility. Ganle et al (2015), and Arthur-Holmes & Busia (2020) also 
reported that in Ghana, meal preparation in the household is often regarded as the duty of the 
mother. Fathers believed that children had to be fed frequently and given a variety of foods. This 
may have implied that fathers’ a good understanding on the need for dietary diversity. According 
to Ambikapathi et al (2019), the nutrition knowledge of men influences the dietary diversity of 
their children. Fathers’ expressed difficulty in feeding children in both arms of the study. This was 
due to their work schedules and their perception of women’s roles in the home. They were 
comfortable with their children being breastfed after six months, which suggests that they 
understood the benefits of breastfeeding even after complementary feeding had been initiated. 
Similar to this study, fathers in a Tasmanian study were supportive of their wives breastfeeding 
after 6 months (Hansen et al., 2018) 
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5.6 Fathers practice towards infant feeding of children 0-5 months 
 
Only a few fathers took part in the feeding of their children because mothers stayed home with the 
children. The results support the theory that women are the primary caregivers of children in the 
household (Ganle et al., 2015). In instances when the mother was away, breastmilk was given 
fathers by either a spoon and cup or a feeding bottle. This result was expected since these are 
reported as common tools that can be used when feeding directly from the breast is hindered 
(Ramussen et al., 2017). Fathers reported that decision to breastfeed was solely the mothers to 
take. Comparable to this study, a study in Uganda found that 80.6% of fathers did not take part in 
deciding whether or not to exclusively breastfeed (Kansiime et al., 2017). Fathers’ low 
participation in decision making may be because of poor knowledge on how far their input goes 
in shaping the nutrition of their children. Even though fathers did not play an active part in decision 
making, they perceived that the support they offered encouraged the mothers of their children to 
breastfeed exclusively. Several studies reinforce this result (Nickerson et al., 2012; Martin et al., 
2021, Kansime et al., 2017; Tohota et al., 2009, Hansen et al., 2018), where mothers reported that 
words of encouragement from their partners help then to stick to their decision to exclusively 
breastfeed. 
 
 
5.7 Fathers practice towards infant feeding of children 6-24 months 
 
Similar to fathers of children 0-5 months, it was reported that mothers were responsible for the 
feeding and the decision to introduce complementary food. Fathers viewed their responsibility in 
infant feeding mainly as providing support, with all other responsibilities ascribed to the mother 
of the child. The results showed that fathers purchased food for their children. This was expected 
because in the African setting fathers are regarded as the main providers of the household with 
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other responsibilities ascribed to the mother. However, some studies report that these cultural 
ideologies of gender roles have placed boundaries towards male physical and emotional 
involvement in childcare (Gowda & Rodriguez, 2019, Cerrato & Cifre, 2018; Nukunya, 2016; 
Mkandawire et al., 2022). 
 
 
5.8 Nutritional status of children 
 
The prevalence of stunting and wasting in this study were higher than that recorded for the 
Greater Accra region (12.6% and 5.8% respectively) (MICS, 2017). This study used a sample of 
180 children from 0 to 24 months however, the MICS survey was conducted amongst children 
under the age of five from about 12, 000 households. As such, the difference in sample size may 
have been a contributing factor to the difference in results from previous studies. Also, this study 
was conducted in only one district of the region and thus implies that certain areas of the region 
could have prevalence rates higher than the national prevalence. On the other hand, levels of 
underweight in the district was however lower than the prevalence of 9.2% reported by MICS 
(2017) for the Greater Accra Region. This may have also occurred as due to methodological 
differences in both studies. 
 
 
5.9 Association between fathers’ KAP and the nutritional status of children 
 
The study showed that the nutritional status of children was independent of fathers’ KAP. 
However, some research has shown that fathers’ knowledge and support positively affected the 
nutritional status of children (Bilal et al., 2015; Dinga et al., 2018; Aoko et al., 2018). To buttress 
the results from this study, another study conducted in northern Ghana also found that there was 
no association between maternal social support and the nutritional status of children. Nonetheless, 
they emphasized that support from fathers must be improved in order to boost the confidence of 
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mothers in addressing the nutritional needs of children (Wemakor et al., 2022). Even though 
fathers KAP did not influence the nutritional status of children in this study, it may have 
contributed positively to the decisions mothers took concerning infant feeding and their caregiving 
practices. This may have been the reason for the high prevalence of normal nutritional status 
amongst children in the study. Kansime et al., (2017) in their study indicated that the absence of 
associations between the KAP of fathers and the nutritional status of children does not dispute the 
fact that the efforts of fathers are crucial in shaping the nutritional status of their children. 
 
