Complementary feeding decisions by mothers in urban Ghana are largely driven by perceived benefits to the child’s health, cost, and time constraints

Complementary feeding involves not only the content of the diet, but also caregiver behaviors. To design and develop successful complementary feeding interventions, caregiver feeding behaviors and the reasons for these behaviors must be understood.

The objective of this study was to present a picture of the general patterns of complementary feeding behaviors in urban Ghana and identify the reasons behind decisions made by caregivers, using exploratory, qualitative techniques such as those employed in focused ethnographic studies.

Interviews were conducted with 30 infant caregivers in urban and peri-urban areas of Ghana, with a range of ages of infants and a range of socioeconomic status.

Mothers reported that factors influencing their feeding decisions were: (from most important to least important): healthiness of the food (i.e., nutritional quality), child acceptance of the food, cost, convenience, ease of acquisition, and influence of others. There was a strong cultural consensus that the food’s ability to make the child healthy and strong was the most important factor mothers considered in making feeding decisions for their children.

Traditional complementary foods, such as koko or Hausa koko, received the lowest health ratings, but were considered healthier than commercially produced cereals if they were prepared with additional ingredients or milk. Mothers were well aware of the nutritional advantages of milk. It also appeared that the mothers had been exposed to nutrition messages about the value of adding fish powder, ground roasted peanuts, soy flour and/or oil to traditional porridges. There was strong cultural consensus regarding the perceptions of the health qualities of specific cereal foods. Women frequently commented that meat and fish in stews were excellent sources of nutrients.

The mothers defined healthy foods as foods that were nutritious. While vitamins were not a universally understood concept in relation to “healthiness” of food, hygiene was. Clean food meant different things to different mothers: commercially prepared, made from scratch, or prepared at home. Overall, healthy foods were considered to be foods that were higher in nutrients and sanitary.

Nearly all of the mothers voiced concerns about having enough money to feed and take care of their children. Mothers mentioned that their decisions on which foods to feed their children were also affected by the child’s acceptance of the food, ease of access and distance to obtain the food, and time required to prepare the food.

Cerelac®, a commercial, fortified, instant porridge that is ready to mix with water or milk, was universally ranked as the most convenient complementary food because packets could be purchased quickly and easily from neighborhood kiosks and in individual packets for a small amount of money. Preparation did not require cooking over a fire but simply using water that had been stored in a thermos. Non-cereal foods typically received low ratings on convenience because they required long and complex preparation.

Cost was a major concern for mothers. The health qualities of the foods they gave their children were also of primary importance. This created problems because the cheapest foods were not seen as the healthiest ones. An optimal complementary food for this population would be a food that mothers perceive as healthy, affordable, and convenient.

Balancing nurturance, cost and time: complementary feeding in Accra, Ghana. Pelto GH, Armar-Klemesu M. Matern Child Nutr. 2011 Oct;7 Suppl 3:66-81. doi: 10.1111/j.1740-8709.2011.00351.x.

Summary written by A&T to highlight key infant and young child feeding findings as well as program implications.

To read author's abstract, visit PubMed.