Title: Investigating factors that influence the practice of exclusive breastfeeding among mothers
in an urban general hospital in Ghana: A cross-sectional study
Version: 4 Date: 30 Nov 2022
Reviewer's report:
Thank you for the opportunity  to review the manuscript: Investigating factors that influence the
practice of exclusive breastfeeding among mothers in a peri-urban general hospital in Ghana:
A cross-sectional study
Thank you for addressing the suggestions. The changes have strengthened the manuscript.
My comments and suggestions are below for your consideration.
Abstract
Results
Line 39. Do you mean exclusively breastfed up to six months or at six months?
Please avoid starting a sentence with 68.8%. Instead, use text. Or perhaps write,  Of the sample
of ### mothers, 68.8% …
Introduction
Line 58.  World Health Organization (WHO)
Delete – “because it has shown to have benefits”
Please define exclusive breastfeeding here.
Line 104: delete “various” and in line 115.
Methods
This appears to be a retrospective cross-sectional study ? as the EBF measure was collected
based on the mother's recall.
Please consider deleting or clarifying the sentence “This was to adequately capture those who
had completed the recommended six months of EBF and limited to 24 months to aid or reduce
recall biases.”  How do you know that they have completed EBF.
Inclusion criteria
Line 130-137. Please review this paragraph as the information is unclear and confusing. Please
include age range if used for inclusion criteria, parity, whether mothers who gave birth to
preterm or term babies were included and if not why not. Any other criteria such as intention to
breastfeed? Mothers co-morbidities? Multiple or only singleton babies?
Infant: Congenital abnormalities?
Sampling
How many births per year was the sample taken from? How was the sample size estimated –
please justify using a citation and describe how the estimated sample size was arrived at.
Why was a random sampling technique used in a cross-sectional study?
Data collection process
Line 161 “ Registrant postnatal mothers and with children aged between 6 to 24 months were
recruited from the Child Welfare Clinic of the Tema General Hospital. “ This perhaps belongs
under the heading Recruitment. the age of the infant needs to be included in the inclusion criteria.
There is some repetition here please review.
How was the questionnaire /survey validated? Please provide a citation to support this.
Please include the sample population number enrolled in the study.
Measurement of variables
Please clarify – if the infants feeding or the mother's practices were the unit of analysis-
dependent variable?
Please remove the word “Various” and replace it with specific measurable variables, and define
and give the criteria and citations to support them.
Were the mothers asked about feeding other food or fluids? What criteria was used to assess
EBF? Such as the WHO criteria /indicators see below
Indicators for assessing infant and young child feeding practices: definitions and measurement
methods. World Health Organization (WHO) / UNICEF. Technical expert advisory group on
nutrition monitoring (TEAM) 2021 Geneva
Sample size determination
Please move this section to the Sampling procedure
Data analysis
Please provide a citation to support this section.
The authors state that binary logistic regression was used but, in the Results, multiple logistic
regression is reported. Please clarify
Please include the confounding variable used in the model and why these were chosen. Support
with a citation
Missing data- how was this managed?
How was bias addressed?
Any sensitivity analysis?
Discussion
consider starting this section off by repeating the aim of the study and showing the reader how
you addressed the aim and what was found (key findings).
Line 379-386  please avoid repeating statistics in the discussion section. Discuss your results
in light of other work.