 
5.10 Predictors of the nutritional status of children 
 
Sex of the child significantly predicted the nutritional status of children. Male children were less 
likely to be nourished as compared to females. The results of this study are buttressed by findings 
from the 2011 national survey in Ghana and the 2017 MICS survey. The mechanism as to how sex 
affects the nutritional status of children is not clearly understood. According to Thurstans et al 
(2020), the perception of boys having a larger appetite and hence the need to start complementary 
feeding. Prioritizing male children over females and giving them other foods perceived to be better 
than breastmilk may be a contributing factor for this outcome. 
Marital status was also a significant predicator for the nutritional status of infants 6-24 months of 
age. Unmarried men were more likely to have a child that was undernourished. Although 
unmarried fathers may have offered financial or physical support, it may not have been as 
consistent as married fathers. Married men may have had a higher sense of commitment towards 
the needs of the child since they were bound to the mother through marriage. According to the 
Izugbara (2016), Amadu et al (2018), and Hertz et al (2020), in their studies also report that marital 
status influences the nutritional status of a child. 
 
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5.11 Fathers’ roles in infant feeding 
 
From the discussion and interviews fathers indicated that they provided financial, physical and 
emotional support for mothers. Providing financial support was centred on the provision of money 
for the purchasing of food for the infant. It also involved the provision of money to cater for the 
transportation of mothers to growth monitoring sessions. This notion is typical in the African 
setting, where a father’s duty is to provide money to buy food and other household items for the 
family (Kumwenda, 2017; Martin et al, 2021, Thuita et al, 2015; Ritcher et al., 2010; Ramphele, 
2002). 
In relation to physical support, fathers helped to perform some domestic tasks, helped in meal 
preparation, shopping for food items and attending antenatal clinics. Fathers offered physical 
support to help ease the caregiving burden of mothers. Over the past few years, research has shown 
that there has been a redefinition in traditional roles in the household, with more men taking up 
chores defined as feminine to help support their spouses (Esping-Andersen & Billari 2015; 
Goldscheider et al., 2015). Despite this progress, Oláh et al (2018), argue that this reformation 
may take a while to be accepted in some countries. It was also found that fathers offered 
emotional support to mothers by reminding and encouraging them to feed. Emotional support 
from fathers has been reported in other studies (Brown & Davies, 2014). 
5.12 Sources of information on infant feeding 
 
Some fathers stated that the health centers were one of their sources of information on infant 
feeding. They received information on infant feeding during antenatal sessions According to 
studies, these sessions help to improve the knowledge of infant care givers (Kyei-Arthur et al., 
2021; Acheampong, 2020; Gyampoh et al., 2014; UNICEF, 2007). Other men reported that they 
received information from their wives since they attended health facilities. Grandmothers were 
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also mentioned a source of information to fathers. In Africa, grandmothers are known to hold a lot 
of information and are often sought after for guidance on issues concerning infant feeding (Aubel, 
2012). Another source of information fathers mentioned was the internet. The internet may have 
sufficed as a source of information since it allows for easy access to information on infant feeding. 
However, people who are not tech savvy may not benefit fully from this body of information 
(Chou et al., 2009). Thus, information accessibility is skewed towards a high caliber of people in 
society (Vinshula et al., 2022). 
 
 
5.13 Barriers to fathers’ involvement in infant feeding 
 
Culture is one of the primary determinants of the involvement of fathers in the feeding of their 
children. Participants in this study were comfortable taking up other chores at home however, the 
majority stated that feeding the child, woman role to play. This finding is corroborated by other 
African studies where the feeding of children was associated with women and the provision of 
support ascribed to men (Ganle et al., 2015). 
Fathers also stated that tiredness from work and financial problems made it difficult to participate 
during feeding times. Fathers mentioned that they worked long hours in order to earn a little more 
money to take care of their families. According to Craig and Powell (2011), and Fursman, (2009) 
when fathers work long hours, it intensifies the caregiving burden on mothers. Once caregiver’s 
burden is threatened, there is the chance that the quality of care a child requires would be 
compromised (Liu et al., 2020; Findling et al 2022; Nortey et al., 2017). 
 
