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Breast-feeding practice in Saudi arabia
Wajih N. Sawaya, Raja 1. Tannous, Abdulaziz 1.
Al-Othaimeen, and Jehangir K. Khalil
Ministry of Agriculture and Water, Riyadh, Saudi Arabia
The Kingdom of Saudi Arabia is one of the richest countries in the world. It has experienced very rapid socio-economic change during the last decade. This has profound nutritional implications, particularly in view of the rapid alterations in lifestyle, food supplies, and eating patterns. The impact and dimensions of these socioeconomic and cultural transformations on the nutritional status of the Saudi population in general and on infant nutrition in particular is not well documented, except for some preliminary observations on the health care in a few villages [1, 2] and on a sample of children attending the outpatient clinics of the military hospital in Riyadh [31. Since the data in literature strongly correlate such transformation with a decline in breast-feeding, it was considered desirable to investigate the extent and duration of this practice in Saudi Arabia.
This report is part of a dietary survey of infants and preschool children in Saudi Arabia conducted by the Ministry of Agriculture and Water in collaboration with UNICEF and the Nutrition Unit of the Ministry of Health, Riyadh. Four regions were included in the survey: central (Riyadh area, two villages), western (Jeddah area, three villages), eastern (Qatif area, one village), and south-western (Aloha area, eleven villages). Most of the locations in these region could be considered semi-rural, being 3 to 70 kilometres from the closest city. Information was obtained through a pre-tested questionnaire administered by educated women volunteers from the villages who were
See the Editorial Note to the preceding article, p. 62. recruited and trained by UNICEF staff in Riyadh. In all, 849 children (49 per cent male, 51 per cent female) were surveyed. They were grouped by age in 12-month increments from 0 to 72 months. Distribution in the various age groups was as follows: 20.6 per cent 0-12 months; 21.2 per cent 13-24 months; 17.6 per cent 25-36 months; 18.6 per cent 37-48 months; 12.6 per cent 49-60 months; and 9.4 per cent 61-72 months. The distribution of the children by region was: central 20 per cent, western 28 per cent, eastern 23 per cent, and south-western 29 per cent.
Feeding Patterns of Infants
As a rule, in Saudi Arabia babies are seldom breast fed at birth. First they are given a few sips of water and then ghee until the mother lactates on the second or third day. Ghee is thought to lubricate the infants gut and provide initial nourishment. If it is not available, a few drops of castor oil are used to lubricate the gut, and then a wet-nurse breast-feeds the baby until the mother lactates [1, 4]. A similar practice is reported in the neighbouring Yemen Arab Republic, where the majority of mothers start breast feeding on the third day, although breast-feeding from the first day is not uncommon .
Of the infants in our study, 41.3 per cent were exclusively breast-fed and 43.7 per cent were breast fed but received supplementary bottle-feedings. A small number (6.5 per cent) were bottle-fed after the cessation of breast-feeding. Thus, over all, a high percentage of the infants (91.5 per cent) were
breast-fed. Only a small percentage (8.5 per cent) were fed by bottle alone. These results are compatible with those reported for two villages in the Qasim region [41, where 58.8 per cent of infants were fed breast milk alone, 35.7 per cent received supplementary bottle-feedings, and 5.5 per cent were fed by bottle alone.
The duration of breast-feeding was two years for the majority of infants in all regions. The percentage of mothers who breast-fed for two years was 62 per cent. A significant number of babies received breast milk for three years or more; these babies were mostly male.
Reasons for Stopping Breast-feeding
Table 1 shows the reasons given by mothers for stopping breast-feeding. New pregnancy was the major reason in all regions. Insufficient breast milk, the child's refusal of the breast, and the child's ability to eat food were the other important reasons. These findings are in agreement with the data reported on infant feeding in Riyadh 13]. From 8 to 21 per cent of the mothers in the central, western, and south-western regions gave reasons other than those specified in table 1 for stopping breast-feeding. Availability of bottle milk was not cited as a major reason for stopping.
