A systematic review and meta-analysis of breastfeeding rates and practices in the United Arab Emirates (UAE)

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Study Design Systematic review and meta-analysis. Methods A systematic review and meta-analysis of relevant published peer-reviewed literature in the MEDLINE (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases from 2013 to 1st August 2023. When statistical pooling was not possible, results were synthesized narratively. Results Twelve studies were included. Pooled data from five studies (n=2009) indicated that 62% of women initiated breastfeeding within the first hour after birth (95% CI: [0.45 - 0.78], I2 = 98.3%). At three months, pooled data from three studies (n=851) showed that 73% of these women were still breastfeeding (95% CI: [0.42 - 0.96], I2 = 98.7%). At six months, the rate of exclusive breastfeeding, based on pooled data from three studies (n=1121), was 29.5% (95% CI: [0.14 - 0.477], I2 = 97.5%). Significant heterogeneity was observed, suggesting that the results should be interpreted with caution. Three key themes emerged from the analysis: (1) balancing supportive factors with traditional practices, (2) the role of health service provision in breastfeeding, and (3) the influence of socioeconomic factors. Conclusions This review highlights the importance of integrating cultural competence into healthcare strategies to better support breastfeeding mothers. Additionally, a national infant feeding survey is recommended to address the existing knowledge gaps in the UAE. Figures Figure 1 Figure 2 Statement of Significance Problem or Issue Breastfeeding is recommended for optimal infant outcomes. Breastfeeding rates are thought to be suboptimal, but actual rates are not known in the UAE. What is already known Cultural, antepartum, intrapartum, and postpartum practices can affect the initiation of breastfeeding. Parity may have an impact on breastfeeding. What this paper adds A pooled estimate of breastfeeding initiation rate as well as estimated exclusive breastfeeding rates at 3 and 6 months and a summary of the evidence regarding influencing factors and practices. Highlights the need for extended provision of breastfeeding support in the community postpartum. Introduction Breastfeeding is widely recognized as the optimal method of infant feeding with short and long term benefits for mother and baby (1, 2). The World Health Organization (3, 4) and United Nations Children’s Fund (UNICEF) recommend initiating breastfeeding within one hour of birth, exclusively breastfeeding (EBF) for at least six months and up to two years (3, 5). EBF has been defined as offering only breast milk including expressed breast milk to infants up to six months of age; with exception of oral rehydration salts, nutritional supplements (vitamins & minerals) and medications if needed (WHO, 2008). Globally, breastfeeding has been shown to improve both physical and mental health outcomes for mother and infant, irrespective of the country’s income level (2, 6). The Sustainable Development Goals (SDGs) emphasise the importance of breastfeeding as a preventative measure to save babies' lives (United Nations (UN), 2015) (7). However, the aggressive marketing of formula which often violates the WHO International Code of Marketing of Breastmilk Substitutes, poses a significant challenge to breastfeeding initiation and continuation (8). The latest Lancet breastfeeding Series calls for a collective commitment to improving breastfeeding practices at the population level rather than the responsibility of women (8). In the United Arab Emirates (UAE), rapid modernisation since its foundation in 1971 has led to shifts in traditional practices, including increased promotion of formula feeding and other infant food. The UAE government, however, has made efforts to prioritise breastfeeding in its national policies. The UAE’s National Strategy 2017-2021 aimed to increase breastfeeding rates from 34% to 50% for infants up to six months(9). Recent media launches introduced the new UAE Nutrition Strategy (2022-2030), which continues to prioritize breastfeeding, although an English version of the strategy is not yet publicly available (10, 11). UAE Federal Law mandates breastfeeding, with provisions for paid maternity leave of ninety days and an allowance of two continuous hours per day for breastfeeding upon return to work for six months (10, 11). Factors influencing breastfeeding Women’s decision to initiate and continue breastfeeding are influenced by a variety of physical (12) and psychosocial factors (13). A systematic review and meta-analysis of factors influencing breastfeeding in high income countries (12) reported smoking, mode of birth, parity, dyad separation, maternal education, and maternal breastfeeding education for determining initiation and duration of breastfeeding. Moreover, the context of a woman’s life, including her intentions, self-efficacy, and support systems, play a critical role in breastfeeding outcomes (13). However, breastfeeding intention as the strongest predictor of breastfeeding initiation and continuation, can be influenced by women’s attitude, support and advice from family, friends and health professionals, sociocultural norms and social media (11). In the UAE, breastfeeding is deeply intertwined with religious beliefs and cultural expectations among Muslim women, for whom motherhood and breastfeeding are seen as privileges and religious duties (11). Breastfeeding also offers a natural family planning method through lactational amenorrhea (14). Despite this, exclusive breastfeeding remains suboptimal in the UAE. Historically high breastfeeding rates have declined over the past thirty years, with recent studies showing a prevalence of 44% in Abu Dhabi (15), 31% in Dubai, and 22% in Sharjah (16). According to a review by Taha in 2017 (11), a National UAE 1988 infant feeding study reported that 