5.14 Overcoming Barriers 
 
Some fathers from this study indicated that they had to make a deliberate effort to break the cycle 
of emotional absence passed down from their fathers. Fathers were aware that playing an active 
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part in the nutrition of their required more that financial provision. High emotional sensitivity from 
a father is known to impact the development of children later on in life (Coyl -Shepherd & 
Newland, 2013; Nettle, 2008; Goodsell & Meldrum 2010, Jessee & Adamson 2018). 
Education and the media were also mentioned as a means of improving fathers’ involvement. 
According to Arlinghaus & Johnston (2018), education is a tool that is used to create awareness 
on a particular phenomenon and is efficient in promoting behaviour change. Educating both boys 
and girls at an early age helps to break gender stereotypes on the roles women and men should 
play at home (Solbes -Canales et al., 2020). This may help shape the thought process of boys as 
they grow to become men. The media has also been very instrumental in inciting behaviour change 
(Elegbe, 2017; Servaes & Malikaho, 2012). As such, it could also be beneficial in spreading 
information on the need for fathers’ involvement in infant feeding. Various media forms can be 
used to propagate culturally sensitive messages to help change the perception of masculinity in 
society. 
Again, fathers raised the need for policy change to allow them spend time with their children after 
birth. The Ghana labour law (Act 651) states that women are entitled to at least 12 weeks off work 
for her maternity leave. On the contrary, no such law exists for men hence denying them the chance 
of spending quality time with their families. 
 
 
5.15 Strengths and limitations of the study 
 
The study was conducted in a predominantly urban area and thus the results derived cannot be 
generalized to rural areas in the country. The disparities between these two areas may influence 
the KAP of fathers entirely and may paint a different picture of fathers’ involvement. 
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Also, the study did not explore other methods in assessing the nutritional status of children. This 
may have accounted for the high occurrence of normal nutritional status amongst the children 
within the district. 
Nonetheless, fathers’ poor practices towards infant feeding should not be overlooked. It must be 
given the needed attention since the implications for the overall health of children are comparable. 
The needed attention and support will help promote fathers’ actions towards the nutrition of their 
children. 
Another limitation was difficulty in recruiting fathers for the qualitative arm of the study. In view 
of this, only one focus group discussion was held in addition to in-depth interviews. Despite this 
challenge, the results derived from the in-depth interviews were comparable to the points raised 
from the focus group discussion. 
Nonetheless, fathers’ poor practices towards infant feeding should not be overlooked. It must be 
given the needed attention since the implications for the overall health of children are comparable. 
The needed attention and support will help promote fathers’ actions towards the nutrition of their 
children. 
Another limitation was difficulty in recruiting fathers for the qualitative arm of the study. In view 
of this, only one focus group discussion was held in addition to in-depth interviews. Despite this 
challenge, the results derived from the in-depth interviews were comparable to the points raised 
from the focus group discussion. 
In addition, the study draws strength from the fact it is the first to assess the relationship between 
paternal involvement and the nutritional status of children. Also, fathers were interviewed directly 
for this study making the data more reliable. 
 
 
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CHAPTER SIX 
6.0 CONCLUSIONS AND RECOMMENDATIONS 
 
6.1 Conclusions 
All fathers had good knowledge and poor practices towards infant feeding. Fathers were supportive 
of their wives during infant feeding. They helped out with domestic work, fed children and offered 
words of encouragement to the mothers. Fathers also indicated their displeasure of cultural 
standards, financial constraints and tiredness from work impeding their levels of involvement in 
IYCF. 
6.2 Recommendations 
 
