i 
 

ENSIGN COLLEGE OF PUBLIC HEALTH, KPONG,  

EASTERN REGION, GHANA 

 

 

 
 

 

COMMON CHILD SURVIVAL PRACTICES OF WOMEN AT ASHAIMAN 

MUNICIPAL  
 

 
 

By 

 

 

 

 

KPORTANYE CHARITY DOVLO 
 

 

 

 

A thesis submitted to the Department of Community Health in the Faculty of 

Public Health in partial fulfilment of the requirements for the degree  

 

 

MASTER OF PUBLIC HEALTH 

 

 

 

 

 

 

 

 

JUNE, 2016 

 

 

 

 

 



ii 
 

 
ENSIGN COLLEGE OF PUBLIC HEALTH, KPONG,  

EASTERN REGION, GHANA 

 

 

 
 

 

COMMON CHILD SURVIVAL PRACTICES OF WOMEN AT ASHAIMAN 

MUNICIPAL  
 

 
 

By 

 

 

 

 
 

KPORTANYE CHARITY DOVLO 

 

 

A thesis submitted to the Department of Community Health in the Faculty of 

Public Health in partial fulfilment of the requirements for the degree  

 

 

MASTER OF PUBLIC HEALTH 

 

 

 

 

SUPERVISOR: DR. PHYLLIS ANTWI 

 

 

 

 

 

 

 

JUNE, 2016 

 



iii 
 

DECLARATION 

I hereby declare that except for references to other people work, which I have dully 
cited, this project submitted to the school of Graduate Studies, Kwame Nkrumah 
University of Science and Technology, Kumasi is the results of my own investigation, 
and has not been presented for any other degree elsewhere 
 
 
 
 
KPORTANYE CHARITY DOVLO      ..........................             ............................ 
(Student)                                                 Signature                             Date  

 

Certified By: 

Dr. Phyllis Antwi                              ……………..........            ................................. 
(Supervisor)                                          Signature                               Date 
 
 
 

Certified By: 

Dr. Christopher N. Tetteh              ……………….....                 ...............................        
(Dean)                                                 Signature                               Date 
 

 
 
 
 

 

 

 

 

 

 



iv 
 

                                                    DEDICATION 

I dedicate this work to God Almighty, in honour of my late parents, my dear husband, my 

children and my entire family for their support and encouragement during my study. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  



v 
 

ACKNOWLEDGEMENT 

  

My profound gratitude goes to the Almighty God for His tender mercies and loving kindness. 

My sincere thanks go to Dr. Phyllis Antwi my supervisor and Dr Juliana Enos, my co- supervisor 

and the entire Ensign College lecturers who made it possible for me to come this far. My special 

thanks to Mr Emmanuel Kwarteng for your prayers and encouragement. 

  



vi 
 

 

GLOSSARY                

 

BCG – Bacille Calmette Guerin 

CHAG – Church hospitals  association Ghana 

CHPS – Community –based health planning and services 

CWC – Child welfare clinic 

DDT – Diphtheria Pertussis Tetanus 

EBF – Exclusive Breastfeeding 

Hep B/Hip – B / Haemophilus influenza type b 

ITNs - Insecticide treated mosquito nets 

IYCF – Infant and young children feeding 

 MDAs – Ministries departments agencies 

 PHC – Population and Housing Census 

RBM -   Roll back malaria 

TBAs -   Traditional birth attendants 

TZ – Tuo zafi 

UNICEF – United Nations Children’s Fund 

WHO - World Health Organization 



vii 
 

                                                  ABSTRACT 

 In most developed countries, the health of the new born and infants are taken very 

seriously. Even dough there is tremendous effort to reduce infant mortality in 

Ghana yet, child mortality still remain high. Hence, the need for investigating the 

common child survival practices which contribute to child deaths. The objective of 

this study was to investigate common child survival practices including timing of 

the initiation of breastfeeding, complementary feeding practices, completeness of 

immunization and knowledge and practices related to childhood illnesses among 

mothers of children under one year of age in Ashaiman. 

 

The study was conducted using a quantitative research approach and data was 

analyzed with Stata statistical software and microsoft Excel. A simple random 

sampling technique was used to select the respondents. In all 400 mothers were 

sampled and administered with closed and open ended questions.  

 

 Result showed that about 53% of mothers breastfed their infants immediately after 

birth. Only about 30.5% introduce complementary food after the child attains six 

months; mothers about 88% however did well by sending their infants for 

immunization; while in assessing knowledge and practices in relation to childhood 

illnesses, mothers about 43.9% provided self medication to their children. It was 

also found out that some mothers do not use insecticide treated nets (ITNs) for 

their children. 

 

In conclusion common child survival practices in relation to initiation of 

breastfeeding (breast milk) and immunization met World Health Organization 

(WHO) recommendations whiles introduction of complementary foods and 



viii 
 

knowledge and practices related to childhood illnesses do not very much meet the 

W.H.O standard of recommendations. Findings will inform the municipal 

directorates to put measures in place to secure the health of infants in the 

municipality. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



ix 
 

 

 

TABLE OF CONTENT 

 

Declaration and certification  ------------------------------------------------------------------------- iii 

Dedication ----------------------------------------------------------------------------------------------- iv 

Acknowledgment -------------------------------------------------------------------------------- v 

Glossary  ----------------------------------------------------------------------------------------- vi 

Abstract  ----------------------------------------------------------------------------------------- vii 

Table of Content  ------------------------------------------------------------------------------- ix 

CHAPTER ONE  

1.0. Introduction----------------------------------------------------------------------------------------  1   

1.1 Background of the study-------------------------------------------------------------------------- 1 

1.2 Problem statement---------------------------------------------------------------------------------  2 

1.3 Objectives------------------------------------------------------------------------------------------- 3 

1.4 Justification----------------------------------------------------------------------------------------- 3 

1.5 Scope of study-------------------------------------------------------------------------------------- 4 

1.6 Structure of the thesis -----------------------------------------------------------------------------    4 

 

CHAPTER TWO 

2.0 LITERATURE REVIEW--------------------------------------------------          5  

2.1 Introduction ------------------------------------------------------------------------------------------          5 

2.2 Infant feeding practices ---------------------------------------------------------------------------- 5 

2.2.1 Breastfeeding ------------------------------------------------------------------------------------- 5  

2.2.2 Breastfeeding practices----------------------------------------------------------------------------           7  



x 
 

2.3 Timing of initiation of breastfeeding---------------------------------------------------------------        10 

2.4 Complementary feeding ------------------------------------------------------------------------------       11 

2.4.1 Practices related to complementary feeding -----------------------------------------------------      11  

2.5 Completeness of infant immunization---------------------------------------------------------------      14  

2.6. Knowledge and practices related to childhood illnesses-----------------------------------------       15 

2.6.1 Malaria ----------------------------------------------------------------------------------------------- 15 

2.6.2 Diarrhoea diseases ---------------------------------------------------------------------------------- 16  

2.6.3 Acute respiratory infection ------------------------------------------------------------------------ 16  

2.6.4 Other child health care practices ------------------------------------------------------------------- 17  

2.7 Socio-economic factors  ------------------------------------------------------------------------------ 20 

2.8 Traditional practices------------------------------------------------------------------------------------       21  

 

CHAPTER THREE 

METHODOLOGY------------------------------------------------------------------------------------- 22 

3.1 Introduction----------------------------------------------------------------------------------------- 22  

3.2 Study area  -----------------------------------------------------------------------------------------  22  

3.2.1 Demographic characteristics of Ashaiman Municipality----------------------------  22 

3.2.2 Health Directorate of Ashaiman--------------------------------------------------  24  

3.3 Data collection techniques and tools -----------------------------------------------------------              25 

3.4  Study population ---------------------------------------------------------------------------------- 25 

3.5  Research design-----------------------------------------------------------------------------------  25           

3.6. Sampling method---------------------------------------------------------------------------------- 26 

3.7. Study variables-------------------------------------------------------------------------------------  27 

3.8 Sample size calculation----------------------------------------------------------------------------            27 

3.9 Pre-testing    ---------------------------------------------------------------------------------------              27 



xi 
 

3.10Data handling -------------------------------------------------------------------------------------  28 

3.11. Data analysis ------------------------------------------------------------------------------------              28 

3.12 Ethical consideration----------------------------------------------------------------------------  28 

3.13. Limitation to study------------------------------------------------------------------------------              29 

CHAPTER FOUR  

4.1. Results --------------------------------------------------------------------------------------------              30  

 

CHAPTER FIVE 

5.0 Discussion -----------------------------------------------------------------------------------------              44 

5.1 Timing of initiation of breast feeding after delivery------------------------------------------------ 44 

5.2 Practices related to introduction of complementary feeding--------------------------------------- 45 

5.3 The completeness of infant immunization by 12 months of age ---------------------------------- 46  

5.4 Knowledge and practices related to other childhood illness ---------------------------------------- 46  

 

CHAPTER SIX 

6.1. Conclusion -------------------------------------------------------------------------------- 48 

6.2. Recommendations-----------------------------------------------------------------------             48 

References--------------------------------------------------------------------------------------            50  



xii 
 

LIST OF TABLES  

 Table 4.1 Demographic Characteristics of respondents----------------------------------------------31  

     

Table 4.2 Place of delivery---------------------------------------------------------------------------    32 

Table 4.3 Timing of initiation of breast feeding after birth -------------------------------------     33 

Table 4.4 Reasons for starting breastfeeding at the said time -------------------------------------      34 

Table 4.5 Problem with breast milk on first day after delivery--------------------------------------- 34 

Table 4.6 What Mothers did when they had problems with flow of breast milk --------------------35 

Table 4.7 Mothers still breastfeeding----------------------------------------------------------------------35 

Table 4.8 Reasons for not breastfeeding ------------------------------------------------------------------35 

Table 4.9 Complementary feeding Practices------------------------------------------------------------ 36 

Table 4.1.10 Reason for introducing complementary food at that age-----------------------------   36 

Table 4.1.11 Practices of complementary feeding initiation------------------------------------------ 37 

Table 4.1.12 Childhood illness------------------------------------------------------------------------------38  

Table 4.1.12 Fever --------------------------------------------------------------------------------------------38 

Table 4.1.13 Vomiting---------------------------------------------------------------------------------------39 

Table 4.1.14 Diarrhoea---------------------------------------------------------------------------------------39 

Table 4.1.15 Diarrhoea and Vomiting----------------------------------------------------------------------40 

Table 4.1/16 Difficulty in breathing-------------------------------------------------------------------------40 

Table 4.1.17 What mothers do when baby is coughing---------------------------------------------------41 

Table 4.1.18 Malaria Prevention------------------------------------------------------------------------------41 

 

 

 

 



xiii 
 

                                                  LIST OF FIGURES  

 

Figure 4.1  Ages of infants -------------------------------------------------------------32 

Figure 1. Stages of immunization completion among infants 0-12months in Ashaiman---- 37 

 

 



1 
 

 
CHAPTER ONE 

 INTRODUCTION 

1.1 Background of the study 

Child survival practices are the standard and healthy practices done to keep a child alive 

(UNICEF, 2012). Although Ghana has made major strides towards reducing child mortality, 

the number of deaths in children, and especially in infants remains unacceptably high (Ghana 

Health Service, 2006). 

