Date of Award

January 2021

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Amber Hromi-Fiedler

Abstract

Adherence to breastfeeding and complementary feeding recommendations is a proven strategy for promoting the well-being of infants and young children and ensuring their proper development. Cultural beliefs inform caregivers’ likelihood to follow these guidelines as they influence caregivers’ thoughts about maternal behavior during the prenatal and lactation periods, child feeding behaviors, and health. Refugee camps or settlements are a unique space to study the coexistence of cultural beliefs held by residents and staff. Understanding the pathways by which cultural beliefs modulate caregiver infant and young child feeding (IYCF) behavior (and therefore impact child health) within these settings is of paramount importance to global health because refugees are some of the most vulnerable people in the world. This study aimed to understand, from the perspective of health care providers, cultural beliefs related to IYCF practices among refugees in Ampain and Krisan refugee camps of Ghana’s Western Region.This qualitative study consists of eight semi-structured, in-depth interviews conducted in 2019 with Ghanaian, Liberian, Togolese, and Ivoirian healthcare workers. All were audio recorded and some translated from French. After transcription, the study team used a grounded theory approach to code for emerging concepts until no new themes became apparent. Nine domains were identified: caregiver IYCF cultural beliefs, provider training, family roles, provider IYCF knowledge & beliefs, provider education delivery, support, healthcare access, food security barriers, and caregiver IYCF practices. Cultural beliefs were a major driver of IYCF practices. They directly influenced caregiver feeding behavior and were also related to them indirectly through two distinct pathways. Findings presented here refuted our hypothesis that providers in Ampain and Krisan were largely unaware of cultural beliefs present in the camps outside of their professional interactions with refugees and that providers did not take beliefs into account during their education activities. IYCF practices were shown to be a multifactorial outcome with cultural beliefs at their root. Providers were responsive to other factors, such as family structures and economic challenges, that influenced breastfeeding and complementary behaviors. These results therefore characterize some of the barriers to and facilitators of following IYCF recommendations experienced by refugees, from the point of view of health care workers.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/01/2022

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