• A longitudinal study design could be employed to determine if the same results may be 
produced. 
• Information from this study should be used to shape interventions that are targeted towards 
improving paternal participation in young child feeding 
• Interventions targeting fathers’ involvement should involve different media channels in 
order to improve the attitudes and practices of fathers. 
• Services at health facilities should be improved. 
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APPENDIX 
Appendix 1- Questionnaire 
Fathers’ knowledge, attitudes and practices concerning Young Child feeding and Nutritional 
status in the La Nkwantanang Madina Municipal District of the Greater Accra Region. 
Kindly tick the appropriate boxes below and fill in the blank spaces below 
A. Socio demographic characteristics 
1. Place of residence………………………… 
2. Classification of place of residence 
 Rural  
 Urban  
 Peri-urban  
3. Age ……... 
4. Formal Education (completed) 
 Primary  
 Secondary  
 Tertiary  
 None  
5. Marital status 
 Married  
 Single  
 Divorced/ separated  
 Widow 
6. Occupation  
 Business  
 Farming  
 Office worker  
 Service worker (carpenter, mason, plumber etc) 
 Teacher/ lecturer 
 Health care  
 Other(specify) ……………… 
7. Religion 
 Christianity  
 Islam  
 Traditionalist  
 Other (specify) ……………………… 
8. Ethnicity  
 Akan  
 Ga  
 Ewe  
 Dagomba  
 Others (specify) ……………………. 
9. Income level (monthly) 
 <500 
 600-1000 
 1,100-1,500 
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 1,600- 2000 
 >2000   
10. Number of household members…………………. 
11. Number of children under 5……………………… 
12. Number of antenatal care session visits (accompanying woman) during the pregnancy (of 
index child) period …………… 
13. Number of postnatal care session visits (accompanying woman) after child’s birth delivery 
 1 
 2 
 3 
 4 
Child’s Information  
1. Child’s age (in months) ……….. 
2. Sex 
 Male  
 Female 
B. Fathers’ nutrition knowledge, attitudes and practices for children 6 to 24 months    
Practices  
1. When the mother of the child is not at home, who feeds the baby? 
 Yourself  
 Grandmother 
 Other children 
 Other (specify)…………. 
 Don’t know/no answer 
2. What type of food is fed to the baby when the mother is not around?  
 Breastmilk by spoon, cup or bottle 
 Infant formula by spoon, cup or bottle 
 Other liquids (specify) 
3. Whose responsibility is it to take decisions on breastfeeding the child exclusively? 
(You can tick more than one response) 
 Yes  No  
a. Mother    
b. Father    
c.   
Grandmother  
d. Caregiver    
e. Other   
(specify) 
 
4. Do you encourage the mother of your child to practice exclusive breastfeeding? 
  
5. What is the first food a new-born baby should receive? 
 Only breastmilk 
 Other (specify)……... 
 Don’t know 
6. Have you heard about exclusive breastfeeding? 
 Yes 
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 No → continue to question K.11 
7. What does exclusive breastfeeding mean? 
 Exclusive breastfeeding means that the infant gets only breastmilk and no other liquids or 
foods 
 Other (specify)……….. 
 Don’t know 
 
8. How long should a baby receive nothing more than breastmilk? 
 From birth to six months 
 Other (specify)……… 
 Don’t know 
9. Why is breastmilk alone sufficient to feed babies during the first six months? 
 Because breastmilk provides all the nutrients and liquids a baby needs in its first six months 
 Because babies cannot digest other foods before they are six months old 
 Other (specify)……. 
 Don’t know 
 
10. How often should a baby younger than six months should be breastfed or fed with breastmilk? 
 On demand, whenever the baby wants 
 Other (specify)…………. 
 Don’t know 
11. What are the benefits for a baby if he or she receives only breastmilk during the first six 
months of life? (You can tick more than 1 response) 
 
 Yes  No  Don’t know 
a. He/she grows    
healthily  
b. Protection    
from diarrhoea 
and other 
infections  
c. Protection    
against obesity 
and chronic 
diseases in 
adulthood  
d. Protection    
against other 
diseases 
(specify) 
 
12. What are the physical or health benefits for a mother if she exclusively breastfeeds her baby? 
 
 Yes No Don’t know 
a. Delays fertility    
 
b. Helps her lose    
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the weight she 
gained during 
pregnancy 
c. Lowers the risk    
of breast and 
ovarian cancer 
d. Lowers the risk    
of losing blood 
after giving 
birth  
e. Improves the    
relationship 
between the 
mother and 
baby 
f. Other (specify)    
 
.  
13. Many times, mothers complain about not having enough breastmilk to feed their babies. Please 
tell me different ways a mother can keep up her milk supply. 
 
