Title: Investigating factors that influence the practice of exclusive breastfeeding among mothers
in an urban general hospital in Ghana: A cross-sectional study
Version: 1 Date: 10 Sep 2022
Reviewer's report:
Introduction
Delete against 100% target in line 73
The statement (lines 73-76) “The survey re-conducted in 2014 however showed a decrease
in this number, as only 52% of infants below 6 months were exclusively breastfed with only
36% continued to be exclusively breastfed by 4-5 months” is misleading especially from “36%
continued to be exclusively breastfed by 4-5 months”. Kindly delete or make it a fresh sentence.
Edit lines 75-76.
The authors should add factors that discourage and encourage mothers to practice exclusive
breastfeeding. There are more studies on this even in Ghana.
The problem statement is not clear, it is very generic. There is enormous research on exclusive
breastfeeding in Ghana. They need to situate their work in the global, sub-Saharan and Ghanaian
contexts. They should be able to let the audience know which studies have been done in Ghana
and what is the gap. As of now, I am not seeing the specific gap that this paper seeks to fill.
There is a decrease in EBF in Ghana but what is accounting for the decrease is not known. So,
the authors should look at the problem statement well.
Again, from the topic, the concentration is on peri-urban, I did not see any linkage of peri-
urban in the introduction. Contextual and environmental factors have a significant role in EBF.
Evidence shows that there is a significant difference in EBF between urban and rural areas. They
need to look at that and add it in the introduction, especially in the gap section.
The authors need a theory or framework to guide the study in the introduction and discussion.
Methodology
The whole methodology section needs to be rewritten in sub-headings. They should start with
research design, study area, inclusion and exclusion criteria, sampling procedure, measurement
of variables (describe how the dependent and dependent were measured), data collection process
and data analysis.
Why did the authors use children from 6 months to 24 months instead of those 6 months and
below? They need to justify their choice
Which period was the data collected? Authors should specify the month and the duration of the
data collection.
The process of data collection is not exhaustive. Kindly explain how the people were contacted,
and consent.
Was the questionnaire self-administered?
Results
I think the authors should check the Table numbering in the manuscript well. The content of
table 1 is not part of the submitted document for review. Table 1 has knowledge on exclusive
breastfeeding.
Lines 154-155, an average mean weight of 8.7kg is not necessary, kindly delete. They should
rather report on the proportion of infants who had low, normal or high birth weight.
It would be best if you recategorized parity into 1, 2, 3, 4 and above.
Avoid using some words, for example, line 160 “the analysed data” Just go straight to the point.
Line 171, you have already indicated the sample in Line 149. There is no need to repeat it here.
Line 177, what proportion of the mothers felt they were not producing enough breastmilk for
their babies?
Did all mothers perceive that they did not have enough break milk? I don’t think so. Kindly
filter the data and provide the correct proportion
Kindly check and report on the adequacy of breast milk for 6 months (Table 1). I think lines
174-177 are not the right interpretation “Compared to the 50 (22.5%) mothers who thought
breastmilk during the first six months does not give appropriate nourishment for their babies,
more than three-quarters (76.1%) of the mothers believed that exclusive breastfeeding was a
source of giving their babies with adequate nutrition”
Line 186, colostrum statement is hanging
Only 23 respondents were living with their parents but about 64 parents help mothers to take
care of their infants. Is something the authors need to interrogate the data again.
Is figure 1 in percentages or what? The authors should make it very clear.
Why did the authors run the bivariate analysis with only a few variables? They should have
included all the variables and selected the significant variables for the multivariate analysis.
The basis of the multivariate analysis is wrong. The authors should have run a bivariate analysis
for all the variables and then select the significant variables for the multivariate.
A redo of the bivariate and multivariate analysis will affect the discussions of the study. Hence,
I did not read the discussion of the study. Looking forward to the new discussions to be read.
Strength and limitation
Authors should include how they were able to overcome the measurement error that they
attributed to recall errors or social desirability bias.