BREASTFEEDING PRACTICE AND MOTHERS AWARENESS AND PRACTICE OF ABSOLUTE BREASTFEEDING IN ARAR, SAUDI ARABIA

Background: Human milk meets all the nutritional requirements of infants for the first 6 months of life, and it is associated with a lower incidence of diarrhea than partial or artificial feeding. The infant should be exclusively breastfed for at least 4 months of life and if possible for 6 months, as recommended by WHO and UNICEF. Objectives: The main objective of this study was to determine the breastfeeding status for children under 24 months in Arar city, and to determine breastfeeding practice in relation to some socidemographic and nutrition related variables. Participants and methods: A cross-sectional study was carried out in Arar city, mothers were selected from the attendees of the female side of 6 randomly selected primary health care centers in the city. They interviewed and filled a questionnaire which included the needed questions. Results: Among the 400 studied children,17.2% got breastfeeding, 41.0% had both breast and artificial feeding while 41.8% depended on artificial feeding only. Absolute breastfeeding in the first 6 months of life was found in 34.7% of infants and in the first 4 months of life was found in 13.8%. Sources of health education of the mothers about absolute breastfeeding period were doctors in 12.1%, health education team of the hospitals in 24.1%, relatives and friends in 11.8%, the media in 3.8% while no health education about absolute breastfeeding period was reported by 48.2% of the studied mothers. The reported causes of artificial feeding was difficulty of breastfeeding during working hours in 41.8%, missing of support in 25.7%, preference of formula milk in 11%, thinking that breastfeeding leads to breast enlargement and redundancy in 8.6% and thinking that breastfeeding leads to obesity of the mothers in 4.5%. No significant relationship between type of child feeding and child age, sex, mother education, mother's working status, father's work or mother age group [P >0.05]. Conclusion: 17.2% got breastfeeding, 41.0% had both breast and artificial feeding while 41.8% depended on artificial feeding only. Absolute breastfeeding in the first 6 months of life was found in 34.7% of infants and in the first 4 months of life was found in 13.8%. With deficiency of exclusive breastfeeding among infants of Arar, Saudi Arabia. Programs promoting exclusive breastfeeding in the first 6 months of age must be conducted to increase mothers’ awareness of the exclusive breastfeeding duration is recommended. Keywords: Breastfeeding; Exclusive breastfeeding; Breastfeeding Practice; Arar, Saudi Arabia

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Hyperhomocysteinemia in Pakistani women suffering from unexplained subfertility

Background: Hyperhomocysteinemia (hhcy) has been considered as a risk factor for several obstetrical complications such as early pregnancy loss, pre-eclampsia and IUGR. Recently its association with infertility has been underscored in IVF failures; however limited information is available about the relationship of hhcy and subfertility. Objective: To find out the association between unexplained subfertility and hhcy in Pakistani women. Materials and methods: This observational study was conducted in Department of Obstetrics and Gynaecology, Liaquat University Hospital Hyderabad from 1st April 2008 to 31st March 2009. Study group consisted of all those women who were subfertile for more then one year, have body mass index less than 25, regular menstrual cycle, normal pelvic examination findings and no past history of pelvic inflammatory disease. Exclusion criteria was male factor subfertility, endocrine and ovulatory dysfunction and tubal blockage. Evaluation was done by semen analysis, pelvic ultrasound scan, hystero-salpingography and hormonal assays. Fasting serum levels of homocysteine were determined using a fluorescence polarization immunoassay. Results: In total, 61 subjects were enrolled in the study including 49 subfertile women and 12 healthy women. Among subfertile women, 39 (80%) were suffering from primary subfertility while 10 (20%) were complaining of secondary subfertility. Majority of the subjects were young, house wives and residents of Hyderabad city. Mean serum fasting homocysteine levels were significantly higher in women suffering from unexplained subfertility as compared to controls (12.8+5.1 versus 9.7+1.7, p-value= 0.04). Conclusion: Hyperhomocysteinemia was observed in women suffering from unexplained subfertility. However large scale clinical studies are required to confirm the association

Severe acute maternal morbidity (SAMM) in postpartum period requiring tertiary Hospital care

Background: Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. Objective: To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. Materials and Methods: This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. Results: The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions). The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH) (50%), preeclampsia and eclampsia (30%) and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34) and maternal mortality rate was 4.8%. Conclusion: PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high

Hyperhomocysteinemia in Pakistani women suffering from unexplained subfertility

Abstract Background: Hyperhomocysteinemia (hhcy) has been considered as a risk factor for several obstetrical complications such as early pregnancy loss, pre-eclampsia and IUGR. Recently its association with infertility has been underscored in IVF failures; however limited information is available about the relationship of hhcy and subfertility. Objective: To find out the association between unexplained subfertility and hhcy in Pakistani women. . Study group consisted of all those women who were subfertile for more then one year, have body mass index less than 25, regular menstrual cycle, normal pelvic examination findings and no past history of pelvic inflammatory disease. Exclusion criteria was male factor subfertility, endocrine and ovulatory dysfunction and tubal blockage. Evaluation was done by semen analysis, pelvic ultrasound scan, hysterosalpingography and hormonal assays. Fasting serum levels of homocysteine were determined using a fluorescence polarization immunoassay. Results: In total, 61 subjects were enrolled in the study including 49 subfertile women and 12 healthy women. Among subfertile women, 39 (80%) were suffering from primary subfertility while 10 (20%) were complaining of secondary subfertility. Majority of the subjects were young, house wives and residents of Hyderabad city. Mean serum fasting homocysteine levels were significantly higher in women suffering from unexplained subfertility as compared to controls (12.8+5.1 versus 9.7+1.7, pvalue= 0.04). Conclusion: Hyperhomocysteinemia was observed in women suffering from unexplained subfertility. However large scale clinical studies are required to confirm the association