 

Survival of the newborn, in particular, is an issue of great concern especially in developing 

countries.  Though various efforts have been made by governments to reduce infant mortality, 

neonatal mortality keeps increasing. Today, one in every 12 newborn dies before reaching his 

or her fifth month in most developing nations, including Ghana (WHO, 2006).Of the 

approximately four million global neonatal deaths that occur annually, 98 percent occur in 

developing countries, where most newborns die at home while they are cared for by mothers, 

relatives, and traditional birth attendants (WHO, 2013). Almost two-thirds of infant deaths 

occur in the first month of life, and among those, two-thirds die in their first 24 hours after 

birth (Lawn et al, 2005). In a middle income country such as Ghana, which is experiencing 

higher levels of economic development and access to services, such low child survival rates 

are unacceptable. 

This concern towards newborn survival has motivated a search into how parents, especially 

mothers, adhere to the standards of child survival practices.Child survival practices contribute 

significantly to the poor infant survival rates in developing countries. These practices have the 

tendency to propel the infant to healthy living and low death rates as experienced in advanced 

communities, or high morbidity and mortality rates as exists in poor communities. In Ghana, 

child survival practices are driven by a host of intersecting socio-economic and cultural 



2 
 

factors; this study focuses on assessing practices in relation to the survival of infants in 

Ghana. Child survival practices include the timing and initiation of breastfeeding. It also 

includes the introduction of complementary foods at the appropriate time as well as practices 

related to the care of the child at home and during illness. Therefore this study aims to 

investigate child survival practices among women in Ashaiman, A low income community in 

the greater Accra region of Ghana. Practices investigated include the timing of initiation of 

breast feeding after birth, introduction of complementary feeding, infant immunization 

completeness as well as knowledge and practices related to other childhood illnesses of 

women with children less than one year of age within the Ashaiman district. 

 

 

 

 

1.2 Problem Statement 

Literature on infant survival practices of women in the African sub-region, including Ghana, 

is rather scanty. Yet, knowledge of child survival practices in Ghana is critical to the success 

of child survival programs. This study sought to investigate child survival practices among 

women of infants aged 0-12 months at Ashaiman in the Greater Accra Region of Ghana, in 

order to understand the factors contributing to poor child survival in poor communities. This 

is because Ashaiman is generally perceived as a less endowed socio-economic environment 

with increasing child and maternity deaths (Ghana Health Service, 2011). The increasing 

child mortality within the Ashaiman district, and Ghana as a whole, motivates a search into 

the child survival practices of mothers. The study will specifically investigate practices such 

as introduction of complementary feeding, infant immunization completeness as well as 

knowledge and practices related to other childhood illnesses in the community.    

 



3 
 

 

 

1.3 Objectives 

General Objective 

To investigate child survival practices among mothers with children less than one year of age 

in Ashaiman. 

  

Specific Objectives 

1. To investigate timing and initiation of breastfeeding. 

2. To assess practices related to the introduction of complementary feeding. 

3. To ascertain the completeness of infant immunization by twelve months. 

4. To assess the knowledge and practices related to other childhood illnesses such as malaria, 

diarrhoea and acute respiratory diseases among mothers with children less than one year of 

age. 

 

 

 

1.4 Justification 

Although the WHO recommended length of exclusive breastfeeding (EBF) is six months; in 

Ghana, the average length of EBF is four months (Biks, 2015). EBF prevents morbidity and 

mortality among infants. However, in Ghana, morbidity and mortality is very high especially  

in the low socio economic areas in of the country. Appropriate introduction of breast milk and 

other infant feeding and child care practices at the household level should prevent childhood 

illnesses. Infant are victims of childhood illnesses as a result of inappropriate infant feeding, 

immunization and child care practices.  This study seeks to investigate child survival practices 

of women with children under one year of age at Ashaiman, a suburb of Accra, Ghana. This 



4 
 

study seeks to provide an empirical basis on which other researches could be conducted to 

provide an in-depth understanding of child survival practices in Ghana. 

 

1.5 Scope of Study 

This study is limited to mothers with children aged 0-12months in Ashaiman district in 

Greater Accra Region. It basically explores child survival practices of mothers of children 

under one year of age at Ashaiman community.  

 

1.6 Structure of the Thesis 

The thesis consists of six chapters. 

Chapter one, comprises of introduction, problem statement, Justification, Research objectives 

and the scope of study. Chapter two focuses on review of related literature. Chapter three 

presents the methodology of the study. It comprises the research design, the target population 

of the study, the sample size, the sampling techniques, the data collection instrument, and the 

statistical tools which were used in the data analysis. Chapter Four, explains and interpret the 

results obtained from data collected. Then chapter five presents the discussion of main 

results/findings. Finally, chapter six present the conclusions and recommendations based on 

findings from the study.  

 

 

 

 

 

 

 



5 
 

CHAPTER TWO 

LITERATURE REVIEW 

2.1 Introduction 

This section reviews evidence on child survival practices and defines theoretical concepts 

related to the main variables to be studied. The empirical evidence from studies on child 

survival practices are presented as well as theoretical literature which define and explain the 

main variables and concepts to be studied (Huberman & Miles, 1994). The review focuses on 

child survival practices relative to breastfeeding, complementary feeding practices, 

completeness of infant immunisation as well as knowledge and practises related to other 

childhood illnesses such as malaria, diarrhoea and acute respiratory diseases,    

 

2.2 Infant Feeding Practices 

One of the major determinants of children’snutritional status and high rates of malnutrition in 

Ghana is infant feeding(Kelly, 2004). Infant feeding includes breast feeding, formula feeding, 

solid food intake and other complementary foods and fruits and liquids (Kelly, 2004). 

 

 

2.2.1 Breastfeeding  

Breast milk as an infant feeding is world widely accepted and adopted as global health policy 

for both developed and developing countries. According to the WHO (2006), breast milk 

provides optimal nutrition and promotes the child's growth and development; it is associated 

with improved growth during the first months of life. By breast-feeding, a mother begins the 

immunization process at birth and protects her child against a variety of viral and bacterial 

pathogens before the acquisition of active immunity through vaccination. Breast milk has 

unique anti-infective properties. Frequent and exclusive breast-feeding can be an appropriate 

method of fertility regulation for many women, particularly when other family planning 



6 
 

methods are not readily available or desired. Early contact (immediately after birth) between 

the mother and the baby, according to the WHO (1999), has a beneficial effect on breast-

feeding. Early suckling provides the baby with colostrums that offers protection from 

infection, gives important nutrients, and has a beneficial effect on maternal uterine 

contractions.  

The baby's skin and gastrointestinal tract are colonized with the mother's microorganisms, 

against which she has antibodies in her breast milk. Important factors in establishing and 

maintaining breast-feeding after birth include: giving the first feed within one hour of birth, 

correct positioning that enables good attachment of the baby, frequent feeds, no prelacteal 

feeds or other supplements, and psychosocial support for breast-feeding mothers. Babies have 

a wide range of behaviours following spontaneous delivery and are not all ready to feed at the 

same time. Breast feeding protects against infectious diseases such as gastro intestinal 

infections, other nutritional diseases e.g. malnutrition that largely is a contributing factor to 

child morbidity and mortality in developing counties. Breast feeding can be life-saving in 

places where sanitation and safe water is often a problem. 

Studies have shown that breast feeding infants have different growth patterns as compared to 

formula fed infants (Bhandari et al, 2003). Breast feeding improves health and survival status 

of the new born and emotional attachment of the child to the mother. It also has a long term 

benefit of protecting against child obesity and breast cancer for the mother. Breast feeding 

helps the mother to prevent excessive blood lost after delivery and delays in return to fertility 

(Bhandari et al, 2003). It also reduces cost of child feeding because the mother will not be 

buying expensive formula and other substitutes. 

 

There is evidence that, breast feeding for at least four months prevents allergy wheezing in 

early childhood compared to formulae feeding. Not all formulas have the same protective 

benefit (Ahmad et al, 1991).Mothers who are employed or not employed do not feed their 



7 
 

infant well because they are engaged in domestic chores that keep them away from infant 

feeding routines (Sullivan, leathers and Kelly, 2004; Bick, Macarthur and Lancashire, 

1998).People who help in taking care of the infant also influence mother’s choice of infant 

feeding practices. 

 

2.2.2 Breastfeeding Practices in Ghana 

Breast feeding is widely practiced in Ghana with about ninety-seven percent of babies breast 

fed initially over the past five years., In Ghana studies have shown that only eight percent of 

infants are   exclusively breast fed for up to four months and forty-five percent are given 

complementary feeding by three months of age (Kelly, 2004). According to the Ghana 

Demographic and Health survey,(2009), only seventeen percent of children are exclusively 

breastfed, thirty–eight percent fed on breast milk and water, or water based liquid (Ghana 

Statistical Service & Ghana Demographic Health Survey 2009). Child malnutrition as a result 

for morbidity and mortality in Northern Ghana is highest because exclusive breastfeeding is 

low. Health care providers are promoting exclusive breastfeeding but much success was not 

achieved because of feeding practices that are directly related to varied economic, socio-

cultural and religious factors in the community and various dynamics prevailing at the 

household level.  

