Determinants of Successful Exclusive Breastfeeding for Saudi Mothers: Social Acceptance Is a Unique Predictor

Evaluating a woman-centred web-based breastfeeding educational intervention in Saudi Arabia: A before-and-after quasi-experimental study

BACKGROUND

Although digital educational resources are used worldwide to educate new parents, the impact of digital resources tailored specifically to women's needs on breastfeeding practices is not well explored.

AIM

The study aimed to evaluate the effectiveness of using a women-centred Web-Based Breastfeeding Educational Resource (WEBBER) in increasing the rate of exclusive breastfeeding at one month after birth.

METHODS

A quasi-experimental study with before and after intervention was conducted in one metropolitan hospital in Saudi Arabia. Participants were primiparous women (n=290) aged 18 or above who intended to breastfeed. The intervention involved introducing the WEBBER to pregnant women and reinforcing its uses as a routine breastfeeding educational resource. Women's characteristics and infant feeding data were collected at one month after birth via an online survey.

FINDINGS

The rate of exclusive breastfeeding at one month postpartum among the women who received the WEBBER intervention was nearly three times higher compared to the women prior to the introduction of the intervention (66 % vs. 26 %, p-value <.001). Furthermore, other predictors of exclusive breastfeeding at one month were the mother being unemployed, the baby not receiving infant formula in the hospital, and the mother having postnatal intention to continue breastfeeding for 6 months or more.

DISCUSSION AND CONCLUSION

Using WEBBER as a routine breastfeeding educational resource increased the rate of exclusive breastfeeding one month after birth. Embedding woman-centred digital resources into routine breastfeeding education is an effective intervention for women in Saudi Arabia.

Influence of maternal characteristics and infant feeding patterns on infant growth from birth till 18 months: The MISC study

BACKGROUND

The growth and development of infants during the first 1000 days of life are crucial for their health.

OBJECTIVES

This study aims to assess the impact of maternal characteristics and infant feeding patterns on infant growth from birth to 18 months.

METHODS

Data were derived from the 2-year perspective Mother Infant Study Cohort (MISC) study which included six visits from the third trimester of pregnancy until 18 months postpartum. A convenient sample of 256 pregnant women aged 19-40 years was recruited from Sharjah, Dubai and Ajman in the United Arab Emirates.

RESULTS

Amongst mothers' characteristics, Arab nationality, pre-pregnancy overweight/obesity, higher gestational weight gain and lower physical activity were found to increase the likelihood of infants being overweight at 6, 12 and 18 months. Exclusive breastfeeding was positively correlated with reduced odds of the infant being overweight at 18 months (aOR = 0.31, 95% CI: 0.12-0.81). Breastfeeding for up to 6 months and the introduction of solid foods after 6 months was associated with reduced odds of the infant being overweight at 12 months old (aOR = 4, 95% CI: 1.1-14.6; aOR = 2.97, 95% CI: 1.09-8.08, respectively).

CONCLUSION

The findings spotlight the influence of maternal characteristics and infant feeding on infant growth. This asserts the need for evidence-based programmes targeting mothers to promote optimal feeding practices and foster healthy child growth.

The Prevalence of Exclusive Breastfeeding Practice and Its Predictors in the First Six Months of Life Among Working Mothers in Riyadh, Saudi Arabia

Introduction The United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) recommendations are early initiation of breastfeeding and exclusive breastfeeding (EBF) for the first six months of infants' lives. Despite the WHO and UNICEF recommendations and expanding evidence of the significance of exclusive breastfeeding, about two-thirds of infants worldwide have not received exclusive breastfeeding for the six recommended months. This study aims to estimate the prevalence of working mothers exclusively breastfeeding in the first six months of infants' lives and investigate their predictors in Riyadh, Saudi Arabia. Methods A cross-sectional community-based study was conducted for four months in 2022. The study included working mothers who have a child in the age range of 6-24 months living in Riyadh. Data was collected through an online questionnaire and analyzed using the Statistical Package for the Social Sciences (SPSS) version 29 (IBM SPSS Statistics, Armonk, NY) program. Results A sample of 118 participants were included in the study. Their prevalence for EBF practice for the recommended period is 28% (n=33). Around 58.5% (n=69) of the participants did not receive breastfeeding counseling during antenatal visits. Almost half the infants were given prelacteal feeding. Male infants are two times more likely to be exclusively breastfed for the recommended period than female infants. Work-related pressures were a key factor in the discontinuation of breastfeeding (53.4%, n=63). Conclusion This study highlights the lack of breastfeeding counseling and breastfeeding work regulation, alongside concerns about colostrum avoidance and prelacteal feeding. While EBF rates show progress, delayed initiation and work-related pressures remain challenges. Gender disparity in exclusive breastfeeding urges targeted interventions for more equitable outcomes.

