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Background   Exclusive breastfeeding (EBF) for the first six months after birth has been recommended by the WHO as the best infant feeding strategy. Data on EBF rates among twin infants in Ghana remain limited and for that matter hypothesized to be low.Aim   The study sought to measure the prevalence of EBF and identify associated factors among twins in the Tamale metropolis.Methods   A cross-sectional survey involving 185 mother-twin pairs was conducted in four health facilities in the Tamale metropolis providing Child welfare Clinic (CWC) services. Socio-demographics data on both mother and twin were taken. Biomedical (e.g. perceived onset of lactation, confidence of producing enough milk, parity, delivery place, delivery type, time of breastfeeding initiation) and bio cultural factors (e.g. family cooperation for current infant feeding, breastfeeding counselling) were also obtained. In-depth interviews were also conducted with a sub sample of mothers (30) who were purposively selected to generate qualitative data on breastfeeding and associated cultural factors in twins as this data was necessary to aid in the explanation of the quantitative results.Results   Only 17% of twin infants were exclusively breastfed for six months. Women who were not confident that they could produce enough breast milk were about 83% less likely to practice exclusive breast-feeding (EBF) compared to those who were confident that they could produce enough breast milk (AOR = 0.17; CI = 0.04, 0.73;  p -value = 0.017). Moreover, mothers who had no access to radio were about 87% less likely to practice EBF (AOR = 0.13; CI = 0.02, 0.79;  p -value = 0.017). Moreover, mothers who had no access to radio were about 87% less likely to practice EBF (AOR = 0.13; CI = 0.02, 0.79;Conclusions   The study shows that, ownership of radio, confidence of producing enough breast milk and admission of the children into NICU were identified as the most important factors affecting exclusive breastfeeding of twins. Beyond Educating, encouraging and assuring twin mothers of their abilities to produce enough breast milk to satisfy their children, healthcare professionals should pay more attention on providing appropriate information on breastfeeding to mothers and caregivers.

Exclusive Breastfeeding and Associated Factors among Mothers with Twins in the Tamale Metropolis