 

Socio-cultural factors, norms and customs of communities are crucial in influencing 

nutritional health status of an infant. The environment in which care is given to infants also 

affects feeding behaviour of the infant. Evidence shows that children born in urban area breast 

fed in early hours earlier than babies born in rural areas. In some cultures, male babies were 

breast fed after three (3) days of birth whilst girls are breastfed after four (4) Days. In some 

cultures, the first breast milk (colostrums) is expressed out for the reason of being harmful 

unclean and or unwholesome. Colostrums decreases infant morbidity and mortality especially 



8 
 

in developing countries by reducing risk of infections and diseases such as, diarrhoea, 

gastroenteritis, respiratory and other infections (Ahmad et al. 1999). 

According to Ahmad et al (1999) reasons for discarding colostrums were as follows: 

• It is dirty and the body can contract disease. 

• It contains blood or pus and therefore not good for babies. 

• It causes abdominal pains, diarrhoea and other digestive problems. 

• Water and sheabutter with herbs (sampuliving among kusasi ethnic group to stop 

navel pains) was given to infants whilst mothers wait for clean whitish breast milk. 

• Inscribed Islamic verses washed with special water for protection against disease. 

 

 

The average length of exclusive breast feeding in Ghana is four (4) months (Annim, 

Awusabo-Asare, & Amo-Adjei, 2013). Forty –one percent of breast fed children and eleven 

percent of non breast fed children between six to twenty three months are fed accordingly as 

recommended by infant and young children feeding (IYCF) practices (Annim, Awusabo-

Asare, & Amo-Adjei, 2013).A study conducted in low socio-economic settlements of 

Karachi, Pakistan, revealed that newborns were bathed immediately after delivery as the 

vemix was considered “dirty looking” and it was felt it should be removed. Daily massage of 

the newborn with mustard oil and risky feeding practices such as giving prelacteals, 

supplementary feeds, delaying first feed were common. Apart from breast milk which was the 

preferred feed during neonatal period, other feeds like honey, ghutti and water were also 

given in order to reduce colic or act as laxative, these were perceived health benefits 

mentioned by mothers as well as TBAs (Fikree et al., 2005).   

 

A cohort study conducted by UNICEF (2015) used total of 255,495 live-born women-infant 

dyads as the sample for the study. Rates and determinants for the exclusive breastfeeding sub-



9 
 

study at 42 days post-partum were assessed from among a sub-sample of 105,563 subjects. 

Although there was heterogeneity by site, and early initiation of breastfeeding after delivery 

was high, the Pakistan site had the lowest rates of early initiation of breastfeeding. The 

Pakistan site also had the highest rate of lack of exclusive breastfeeding at 42 days post-

partum. Across all regions, factors associated with failure to initiate early breastfeeding 

included nulliparity, caesarean section, low birth weight, resuscitation with bag and mask, and 

failure to place baby on the mother’s chest after delivery. Factors associated with failure to 

achieve exclusive breastfeeding at 42 days varied across the sites. The only factor significant 

in all sites was multiple gestation. 

 

However, a study conducted by Yadav (2007) on traditional practices in newborn care in 

Nepal shows that colostrums is regarded as dirty milk in some communities, and babies were 

fed with cow or goat milk immediately after birth for the popular belief that it will make the 

baby become more intelligent.  

 

Biks (2015)studied the risk factors that are associated with infant mortality in Northwest 

Amhara Region, Ethiopia. A prospective open cohort study involving 1752 infants 

(1472.4518 person years of follow-up) was undertaken from November 2009 to August 2011. 

Kaplan-Meier Survival analysis was used to estimate infant mortality rate. Risk factors 

associated with infant mortality were assessed using multivariate Poisson regression. The 

overall infant mortality rate was 88 per1000 person-years. After controlling other important 

predictors in multivariate Poisson regression, infants not exclusively breastfed [IRR = 7.86, 

95% CI: (5.11, 12.10),], breast milk initiated after 24 hours of birth[IRR = 4.84,95% CI: 

(2.94,7.99)], mothers not washing hands with soap after visiting toilet and before feeding 

child[IRR = 4.61, 95% CI: (2.24, 9.48)], being rural residents [IRR = 2.33, 95% CI: (1.12, 

4.88)], infants born within 24 months for the previous birth [IRR = 2.79, 95%CI: (1.88, 



10 
 

4.15)], have increased the risk of infant mortality. In conclusion, exclusive breast feeding is 

the strongest predictors of infant survival in these predominantly rural setting wherehygienic 

standards are poor. Supporting mothers to exclusively breast feeding which is cost effective, 

safe and feasible strategy can help reduce infant mortality in the study setting. 

 

 

2.3Timing of Initiation of breast feeding 

Provision of mother's breast milk to infants within one hour of birth is referred to as 

“initiation of breastfeeding” and ensures that the infant receives the colostrums, or “first 

milk”, which is rich in protective factors (Paddock, 2007).Breastfeeding in the first hour of 

life shows that early initiation and exclusive breastfeeding for six months can save lives. A 

2006 study published in the journal paediatrics suggested that 41% of newborns that die in the 

first month of life could be saved if breastfed in the first hour of life. The WHO indicates that 

colostrums in the first hour increases the likelihood that babies will continue to be breastfed 

which gives them the ability to fight malnutrition. Breastfeeding in the first hour or so after 

birth also confers benefits to the mother such as improved lactation and less loss of blood. In 

conclusion it is imperative to encourage initiation of breastfeeding in the first hour after birth 

because it has an added advantage of helping to bond mother and baby in a natural, 

uninterrupted way and maximise the chance the infant will latch onto the breast and stimulate 

lactation.  

 

2.3.1 Initiation of Breastfeeding 

According to Deogaonkar and Milind (2004) early initiation of breastfeeding within 1 hour 

after birth was commonly practiced; TBAs ensured that newborn babies they deliver are 

breastfed immediately after birth.  Breastfeeding was initiated within the first hour after birth. 

Breastfeeding practices, (especially, breastfeeding on demand) as well as hygienic 



11 
 

breastfeeding practices should be reinforced. Knowledge on more serious newborn danger 

signs other than high body temperature, diarrhoea, excessive crying was minimal. Although 

mothers claim they will take their newborn babies to the hospital upon recognition of the 

perceived danger signs, the practice of buying “over-the-counter” drugs to treat newborn 

babies as well as the giving of enema were identified.    

 

Ani, Kaur and Kumah (2011) conducted a study on the effect of initiation of breast-feeding 

within one hour of the delivery on "maternal- infant bonding". Two hundred and eighteen 

mother infant dyads were enrolled for the study and considered for analysis. Each group 

(control and experimental) comprise of one hundred and nine mother infant dyads. Mothers 

who initiated breast feeding after one hour of the delivery were considered in the control 

group and the mothers in the experimental group initiated breastfeeding within one hour of 

the delivery. The result revealed that the initiation of breast feeding within an hour of delivery 

improves maternal infant-bond.  Khadduri et al. (2007), state that most women breastfed their 

babies, but initiation within 1 hour of birth and colostrums feeding were not common.   

 

 

 

2.4Complementary Feeding 

Complementary feeding is the timely introduction of safe and nutritional foods in addition to 

breast-feeding (BF), clean and nutritionally rich additional foods is introduced at six months 

of infant Age. Complementary feeding strategies embraces a wide variety of interventions 

designed to improve not only the quality and quantity of these foods but also improve the 

feeding behaviours; such as effective and timely provision of appropriate complementary 

foods (nutritional counselling) and education to mothers about practices of complementary 

feeding on growth. 



12 
 

 

2.4.1Practicesrelated to complementary feeding  

Mothers with infants with diarrhoea diseases are encouraged to feed children with breast milk 

and or normal food to increase the amount of fluids given. This prevents severe dehydration. 

Infants are usually given koko made from fermented millet or corn dough with little or no 

sugar. Initially it is very light and becomes thicker as the child grows. The child is sometimes 

also given light soup. It normally starts before or at 4 months. By six months solid foods e.g. 

mashed yam, tuozafi (T Z), wean mix and orange juice are introduced.  

 

Abang (2013) assessed breastfeeding and complementary feeding practices and the 

association between duration of EBF with the growth of infants at six months of age in the 

Builsa district in the Upper East region. The study was conducted in two parts. The first was a 

qualitative study utilizing focus group discussions (FGDs) with mothers with six months old 

infants recruited from six communities in the Builsa district. The second was a cross-sectional 

survey of 290 mother-child pairs recruited from six health facilities in the Builsa district. 

Results showed that cultural beliefs underline most of the breastfeeding and complementary 

feeding practices. Early and late introduction of complementary food, water and traditional 

herbs/liquids to newborn babies are common. Grandmother’s support for EBF, thickness of 

porridges and age of introduction of complementary food were significantly associated with 

duration of EBF. 

 

A study conducted in Haryana, India revealed that 75 percent of newborns were given 

prelacteal feeds of honey, tea and diluted milk, and babies are often not breastfed during the 

first 3 days. They are often given sweetened water, this presumes that colostrums was 

discarded (Bhandari et al., 2003).  



13 
 

Studies show that receiving appropriate, adequate and safe complementary foods starting at 

six months of age leads to better health and growth outcomes (UNICEF, 2013). The 

complementary feeding period is the most challenging when it comes to infant feeding as it 

has been widely recognized that optimal complementary feeding does not depend on only 

what is fed but also on how, when, where and by whom the child is fed (Pelto et al., 2002).  

 

A study in India revealed that caregivers lack the awareness and knowledge of what and how 

often to feed their infants (Sharma, 2005). With regards to the challenges of what to feed, how 

and when to feed during the complementary feeding period, WHO/UNICEF in a review in 

1998 on complementary feeding presented age specific guidance on the nutritional 

requirements from complementary food in breastfed children. These guiding principles on 

complementary feeding were recommended to serve as a guide for countries to develop 

locally appropriate feeding recommendations. It is recommended that complementary feeding 

starts at 6 months and breastfeeding continued on-demand until two years of age or beyond. 

The 2008 GDHS reported that 75% of children 6-9 months were consuming complementary 

foods implying that 25% of children in this age group did not meet the recommendation to 

start complementary feeding at 6 months.   

 

Good hygiene and safe food handling are very essential since the peak incidence of diarrhoeal 

diseases occur during the complementary feeding period. It is recommended that caregivers 

and children wash their hands properly before food preparation and eating, storing food 

safely, using clean utensils, bowls and cups as well as avoid the use of feeding bottles as these 

bottles are sources of dangerous pathogenic organisms (PAHO/WHO, 2003). These practices 

are especially important in areas with poor access to safe water and sanitation as unhygienic 

practices and unsafe handling of food can contribute to diarrhoeal diseases and morbidity 

(Kramer and kakuma, 2002; Vaahtera et al., 2001).   



