Table 1 Characteristics and summary of findings of included studies

Agbozo et al., 2016(50)

Duration: Unclear

Location: Nsakina

and Dom Sampaman,

Greater Accra region.

Residence: Rural

Design: Cross-sectional

Sampling: Unclear

Participants were caregiver–child pairs enrolled in either a community-based growth promotion (CBGP) programme or a growth monitoring and promotion (GMP) programme. The two programmes were delivered by community health nurses to promote optimal infant and young child feeding (IYCF). Caregivers who received child welfare services in either the CBGP (N = 124) or GMP (N = 108) between January and March 2012 were invited to participate in a follow-up study.

The food frequency questionnaire used during the 2008 Ghana demographic and health survey was used to collect a 3-day information on habitual dietary intakes of the children. However, it is unclear the specific breastfeeding questions that were asked.

The study separately reported the prevalence of exclusive breastfeeding at six months for children in the CBGP and GMP. Determinants of exclusive breastfeeding were not assessed (see Fig. 1).

Aidam et al., 2005(40)

Duration of study: May to

August 2000

Location: Ablekuma, Greater Accra region.

Residence: unclear

Design: cross-sectional study

Sampling: convenience sampling method

Women with infants 0–6 months attending maternal

and child health (MCH) clinics in Accra (n= 376)

Mothers were asked if eight categories of liquid, mushy or solid foods had been given to the child since birth. The age at which these foods were first introduced was also recorded. A 24-hour recall was then used to verify if any of these same categories of liquids and foods had been given to the child within the past 24 h.

Facilitators: planned EBF on delivery, delivery at a hospital/polyclinic, women living in their own houses, and positive attitude towards EBF.

Aidam et al., 2005(45)

Duration of study: Unclear

Location: Tema municipality, Greater Accra region.

Residence: Urban

Design: Randomised controlled trial

Sampling: Unclear

Pregnant women in their last trimester of gestation, attending prenatal clinics at two hospitals in Tema Township, planned to stay in Tema or Ashiaman for at least six months after delivery, and their term infants delivered singleton at 36–44 weeks gestation with normal birth weight and Apgar scores ≥ 6 (n = 123).

Data were collected on the onset of lactation, current breastfeeding status, total number of breastfeeds over the past 24 h, recall of liquid or semisolid foods introduced to the infant over the previous month and the past 24 h, and frequency and age of introduction of specific liquids or foods and reasons for their introduction.

Facilitators: lactation counselling

Appiah et al., 2021(13)

Duration of study: October 2018 – February 2019

Location: Hohoe, Ho West, and Ketu South, Volta Region.

Residence: Unclear

Design: cross-sectional study

Sampling: Multistage sampling

Mothers living in the selected districts with children aged 0 to 59 months (n = 396).

Mothers were asked when they started breastfeeding after birth, if other foods were given on the first day after birth, the number of times the child was breastfed in a day, and whether the child was ever fed from a bottle with a nipple. The questionnaire also contained questions on whether the mother has ever heard about EBF and the appropriate age of a child when the mother thinks she can start complementary feeding, and the months the child should breastfeed before being weaned off from the breast.

Facilitators: being a Muslim or Traditionalist, counselled on exclusive breastfeeding, children who were never fed from a bottle with a nipple, not knowing when to start complementary feeding or the belief that it is appropriate to start complementary feeding at 1–3 months or six months,

Barriers: counselling on complementary feeding, non-awareness of exclusive breastfeeding, short duration of breastfeeding,

Asare et al., 2018(34)

Duration of study: May to June 2016

Location: Tema East Sub-Metropolitan area, Greater Accra region

Residence: Unclear

Design: cross-sectional study

Sampling: Simple random sampling

Participants were mothers aged 15–49 years attending Child Welfare Clinic at Manhean Health Centre with infants and young children aged 0–24 months (n = 355)

Mothers were asked if they had breastfed the child in the past 24 h, how soon after birth the child was given breastmilk, and whether they were fed with the first breastmilk. Also, information was collected on all foods or liquids given to the child in the last 24 h before the interview and whether feeding was done using a feeding bottle.

Facilitators: Mothers aged 20–24, 25–29, and 30–34

Barriers: Mothers with tertiary education and those from ethnic groups in northern Ghana

Ayawine and Ae-Ngibise, 2015(41)

Duration of study: June 2009 to September 2010

Location: Abuakwa and Barekese, Ashanti region

Residence: Peri-urban and rural

Design: cross-sectional study

Sampling: Systematic, random, and purposive

sampling methods

Nursing mothers attending child welfare clinics in six communities located in the two sub-districts under study (n = 300).

Unclear

Barriers: unmarried mothers, breastfeeding for three months

Boakye-Yiadom et al., 2016(14)

Duration of study: February 2014 to

June 2014.

Location: West Mamprusi district, Northern region

Residence: Unclear

Design: cross-sectional study

Sampling: Multistage sampling

Participants were breastfeeding mothers in their seventh month after delivery with infants 0–6 months of age and residing in the West Mamprusi district (n = 300).