 Yes  No  Don’t know  
a. Breastfeeding    
exclusively on 
demand  
b. Manually    
expressing 
breastmilk 
c. Having good    
nutrition/ eating 
well/ having a 
healthy or 
diversified diet 
d. Drink enough    
liquids during 
the day  
e. Other    
 
14. Many mothers need to work and are separated from their baby. In this situation, how could a 
mother continue feeding her baby exclusively with breastmilk? 
 Expressing breastmilk by hand, storing it and asking someone to give breastmilk to 
the baby 
 Other (specify) ______________________________________ 
 Don’t know 
15. If a mother has difficulties feeding breastmilk, what should she do to overcome them? 
 Seek professional help from health-care services: doctors, nurses, midwives or other 
health professionals 
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 Other (specify)………. 
 Don’t know 
        Attitudes 
16. How good do you think it is to breastfeed your baby exclusively for six months? 
 1. Not good 
 2. You’re not sure 
 3. Good 
If Not good: 
Can you tell me the reasons why it is not good? 
_____________________________________________________ 
_____________________________________________________ 
  
17. Do you think exclusive breastfeeding for 6 months is good for your child? 
 Yes  
 Not too sure  
 No, it is not  
If No: Can you tell me the reasons why? 
               _____________________________________________________ 
    _____________________________________________________ 
18. Do you think it is difficult for mothers to breastfeed their babies on demand? 
 Yes  
 No  
If Difficult: 
Can you tell me the reasons why it is difficult? 
_____________________________________________________ 
_____________________________________________________ 
 
19. How confident do you feel in how the mother breastfeeds your child? 
  Not confident 
 Ok/so-so 
 Confident  
If Not confident: 
Can you tell me the reasons why you do not feel confident? 
_____________________________________________________ 
_____________________________________________________ 
20. How confident do you feel in mothers expressing and storing breast milk so that either you or 
someone else can feed your baby? 
 Not confident 
 Ok/so-so 
 Confident  
If Not confident: 
Can you tell me the reasons why you do not feel confident? 
_____________________________________________________ 
 
C. Fathers’ nutrition knowledge, attitudes and practices for children 6 to 24 months    
 
Practices  
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24. Do you participate in feeding your child who is 6-24 months old? 
 yes 
 no 
If yes, how many times have you fed the child in the past 24 hours? 
 Once  
 Twice 
 Three times  
 Four times  
 Five times  
If No: 
Can you tell me the reason why? 
_____________________________________________________ 
_____________________________________________________ 
25. Whose responsibility is it to feed the child? (You can tick more than one response) 
 
 Yes  No  
a. Mother    
b. Father    
c. Grandmother    
d. Other (specify)   
 
26. Who made the decision on when to introduce complementary feeding? 
 Mother  
 Father  
 Both  
 Other (specify) 
27. Whose responsibility is it to make decisions on when to introduce complementary feeding?  
28. (Tick the appropriate answer. You can tick more than one response) 
 
 Yes  No  
a. Mother    
b. Father    
c. Grandmother    
d. Other (specify)   
 
29. Do you buy food specifically for the child? 
 Yes  
 No  
30. Whose responsibility is it to buy food for the child?  
(Tick the appropriate answer. You can tick more than one response) 
 
 Yes  No  
a. Mother    
b. Father     
c. Grandmother    
d. Other (specify)   
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31. Do you take part in making decisions to buy food for your child? 
 Yes  
 No  
If No: 
Can you tell me the reason (s) why you do not take part in the decision making of purchasing 
food? 
a.  
b.  
c.  
d.  
e.  
31. Whose responsibility is it to make decisions to buy food for the child? 
 Mother  
 Father  
 Grandmother  
 Other (specify) 
32. Who actually buys the food for your child? 
 Mother  
 Father  
 Grandmother 
 Other (specify) 
Knowledge  
33. Until what age is it recommended that a mother continues breastfeeding? 
 Six months or less 
 6–11 months 
 12–23 months 
 24 months and more (correct response) 
 Other (specify)………… 
 Don’t know  
34. At what age should babies start eating foods in addition to breastmilk? 
 At six months 
 Other (specify)………… 
 Don’t know 
35. Why is it important to give foods in addition to breastmilk to babies from the age of six 
months? 
 Breastmilk alone is not sufficient (enough)/cannot supply all the nutrients needed for 
growth/from six months, baby needs more food in addition to breastmilk 
 Other (specify)………... 
 Don’t know 
To feed their children, many mothers give them maize or rice porridge. 
 Please tell me some ways to make porridge more nutritious or better for your baby’s health. 
36. Which foods or types of food can be added to rice porridge make it more nutritious? 
 Yes  No  Don’t know 
a. Animal    
source foods 
(meat, 
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poultry, fish, 
liver/organ 
meat eggs 
etc.) 
b. Pulses and    
nuts: flours of 
groundnut 
and other 
legumes 
(peas, beans, 
lentils, etc.) 
sunflower 
seed, peanuts, 
soybeans 
c. Vitamin-A-    
rich fruits and 
vegetables 
(carrot, 
orange-
fleshed sweet 
potato, 
yellow 
pumpkin, 
mango, 
pawpaw) 
d. Green leafy    
vegetables 
(e.g., 
Komtomire, 
Ayoyo) 
e. Energy-rich    
foods (e.g., 
oil, butter) 
f. Other    
(specify) 
 