14 
 

 

The amount of complementary food needed by a child increases as the child gets older since a 

child’s energy requirements increases with age. It is recommended that children at 6-8 

months, 9-11 months and 12-24 months receive 137-187 g/day, 206-281 g/day and 378-515 

g/day amount of complementary food respectively. Due to the difficulty in measuring these 

amounts, the GHS has used common household measures to determine the amounts of food to 

be given. Hence it has recommended that children at six months consume one stew ladle, 

children 7-8 months consume one soup ladle, children 9-11 months consume one to two soup 

ladles and children 12-24 months consume two soup ladles of complementary food.   

 

2.5 Completeness of Infant Immunization 

According to the guidelines of world Health Organization (WHO, 2006) and United Nation 

International Children’s Emergency Fund (UNICEF) for an infant to be considered as being 

immunized or vaccinated children should receive the following vaccinations; A dose of 

BacilleCalmette Guerin (BCG) at birth, Oral poliomyelitis (four doses), pentavalent vaccine, 

Measles at nine month (where there an outbreak, it is given at six months and repeated at one 

year. Yellow fever vaccine between nine to twelve months.  

 

According to UNICEF and WHO (2014) Child immunization measures the percentage of 

children ages 12-23 months who received vaccinations before 12 months or at any time before 

the survey. A child is considered adequately immunized against measles after receiving one 

dose of vaccine. 

Pediatrics (2002) performed a retrospective cohort study of 504 children who were adopted 

from other countries and evaluated in 1997 and 1998. The goal was to determine the 

acceptability of overseas vaccinations for meeting US immunization requirements. They 

assessed immunization records for both valid documentation of receipt of vaccine and 



15 
 

comparability with the recommended US schedule. Pediatrics (2002) determined the number 

of children who were up to date (UTD) for diphtheria-tetanus-pertussis, polio, hepatitis B, and 

measles-mumps-rubella vaccines under the US schedule. 

 

Results showed that children’s mean age at initial US evaluation was 19 months; 71% were 

girls, and most (88%) had resided in orphanages. They were adopted from16 countries, most 

frequently from China (48%) and Russia (31%). Thirty-five percent (178) of children had 

overseas immunization records, 167 (94%) of which were considered valid. Most children 

with valid records (112 [67%] of 167) were UTD for 1 or more vaccine series under the US 

Schedule. The majority (65%) of internationally adopted children had no written records of 

overseas immunizations. Among the 178 children with documented overseas immunizations, 

167 (94%) had valid records and some vaccine doses that were acceptable and UTD under the 

US schedule. Additional research and more specific guidance in the most cost-effective 

approaches to evaluation of overseas vaccinations are needed to ensure appropriate state-side 

vaccination and to improve the health of these children and their communities. 

 

Dummer and Parker (2012) conducted a study that included 8,245 babies born in Nova Scotia 

during 2006. Immunization data were derived from three sources: Provincial Medical 

Insurance Physician Billing data, public health records, and self-report by parents. 

Immunization uptake rates for vaccines included in the Nova Scotia immunization schedule 

were calculated at ages 12, 18 and 24 months. Logistic regression was used to analyze 

vaccine uptake in relation to socioeconomic factors. A telephone survey of a sample of 

parents of study children less than 25 months was completed.  

 

The overall immunization completeness rate was 49% at 12 months, 40% at 18 months and 

58% at 24 months of age. Immunization completeness was significantly higher in more 



16 
 

socially disadvantaged communities. It was concluded that Nova Scotia spends many millions 

of dollars on vaccine purchase and administration, but, as with numerous Canadian 

jurisdictions, there is no accurate system for monitoring or evaluating the program. The 

timeliness and completeness of immunization administration to pre-school children in Nova 

Scotia is inadequate. Further work should elucidate the barriers and enablers to immunization 

to ensure that public health education targets those most likely to be under-immunized. A 

provincial vaccination database should be established to monitor and evaluate the system. 

 

According to the guidelines of world Health Organization (WHO) and United Nation 

International Children’s Emergency Fund (UNICEF) for an infant to be considered as being 

fully immunized or vaccinated children should receive the following vaccinations. 

A dose of  BacilleCalmette Guerin (BCG). 

It is recommended per the guidelines that before 12 months the child should have completed 

the vaccination. The Ghana Demographic and Health Survey (GDHS) recorded that 

Vaccination information is obtained in two (2) ways; from health cards and mother’s verbal 

reports.  

 

The WHO (2005) stipulates that BCG should be given as soon after birth as possible in all 

populations at high risk of tuberculosis infection, and a single dose of OPV should be given at 

birth or two weeks after birth (this is recommended to increase early protection). Hepatitis B 

vaccine (HBV) should be integrated into national immunization programmes in all countries 

by 2020. Where perinatal infections are common it is important to administer the first dose as 

soon as possible after birth. It is estimated that about 12 million pregnant women in Sub-

Saharan Africa do not get tetanus immunization, however, the presence of a midwife, nurse or 

doctor at child birth in developed countries is taken for granted (Vinod, 2005). 

 



17 
 

The Ghana Demographic and Health Survey (GDHS) recorded that Vaccination information 

is obtained in two (2)ways; from health cards and mother’s verbal reports. 

 

 

2.6 Knowledge and Practices related to Childhood illnesses 

2.6.1Acute Respiratory Infection: 

Acute respiratory infection is an infection that may interfere with normal breathing. It usually 

begins as a viral infection in the nose, trachea or lungs. Infections can spread through the 

entire respiratory system if not dealt with medically. This infection is crucial since it can 

spread from one person to another. The disease is quite dangerous for children. 

  

Respiratory tract Infection including pneumonia is the leading cause of death among children 

under 1year in Ghana. Early diagnosis and treatment of antibiotic against pneumonia could 

prevent a large proportion of death.It was found out that giving cough mixture to infants 

besides fatality adverse effects includes convulsions rapid heart rates and reduced levels of 

consciousness (Awasthi et al, 2006). 

 

2.6.2Malaria: 

Malaria is an infection of the blood that is carried from person to person by mosquitoes. 

Malaria has existed for thousands of years and can be found almost every part of the globe. 

Millions of people are infected every year and close to one million of them die. Malaria is 

caused by protozoan of the genus plasmodium. 

 

Malaria can result in mortality in infants and children under five years. 

Studies have shown that twenty-two percent of under five mortality is caused by malaria 

(Ghana Health Service, 2006). Ghana has made several efforts to control malaria; the latest 



18 
 

being roll back malaria initiative that was introduced in 1999 and introduction of insecticide –

treated mosquito nets (ITNS) and protective measures and prompt effective treatment for 

malaria especially among pregnant women and children under 5years. 

 

 

2.6.3Diarrhoea Disease: 

The Ministry of Health’s Standard Treatment Guidelines (2004) defines diarrhoea as passing 

frequent, loose, watery stools three or more times in a day. Diarrhoea is often accompanied by 

vomiting. It is very common in children. The WHO (2000) defines diarrhoea as the passage of 

three or more loose or liquid stools per day.  

 

Diarrhoea is a common disorder of the gastrointestinal system experienced by most of the 

population sometime in their lives. Interventions may be considered necessary by patients 

because of their beliefs and attitude towards normal bowel function (Hogue, 2000). Causes of 

diarrhoea are mostly the use of contaminated water from unhygienic practices in food 

preparation and excreta. Diarrhoea causes severe dehydration that leads to major cause of 

morbidity and mortality.  

 

2.6.4Other Child Health Care Practices 

Improvement in the survival of the newborn is dependent on healthcare that spans antenatal, 

intranatal and postnatal periods, that is, interventions directed to mothers during 

pregnancy;labour and delivery have a profound impact on newborn survival especially during 

the first week of life when three-fourths of neonatal mortality occurs. Moreso, improvements 

in the survival of the newborn includes the care given to women in the pregnancy period as 

for example; nutrition of young girls can have an impact on their adult height which in turn 

can influence outcomes for labour and delivery. Another example would be that the 



19 
 

pregnancy folic acid status of the mother can determine the incidence of some congenital 

abnormalities. Maternal care is therefore not only important for reducing maternal mortality 

but also neonatal mortality.  

 

A study conducted in a rural community in northern India to assess household practices that 

can affect neonatal health among 200 caregivers reports that more than half of the caregivers 

recognized fever, irritability, weakness, abdominal distention/vomiting, slowbreathing and 

diarrhoea as danger signs in neonates. 30.38 percent of caregivers saw illness in neonates 

manifest in the form of continuous crying (Awasthi et al., 2008).  

 

Another study in Nepal reports that newborn babies are considered dirty since they came out 

of their mother’s womb, so almost all newborn babies are bathed within the first hour of birth 

(Yadav, 2007). The WHO also recommends that newborns should be observed for crying and 

breathing immediately after delivery and asphyxiated newborns should be recognized and 

resuscitated, and that newborns should be breastfed within one hour and should only be fed on 

breast milk. 

 

In Pakistan, though respondents knew about the benefits of clean delivery, they rarely 

practiced it, moreso, good knowledge and practices for maintaining the newborn's warmth 

were predominant, while delayed initiation of breastfeeding, avoidance of colostrum and 

prelacteal feeding were also common. Unhygienic cord care, including an unclean cut and 

application of ghee (black cosmetic powder) on the cord-stump, was the norm. Knowledge of 

some danger signs in newborns was common, but timely action upon recognition was not 

provided (Yadav, 2007).   

 



20 
 

Dhaded et al (2015) conducted a study on infant survival practices using prospectively 

collected data with high follow up rates (99%), we documented characteristics associated with 

neonatal mortality. Low birth weight and prematurity are among the strongest predictors of 

neonatal mortality. Other risk factors for neonatal deaths included male gender, multiple 

gestation and major congenital anomalies. Breech presentation/transverse lie, and no antenatal 

care were also significant risk factors for neonatal death. Coverage of interventions varied by 

setting of delivery, with the overall population rate of most evidence-based interventions low. 

This study informs about risk factors for neonatal mortality which can serve to design 

strategies/interventions to reduce risk of neonatal mortality. 

 

The Newhints research (2007) reports that ‘Asram’ is considered the most common problem 

in newborns and that almost all cases of severe illness in newborns is attributed to Asram. 