Unclear

Facilitators: Household wealth index, antenatal care attendance, knowledge of exclusive breastfeeding, place of delivery, and mother-to-mother support group.

Danso, 2014(48)

Duration of study: Unclear

Location: Kumasi metropolis, Ashanti Region

Residence: Unclear

Design: cross-sectional study

Sampling: Purposive and random sampling

The study population consisted of professional working mothers aged 40 or younger who were in full-time employment and working in the Kumasi metropolis of Ghana (n = 1000).

Unclear

Barriers: Maternal employment, influence of family members*

Diji et al., 2017(37)

Duration of study: January to March 2015

Location: Kumasi South, Ashanti Region

Residence: Unclear

Design: cross-sectional study

Sampling: Simple random sampling

Participants were mothers with healthy infants aged 3–9 months (n = 240)

Unclear

Facilitator: Mother self-employed

Barriers: increasing age of the child

Dun-Dery and Laar, 2016(43)

Duration of study: January to July 2015

Location: Wa, Upper West region

Residence: Urban

Design: cross-sectional study

Sampling: systematic random sampling

Professional working mothers resident in Wa (n = 369).

Exclusive breastfeeding rate was measured using three questions: (1) How many months did you breastfeed the child on only breastmilk, (2) At what age of the child did you introduce other foods and drinks, and (3) Did you give the child anything to eat or drink apart from breast milk before the child was six months old.

Facilitators: Normal delivery

Barriers: Less than three months of maternity leave, formula feeding recommendation from health workers, and advice by a support person to formula feed.

Ganle and Bedwei-Majdoub, 2019(17)

Duration of study: January 2017 to May 2018

Location: Shai-Osudoku District,

Greater Accra

region

Residence: Rural

Design: Prospective cohort study

Sampling: Convenient sampling method

Mothers aged 15–49 who had normal and full-term delivery at the Shai-Osudoku District Hospital (n = 322).

The exact timing of exclusive breastfeeding initiation and discontinuation was collected from mothers through monthly follow-up visits via telephone and home visits in some cases.

Barriers: four or fewer antenatal visits, lack of support from family, outside pressure to

provide other food to the baby, and living in an urban area.

Iddi et al., 2020(51)

Duration of study: Unclear

Location: Tamale, Northern Region

Residence: Unclear

Designed: Cross-sectional study

Sampling: systematic and convenient sampling.

Women who worked as nurses in Tamale and had babies younger than six months were asked to take part in the study

(n = 125).

Mothers were asked to complete a questionnaire about their exclusive breastfeeding practices and engaged in focused group discussions to record their diverse experiences with the practice of exclusive breastfeeding in the workplace setting, as well as the facilitators and barriers of exclusive breastfeeding in the work environment.

The prevalence of exclusive breastfeeding was reported (see Fig. 1).

Kyei-Arthur et al., 2021(32)

Duration of study: Unclear

Location: Nationally representative sample (2014 DHS)

Residence: Rural and urban

Design: cross-sectional study

Sampling: Multistage sampling

Infants less than six months (exclusively breastfed or not) who had both maternal and paternal characteristics (n = 180).

Exclusive breastfeeding was measured using several food items such as breastmilk, water, liquids, milk, and solid food. Infants fed only on breast milk 24 h before the survey were considered exclusively breastfed.

Facilitators: increasing number of children ever born, increase in antenatal care visits

Barriers: Paternal primary education, paternal desire for more children, father being a Muslim, older age of infants,

Manyeh et al., 2020(33)

Duration of study: January 1, 2011, and December 31, 2013,

Location:  Shai-Osudoku and

Ningo-Prampram districts, Greater Accra region

Residence: Rural

Design: cross-sectional study

Sampling: Unclear

All women residents in the Osudoku and Ningo-Prampram districts who were registered in the Dodowa HDSS and gave birth between January 1, 2011, and December 31, 2013 (n = 1870).

Breastfeeding practices from birth to the first six months of life of the index child were collected from mothers retrospectively at six months

Facilitators: Mothers aged 25–29 and 30 + years, household size of more than five members

Barriers: mothers who are artisans, residence in a fishing district

Marquis et al., 2016(36)

Duration of study: 2003 and 2008

Location: Yilo Krobo and Manya Krobo

Districts, Eastern region

Residence: unclear

Design: Prospective cohort study

Sampling: Unclear

Participants were pregnant women (at the time of enrolment) who took part in a VCT pre-test counselling, delivered a live infant with no birth defects, and had no clinical or physical ailments that would limit their ability to care for their infant (n = 482).

Mothers were visited at home twice weekly and asked about their infant’s breastmilk intake, non-milk liquids, animal-based milk, infant formula and solid and semisolid foods during the previous days since the last visit.

Facilitators: Lower weight-for-age z-score and higher number of children under five years in a household.

Barriers: Mother’s HIV-positive status and Akan or northern ethnic groups.

