Public Health Nutrition · 4 authors, 4 centres
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This cross-sectional study of 422 mother–father pairs in Northern Ghana found that 63.5% of fathers had high involvement in childcare activities, most commonly providing money for food. Children whose fathers were highly involved were 3.3 times more likely to receive a minimum acceptable diet (AOR = 3.33, 95% CI: 1.41–7.90). The findings suggest that nutrition interventions should target both fathers and mothers to improve child feeding practices in rural Ghana.
{"Background": "Childhood undernutrition associated with poor feeding practices remains a public health problem in low- and middle-income countries, including Ghana. Nearly 45% of deaths among children under 5 years are linked to undernutrition. While mothers have traditionally been the focus of nutrition education, fathers play a critical role in household decision-making, including financial choices about food purchases. However, paternal involvement in infant and young child feeding has not been adequately studied in low- and middle-income countries where household decision-making is dominated by men. This study aimed to assess the level of fathers' involvement in childcare activities and its association with diet quality of children aged 6\u201336 months in Northern Ghana, and to identify predictors of fathers' involvement.", "Methods": "A community-based analytical cross-sectional study was conducted in five districts of Northern Ghana (Nadowli-Kaleo, Wa West, Tolon/Kumbungu, Savelugu/Nanton, and Kassena/Nankana). A sample of 422 mother\u2013father pairs with at least one child aged 6\u201336 months was selected using systematic random sampling from five rural communities per district. Data were collected via structured interviews with both mothers and fathers. Fathers' involvement in childcare was assessed using an 11-item scale (modified from Thuita et al., 2015), with scores at or above the median classified as 'high' involvement. Child dietary practices were assessed using a qualitative 24-hour dietary recall, and minimum acceptable diet (MAD) was defined per WHO guidelines as meeting both minimum meal frequency and minimum dietary diversity. Nutrition-related knowledge was assessed using 20 questions (high = >70% correct), and attitudes were measured on a three-point Likert scale across 11 statements. Household wealth index was derived using principal component analysis of assets and housing quality. Multivariable logistic regression was used to identify predictors of MAD and factors associated with fathers' involvement.", "Key Results": "The mean age of fathers was 36.5 \u00b1 9.2 years. Most mothers (56.4%) had no formal education, and 56.9% of households had a high wealth index. The overall level of fathers' involvement in childcare and feeding activities was high among 63.5% of respondents. The most common activity was providing money to buy food for the child (95.7%), followed by providing transport money to child health clinic (92.9%) and handling/playing with the child (91.5%). The least common activities were sweeping the compound (37.7%) and helping with cooking (40.0%). In multivariable analysis, children whose fathers had high involvement in childcare were 3.33 times more likely to receive a minimum acceptable diet (AOR = 3.33, 95% CI: 1.41\u20137.90). Other significant predictors of MAD included: high fathers' nutrition knowledge (AOR = 1.65, 95% CI: 1.08\u20132.50), mothers with at least senior high school education (AOR = 2.05, 95% CI: 1.05\u20133.98), mothers who participated in care group nutrition education (AOR = 2.26, 95% CI: 1.41\u20133.60), and household wealth index (AOR = 1.09, 95% CI: 1.01\u20131.16). The set of predictors accounted for 12.3% of the variation in MAD (Nagelkerke R\u00b2 = 0.123). Factors associated with higher fathers' involvement included: positive nutrition-related attitudes (AOR = 2.85, 95% CI: 1.78\u20134.68), high household wealth index (AOR = 1.69, 95% CI: 1.09\u20132.62), older child age 24\u201336 months (AOR = 3.04, 95% CI: 1.40\u20136.58), and residence in Savelugu District (AOR = 2.39, 95% CI: 1.19\u20134.79).", "Clinical Implications": "This study provides evidence that fathers' involvement in childcare activities is positively associated with improved child feeding practices in rural Northern Ghana. The findings support a policy shift toward including both men and women as key actors in nutrition interventions. Currently, most nutrition programmes focus on pregnant and lactating women, overlooking the influential role of fathers in household decision-making. Interventions should aim to improve fathers' nutrition knowledge and attitudes, as these were significant predictors of both their involvement and children's diet quality. Given that financial support was the most common form of involvement, programmes should also address economic barriers that limit low-income fathers' participation. The study's cross-sectional design limits causal inference, and self-reported feeding practices may be subject to recall bias. Nonetheless, the results align with studies from Ethiopia, Kenya, Bangladesh, Malawi, Peru, Zambia, and Vietnam showing that involving fathers improves child-feeding outcomes."}