Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates

Breastfeeding (BF) is considered the ultimate method of infant feeding for at least the first 6 months of life. Exclusive breastfeeding (EBF) is one of the most effective interventions to improve child survival. The main objective of this study was to assess the prevalence and duration of exclusive breastfeeding and the associated factors among women in Dubai and Sharjah, UAE. A cross-sectional study was conducted in four hospitals and four healthcare centers in Dubai and Sharjah between September 2017 and December 2017. Hospitals and centers are governmental and provide maternal and child health services. A convenience sample of 858 Arab and Emirati mothers with children under the age of 2 years participated in the study. Face-to-face interviews were conducted by using structured questionnaires. The study was approved by the University Ethical Committee and the UAE Ministry of Health before data collection. Descriptive statistics were computed to describe all the questionnaire items. The chi-square test was used to compare the study\u27s categorical variables. A binary logistic regression analysis was used to predict the relationship between BF and its associated factors. Statistical tests with P-values \u3c 0.05 were considered statistically significant. The mean age of the participating mothers was 30.6 (SD 5.5) years. Results showed that the prevalence of exclusive breastfeeding among the study participants was 24.4% (31.1% in Sharjah and 22% in Dubai; P = 0.003). The binary logistic regression reported that mother\u27s and father\u27s education, skin-to-skin period, number of children, mothers\u27 health, and place of living were significantly associated with exclusive breastfeeding (P \u3c 0.05). The results reported a significant association between EB and duration of breastfeeding (OR = 6.9, P = 0.002), husband education (OR = 2.1, P = 0.015), mother education (OR = 1.3, P = 0.027), number of children (OR = 7.9, P = 0.045), having any health problem (OR = 1.2, P = 0.045), and living place (OR = 1.4, P = 0.033), and a non-significant positive effect of family size and family income. Furthermore, the result reported a significant association between mixed breastfeeding and duration of breastfeeding (OR = 0.1, P = 0.000), skin-to-skin period (OR = 0.3, P = 0.002), underweight (OR = 4.7, P = 0.034), last infant\u27s sex (OR = 1.6, P = 0.010), having maid at home (OR = 2.1, P = 0.000), number of children (OR = 0.2, P = 0.013), and living place (OR =1.1, P = 0.014), and a non-significant association with family size and family income. Therefore, a health promotion program for exclusive breastfeeding during antenatal health visits, together with initiating health policies in maternal hospitals to encourage the initiation of breastfeeding during the first hour of birth and the introduction of skin-to-skin contact during the first 5 min of birth are highly recommended

Overweight and Obesity among Palestinian Adults: Analyses of the Anthropometric Data from the First National Health and Nutrition Survey (1999-2000)

Background. A cross-sectional survey was designed to provide a baseline data on the prevalence and distribution of overweight and obesity and their associations among adults in Palestine. Methods. A random representative sample of 3617 adults aged 18–64 years was collected between October 1999 and October 2000. Results. The prevalence of overweight was 35.5% in women and 40.3% in men, obesity was 31.5% in women and 17.5% in men. Adults aged 45–54 years old were significantly more likely to be obese (29.2% in men and 50.2% in women) or overweight (48.1% in men and 37.2% in women). When compared with women, men showed significantly more normal BMI level (40.5% versus 31.6%; P < 0.05). Cut-off points for a high waist circumference and high waist-to-hip ratio identified 57.8% and 47.2% of the population, respectively, to be at an increased and high risk for cardiovascular disease. Sociodemographic factors (age, sex, educational level, and marital status) were also found to be significantly related to BMI. Conclusion. Obesity and overweight are enormous public health problems in Palestine. Population-based research at the national level to investigate the social and cultural factors associated with high prevalence of overweight and obesity among Palestinian adults should be implemented

Cluster analysis for food group consumption patterns in a national sample of Palestinian schoolchildren: Evidence from HBSC Survey 2013-2014

