Ever and Exclusive Breastfeeding Practice During the First Six Months of Infants' Life in Bahrain: A Cross-Sectional Study.

OBJECTIVE: This study aimed to determine the prevalence of mothers practicing ever and exclusive breastfeeding for the first six months of life in Bahrain, a high-income country, and determine the variables associated with ever and exclusive breastfeeding. METHODS: This cross-sectional interview study on breastfeeding patterns was conducted on 345 women attending the Well Baby Clinic during their regular childcare visits at the Bahrain Defense Force Hospital from January 2019 to June 2019. Eligible women had at least one newborn aged six months to two years. The prevalence of ever and exclusive breastfeeding and its associated variables were analyzed using Chi-square and multivariate logistic regression and addressed by the odds ratio (OR) and respective 95% confidence interval (95% CI). RESULTS: During the first six months of the infant's life, 56% (95% CI: 50.8%-61.5%) of mothers breastfed their infants, but only 5.5% (95% CI: 3.3%-8.5%) practiced exclusive breastfeeding. The multivariate logistic regression results showed that women were less likely to practice ever breastfeeding in the age group of 20-24 years (OR = 0.399, 95% CI: 0.167-0.953, p < 0.05) and had low education levels (OR = 0.388, 95% CI: 0.184-0.881, p < 0.05). Besides, mothers on contraceptives were not associated with ever breastfeeding (OR=1.926, 95% CI: 1.100-3.373, p < 0.05). Furthermore, the multivariate analysis revealed that mothers who had infants born with chronic disease were more likely to exclusively breastfed them (OR = 4.183, 95% CI: 1.138-15.378, p < 0.05). On the other hand, a significant association existed between women who did not have antennal care and exclusively breastfeeding (OR = 3.951, 95% CI: 1.460-10.692, p < 0.01). Furthermore, the main reason reported by mothers for not ever or exclusively breastfeeding was insufficient breast milk. Besides, difficulty during breastfeeding was another primary reason for not ever breastfeeding. CONCLUSION: The prevalence of exclusive breastfeeding is very low in Bahrain. To increase the exclusive breastfeeding prevalence rate, education programs and intervention studies, protocols, and training on overcoming mothers' challenges during breastfeeding must be implemented to increase exclusive breastfeeding rates.

Adapted Evidence-Based Clinical Practice Guidelines for Diagnosis and Treatment of Epilepsies in Children: A Tertiary Children's Hospital Update.

HYPOTHESIS AND/OR BACKGROUND: We recently updated and merged the adapted clinical practice guidelines (CPGs) for the diagnosis and treatment of children with epilepsy of a tertiary-level hospital. Medical knowledge is always evolving. As a result, it is critical to revisit the clinical standards on a frequent basis to ensure that the best services are offered to the target receivers. The purpose of this article was to update and merge the CPGs at Alexandria University Children Hospital (AUCH) for the diagnosis (2014) and treatment (2016) of children with epilepsy to unify and standardize the practice for better care and outcome. METHODS: This review and update CPG project was initiated by assembling a Guideline Review Group (GRG). The GRG conducted focus group discussions and decided to search any published updates of the recommendations of the previously identified high-quality and evidence-based CPG developed by the SIGN (Scottish Intercollegiate Guidelines Network) and to merge the two previous local CPGs under one comprehensive CPG for full management of epilepsy in children. The high quality of the selected source CPG from SIGN was based on quality assessment of CPGs undertaken previously using the Appraisal of Guidelines for Research and Evaluation II Instrument. The GRG followed the Checklist for the Reporting of Updated Guidelines (CheckUp), which is the CPG tool recommended by the Enhancing the Quality and Transparency of health Research Network for reporting of updated CPGs in addition to the RIGHT-Ad@pt Checklist for Adapted CPGs. The finalized updated CPG draft was sent to the external reviewer group topic experts. RESULTS: The group updated 10 main categories of recommendations from one source CPG (SIGN). The recommendations included (1) epilepsy diagnosis; (2) recognition, identification, and referral; (3) pharmacological treatment of epilepsy and epilepsy syndromes; (4) nonpharmacological treatment of epilepsy and epilepsy syndromes; (5) managing pharmacoresistant epilepsy; (6) management of epilepsy in special groups; (7) medications; (8) children and caregiver education and support; (9) comorbidities and mortality; and (10) transitional care from pediatric to adult care services. CONCLUSIONS: The finalized CPG provides evidence-based guidance to health care providers in AUCH for the diagnosis and management of epilepsy in children. The study also established the significance of a collaborative clinical and methodological expert group for the update of CPGs, as well as the usability of the "CheckUp" and "RIGHT-Ad@pt" CPG Tools.