Dr.Fouzia AL.Hreashy. Assistant Professor, Consultant Family Medicine. Al.Imam Mohammed Bin Saud Islamic University. Riyadh, Saudia Arabia

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1 Dr.Fouzia AL.Hreashy Assistant Professor, Consultant Family Medicine Al.Imam Mohammed Bin Saud Islamic University Riyadh, Saudia Arabia South GP conference, Dunedin, NZ 2014 ( Workshop )

2 Capital: Riyadh. General information Saudi Arabia Major cities: Jeddah, Mecca, Medina, Dammam. Population: The official religion: Islam. Official Language: Arabic, English (commercial). Currency: Saudi riyal. National Day: September 23. Area: km 2. The land border: 4415 km. Coast: 2640 km. Climate: generally hot dry summers, cold dry winter, the southern regions are characterized by low temperatures. Exports: petroleum and petroleum products 90%

3 Age Distribution

4 Health care system is of priority in the country MOH is the major provider and finance of health care. 244 hospitals primary care centers. Other medical governmental services : Security Force, king Faisal specialist, National Guard, Military, Higher Education hospitals. Private sectors: 125 hospitals 2218 dispensaries.

5 A chance for breastfeeding education Is it used!!

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7 Childhood Immunization Of S.A. Free to all

8 Growth Chart Of Saudi Children The country is currently using US growth chart National growth chart available but not yet implemented in all places. WHO growth chart for breastfed children are not used.

9 Breastfeeding in Islam Breastfeeding was mentioned in Holy Goran. 2 years duration of lactation. Colostrums in first three days of life. The nursing mothers should be supported by the husband. Brotherhood form nursing mothers. Adoption of orphanages is acceptable through breasfeeding. Milk bank is forbidden in Islam.

10 Breastfeeding Promotion

11 National Organization Ministry Of Health Nutrition Department Breastfeeding Promotion National Committee Members: Ministry of Health Ministry of Education Ministry of Higher Education Ministry of Social Affairs Ministry of Islamic Affairs Saudi Food and Drug Ministry of Information

12 Baby Friendly Centers in S.A. private sectors 2 Others 4 MOH hospital 23 MOH PHC 21

13 Distribution of baby friendly centers per region

14 The Saudi Law For Breast Milk Substitute Violation

15 Culture women changes in S.A. In relation to lactation Women: segregation is the natural system. Dress :the principle of hijab. Food and alcohol: rich diet and alcohol is forbidden, smoking for still. women is not known and seen as social stigma and Traditions : deeply rooted, religious conservatism. Work: more avenue for women to work. Housemaid : part of many families. Male permission: norm system changing in some families including lactation. Postpartum traditions: major changes. Children in social life : many changes. more moderates

16 Counseling in breastfeeding among health care workers? Training on communication / consultation / counseling is needed. Language : a major barrier for non-arabic speaking ( especially nurses). Specialty : who should counsel the mother? (an area of conflict) Time of consultation : too short for doctors, inappropriate place for nurses, health educator are prioritized for diabetes ( 25% of the country are diabetic ). With whom : mother VS father VS parents VS grandparents.

17 System Of Work between GP & Hospital in terms of lactation support

18 Comparison Of Expected Support Hospital Antenatal preparation for high risk pregnancies Care at delivery and early hours of postpartum care. Care of neonates with high risks Avoid milk formula breakdown of code of ethics. Primary care Antenatal preparation for low risk pregnancies Postpartum care Care of neonates with low risks Avoid milk formula breakdown of code of ethics. Community support. Follow up for well-baby for 2 years.

19 What is the expected role of GP in supporting breastfeeding? Open discussion with the audience

20 Mother s Work and lactation Increasing prevalence of academic studies and work opportunities. Two months for every postpartum ladies (off work with full payment ). Baby care vacation :Three years allowed during the whole years of working ( 25% of salary women - government work). An hour of lactation is allowed for mothers. ( nongovernmental job) Nurseri s for younger children are limited in their numbers: grandmothers or housemaids or special child caregiver is the usual. Milk expression habit is not familiar. Nursing mothers custom faded away.

21 Lactation Education at school and university ( Health science) The optimal level ( we think it is similar to other parts of the world). No evidence Seems to be good in theoretical not the clinical practical aspect of training.

22 Research On Lactation( few) Prevalence Initiation rate of breastfeeding is high (around 90%). Low rate of timely initiation ( within the first hour ). Exclusive breastfeeding rate range ( %)- definition problem. Partial ( mixed) feeding is common. Mean duration of breastfeeding declines overtime (13.4 months in 1987 to 8.5 months in 2010) International breastfeeding journal 2014.

23 what is the problem? lock to the breast milk factory by the milk formula Graph 1 : The cumulative frequency of the duration of breastfeeding and age of starting the milk formula among the total sample Percent Birth One Tw o Three Four Five Six Months Age of Starting Formula Breastfeeding

24 Campaigns For Breastfeeding Promotion public and HCP Arabic and English

25 Breastfeeding Week is in September August is overlapped with summer holidays and holy month of Ramadan(fasting) Breastfeeding week plays a role in the promotion.what do you think?role for GP?

26 Summary

27 Thanks For Contribution