(Described as a sickness that attacks children under one month old or in the womb, caused in 

numerous personalistic ways; for instance by seeing the breasts or stomach of the pregnant 

woman, or a pregnant woman walking past a house with Asrammedicine in it). And herbs are 

used to both protect from and to treat Asram (by bathing soon after birth). 

 

A study conducted among the rural poor in western Uttar Pradesh, to identify factors 

influencing newborn care shows that nearly all newborns were left wet and naked on the floor 

until the placenta was delivered and bathed immediately after birth, and very few birth 

attendants washed their hands with soap before assisting the delivery. It also reports the use of 

new blade dipped in hot water to cut the cord and unsterilized cord tie after birth. 

Mothers’/caretakers’ behaviour were influenced by Mother-in-Laws advice, traditional 

beliefs, and pursuance of a practice because it was the norm in the community (Sethi et al., 

2005).    

 



21 
 

According to Deogaonkar and Milind (2004) the use of sterilized instruments or materials in 

the Asante-Akim town for cord cutting and tying of the cord was common, but, application of 

harmful substances such as ash, salt, tomato juice and mashed uncooked cocoyam on the cord 

stump of newborn babies must be prevented because it leads to the contraction of various 

childhood illnesses. Although there was enough evidence about mothers’ knowledge on 

newborn care, harmful and unhygienic newborn care practices were common, this can be 

attributed to tradition and lack of family support as most of these practices are carried out 

after discharge from the hospital and in the absence of the TBA (in deliveries outside health 

facilities). Newborn babies were bathed with herbal preparations with the aim of protecting 

them from falling sick (especially from contracting a disease traditionally called “Asram”). 

Mothers attribute “asram” to evil spirits (believed to be transmitted by people with ‘bad eyes’) 

to either the unborn child or the neonate, mothers believe that it can be treated only with 

traditional medicine(s). Majority of mothers would not give their newborn babies to strangers, 

this they claim prevent newborn babies from contracting diseases which may be transferred 

physically or spiritually to them.    

 

2.7 Socio-Economic Factors 

Regional variations in the causes of perinatal and neonatal mortality and morbidity rate is 

linked to the level of social and economic development, the quality of health services, the 

environmental circumstances as well as cultural practices (WHO, 2002). The health of a 

country is directly dependent on its economic and social development. Social and economic 

growth is also based on the healthy living conditions and access to good and quality health 

care for all the people of the nation, and it is their right. The health indicators of a society or 

nation are therefore affected by inequalities in economic and social conditions. The most 

affected indicators of health in a country are maternal and infant mortality rates.  

 



22 
 

Socio-economic factors that affect access to health care and causes child mortality operates at 

the individual, family and community level and is a complex issue. The individual woman 

makes decisions about her health and the health of her child depending on her educational 

level, occupation, level of personal income or wealth and their autonomy. The aggregate 

family income, occupation and education of family members could also affect access to health 

care for the woman and her newborn baby. With the community, the collective resources and 

wealth plays an important role in the socio-economic aspects of the health needs of 

community members (McCarthy & Maine, 1992) and impacts child survival.  

 

Parlato et al (2004), classified constraints influencing people’s ability and willingness to 

change intrapartum care practices into: informational, social, cultural, and economic. 

Informational constraints refers to constraints in knowledge such as the clients’ lack of 

information regarding current recommended essential newborn care practices and their health 

outcomes, that is, a major reason for not adopting a new practice could simply be lack of 

knowledge and a sound understanding of its availability, use and benefits.   

 

2.8Traditional Practices  

Some traditional practices of newborn care may not be in accordance with these guidelines. 

The fact that most births take place at home shows that such traditional methods might be 

used more frequently. Hygiene and aseptic conditions may be unknown or very difficult to 

achieve in many poor communities. People may not be aware of the environmental dangers of 

infection and may not make much effort in combating them, this pervasive acceptance of 

unhygienic conditions may extend to cord care, drying and wrapping of the newbornetc 

(Parlato et al., 2004).   

 



23 
 

In cultures where birth is considered ‘polluting’, skin-to-skin contact or delayed bathing may 

be regarded as a dangerous practice, moreso, they could be seen as a violation of religious 

beliefs, perceived as compromising the religious standing of those who come into contact 

with the ‘polluted’ infant.  

 

Socio-cultural factors of practices such as the family’s belief that applying substances on the 

cord stump quickens the healing process whereas in reality, this practice rather increases the 

risk of infection. There’s often a religious or cultural significance to the application of certain 

substances. Not all traditional practices are harmful, some modern practices, such as bottle 

feeding and the use of pacifiers or dummies, are considered unsafe. Because each community 

has its own unique culture and tradition, traditional practices may differ from community to 

community (WHO, 2006).   

 

The World Health Organization further maintains that some modern practices such as bottle-

feeding, use of pacifiers and separation of mother from her newborn baby are discouraged and 

special efforts are made to study home remedies for simple problems and to promote those 

that are effective. Some traditional practices such as applying unclean substances on the cord 

are dangerous and should be discouraged or replaced with safer alternatives.    

 

 

 

 

 

 

 



24 
 

 

CHAPTER THREE 

METHODOLOGY 

3.1 Introduction 

Chapter three presents the methodology that was used in order to test the hypothesis. It 

elaborate/describes the research design, study setting, study population, sample size sampling 

techniques, data collection procedure, data analysis procedure and ethnical consideration. 

Instrument that were used in the research and statistical techniques used in the study are 

described. 

 

3.2 Study Area 

Ashaiman municipal is a district withinthe Greater Accra Region of Ghana. It was formerly a 

sub district under the Tema metropolitan health directorate until 2008 when it was demarcated 

as a new municipal. It lies within the south-eastern part of Ghana and is located about four (4) 

kilometers at the northern part of Tema and thirty (30) kilometers from Accra the capital city 

of Ghana. 

 

Ashaiman municipality is borded on the south by the main Accra-Tema motor-way, east by 

the Akosombo road, north by the Michel camp and Zenu road and west by Adjei-

kojo.Ashaiman thus shares a boundary currently with Tema metropolitan area and 

KponeKatamansomunicipal.The municipal spans over a land size of 45km². 

 

3.2.1 Demographic Characteristics ofAshaiman Municipality 

Ashaiman is a sprawling “urban settlement” parts of which exhibit characteristics of a slum. 

This pertains especially around the core business artena of the community. The 2010 

population census report estimated the population of Ashaiman to be 190,721 growing at a 



25 
 

rate of 4.6%, which is higher than the national growth rate of 2.6% (Ghana Statistical Service, 

2012). 

The 2010Population Housing Census (PHC) report estimated that 93,727 of Ashaiman 

population were males with 97,245 being females. With an inter-censal growth rate 4.6%, 

current estimates show that 49.07% are Males and 50.92% are females. This compares with 

the regional figures which has the same higher female proportion of sex distribution. 

 

Table 3.1 Table of Age-Sex Composition of Ashaiman population 2010 

Age Cohort Males Females Total Population 

Absolute % Absolute % Absolute % 

0-14 29,798 48.96 31,065 51.04 60,863 31.87 

15 – 64 61,605 49.07 63,949 50.93 125,554 65.74 

65 + 2,324 51.02 2,231 48.98 4,555 2.39 

Total 93,727 49.07 97,245 50.92 190,972 100 

Source: GSS, 2010 Population and Housing Census 

 

TheAshaiman population for the year 2014 was 215,777 projected from the 2010 population 

census with a growth rate of 3.1%, giving a population density of 4,795 per square kilometers. 

The rapid population growth can largely be attributed to the fact that Ashaiman continues to 

serve as a dormitory town for most youths who migrate from the surrounding communities 

and other parts of the country to Ashaiman in search of jobs in the Tema Metropolis and other 

neighbouring West African countries. 

 

As a result, there is increased social vices: Ashaiman being mostly slum has heightened 

degrees of social vices which include high crime rates, drug abuse, prostitution, teenage 

pregnancy,  child labour, high school drop outs, malnutrition due to financial constraints and 



26 
 

lack of knowledge, malaria due to poor sanitation conditions, Road traffic accidents, all these 

vices are due to the socioeconomic status of the community. Sexually transmitted disease 

such as HIV/AIDS infection is prevalent in the municipality, due to the high rate of 

prostitution and drug abuse, High prevalence of tuberculosis as a result of overcrowding and 

poor sanitation. 

 

3.2.2 Health Directorate of Ashaiman 

Ashaiman municipal health directorate is a district of the highest administrative authority 

which represents Ghana health service in the municipality. It coordinates and plans the 

activities of the various health programs for all health facilities both private and public 

including clinics, maternity homes and herbal centers in the municipality. 

Its major collaborators /stakeholders include District Assembly, Ministries departments and 

Agencies (MDAs) including social welfare, Ghana educational service and Youth and sports, 

Agriculture, Roads and Highways and Faith based organizations. 

The Ashaiman municipal health directorate reports directly to the Regional Health Directorate 

and the Ashaiman municipal Assembly. Currently the municipality is divided into seven (7) 

sub municipal areas for the purposes of planning and delivery of services; namely; 

 

AmuiJor, Blakpatsona, Nii Man, Gbemi, TsinaiAgber, Mantseman and Maamomo. Six out of 

the seven sub- municipalities have no functional public facility .The municipality has one (1) 

polyclinic. The polyclinic provides quality of care delivery for the insured with valid national 

health insurance scheme and to the uninsured community members. There are eighteen 

(18)registered private clinics/hospitals and maternity homes well spread in the municipality 

which supplement the efforts of the public health facility available. These private facilities 

also provide a wide range of services i.e. theatre, scan, maternity, laboratory, etc. that caters 

the needs of the community members, workers and their dependents. The municipality lacks 



27 
 

CHIP compounds but has forty –two (42) CHIP zones whose activities is to run child welfare 

clinics. These CHIP zones are headed by health personnel precisely community health nurses 

whose activities are to run child welfare clinics, visit homes to render health services to 

pregnant women, under five children and the aged, they also run school health talks by 

visiting the various schools located within the community, these CHIP zones are located 

within private health facilities, others are under trees, canopies and the rest are in assembly 

provided buildings. 

There are forty-one (41) pharmacies and licensed chemical shops which are located all over 

the municipality and this serves as the first point of call for most people seeking health care. 