Of 849 infants, 72 (8.5 per cent) were bottle-fed exclusively, that is, never breast-fed. The tendency to use the bottle was highest in the central region and lowest in the eastern region, which are examples of urban and rural areas respectively. Comparing these results with the data of Abdulla et al. 141. it can be observed that the number of infants exclusively fed by bottle increased from 5.5 per cent to 8.5 per cent (this study) but is still less than the 12 per cent reported by Lawson . The percentage of infants receiving supplementary bottle-feeding also exceeded that of Abdulla et al. (35.7 per cent) . The duration of bottle-feeding was two years for a majority of infants; thereafter, the number declined until, at the end of the third year, only a small percentage were still being bottle-fed (table 2). The average age at which the bottle was introduced to supplement breast-feeding varied between 2.4 and 8.4 months for the four regions, with an average of 4 months for all regions (table 3). The bottle was introduced earliest in the Riyadh region and latest in the Qatif region. The milk source for bottle-feedings was mainly powdered milk (table 4). The water source for the preparation of bottle milk differed among the regions (table 5). in the central and eastern regions, tap water was the main water source; in the south-western region it was well water, and in the western region, treated water. In the south-western and eastern regions, water was almost always boiled before preparing milk. In the central region 96 per cent and in the western region 86 per cent of the mothers boiled water for use in milk preparation.
The major emphasis in this study was on the frequency and duration of breast-feeding with or without supplementary feeding. The data demonstrated that the majority of mothers entertained strong positive feeling about the importance of breast-feeding and its duration. The majority breast fed their children exclusively for at least two to four months when supplementary bottle-feeding was included. The duration of breast-feeding alone or supplemented with bottle-feeding was two years in the
TABLE 1. Reasons for stopping breast-feeding (percentages)
|Insufficient breast milk||18||9||16||6||12|
|Desire for new pregnancy||-||1||-||13||3|
|Child refused breast||16||14||14||6||12|
|Child's ability to eat food||3||11||14||35||16|
|Availability of bottle milk||1||-||1||1||1|
TABLE 2. Duration of bottle-feeding for infants bottle-fed onlya
a. Infants who were never breast-fed.
TABLE 3. Average age of children at the time of starting bottle-feedinga
|All regions||4 0|
a. Children who received bottle feeding supplementary to breast-feeding.
TABLE 4. Milk source for bottle-feeding ( percentages)
a. Percentages calculated from the number of respondents 1>59%) who answered this question.
TABLE 5. Water source for the preparation of bottle milk (percentages)
|Source||Mother boils water for the bottle|
|Bottled water||Tap water||Well water||Treated water in container||Other|
a. Percentages calculated from the number of respondents (>56%j who answered this question. majority of cases. Even when the bottle was the sole source of feeding, the duration of feeding milk was similar to that of breast-feeding.
The positive attitude to and the continuation of breast-feeding for two years is a religious practice. Saudi Arabia is a Muslim society, and breast-feeding for two years is a tradition derived from the holy Koran 16].
The frequency of breast-feeding is not disappointing considering the socioeconomic changes experienced by Saudi society in the recent past. In many developing societies, the abandonment of breast-feeding for bottle-feeding is attributed, among other things, to urbanization and the accompanying need for mothers to work to supplement family income. In Saudi Arabia, mothers feel little need to be employed because of the reasonably good economic conditions of the family and the traditional reluctance to allow women to work alongside men.
Our results, when compared to those of Abdulla et a). 141, suggest a slight increase in bottle-feeding.
Although this shift is not alarming, steps should be taken to check it. An effective nutrition education programme is recommended to emphasize the advantages and proper management of breast-feeding and proper weaning to ensure sound infant feeding.
1. Z.A. Sebai, The Health of the Family in a Changing Arabia (Tihama Publications, Jeddah, Saudi Arabia, 1981).
2. Z.A. Sebai, "Community Health in Saudi Arabia,'' Saudi Med. d., Monograph No. 1 (1982).
3. M. Lawson, "Infant Feeding Habits in Riyadh,'' Saudi Med. J., 1: 26-29 (1981).
4. M.A. Abdulla, Z.A. Sebai, and A.R. Swailem, "The Health Status of Children," in Z.A. Sebai, ea., Community Health in Saudi-Arabia, Saudi Medical Monograph No. 1 (1982).
5. S. Beckerleg, "Socio-religious Factors Affecting the Breast feeding Performance of Women in the Yemen Arab Republic," Hum. Nutr. Appl. Nutr., 38A: 368-376 (1984).
6. O.A. Darwish, E.K. Amine, and S.M. Abdulla, "Impact of Socioeconomic Level on Infant Feeding Patterns in Iraq,"
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