37. Do you know any ways to encourage young children to eat? 
 Yes  No  Don’t know  
a. Giving them    
attention during 
meals, talk to 
them, make 
mealtimes 
happy times  
b. Clap hands     
c. Make funny    
faces/play/laugh 
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d. Demonstrate    
opening your 
own mouth very 
wide/modelling 
how to eat 
e. Say    
encouraging 
words 
f. Draw the    
child’s attention  
g. Other (specify)    
 
 
Attitudes  
38. How confident do you feel in preparing food for your child? 
 Not confident 
 Ok/so-so 
 Confident 
If Not confident: 
Can you tell me the reasons why you do not feel confident? 
_____________________________________________________ 
_____________________________________________________ 
39. How good do you think it is to give different types of food to your child each day? 
 Not good 
 You’re not sure 
 Good 
If Not good: 
Can you tell me the reasons why it is not good? 
_____________________________________________________ 
_____________________________________________________ 
40. How difficult is it for you to give different types of food to your child each day? 
 Not difficult 
  So-so 
  Difficult 
If Difficult: 
Can you tell me the reasons why it is difficult? 
_____________________________________________________ 
_____________________________________________________ 
41. How good do you think it is to feed your child several times each day? 
  Not good 
 You’re not sure 
 Good 
If Not good: 
Can you tell me the reasons why it is not good? 
_____________________________________________________ 
_____________________________________________________ 
42. How difficult is it for you to feed your child several times each day? 
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 Not difficult 
 So-so 
 Difficult 
If Difficult: 
Can you tell me the reasons why it is difficult? 
____________________________________________________ 
_____________________________________________________ 
43. How good do you think it is to continue breastfeeding beyond six months? 
  Not good 
 You’re not sure 
 Good 
If Not good: 
Can you tell me the reasons why it is not good? 
_____________________________________________________ 
_____________________________________________________ 
44. Do you think it is good for your child to continue breastfeeding beyond six months? 
  Not good 
  Not too sure  
  It is good  
If not good: 
Can you tell me the reasons why it is not good? 
_____________________________________________________ 
_____________________________________________________  
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Appendix II- Discussion and interview guide 
Fathers’ knowledge, attitudes and practices concerning Young Child feeding and Nutritional 
status in the La Nkwantanang Madina Municipal District of the Greater Accra Region. 
Focus group discussion/ In-depth interview guide 
Date: 
Start time: 
End time: 
Name of Facilitator: 
1. What responsibilities do you think fathers have to ensure proper breastfeeding of children? 
I. What do you understand by proper breastfeeding? 
II. What do you understand by appropriate complementary feeding? 
III. How do you as a father ensure that your child is breastfed properly? 
IV. Where do you receive information on breastfeeding? 
V. What responsibilities do you think fathers have when it comes to ensuring proper 
complementary feeding? 
VI. How do you as a father ensure that complementary feeding is done properly? 
VII. Where do you receive information on complementary feeding? 
2. What do you think are the factors that affect fathers’ involvement in IYCF? 
I. What are the cultural factors that affect your participation in infant feeding? 
II. How do these factors affect that you participation? 
I. What do you think are some of the economic factors that affect your involvement in infant 
feeding? 
II. How do these factors affect your level of participation? 
I. What do you think are some religious factors that affect your participation? 
II. How do these factors affect your involvement in the infant feeding process? 
I. What are some of the factors in the health system that affect your participation in infant 
feeding? 
II. How do these factors affect the participation in infant feeding? 
3. How do you think these factors can be overcome? 
I. Cultural 
II. Religious 
III. Economic 
IV. Health system 
4. What additional responsibilities do you think fathers can take on to ensure that optimal IYCF is 
practiced appropriately? 
 
