Abstract: Background: The World Health Organization (WHO) recommends optimal feeding practices during infancy and early childhood for better health and growth of children.

Objective: To determine the factors affecting exclusive breastfeeding (EBF) duration and the time of introducing complementary feeding (CF) in Mecca City, Saudi Arabia.

Methods: This cross-sectional study recruited 814 Saudi mothers. All mothers filled out a closed questionnaire on family sociodemographics, health status of mothers and infants, and postpartum breastfeeding habits and patterns. The patterns of CF and bottle-feeding were examined, and binary logistic regression was performed.

Results: The mean ± standard deviation EBF duration was 4.6 ± 2.5 months. The EBF rate showed a sharp decrease from 50.6% at birth to 14.4% at 6 months among children. Employment of mothers, weight at childbirth <2.5 kg, weight of 2.6–3 kg at child birth, postnatal disease in infants, and pacifier use for infants were associated with a low EBF rate. Intermediate education of the mother was found to increase EBF duration as compared to mothers with higher levels of education. Most mothers introduced plant-based CFs to infants at 4 months of age (median), but animal-based CFs were introduced only after 8 months (median). The median age of starting milk formula was 3 months.

Conclusion and Recommendation: The reported rate of EBF is far below the current international recommendations. The patterns of CF practices and bottle-feeding differ widely from the WHO recommendations in Mecca City. National campaigns should be implemented to promote EBF in Saudi Arabia.

Keywords: Bottle-feeding, Complementary feeding, Exclusive breastfeeding, Mecca, Saudi Arabia.

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Method: It was a retrospective descriptive study. Data were extracted from the clinical records of the patients admitted from 2005 to 2014 for neonates and cases aged 1-59 months with IDs. For cases with SAM data were available from 2010 to 2014. Data were analyzed using SPSS version 20.

Results: Between 2005 and 2014, 39282 under-5 hospitalized and 33.6% were neonates. Of 26069 aged 1-59 months, 15224(58.4%) hospitalized with IDs. Pneumonia (44.6%), diarrhea (29.9%), and meningitis (10.6%) were the main subgroups. During the study period, there were 4183 under-5 deaths. Neonatal deaths accounting for 3671 (87.8%). Deaths aged 1-59 month were 512(12.2%) and IDs contributing 440(85.9%). Compared to 2005/06, neonatal hospitalization and death declined by 9.2% and 18.1% in 2013/14, and IDs by 56.8% and 79.2%, respectively. Pneumonia reductions were 65.4% and 83.7%, diarrhea 42% and 95.5%, and meningitis 73% and 83%, respectively. Between 2010-2014, SAM cases were 1781 of 13689 total hospitalization [13% (95%CI 12.5-13.6)] and 53 SAM deaths of 224 total deaths [23.7 % (18.6-29.6)]. SAM hospitalization rate increased from 8.5% in 2010, to 18.4% in 2014 and death rate increased from 27% (17.6-39.0) to 57.5% (42.2-71.5), respectively.

Conclusion: Despite significant decline in IDs and vaccine preventable diseases, this study showed 87.8% of under-5 mortality were neonates. The increasing trends in SAM hospitalization and death are alarming. Interventions to improve neonatal survival and to reduce SAM morbidity and mortality are urgently needed.

Abstract: Background: The aim of the population-based study was to determine prenatal, obstetric, neonatal outcomes and contraceptive behaviors in women with four or more pregnancies.

Methods: This study was conducted with women (n=294) using a questionnaire in two family centers of Manisa, Turkey where the fertility rate was high.

Results: In the study, the mean number of pregnancies was 5.6±1.5. Loving children, willing to have a larger family and to have a male child were determined the main reasons of extreme fertility. Although 93.2% of women did not desire to have children in the future, only 43.3% of them used a birth control method. The rates of gestational diabetes, hypertension, depression, physical violence, lower weight of baby, risk of miscarriage, preterm birth and cesarean section were higher in the women with more pregnancies.

Conclusions: It is very important to provide women with more pregnancies who had unmet need with client-centered counseling to encourage them to use more effective methods.

Keywords: Birth control methods, contraception, neonatal outcomes, obstetric outcomes, prenatal outcomes, unmet need.

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