 

3.3 Data Collection Techniques and Tools 

A questionnaire was used to collect data. A pilot study was conducted in crystal hospital and 

its environs with the same characteristics as in the study area. After the research assistants 

were trained to what they will do in the field. The pilot resources were not added in the study 

result. The purpose of the research study was communicated to mothers who were assured 

that the questionnaire would be treated with confidentiality and the information was to be 

used for academics work as for probably policy change. 

 

3.4Study Population 

The study was on infant survival as practise among women with child under one year as 

Ashiman. Ashiman has a population of wife of 64,733 of which 400 hundred women with 

child 0 - 12 months were selected using the following methods. 

 

3.5 Research Design 

The study was conducted using the quantitative approach to research. According to Burns and 

Grove(2005) quantitative research approach is a formal, objective, systematic process in 



28 
 

which numerical data are used to obtain information about the world. The study also adopted 

the cross-sectional research design. Malhorta, Hall and Shaw (2007) defined cross-sectional 

design as a type of research design involving the collection of information from a given 

sample of population elements only once”. This was used because data was gathered from the 

target respondents only once. 

 

 

3.6Sampling Method 

Across sectional study was carried out in Lebanon zone II and Ashaiman polyclinic and in the 

community.Four hundred mothers with children under one year were selected using a 

Monkey survey calculator to obtain a sample size with total WIFA of 64,733 at 95 percent 

confident interval with margins of error of 5 percent.Cross sectional quantitative methods and 

simple random sample was used. 

 

A sample size of 100 mothers with children under one year was selected in Lebanon Zone II 

Clinic and Ashaiman Polyclinic.There is CWC in every week in Ashaiman Clinic. The 

sample size was divided into four(4)parts that is 25 for each week. All registration numbers of 

infants in week one register were written on a piece of paper, folded and put in a box. 

The box was shaken vigorously to make sure all pieces of paper were well mixed. 

A piece of paper was picked after each vigorous shake till the 25th piece of paper was picked. 

The papers were selected and those mothers were interviewed, where the mothers were not 

around, the registration number was kept and the mother interviewed on the next visit. 

The same procedure was repeated for all the weeks in Lebanon Zone II Clinic. 

In Lebanon Zone II community, the area was divided into four(4) parts, the Northern part, 

South, East and West part.A random sample was used to select the first house. After the first 



29 
 

house, every fourth house was entered, till the 100 respondents were successfully selected and 

interviewed.The same was repeated in ZongoLaka and Lowcost community. 

TheQuestionnaire was administered at separate times in each of the clinics.Thedata collected 

was analysed using STATA. 

 

3.7Study Variable / Unit 

Children from 0-12 months were studied as the study unit or variable. Mothers with children 

from 0-12 months are the respondent. 

 

3.8 Sample size Calculation 

Study was conducted among women with children under one year at Ashaiman.Woman in 

fertility age (WIFA) in Ashaiman totally 64,733using monkey survey calculator, the total 

population of 64,733 at 95 percent confident interval with margin of error of 5 percent yielded 

a sample size of 400. 

 

3.9Pre-Testing 

Designed questionnaire were administered to respondents at crystal hospital in Ashaiman and 

in the community. 50 respondents were used for the pre - test exercise, 25 respondents at the 

crystal hospital and 25 respondents in the community. The pre - test exercise was to help 

identify the questionnaire whether it met its objectives of the study (research).The 

questionnaires were clearly, simple and easily understood. 

 

3.10Data Handling 

Mothers with children one year and below with the ages between 16-40 years were 

interviewed face to face with instant answers at the clinics and in the community. 



30 
 

The questionnaire consists of Demography of the mother and objectives of the research. 

Infant survival practices among women with children under one year at Ashaiman questions 

were asked in the language that the respondents’ best understood clearly. The interviewer 

wrote exactly the answers the respondents gave. 

 

3.11Data Analysis 

Data obtained from the questionnaire survey was analysed using statistical package for social 

sciences (STATA). The analysis of data was gathered, organized and interpreted using 

statistical tools such as frequencies, mean and percentages. Therefore mainly descriptive 

statistical tools were used. Descriptive tools such as frequency and percentage were used to 

analyse the data. Descriptive tools helped to easily comprehend the data collected. 

 

3.12Ethical Consideration 

Written information consent was obtained from each woman beforeemployment into the 

program. The data obtained was kept strictly confidential and made available to only persons 

connected to the study. 

 

Ethical approval for the conduct of the study was obtained from Ethical review committee of 

the Ghana health service. Administrative approval for the study was obtained from district 

assembly municipal health directorate, directors of the health facilities and authorities of the 

participating communities. 

 

3.13Limitations to Study 

The current study is limited in scope and sample size. This may render the results 

unrepresentative enough for generalization. Also due to the limited time available in 



31 
 

completing the project several concepts such as infant mortality issues were not explored 

enough adequately.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



32 
 

CHAPTER FOUR 

RESULTS 

4.1 Data Analysis and Discussion of Results 

Four hundred participants were interviewed in Ashaiman and the results were as follows; 

First the demographic characteristics of the respondents are provided and then the results of 

the main findings are discussed. 

 

Table 4.1.1Demographic Characteristics of Respondents 

 

Variable Frequency Percent 

Age group of mother 

  
16 to 34 355 88.75 

35 to 45 42 10.5 

46 to 48 3 0.75 

Age group of infants 

in months 

  
≤3 86 21.5 

4 to 5 125 31.25 

6 to 7 69 17.25 

8 to 12 120 30 

Religion 

  
Christian 361 90.25 

Muslim 39 9.75 

Ethnicity 

  
Akan 146 36.9 



33 
 

 

 

 

Source: Field Survey, 2016 

The minimum age of a mother is sixteen years whiles the maximum is forty-eight years, with 

the majority ages falling between sixteen and thirty four years. The majority age group is 

represents about 88.75% of the sample size. Meanwhile the age group of mothers between 46-

48 represents the least represented age group of 0.75% of the sample size. 

 

Also the age group of infants between 4-5months represented the largest sample compared to 

infants under 3months, 6-7months and 8-12months. 6-7months old infants were the least 

represented with 17.25% of the sample. 

 

Among the correspondent interviewed, majority were Christians. Most of the mothers are 

Akans and Ewes while the rest of the sample of mothers were distributed amongst Ga-

Adangbes, Krobos and Dagombas as well as other ethnic groups not captured by the survey 

instrument. 

 

 

 

 

 

 

 

Dagomba 38 9.6 

Ewe 134 33.8 

GA/Ga Adangbe 54 13.6 

Krobo 8 2.0 

Other 20 5 



34 
 

 

 

 

 

 

 

            Source: Field Survey, 2016 

Mothers who obtained JHS and primary level education represents 57.25% of the sample 

studied. However 13.5% did not receive any formal education whereas only 4% attained 

tertiary level education.  

AGE(MONTH) FREQUENCY PERCENT 

0-6 268 67.0 

7-12  33.0 

 

 

 

 

Number of Infants 

Percentage of Infants 

0

50

100

150

200

250

300

350

400

450

Childs Age 0--6 7--12 Total

Education   

None 54 13.5 

Primary and JSS/JHS 229 57.25 

Secondary 101 25.25 

Tertiary 16 4.0 

AGES OF INFANTS 



35 
 

From a graphical perspective the number of infants to the percentage of infants was displayed 

on the histogram. It is shown that majority of (infants) are between 7-12 whiles the rest fell 

between 0-6 months. The table also indicates similar information where 67% was infants 

between 0-6months whereas 33% were between 7-12months. 

 

Table 4.1.2 Place of Delivery 

Place of Delivery 

Delivery Place Frequency Percent 

CHAG 2 .5 

Home 17 4.3 

Private health facility 89 22.3 

Public health facility 292 73.0 

Total 400 100.0 

Source: Field Survey, 2016 

Majority of deliveries are supervised in public health facility whereas minority of deliveries 

were supervised in CHAG. There were relatively few people who delivered at home. 

 

 

Table 4.1.3 TIMING OF INITIATION OF BREAST FEEDING AFTER BIRTH 

Time of  initiation of breastfeeding FREQUENCY PRECENTAGE 

Immediately 212 53.00 

30 minutes after 109 27.32 

One hour after 15 4.00 

Other than one hour 64 16.04 

 Source: Field Survey, 2016 

Table 4.1.3 showed the time of initiation of breastfeeding after delivery. Results showed that 

53% representing 212 mothers immediately initiated their newborn babies. Meanwhile 

27.32% representing 109 mothers initiated the newborn babies after 30 minutes of delivery 



36 
 

whereas 4% and 16.04% respectively initiated the newborn baby one hour after delivery and 

other than one hour after  delivery. The distribution indicates that majority of the sample 

immediately initiates the new born baby. 

Table 4.1.4                 Why you started breast feeding at this time 

 
FREQUENCY PERCENT 

Health directive 326 81.5 

Hunger/No Food 18 4.5 

No reason 31 7.8 

Lack of fitness 15 3.8 

Personal decision/belief 10 2.5 

Total 400 100.0 

Source: Field Survey, 2016 

Table 4.1.4 enumerates various reasons why mothers initiated breastfeeding their newborn 

babies at the times indicated in table 4.3. About 81.5% of respondents indicated health 

directives as the reason behind the time of initiation of breast. The health directive includes 

midwife, nurse and doctor’s advice on when to initiate the newborn baby to breastfeeding. 

About 4.5% of mothers indicated that they initiated their newborn baby to breast feeding 

because the baby was hungry. About 7.8% of mothers have no reason for initiating their 

newborn babies at the said time. Also 3.8% of mothers indicated that they were not fit enough 

to provide their newborn baby with breast milk. Lastly 2.5% of mothers decided to feed the 

newborn baby based on their personal decision. 

Table 4.1.5 Problem with breast milk on first day after delivery 

Source: Field Survey, 2016 

 FREQUENCY PERCENT 

No 373 93.25 

Yes 27 6.75 



37 
 

Table 4.1.5 indicates whether or not mothers encountered any problems in relation to breast 

feeding on their first day of delivery. About 91% of respondents indicated that they had no 

problems whereas 9% indicated that they had problems. 

 

Table 4.1.6 What did you do when you had problems with flow of breast milk 

 FREQUENCY PERCENT 

I expressed it (forced the milk out) by hand 11 2.75 

I did Nothing 14 3.5 

I applied Ointment/Drugs 2 .5 

No answer 373 93.25 

Total 400 100.0 

Source: Field Survey, 2016 

Table 4.1.6 indicated what mothers did when they had problems with the flow of breast milk. 