Are Pediatric Residents in Saudi Arabia Equipped to Provide Breastfeeding Care? A Cross-Sectional Study

Background

There is a progressive reduction in breastfeeding rates in Saudi Arabia. Counseling and support from health-care providers are useful in overcoming barriers to continuing breastfeeding. However, medical education and residency programs often do not adequately provide breastfeeding training.

Objective

To determine the knowledge, comfort level, perception, and clinical practices of pediatric residents regarding breastfeeding in Saudi Arabia and to measure the level and type of education received during their residency training.

Materials and Methods

This cross-sectional study included pediatric residents from across Saudi Arabia who were registered with the Saudi Commission for Health Sciences and was conducted from February 2021 to January 2022. A validated self-reported questionnaire was used to elicit information from the respondents. Knowledge score was calculated as a percentage of correct answers.

Results

A total of 253 residents completed the survey. The mean knowledge score was 58.4% ± 22.7%, which was lower than the cut-off threshold of good knowledge. Almost half of the residents (49.4%) were confident about addressing breastfeeding-related concerns. Although nearly all residents (91.7%) agreed that breastfeeding promotion is part of their role, 35% never or rarely met the mother before birth to discuss breastfeeding. Didactic teaching was the most prevalent educational tool during their training (34.3%); however, most residents preferred learning through interactive workshops (83.7%) and following lactation consultants (82.8%).

Conclusion

Despite positive perceptions and confidence in providing breastfeeding care, pediatric residents in Saudi Arabia lack optimal knowledge of breastfeeding. These findings indicate the need for enhancing breastfeeding curricula in pediatric residency programs to improve breastfeeding consultation and management.

Telemedicine Breastfeeding Consultation: The Saudi Experience

Background Telemedicine is widely used in health specialties. Yet, the experience of telemedicine use and its effectiveness in breastfeeding support is a research gap. The purpose of this study was to describe the pattern of telemedicine use for breastfeeding support in Saudi Arabia and to explore patients' satisfaction with the service. Methods A cross-sectional survey was conducted in outpatient settings at Ministry of Health facilities in several Saudi regions. The number of breastfeeding consultations over one year (2021) was analyzed in terms of region, month, method of consultation, and women's maternity status. Data on patient satisfaction and telemedicine techniques were gathered during 2022. Results Across the 16 regions enrolled in the project, 51,571 remote breastfeeding consultations were conducted, representing 28.2% of the total consultations. The eastern region reported the highest percentage (40.7%), and the southern region reported the lowest (2.4%). Almost two-thirds of the consultations were provided to lactating mothers (62.91%). Most data (90%) were collected from breastfeeding clinics in hospitals, and nurses were the main primary health care providers. The mean was 4,255 consultations per month. In terms of technology, telemedicine consultations were mostly conducted by phone (50%) and WhatsApp (38%). Satisfaction with telemedicine was reported by 80% of the participants, with a statistical difference found in those favoring telemedicine over in-person care (p=0.032), particularly for those using phone consultations and Telegram (p<0.001). WhatsApp respondents had the commonest neutral responses (p<0.001). Conclusion Telemedicine breastfeeding care has been widely established with high patient satisfaction. A national protocol outpatient lactation services with an intergrated hospital and primary care services and involvement of different health care professionals are recommended. Although breastfeeding counselling is proven to have a positive change on breastfeeding indicators, telemedicine tool per se needs further work on its role in breastfeeding indicators. Triage of cases to be evaluated face-to-face or referral to a specialist after telemedicine lactation care is an area for future work.