Background: Promoting a healthy diet and lifestyle to reduce the national burden of nutrition-related problems among Palestinians requires an understanding of food consumption trends and patterns. Few studies have examined the food consumption patterns with the macro and micronutrient intakes and nutrition risk factors. The objective of this study was to study the food frequency and nutrient intake consumption patterns of Palestinian schoolchildren and their associations with the socioeconomic and risk factors. This is a national cross-sectional descriptive study conducted on Palestinian schoolchildren from the West Bank. The study examined the food consumption patterns of the macro and micronutrient intakes and nutrition risk factors among 1945 students aged 11-16 years. The data collected using the food frequency questionnaire and 24-hour recall that was administered by trained field workers. Food groups’ classification, nutrient intakes, body mass index (BMI) Z-scores, and socioeconomic di erences were examined across the food groups’ patterns of consumption. We employed Z-score and K-Means cluster analysis to identify food consumption patterns and to examine factors associated with nutrient intakes. The food frequency results identified three food consumption clusters including the traditional, non-traditional, and mixed pattern. A total of 796 students (41%) were in traditional cluster, 458 (23.5%) in non-traditional cluster, and 691(35.5%) in mixed cluster. The nutrient intakes identified three clusters (High, Moderate, and Low consumption patterns) out of macronutrient, vitamins, and minerals categories. Most of the students located in the low consumption cluster for macronutrient, vitamins, and minerals clusters (66.9%, 67.7%, and 64 %) respectively. The traditional cluster was associated with healthy, non-obese, and physically active students and the non-traditional cluster was associated with unhealthy and obese students, but both shown significantly different across the identified clusters. Imbalance in dietary intakes among schoolchildren reflects a lack of dietary diversity. High sugar, fats and oils, and beverages consumption, low consumption of grains, fruits, beans and legumes, and meat are noticed in Palestinian schoolchildren. The findings indicated the importance of considering the food groups\u27 intake variations among Palestinian schoolchildren. As the segments relate to children’s health, nutrition diet programs should consider the high scores of non-traditional and mixed food consumption among school’s children

Links between nutrition, life style habits and academic achievement in Palestinian schoolchildren: A cross-sectional study

Objective: To examine the association between nutrition, physical activity, lifestyle, the combined behavior effect, and the schoolchildren\u27s academic achievement. Design: Observational and cross-sectional study. Setting: West Bank, Palestine. Participants: A group of schoolchildren (n=1945) in grades 5-9 (11-16 years). Measurements: Students were surveyed about the their ’dietary, physical activity (PA), leisure time activity, and academic achievement. Academic achievement was measured using students\u27 marks in Arabic, English, math, science courses, and the total average score. The linear regression model was conducted to analyze the relationship between dietary, PA, combined behavior, and academic achievement, while adjusted for demographic confounders; body mass index (BMI), and parental education. Results: Findings indicated that healthy nutrition and adequate levels of PA significantly predict achievement scores. In both boys and girls, high academic achievement was associated with a high intake of fruits and vegetables (AOR: 1.1 (0.72-1.68); 1.18(0.81-1.7), and (AOR: 1.21(0.8-1.82); 1.33(0.93-1.91), respectively. In both girls and boys, high academic achievement was associated with low intake of soft drink, beverages (juice with sugar) and energy drink (AOR: (0.75(0.47-1.19), 0.85(0.58-1.27)); (0.99(0.63-1.57), 0.76(0.52-1.12)); (0.66(0.38-1.15), 0.49(0.27-0.89)), respectively. The active and healthy nutrition group scored higher on Arabic, English, math, science, and total average score. Conclusions: There is a strong relationship between healthy nutrition, acceptable PA, and the average academic achievement within schoolchildren. Findings emphasize the importance of linking nutrition, school PA, and health policies for improving cognitive functions and academic performance of Palestinian schoolchildren. Thus, school-based healthy lifestyle educational, health behaviors policy, and recommendation programs may have a greater effect on students’ academic achievement

Assessment of the vitamin D status and its determinants in young healthy students from Palestine

The global prevalence of vitamin D deficiency is high. Poor vitamin D status, especially in women, has been reported in several countries in the Middle East despite adequate year-round sunlight for vitamin D synthesis. However, data on vitamin D status in Palestine are scarce. The aim of this cross-sectional study was to evaluate vitamin D status based on serum concentrations of 25-hydroxycholecalciferol [25-(OH)D] among young healthy Palestinian students (18–27 years) and to assess associations between 25-(OH)D concentrations and several predictors. The mean 25-(OH)D concentration of women (n 151) was 27⋅2 ± 14⋅5 nmol/l, with the majority having insufficient (31⋅1 %) or deficient (<60 %) 25-(OH)D status. Only 7 % of women achieved sufficient or optimal 25-(OH)D status. In contrast, men (n 52) had a mean 25-(OH)D concentration of 58⋅3 ± 14⋅5 nmol/l, with none classified as deficient, and most obtaining sufficient (55⋅8 %) or even optimal 25-(OH)D status (11⋅5 %). Among women, 98 % wore a hijab and 74 % regularly used sunscreen. Daily dietary vitamin D intake (3-d 24-h recalls) was 45⋅1 ± 36⋅1 IU in the total group (no sex differences). After adjustment, multiple linear regression models showed significant associations between 25-(OH)D concentrations and the use of supplements (B = 0⋅069; P = 0⋅020) and dietary vitamin D (B = 0⋅001; P = 0⋅028). In gender-stratified analysis, the association between supplement use and 25-(OH)D concentrations was significant in women (B = 0⋅076; P = 0⋅040). The vitamin D status of women in the present cohort is critical and appears to be mainly due to wearing a hijab, regular use of sunscreen and low dietary vitamin D intake. The vitamin D status of the women should be improved by taking vitamin D containing supplements or fortified foods