About 2.75% forced it while 3.5% of respondents did nothing about it. However 0.5% of 

respondents either took in drugs or applied some ointment on their breast in other to produce 

the breast milk. 

Table 4.1.7                               Still breast feeding 

 FREQUENCY PERCENT 

No 15 3.75 

Yes 385 96.25 

Source: Field Survey, 2016 

Table 4.1.7 showed whether mothers were still breast feeding their 0-12months old baby. 

About 96.25% of respondents affirmed that they are still breast feeding their new born babies. 

About 3.75% of respondent showed an alternative view point.  

Table 4.1.8                                                    If No, Why? 

 FREQUENCY PERCENT 

No reason 6 40.0 

due to medical challenges 9 60.0 

Total 15 100.0 

Source: Field Survey, 2016 



38 
 

Respondents who were not still breastfeeding their newborn babies provided some 

alternatives to that effect as indicated in table 4.8. About 40% of respondents had no reasons 

whereas 60% had medical challenges such as a mother falling into coma after delivery and the 

challenge of recovering from a caesarean operation after delivery. 

Table 4.1.9 COMPLEMENTARY FEEDING PRACTICES 

 

 

Source: Field Survey, 2016 

 

Table 4.1.9 showed the introduction of complementary feeding to babies. About 10.75% of 

mothers introduced complementary food when the baby is below six months. About 30.5% of 

respondents introduce complementary feeding when the baby is above 6months. However 

58.75% of mothers are yet to introduce complementary feeding to their wards.  

 

Table 4.2.0  Why do you start introducing complementary food at that age? 

 FREQUENCY PRECENTAGE 

No response 233 58.3 

Health directive 70 17.5 

Inadequate breast milk 40 10.0 

Personal Decision 18 4.5 

Not yet/others 39 9.8 

Total 400 100.0 

Source: Field Survey, 2016 

Table 4.2 indicates a number of reasons in relation to the timing of the initiation of 

complementary feeding. About 58.3% of respondents did not respond to the timing of the 

initiation of complementary feeding. About 17.5% of respondents initiated complementary 

feeding through health directives issued by health officials. Also 10% of respondents 

Introduction of complementary food FREQUENCY PRECENTAGE 

Below 6 43 10.75 

Above 6 122 30.5 

Not yet 235 58.75 



39 
 

indicated that the breast milk was inadequate for the baby. About 10% of mothers who 

initiated complementary feeding did so based on personal decisions. About 9.8% have not 

initiated complementary feeding yet.  

 

Table 4.2.1 Practices of complementary feeding initiation  

Source: Field Survey, 2016 

Table 4.2.1 indicates the main practices under initiation of complementary feeding. About 

36.36% of mothers do not provide fruits as complementary ignition practice whereas 63.64% 

does. Also 98.8% of mothers who initiate complementary feeding wash their hands before 

doing so. About 1.2% however do not. 

About 83.64% of respondents indicated that baby does not vomit out complementary food 

where as 16.36% indicated that babies vomit complementary foods. 

  

 

 

 

 

 

 

Fruits   

No 60 36.36 

Yes 105 63.64 

Wash hands before preparing food   

No 2 1.2 

Yes 163 98.8 

Does baby vomits out food as he/she takes in 

food 

  

No 138 83.64 

Yes 27 16.36 

Total 165 100.0 



40 
 

IMMUNIZATION 

A GRAPH SHOWING INFANTS 0 – 12MONTHS AND STAGES OF COMPLETION 

OF IMMUNIZATION 

The table below summarizes the number (percentage) of babies who have completed their 

immunization cycle, or are on course for the immunization or have not completed the 

immunization cycle.  

Table 4.2.2                                 Status of Immunization  

Status of baby Frequency Percentage 

Immunization not completed 16 4.0 

Immunization completed 32 8.0 

Immunization on course 352 88.0 

Source: Field Survey, 2016 

About 88% of respondents indicated that their babies’ immunization is on course. About 8% 

indicated that immunization has been completed whereas 4% indicated that it is not 

completed. 

 

 

4% 8%

88%

Frequency

Immunization not completed Immunization completed Immunization on course



41 
 

Table 4.2.3  

Last recorded weight after 

Immunization 

FREQUENCY PERCENTAGE 

0-2kg 7 1.8 

3-5kg 160 40.0 

6-8kg 185 46.3 

9-11kg 44 11.0 

over 12kg 4 1.0 

Total 400 100.0 

Source: Field Survey, 2016 

Table 4.2.3 displays the last recorded weight for the babies. The majority of babies weighed 

between 6-8kg representing 46.3% whereas only 1% weighed over 12kg. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



42 
 

CHILDHOOD ILLNESS 

                    

 

Table 4.2.4                                               FEVER 

What do you do when infant is having high fever 

Activity Frequency Percent 

Tepid Sponging 30 7.5 

Bath cold water 51 12.75 

Bath warm water 28 7.0 

Paracetamol syrup 168 43.9 

See the doctor 34 7.8 

Haven’t experienced it 89 22.9 

Total 400 100.0 

Source: Field Survey, 2016 

 

From the table above 43.9% of mothers provide paracetamol syrup to  

Their wards whenever they have fever. About 22.9% have not experienced  

It yet. Only 7% of mothers will bath their wards with warm water only  

When infant is having high fever.  

Table 4.2.5                                          VOMITING 
  

What do you do when infant is vomiting 

Activity Frequency Percent 

Go to health centre 174 43.5 

Did nothing 55 13.75 

Give paracetamol 5 1.25 

Have not experienced it 163 40.75 

Gave ORS 3 0.75 

Total 400 100.0 



43 
 

About 43.5% of respondents go to the health care centre when infant is vomiting. Also 

40.75% of respondents have not experienced their infant vomiting before. Also 13.75% of 

respondents did nothing when infant is vomiting. 

DIARRHOEA 

Table 4.2.6    What do you do when infant is having loose stool? 

Activity Frequency Percent 

Go to health centre 171 42.75 

Did nothing 27 6.75 

Self medicate/see a chemical 

seller 6 1.5 

Have not experienced it 182 45.5 

Gave ORS 6 1.5 

Breastfeed more 8 2.0 

Total 400 100.0 

Source: Field Survey, 2016 

 

Table 4.16 indicates what mothers do when infant is having loose stool. About 42.75% of 

mothers indicated that they visit the health centre, 45.5% of mothers indicated that they have 

not experienced it whereas only 1.5% indicated that they provide or see a chemical seller and 

gave ORS respectively. 

 

 

 

 



44 
 

DIARRHOEA AND VOMITTING 

Table 4.2.7   What do you do when infant is having both condition above? 

Activity Frequency Percent 

No idea 15 3.75 

Have not experienced it 199 49.75 

Go to clinic 186 46.5 

Total 400 100.0 

Source: Field Survey, 2016 

 

Table 4.17 indicates what mothers will do when infant is having diarrhoea and vomiting. 

About 49.75% of mothers indicated that they have not experienced it whereas 46.5 will go to 

the clinic. However only 3.75% had no idea in relation to what they will do.  

 

DIFFICULTY IN BREATHING 

Table 4.2.8   What do you do if the baby is having difficulty in breathing? 

Activity Frequency Percent 

Haven’t experienced it 199 49.75 

provide fresh air 2 0.5 

no idea 18 4.5 

Go to clinic 181 45.25 

Total 400 100.0 

Source: Field Survey, 2016 

 

About 49.75% of mothers indicated that they haven’t experienced their infant having 

difficulty in breathing. Meanwhile about 45.25% go to the clinic when it happens whereas 

only 0.5% provide infant with fresh air when infant experiences difficulty in feeding. 



45 
 

COUGHING 

Table 4.2.9                    What do you do when baby is coughing? 

Activity Frequency Percent 

no idea 10 2.5 

Go to clinic 115 28.75 

Self medicate/see pharmacy 16 4 

Have not experienced it 104 26 

Give cough mixture 155 38.75 

Total 400 100.0 

Source: Field Survey, 2016 

 

On the issue of what mothers do when infant is coughing, about 38.75% of mothers give 

cough mixture. About 28.75% go to the clinic whereas only 2.5% have no idea. 

Table 4.3.0                                                    ITN USE 

Number of times child sleeps under ITN 

Activity Frequency Percent 

Do not use ITN 177 44.3 

<4 days 40 10.0 

> 4 days 183 45.8 

Total 400 100.0 

   

Number of times mother sleeps under ITN 

Activity Frequency Percent 

Do not use net 202 50.5 

<4 days 42 10.5 

> 4 days 156 39.0 



46 
 

Total 400 100.0 

   

Did Child sleep under ITN last night 

Activity Frequency Percent 

No 199 49.8 

Yes 201 50.3 

Total 400 100.0 

      

Did mother sleep under ITN last night 

Activity Frequency Percent 

No 230 57.5 

Yes 170 42.5 

Total 400 100.0 

Source: Field Survey, 2016 

Table 4.20 indicates the use of insecticide treated mosquito nets (ITN) 

About 44.3% do not use ITN. Meanwhile only 45.8% used ITN more than  

4days. Also 50.5% of mothers do not use ITN. However 50.3% of mothers  

Indicated that their infant slept under ITN the previous night. To conclude 

57.5% of mothers did not sleep in ITN the previous month. 

Table 4.3.1                               ITN POSSESSION 

  

Did you receive ITN During pregnancy 

Activity Frequency Percent 

No 294 73.5 

Yes 106 26.5 

Total 400 100.0 

   

If yes, how many 

Activity Frequency Percent 



47 
 

 

Source: Field Survey, 2016 

 

Table 4.21 analyses ITN possession. A large number of mothers (73.5%) did not receive any 

ITN during pregnancy. Only 26.5% received theirs. About 90.6% of those who received it got 

only 1 whereas the rest got two. 85.8% of mothers also indicated that they did not receive ITN 

after delivery. Only 14.3% received it after delivery. About 78.9% of mothers who received 

ITN after delivery got only one whereas 1.8% received three ITN. 