Is the Frequency of Postpartum Breastfeeding Counseling Associated with Exclusive Breastfeeding at Six Months? An Analytical Cross-Sectional Study

Breastfeeding counseling is an essential public health tool in postpartum maternal and infant health. In this study, we aimed to explore the relationship between the frequency of postpartum breastfeeding counseling and the type of feeding outcome at six months. The study design was an analytical, cross-sectional study on mothers of 6-24-month-old children living in Riyadh, Saudi Arabia. We conducted an analysis with descriptive statistics as well as logistic regression models. The findings from our study can be summarized in the following points: First, only 31.9% of the women in our study received postnatal breastfeeding counseling in the first six months after delivery, with the majority receiving fewer than four sessions. Second, there seemed to be a drop in exclusive breastfeeding with time: from 35.3% in the first two months to 29.7% in the second two months and then 20.7% in the final two months. Third, previous exclusive breastfeeding increased the odds of exclusive breastfeeding in the proceeding delivery. Finally, exposure to one or more postnatal breastfeeding counseling sessions increased the odds of exclusive or predominant breastfeeding in the first six months. This study helps to guide decision makers in planning maternal child health services and relevant community-based efforts.

Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape

BACKGROUND

With increasing global rates of overweight, obesity and non-communicable diseases (NCDs) along with undernutrition and micronutrient deficiencies, the Eastern Mediterranean Region (EMR) is no exception. This review focuses on specific nutrition parameters among under five years children, namely ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods and malnutrition.

METHODOLOGY

PubMed, Google Scholar, United Nations International Children's Emergency Fund (UNICEF) databases, World Health Organization (WHO) databases, the World Bank databases and the Global Nutrition Report databases were explored between 10 January and 6 June 2022, to review the nutrition situation among under five years children in the EMR.

RESULTS

The regional average prevalence of ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods was estimated at 84.3%, 30.9%, 42.9%, 41.5%, 32.1% and 69.3%, respectively. Iran, Iraq, Libya and Palestine have seen a decline over time in the prevalence of exclusive breastfeeding. Lebanon, Egypt, Kuwait and Saudi Arabia reported early introduction of infant formula. Moreover, Lebanon, Pakistan, Saudi Arabia and United Arab Emirates were seen to introduce food early to the child, at between 4-6 months of age. The estimated weighted regional averages for stunting, wasting and underweight were 20.3%, 8.9% and 13.1%, respectively. Of concern is the increasing prevalence of stunting in Libya. As for overweight and obesity, the average prevalence was reported to be 8.9% and 3%, respectively. Lebanon, Libya, Kuwait and Palestine showed an increased trend throughout this time.

CONCLUSIONS

In this review, the suboptimal infant and young child feeding patterns and the twofold incidence of malnutrition in the EMR are highlighted and we urge the prioritizing of measures to improve children's nutrition.

Feeding Practices of Infants and Toddlers by Their Mothers in Selected Northern Emirates of the United Arab Emirates

Research on the feeding practices of infants and young children in the United Arab Emirates (UAE) is limited, especially in the northern regions of the country. A retrospective web-based survey was conducted to assess child feeding practices among the mothers of young children aged 6 months to 2.5 years in the northern emirates of the UAE. Information from a total of 475 mothers was collected on maternal socio-demographic factors, child feeding practices, and the use of vitamin and mineral supplements. For the first 6 months, 46.7% of the infants were exclusively breastfed, 43.8% were fed on both breastmilk and formula, and 9.5% were given formula only. Significant differences in the types of feeding were found correlating with maternal age (p = 0.02) and employment status (p < 0.001) but not with educational level, with a higher proportion of younger and unemployed women exclusively breastfeeding. However, although a significantly higher proportion of mothers with lower educational levels breastfed their children for ≥6 months (p = 0.026), they introduced “other milk” (non-breastmilk or formula) before the child reached the age of 12 months (p = 0.022). In this study, 22.1% of the infants and 8.1% of the toddlers did not receive an animal source of iron, while 52.6% of the children received vitamin/mineral supplements. The median daily frequency intake of sweets and savory snacks was substantially higher than the respective intake of fruits and vegetables. Intervention programs that focus on healthy infant and toddler feeding, including food sources of iron and nutrient-dense food groups, are needed in the UAE.

Exploring the Experience of Breastfeeding Among Working Mothers at Healthcare Facility in Saudi Arabia: A Qualitative Approach

Background: Breastfeeding has both short- and long-term benefits for infants, mothers, the environment, healthcare costs, and wider society. In Saudi Arabia, breastfeeding has undergone a considerable decline in recent decades due to population changes and developing socioeconomic status. Limited research studies have explored the relationship between work and breastfeeding in Saudi Arabia. Nevertheless, most research has mentioned employment as the factor having the largest effect on breastfeeding in Saudi Arabia.