Machine learning techniques for predicting depression and anxiety in pregnant and postpartum women during the COVID-19 pandemic: A cross-sectional regional study

Background: Maternal depression and anxiety are significant public health concerns that play an important role in the health and well-being of mothers and children. The COVID-19 pandemic, the consequential lockdowns and related safety restrictions worldwide negatively affected the mental health of pregnant and postpartum women. Methods: This regional study aimed to develop a machine learning (ML) model for the prediction of maternal depression and anxiety. The study used a dataset collected from five Arab countries during the COVID-19 pandemic between July to December 2020. The population sample included 3569 women (1939 pregnant and 1630 postpartum) from five countries (Jordan, Palestine, Lebanon, Saudi Arabia, and Bahrain). The performance of seven machine learning algorithms was assessed for the prediction of depression and anxiety symptoms. Results: The Gradient Boosting (GB) and Random Forest (RF) models outperformed other studied ML algorithms with accuracy values of 83.3% and 83.2% for depression, respectively, and values of 82.9% and 81.3% for anxiety, respectively. The Mathew\u27s Correlation Coefficient was evaluated for the ML models; the Naïve Bayes (NB) and GB models presented the highest performance measures (0.63 and 0.59) for depression and (0.74 and 0.73) for anxiety, respectively. The features\u27 importance ranking was evaluated, the results showed that stress during pregnancy, family support, financial issues, income, and social support were the most significant values in predicting anxiety and depression. Conclusion: Overall, the study evidenced the power of ML models in predicting maternal depression and anxiety and proved to be an efficient tool for identifying and predicting the associated risk factors that influence maternal mental health. The deployment of machine learning models for screening and early detection of depression and anxiety among pregnant and postpartum women might facilitate the development of health prevention and intervention programs that will enhance maternal and child health in low- and middle-income countries

Perspectives and practices of dietitians with regards to social/mass media use during the transitions from face-to-face to telenutrition in the time of COVID-19: A cross-sectional survey in 10 Arab countries

During the COVID-19 pandemic, most healthcare professionals switched from face-to-face clinical encounters to telehealth. This study sought to investigate the dietitians’ perceptions and practices toward the use of social/mass media platforms amid the transition from face-to-face to telenutrition in the time of COVID-19. This cross-sectional study involving a convenient sample of 2,542 dietitians (mean age = 31.7 ± 9.5; females: 88.2%) was launched in 10 Arab countries between November 2020 and January 2021. Data were collected using an online self-administrated questionnaire. Study findings showed that dietitians’ reliance on telenutrition increased by 11% during the pandemic, p = 0.001. Furthermore, 63.0% of them reported adopting telenutrition to cover consultation activities. Instagram was the platform that was most frequently used by 51.7% of dietitians. Dietitians shouldered new difficulties in dispelling nutrition myths during the pandemic (58.2% reported doing so vs. 51.4% pre-pandemic, p &lt; 0.001). Compared to the pre-pandemic period, more dietitians perceived the importance of adopting tele nutrition’s clinical and non-clinical services (86.9% vs. 68.0%, p = 0.001), with 76.6% being confident in this practice. In addition, 90.0% of the participants received no support from their work facilities for social media usage. Following the COVID-19 outbreak, the majority of dietitians (80.0%) observed a rise in public interest in nutrition-related topics, particularly those pertaining to healthy eating habits (p = 0.001), healthy recipes (p = 0.001), nutrition and immunity (p = 0.001), and medical nutrition therapies (p = 0.012). Time constraint was the most prevalent barrier to offering telenutrition for nutrition care (32.1%), whereas leveraging a quick and easy information exchange was the most rewarding benefit for 69.3% of the dietitians. In conclusion, to ensure a consistent provision of nutrition care delivery during the COVID-19 pandemic, dietitians working in Arab countries adopted alternative telenutrition approaches through social/mass media

