Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Rafael Perez-Escamilla


Poor breastfeeding practices can put children at increased risk of morbidity and mortality particularly due to diarrheal and respiratory diseases and impaired physical and mental development. It is therefore important to understand the determinants of exclusive breastfeeding, particularly among residents in refugee settlements who may not have access to key resources and health education. The purpose of this study was to explore if acculturation influenced exclusive breastfeeding practices among Liberian refugees living in the Buduburam refugee settlement. A cross-sectional survey was administered between July - August 2008 to Ghanaian and Liberian women, with at least one biological child between 6 months and five years of age, who lived at Buduburam Refugee Settlement in Ghana. The sample (n=480) consisted of 120 Liberians living in zones 1-10, 119 Liberians living in zones 11-12, 121 Ghanaians living in zone 11-12, and 120 Ghanaians living in urban, Awutu villages 5 kilometers from Buduburam. Liberian mothers who lived in Ghana at least eight years were significantly more likely to exclusively breastfeed (OR: 2.13, 95% CI: 1.25, 3.61) compared to Ghanaian mothers living in Awutu (outside the camp). After adjustment for confounders, Liberian mothers who lived in Ghana for at least 8 years were still more likely to exclusively breastfeed (OR: 1.78, 95% CI: 1.02, 3.09), compared to Ghanaian mothers who lived in Awutu. These findings suggest that increased time in the Ghanaian context of Buduburam improved the chances of relative success with EBF. Further research to understand the “mechanisms” explaining exclusive breastfeeding differences will be crucial for improving breastfeeding in refugee settlements and host communities in low income countries.


This is an Open Access Thesis.

Open Access

This Article is Open Access