Purpose: The aim of this study is to explore the factors that influence breastfeeding among working mothers in a tertiary hospital.

Methods: Using a phenomenological qualitative design, nine working women were recruited through purposive sampling at King Fahad Medical City (KFMC), Saudi Arabia in 2019. A semi-structured interview of 30-50 min was conducted with each participant. Thematic analysis was used to analyze the data.

Results: Most women talked about the difficulties of combining breastfeeding with work, which resulted in the early discontinuance of breastfeeding before six months. The findings show that the key factors that affect breastfeeding include maternal attributes such as knowledge about breastfeeding, prenatal decisions, and mothers’ conflicting priorities, as well as the availability of social and workplace support. These influenced whether working women in healthcare settings in Saudi Arabia were able to continue breastfeeding while employed.

Conclusion: This study highlights the importance of issues and problems faced by working mothers throughout postpartum. Inventive solutions need to be developed to facilitate breastfeeding in the work environment. This will give working women the option to breastfeed for a longer period to improve the health of both themselves and their babies. The availability of a private place and support from employers to utilise the institutional policy will enable working women to continue breastfeeding after returning to work.

Breastfeeding Supportive Services in Baby-Friendly Hospitals Positively Influenced Exclusive Breastfeeding Practice at Hospitalization Discharge and Six Months Postpartum

BACKGROUND

Studies have shown that implementing the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative can protect, promote, and support breastfeeding. However, few studies have valuated the quality of breastfeeding supportive services provided by Baby-Friendly Hospitals from the perspective of service users.

METHODS

This was a hospital-based prospective study, conducted at eight Baby-Friendly Hospitals with a total of 707 pregnant women in Shanghai, China between October 2016 and September 2021. Breastfeeding supportive services during hospitalization were assessed at childbirth discharge using a 12-question questionnaire based on the Chinese "Baby-Friendly Hospital Evaluation Standards". Women were followed up on six months postpartum. The impact of breastfeeding supportive services during hospitalization on the exclusive breastfeeding at discharge and six months postpartum were assessed.

RESULTS

Of the 707 mothers who completed the survey at discharge, 526 were followed up on six months after delivery. The overall exclusive breastfeeding rate among participants was 34.4% at discharge and 52.1% at six months postpartum. Mothers who received better breastfeeding supportive services during hospitalization were more likely to practice exclusive breastfeeding at hospitalization discharge compared with mothers who received poorer services (aOR: 3.00; 95% CI: 2.08, 4.35; p < 0.001). Furthermore, they were also more likely to exclusively breastfeed at six months postpartum (aOR: 1.50; 95% CI: 1.03, 2.22; p = 0.033).

CONCLUSION

Better breastfeeding supportive services during hospitalization were significantly associated with higher rate of exclusive breastfeeding at discharge and six months postpartum. More effective measures should be adopted to improve the implementation of the breastfeeding supportive services in Baby-Friendly Hospitals to promote exclusive breastfeeding and better maternal and child health.

Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study

BACKGROUND

Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors.

METHODS

Using a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes.

RESULTS

Almost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum.

CONCLUSION

This study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.

Consequences of Using Artificial Nipples in Exclusive Breastfeeding: An Integrative Review

Objective: To describe the consequences of using artificial nipples to exclusive breastfeeding. Materials and method: An integrative review carried out in the Medline®, Cinahl, Lilacs, Web of Science, and Scopus databases to answer the following question: What are the consequences of using artificial nipples to exclusive breastfeeding? Results: 38 articles were analyzed; the analysis gave rise to two categories: neonatal factors and maternal factors influencing exclusive breastfeeding. Breastfeeding interruption was the neonatal factor most associated with the use of artificial nipples, while the level of maternal education stood out as an intervening factor in exclusive breastfeeding. Pacifiers were the dummy type more commonly mentioned, followed by feeding bottles and nipple shields. Conclusions: The consequences of offering artificial nipples to breastfed infants are mostly negative and associated with the newborn, such as early weaning, refusal to breastfeed, impaired suction technique, incorrect latch-on, interference with orofacial development, and interruption of exclusive breastfeeding. Mothers who offered artificial nipples to their infants are more likely to experience pain, nipple fissures, frustration, and reduced interaction with their infants.