Mensah et al., 2017(46)

Duration of study: Unclear

Location: Sekere-South District, Ashanti region

Residence: peri-urban

Design: cross-sectional study

Sampling: Convenient sampling method

Nursing mothers attending postnatal care at the postnatal clinics in all the 13 health facilities with child welfare clinics (both public and private) in the Sekere-South District (n = 380)

Not available

Mothers level of education, religion, ethnicity, type of employment, number of births, sources of information about exclusive breastfeeding, steps taken by mothers who said they did not have enough breastmilk, and medical conditions.*

Misch and Yount, 2014(31)

Duration of study: Unclear

Location: Nationally representative sample (DHS survey)

Residence: Rural and urban

Design: cross-sectional study

Sampling: Multistage sampling

Women 15–49 years who were matched to an infant less than six months old, who had completed an IPV module with questions on psychological, physical, and sexual IPV, who also had answered questions about breastfeeding their youngest child, and who had completed data for all outcomes and exposure variables (n = 173).

To determine exclusive breastfeeding, mothers were asked

about liquids or foods their infant had consumed in the prior 24 h.

Barriers: Sexual IPV victimisation

Mogre, Dery and Gaa, 2016(38)

Duration of study: January to July 2015

Location: Tuna, Northern Region

Residence: Rural

Design: cross-sectional study

Sampling: Nonprobability

sampling

Mothers and/or caregivers that attended the antenatal clinic of the Tuna Health Centre with apparently healthy infants aged 0–6 months during the study period (n = 190)

Mothers’ practice of EBF was assessed with a recall of EBF in the last 24 h, mode of breastfeeding, who gave and what kind of food was given to the baby in the mother’s absence, the introduction of liquids

Facilitators: Higher maternal education, infants younger than three months, and higher maternal knowledge of EBF.

Nkrumah, 2017(49)

Duration: July to November 2015

Location: Effutu Municipality, Central Region

Residence: Urban

Design: Cross-sectional study

Sampling: Universal sampling technique

Participants were mother-infant pairs attending a community-based Child Welfare Clinic organized by the Effutu Municipal Reproductive and Child Health Unit between July and November 2015. Mothers with infants up to seven months of age were interviewed (n = 225).

A 24 h self-recall method was used to assess exclusive breastfeeding and mothers’ breastfeeding frequency.

Sector of work*

Nukpezah, Nuvor and Ninnoni, 2018(47)

Duration of study: unclear

Location: Tamale, Northern Region

Residence: Urban

Design: cross-sectional study

Sampling: Purposive, quota, and simple random sampling

Lactating mothers of the Tamale Metropolitan area with a child of at least six months and at most two years at the time of the research and attending a child welfare clinic (CWC) in Tamale Teaching Hospital, Tamale West Hospital or Tamale Central Hospital (n = 393).

Unclear

Sex of child, and knowledge on whether EBF allow child spacing and reduces the risk of breast cancer*

Sika-Bright and Oduro, 2013(18)

Duration: September and December 2012

Location: Duakor, Central region

Residence: Rural

Design: explorative research design

Sampling: Snowball and purposive sampling

Mothers with children aged six months to two years (n = 48).

Breastfeeding mothers were asked about their breastfeeding practices during the first six months of their baby’s life and the factors and attitudes of significant others that informed their breastfeeding decisions and practices.

This qualitative study reported the prevalence of exclusive breastfeeding among children under six months (see Fig. 1).

Tahiru et al., 2020(42)

Duration of study: Unclear

Location: Tamale Metropolis, Northern Region.

Residence: Urban and rural

Design: cross-sectional study

Sampling: consecutive and purposive sampling

Participants were mothers with twins aged 6–23 months in the Tamale Metropolis (n = 185).

Mothers were asked whether the children were given any feed aside from breastmilk in the first six months of life and the age (in months) at which water or other liquids was given.

Barriers: Perceived inability to produce enough breast milk, no access to radio, child admission into neonatal intensive care unit (NICU).

Tampah-Naah and Kumi-Kyereme, 2013(39)

Duration of study: Unclear

Location: Nationally representative sample (2008 DHS)

Residence: Rural and urban

Design: cross-sectional study

Sampling: Multistage sampling

Women aged 15–49 in selected households in the ten regions of Ghana (n = 316).

Maternal recall of breastfeeding practices in the 24 h preceding the survey interview.

Facilitators: delivery in a government health facility, average size of child at birth, mother from Volta region

Yeboah et al., 2019(35)

Duration: January and February 2017

Location: Kumasi, Ashanti region

Residence: Unclear

Designed: Cross-sectional study

Sampling: Simple random sampling

Participants were women with infants aged 6–24 months attending maternal and child health services in five government health care facilities (hospitals and health centres) in the Kumasi Metropolis (n = 160)

Women were asked if they practised exclusive breastfeeding in the first six months of life and the sources of information on exclusive breastfeeding practice.

Facilitators: Maternal age 30–49 years, with normal delivery, maternal unemployment, and absence of sore nipple

Barriers: previous 3–4 deliveries