 
 
 
 
 
 
 
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Appendix III- Consent form 
UNIVERSITY OF GHANA 
 
 
 
COLLEGE OF BASIC AND APPLIED SCIENCES 
Ethics Committee for Basic and Applied Sciences (ECBAS) 
PROTOCOL CONSENT FORM 
Section A- BACKGROUND 
INFORMATION 
 
 
 
Title of Study: Fathers’ knowledge, attitudes and practices concerning Young Child 
feeding and Nutritional status in the La Nkwantanang Madina Municipal 
District of the Greater Accra Region. 
Principal Charity Naa Fofo Anang 
Investigator: 
Certified Protocol  
Number 
 
Section B– CONSENT TO PARTICIPATE IN 
RESEARCH 
 
 
General Information about Research 
You are invited to partake in a study that seeks to understand the extent to which fathers are involved in 
the feeding of their children and how it affects the growth the child. We would like to know what you 
understand about breastfeeding and complementary feeding and whether you play any role when these 
activities are carried out. The entire interview process will take about 30- 45 minutes of your time. 
If you decide to take part in this study, you will be asked questions about your age, ethnicity, your job 
and how much you earn. We will also ask questions about the number of children you have, how you 
support the mother of your child with taking care of the child’s feeding. The weight and height of your 
child will also be taken. The weight of your child will be taken using an electric scale and the height will 
be taken with the use of an infantometer. These measurements of your child will be taken with minimal 
or no clothing on. It is required that these measurements be taken with minimum light clothing or no 
clothing at all. Having heavy clothing, shoes or diapers on, could alter the measurements and fail to 
reflect the true weight and height of the child 
 
Benefits of the study 
You will not receive any direct benefit from the study. Nonetheless, the findings from the study will be 
beneficial to government agencies, and other organizations that are interested in improving the inclusion 
of fathers in infant nutrition. 
 
 
 
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Risk of the study 
There would be the risk of contracting the Covid 19 virus however all covid 19 protocols will be duly 
observed during the interview. The researcher will wear a mask when interacting with you, keep a 1-meter 
distance where applicable and wash hands with soap and water before and after taking the weight and height 
measurements of your child. 
Time constraints would also be a possible risk factor for the study due to the lengthy nature of the 
questionnaire. Therefore, the nature of the study will be clearly explained to before you offer consent. 
 
Confidentiality 
All the information you provide for this study will be treated with caution. Your name will not be mentioned 
in any report also, identification codes will be used for each participant. Hard copies of the questionnaire 
will be kept in locked cabinets. Nevertheless, to ensure that the research work matches up to standard, the 
Institutional Review Board of the College of Basic and Applied Sciences, of the University of Ghana may 
request to inspects the study records as part of its auditing program. 
 
Compensation 
Upon completion of the survey by both you and the mother of your child, you will be compensated with a 
bar of washing soap and a bottle of hand sanitizer. However, if you decide to complete the questionnaire 
over the phone, you will be given GHc5 worth of airtime for any network of your choice. 
 
Withdrawal from Study 
Participation in the study is entirely voluntary and you can decide to take part or not. You will not have to 
explain to anyone if at some point you choose to withdraw from the study 
 
Contact for Additional Information 
If you have any questions concerning this study, kindly reach out to Ms. Charity Anang- 0205509923 
Dr. Agartha Ohemeng-0244862606 
If you have any issues pertaining to your rights as a participant, you can contact the address below: 
Administrator, Ethics Committee for Basic and Applied Sciences 
College of Basic and Applied Sciences University of Ghana 
P. O. Box LG 68 Legon – Accra IP No.: 3014 
Email: ethicscbas@ug.edu.gh 
Section C- VOLUNTEER AGREEMENT 
 
 
"I have read or have had someone read all of the above, asked questions, received answers regarding 
participation in this study, and I am willing to give consent for me, my child/ward to participate in this 
study. I have not waived any of my rights by signing this consent form. Upon signing this consent form, I 
will receive a copy for my personal records." 
 
 
Name of Volunteer 
 
 
Signature or mark of volunteer                                                                       Date 
 
 
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If volunteers cannot read the form themselves, a witness must sign here: 
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered, and the volunteer has agreed to take part in the research. 
 
Name of witness 
 
 
 
Signature of witness Date 
 
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating 
in this research have been explained to the above individual. 
 
 
Name of Person who obtained Consent 
 
Signature of Person who obtained Consent Date 
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Appendix IV- ECBAS approval letter 
 
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Appendix V- Approval letter from Greater Accra Regional Health Directorate and the La 
Nkwantanang Madina District Assembly 
 
 
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