Impact Of Covid-19 Lockdown On Smoking (Waterpipe And Cigarette) And Participants\u27 Bmi Across Various Sociodemographic Groups In Arab Countries In The Mediterranean Region

INTRODUCTION Tobacco smokers are at high risk of developing severe COVID-19. Lockdown was a chosen strategy to deal with the spread of infectious diseases; nonetheless, it influenced people\u27s eating and smoking behaviors. The main objective of this study is to determine the impact of the COVID-19 lockdown on smoking (waterpipe and cigarette) behavior and its associations with sociodemographic characteristics and body mass index. METHODS The data were derived from a large-scale retrospective cross-sectional study using a validated online international survey from 38 countries (n=37207) conducted between 17 April and 25 June 2020. The Eastern Mediterranean Region (WHO-EMR countries) data related to 10 Arabic countries that participated in this survey have been selected for analysis in this study. A total of 12433 participants were included in the analysis of this study, reporting their smoking behavior and their BMI before and during the COVID-19 lockdown. Descriptive and regression analyses were conducted to examine the association between smoking practices and the participant\u27s country of origin, sociodemographic characteristics, and BMI (kg/m2). RESULTS Overall, the prevalence rate of smoking decreased significantly during the lockdown from 29.8% to 23.5% (p\u3c0.05). The percentage of females who smoke was higher than males among the studied population. The highest smoking prevalence was found in Lebanon (33.2%), and the lowest was in Oman (7.9%). In Egypt, Kuwait, Lebanon, and Saudi Arabia, the data showed a significant difference in the education level of smokers before and during the lockdown (p\u3c0.05). Smokers in Lebanon had lower education levels than those in other countries, where the majority of smokers had a Bachelor\u27s degree. The findings show that the BMI rates in Jordan, Lebanon, Oman, and Saudi Arabia significantly increased during the lockdown (p\u3c0.05). The highest percentages of obesity among smokers before the lockdown were in Oman (33.3%), followed by Bahrain (28.4%) and Qatar (26.4%), whereas, during the lockdown, the percentage of obese smokers was highest in Bahrain (32.1%) followed by Qatar (31.3%) and Oman (25%). According to the logistic regression model, the odds ratio of smoking increased during the pandemic, whereas the odds ratio of TV watching decreased. This finding was statistically significant by age, gender, education level, country of residence, and work status. CONCLUSIONS Although the overall rates of smoking among the studied countries decreased during the lockdown period, we cannot attribute this change in smoking behavior to the lockdown. Smoking cessation services need to anticipate that unexpected disruptions, such as pandemic lockdowns, may be associated with changes in daily tobacco consumption. Public health authorities should promote the adoption of healthy lifestyles to reduce the long-term negative effects of the lockdown

Dietary intake and lifestyle practices of eastern mediterranean postpartum women before and during COVID-19 pandemic: An internet-based cross-sectional survey

Background: During the lockdown period, a substantial group of these women reported lifestyle changes. Aim: The aim of the study is to characterize the dietary patterns, intake and the adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Eastern Mediterranean postartum women. Methods: An internet-based cross-sectional survey was used to collect the data. The survey was carried out among 1,939 postpartum women from five countries from the Eastern Mediterranean region. Change in dietary intake from the five food groups and the adherence to USDA's daily recommendations were assessed. Findings: There was a significant increase in the mean (SD) consumption of all the food groups, including bread, rice, and other cereals, fruits, vegetables, milk and milk products, white and red meat, and nuts during the pandemic. Around 84% of participants reported no/low adherence (0–2) to USDA guidelines, whereas only 15% reported moderate or high adherence (3–5) to the guidelines before the pandemic. However, there was an increase in the proportion of subjects reporting moderate/high adherence (22%) during the pandemic. Discussion and conclusions: A substantial proportion of our study participants reported a lower dietary intake than the recommended amounts, and low adherence to the five food groups. Reasonable and applicable actions should be taken to protect postpartum women and their children from the effects of low dietary intake, particularly during pandemics and lockdowns. More researches are needed to identify the modifiable factors which could improve the nutritional status of the postpartum women during the pandemic