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World LINKAGES/Ghana
(abridged)

Total country population (2000): 18.8 million

Project population and area: 3 million in 31 districts in 7 regions, including all 24 districts in the 3 northern regions

Project Duration:1998 to 2004

Map of Ghana Image

Background
Nearly all mothers initiate breastfeeding in Ghana. However, sub-optimal breastfeeding practices begin on the first day. Only 25 percent of women initiate breastfeeding within the first hour after birth. Approximately 20 percent of mothers nationwide practice exclusive breastfeeding for the recommended period of the first six months. The low rate of exclusive breastfeeding is largely due to the introduction of water and other liquids at an early age. The Ghana Health Service estimates that sub-optimal breastfeeding practices contribute to about eight percent of infant deaths or about 3,300 infant deaths each year.

Program Design and Implementation
Assessing the situation. Events leading up to design and implementation of the Ghana Health Service (GHS) and LINKAGES Nutrition Behavior Change Communication Program included a 1997 national nutrition workshop and a 1998 GHS assessment of nutrition and community programs. These events helped to shape the GHS policy guidelines and strategies, with breastfeeding promotion and protection one of its top five child survival strategies.

Building partnerships. The GHS and LINKAGES designed a program that built on established governmental and nongovernmental networks and community-based approaches in the 3 regions of northern Ghana. At its conclusion in September 2004, the program reached all districts in these regions plus 7 districts in 4 southern regions. One of the goals of each partner was to address malnutrition and/or improve household nutrition and food security. The partners used various approaches to achieve their goals: literacy activities, mothers clubs, small income generation and credit, water and sanitation initiatives, community development, growth promotion/monitoring, food distribution, and mobile clinic work. Partners included the Ministry of Local Government, UNICEF, ActionAid, the Association for Church Development Projects (ACDEP), Catholic Relief Services (CRS), Freedom from Hunger/Ghana, Ghana Red Cross, Ghana United Nations Students Association (GUNSA), New Energy, the University for Development Studies, the World Food Program, World Vision International, and regional radio stations.

Implementing the program. The primary program interventions were advocacy and information dissemination, community mobilization and behavior change communication, capacity building, and monitoring and evaluation. The behavior change communication and community strategy was developed with the active participation of the partners (from the sub-district to the national level) through stakeholders workshops, infant feeding assessments, skills building workshops, and pretesting of messages and materials. The result was a collage of locally tailored approaches based on common messages that were conveyed through print materials, mass media, organized support networks, and community events. Over 4 years LINKAGES trained approximately 600 representatives from the partner organizations. The partners then trained thousands of health care providers and community volunteers. In 2001 a nutrition pre-service curricula development and training component was added to the program that involved 51 training institutions worldwide.

Results
LINKAGES and its partners demonstrated that breastfeeding practices could be changed quickly.

Indicator Control Communities Program Communities
2000 2000 2003
Initiation of breastfeeding within first hour 14% 32% 41%
Exclusive breastfeeding (infants 0-5 months) 44% 68% 79%