 

 

 

 

 

1 96 90.6 

2 10 9.4 

Total 106 100.0 

   

Did you receive ITN After delivery 

Activity Frequency Percent 

No 343 85.8 

Yes 57 14.3 

Total 400 100.0 

   

If yes, how many 

 

Frequency Percent 

1 45 78.9 

2 11 19.3 

3 1 1.8 

Total 57 100.0 



48 
 

CHAPTER FIVE 

DISCUSSION OF RESULTS 

5.1 Timing of initiation of breast feeding after delivery 

From the analysis it was realized that most mothers (about 53%) breastfed their infants 

immediately after delivery while only a few (20.04 %) breastfed their infants one hour after. 

Though a marginal improvement has been observed over the years in relation to meeting 

WHO’s standards there is still more work to be done. Generally, the finding of the current 

study is consistent with WHO (2006) recommendations that newborns should be breastfed 

within one hour and should only be fed on breast milk. The finding of the current study is 

however inconsistent with some breast feeding practices in the Asante-Akim town of the 

Ashanti region. Deogaonkar and Milind (2004) indicated that newborns are breast fed one 

hour after delivery. A study conducted by Yadav (2007) on traditional practices in newborn 

care in Nepal shows that colostrums is regarded as dirty milk in some communities, and 

babies were fed with cow or goat milk immediately after birth for the popular belief that it 

will make the baby become more intelligent. Bhandari et al (2003) study in India revealed that 

newborns were given prelacteal feeds of honey, tea and diluted milk, and babies are often not 

breastfed during the first 3 days. These practices seem to relegate the recommendation offered 

by WHO to health units around the globe. 

 

Meanwhile the average length of exclusive breast feeding in Ghana is four (4) months 

(Annim, Awusabo-Asare, &Amo-Adjei, 2013). Forty–one percent of breast fed children and 

eleven percent of non breast fed children between six to twenty three months are fed 

accordingly as recommended by infant and young children feeding (IYCF) practices (Annim, 

Awusabo-Asare, &Amo-Adjei, 2013).To conclude breast feeding newborn babies 

immediately after delivery is highly consistent with WHO’s directive. This means that 



49 
 

Ashaiman Municipal health centre complies with the World Health Organization’s 

recommendation.  

 

5.2 Practices related to introduction of complementary feeding 

From the analysis gathered a number of respondents (about 30.5%) introduced 

complementary food after six months whereas a few introduced it before six months. 

Meanwhile, according to WHO (2006) newborn babies should be given exclusive 

breastfeeding for 6months. This means that some mothers have applied this survival 

technique in the wrong way by introducing complementary feeding within the first 6months 

of birth. Some mothers also indicated that as a way of introducing their newborn babies to 

complementary feeding, they introduce fruits for a start. They however indicated that the 

newborn babies do not vomit after the introduction of this feed. 

 

Results from a study conducted in Builsa district in the Upper East region (Abang, 2013) 

showed that cultural beliefs underline most of the complementary feeding practices. Early and 

late introduction of complementary food, water and traditional herbs/liquids to newborn 

babies are common. Grandmother’s support for EBF, thickness of porridges and age of 

introduction of complementary food were significantly associated with duration of EBF. This 

result is somewhat consistent with the findings of the current study. 

However Bhandari et al (2003) indicated that in India, newborn babies are given sweetened 

water during the first three days instead of breast milk. This finding is inconsistent with the 

WHO’s recommendation. This is because complementary foods are introduced before breast 

feeding. Fikree et al (2005) also indicated that in Pakistan delayed breast feeding is the norm. 

Parents offer prelacteals, supplementary feeds such as ghutti and water. All these practices do 

not conform to the recommendations offered by WHO. 

 



50 
 

5.3 The completeness of infant immunization by twelve months 

The results of this study showed that infant immunization completeness by twelve months is 

on course and is consistently being ensured by mothers and health officials. About 8% of 

children were fully immunized, whereas 88% are still being immunised. Meanwhile only a 

handful of respondents (4%) are yet to engage their newborn babies in the immunization 

process. UNICEF (2007) has found that many infants did not receive routine and standardized 

immunization within the West-Africa sub-region. The report stated that rural areas within 

countries such as Ghana, Nigeria and Ivory Coast did not meet the standardized immunization 

processes. 

According to WHO (2006) by breast-feeding, a mother begins the immunization process at 

birth and protects her child against a variety of viral and bacterial pathogens before the 

acquisition of active immunity through vaccination. According to WHO (2005) immunization 

should be given as soon as a child is born especially in populations that have high risks in 

tuberculosis. They also recommended that immunization may be given 2weeks after birth. 

Vinod (2005) indicated that Africans do not get tetanus immunization. Drummer and Parker 

(2012) indicated that the immunization completeness rate was higher in more socially 

disadvantaged communities of Nova Scotia. 

 

5.4 Knowledge and practices related to other childhood illness 

General responses gathered on childhood illness showed that mothers either provide their 

babies with self-medicated drugs or send them to the nearest health facility (About 43.5% of 

respondents indicated  that they either provide self medicated drugs or send the infant to the 

nearest health facility ). According to Deogaonkar and Milind (2004) childhood illnesses may 

be contracted more easily within the Asante-Akim district due to out-dated traditional birth 

practices. In Northern India Awasthi et al (2008) indicated that some caregivers saw illness in 

neonates manifest in the form of continuous crying, irritability and weakness. Knowledge of 



51 
 

some danger signs in newborns was common, but timely action upon recognition was not 

provided (Yadav, 2007).  Common illness such as irritability, fever, headache, malaria and 

diarrhoea were found across various cities where similar research was conducted. From a 

domestic perspective households can be regarded as a nation’s health production system, in 

that they produce health from the local community level to that of the wider society. Newborn 

care remains a neglected problem and these impacts negatively with government pledging to 

reduce under 5 years mortality by the year 2020, however, the survival of humankind as a 

whole will be impossible without protecting maternal and newborn lives. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHAPTER SIX 

 



52 
 

 

CONCLUSIONS AND RECOMMENDATIONS 
 

6.1Conclusions 

 

Ashaiman has the population that is mixed with those in low literacy and socio - economic 

status out weighing the high literacy and socio-economic class. It was not therefore surprising 

as the greater part of the respondents were Primary , and JHS/JSS as far as education level is 

concerned. The minimum age of the participant was16 years while the maximum is 48 with 

the mean age of 25. Ashaiman has a lot of private facilities but the turn out in Public health 

facilities is encouraging with 73 percent respondents delivered in only public health facilities. 

This may be as the result of the free material service that is being rendered in the government 

settings.  

 

Respondent are still breastfeeding their infants between 0-12 months this means that they 

understood the message to breast feed till child is 2 years. Prolonged breastfeeding has 

advantages as a method of family planning and it also helps in contracting the uterus to 

normal position.  

 

From the data, about 10.75 % of mothers introduced complementary food when the baby is 

below 6 months. About 30.5 % of the respondent introduced complementary feeding when 

the baby is above 6 months. Whoever 68.75 % of mothers are yet to introduced 

complementary feeding to their wards. At 6 months of age, it is believed that nutrients in the 

breast milk are inadequate to support the growth of the child so there is the need to 

compliment the breast milk with food. It was surprising that out of 400 participants, only 30 

percent introduced food at the right age, 69.5 percent did not introduce complementary food 

after 6 months. With mothers whose infant started complementary feeding almost 98.8 

percent were practising good hygiene practises?  



53 
 

 

Even though health - education units are doing their work by educating mothers with infant 

and child under five of what to do when the child has fever, there is still the need to intensify 

the education as only 43.9 percent were able to give syrup paracetamol to their infant with 

high fever. High fever is an indicator for infants getting convulsion and the more it is 

prevented the better. 13 percent of infants do not receive any first aid when vomiting. Infants 

loosing electrolytes through vomiting is a serious sign of becoming severely dehydrated 

leading to collapse of the vein that can result in death. Even though the number is small, no 

child should die as a result of dehydration that can be highly prevented; the same apply to 

having loose stool. There is new school of taught that says that, infants should not be given 

cough mixture.   

 

One of the effective way to prevent malaria that kill under 5 is the usage of insecticide treated 

mosquito net(ITN).Result of the research confirmed that 44.3 percent of infants do not use 

ITN. Ten percent slept in ITN less than the last four days of the study. Only 45.8 percent slept 

in ITN continually for the last 7days of the study. Mothers who slept in ITN's the last night of 

the study were 42.5 percent. Almost 73.5 percent of respondents do not receive ITN during 

their pregnancy and of those who received the ITN during pregnancy received only 1 which is 

90.6 percent .With mothers after delivery, 85.8 percent do not receive ITN. 

 

Finally the research work considered assessing child survival practices among mothers with 

children under one year of age in Ashaiman. 

From the analysis it was realized that most mothers (about 53%) breastfed their infants 

immediately after delivery while only a few breastfed their infants one hour after. 

 



54 
 

A number of respondents, about 30.5% introduced complementary foods after six months 

whereas a few introduce it before six months. 

 

The results showed that infant immunization completeness by twelve months is on course and 

is consistently being ensured by mothers and health officials. About 88% of the children had 

been immunized. Meanwhile only a handful of respondents are yet to engage their newborn 

babies in the immunization process. 

 

 

General responses gathered on childhood illness showed that mothers either provide their 

babies with self-medicated drugs or send them to the nearest health facility (About 43.5% 

showed that mothers either provide self medicated drugs or send infant to the nearest health 

facility.) 

 

6.2 Recommendation 

❖ It is recommended that mothers be educated thoroughly on the timing of breast 

feeding and its practices. 

❖ It is recommended that mothers take the advice of health officials on when to initiate 

complementary foods and what type of foods to initiate the child with. This however 

should be consistent with WHO’s standards. 

❖ It is recommended that a record keeping immunization initiation booklet be provided 

to the family of the infant so that they can monitor the immunization cycle of the 

child. 

❖ It is also recommended that childhood illnesses be minimized if not prevented by 

encouraging mothers to consistently visit health care units for assistance when the 

need arises. 



55 
 

❖ It is recommended that mothers should be provided with ITNs and encouraged to 

sleep under them. 

❖ It is recommended that the good work the health education unit is doing should be 

intensified and frequent updates made known to them by the Ministry of Health so that 

they can educate the public on current issues in relation to infant survival practices. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



56 
 

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Araoye, Olabisi Margaret, 2003. Research Methodology and Statistics for Health and   

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Awasthi S., Verma T., Agarwal M., 2006. Danger Signs of Neonatal Illnesses: perceptions 

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