88% of mothers breastfed, but mix feeding has predominated since the 1970s. A National Survey by MOHAP conducted in 2017-18 reported that 92% of the 2361 women surveyed had ever breastfed (12). However, the survey does not clearly define or calculate breastfeeding practices and notes that 61% of respondents gave birth in the UAE, leaving 39% who did not, which could skew the breastfeeding data specific to the UAE (12). Therefore, the report provides only an estimation rather than an accurate assessment. Purpose of the Review This systematic review aimed to estimate breastfeeding rates and synthesize evidence on factors influencing women’s breastfeeding practices in the UAE. By pooling data from various studies, the review provides evidence to inform policy and planning, potentially guiding interventions to improve breastfeeding rates. Methods Type of study and registration of protocol This study was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42023427736) and adheres to the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) statement (2021) (17) to support transparent reporting and aid the reader assess trustworthiness (18). Inclusion and Exclusion criteria This review was based on studies including adult women over 18 years old who ever breastfed residing in the UAE. We included all published peer-reviewed primary research articles in the English language, including observational studies, cross sectional studies, cohort studies, prevalence studies, case control studies, randomized controlled trials and qualitative studies where data specific to breastfeeding could be extracted. Non-research letters, abstracts and editorials, seminar reviews and case studies/series reporting cases were excluded. Search Strategy and Selection Procedures The MEDLINE (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched for relevant articles from 2013 to 1 st August 2023. A search strategy developed with a health librarian (VC) was used (Table 1). Records were imported into ENDNOTE library. Two researchers (MOC and SM) screened the studies and considered eligibility for the review. Reference lists of relevant articles were also hand searched for potential eligible studies. Results were compiled (n=28), and duplicates (n=1) removed (Figure 1). Where there was more than one study on the same cohort of patients (same population), data were extracted from the study that described the whole population rather than a subset (15, 19, 20, 21, 22, 23, 24, 25, 26). All titles and abstracts were read carefully to confirm if they fulfilled the eligibility criteria. Following this, twenty-one full text articles were retrieved as potentially relevant. Discrepancies were discussed (MOC and SM), and a third reviewer (PLW) was available to help reach consensus. At this stage, two studies were excluded, see Table 2, ‘Characteristics of Included and Excluded Studies’ and the reason noted. Al Ghazal et al 2015 was deemed outside the remit of the review (27). National survey which was located on handsearching (28) was excluded upon discussion since it was not clear which women in the survey gave birth in the UAE. The final list of included studies (n=19) was then verified by two reviewers (MOC and SM). No disagreements arose during this process. Data extraction Two reviewers (MOC and SM) independently extracted the following data based on the summary table. There was no need to consult a third reviewer. Appraisal of methodological quality of studies Methodological quality was assessed using the Mixed Method Appraisal Tool (MMAT) s (29), consisting of seven questions. The reviewers (SM, MOC) independently classified the first two questions which are screening questions about having a clear research question. Then, they classified the other five questions which are more specific based on study design. If the answer to the question was a yes, it scored one point, and if absent, it scored zero (30, 31). The score of 5 was the highest score if the first two screening questions were answered yes, otherwise the appraisal could not be processed for further evaluation (Table 3). Statistical analysis For the prevalence, quantitative analysis was performed where data was available and pooled for a meta-analysis using a random effects model in JBI Summari. The meta-analysis was conducted based on five categories: breastfeeding initiation, any breastfeeding at three, exclusive and any breastfeeding at six months. Effect sizes were expressed as odds ratios with calculated 95% confidence intervals. The presence of heterogeneity was tested using the standard I 2 statisticaltest with a significance level of 90%. A forest plot was created to estimate prevalence of breastfeeding initiation at birth, after one hour, at three months, six months and 12 months (Supplementary files). For the related factors, narrative findings were synthesized through initially reading and re-reading the studies then using ‘Elicit software’ which is a novel tool designed to assist in evidence synthesis and text extraction (32) to tabulate concepts. Three themes emerged after this analysis. Themes were discussed and agreed between authors and presented as a narrative synthesis. Results Characteristics of eligible studies The search of electronic databases led to the retrieval of 198 study titles, 38 duplicates were removed, resulting in 160 articles. The reading of titles and abstracts led the exclusion of 130 articles. Twenty nine papers were submitted to full text analysis, 19 papers representing 12 studies met eligibility criteria and were included in the present systematic review (15, 16, 19, 20, 21, 22, 23, 24, 25, 26, 33, 34, 35, 36, 37, 38, 39, 40, 41). (Figure 1). Of the twelve studies, one was a retrospective survey (35), nine were cross sectional (16, 25, 26, 33, 34, 36, 38, 39, 41) , one was a quality improvement study (37), and one was a longitudinal cohort study (40). There was one qualitative study (41). Two of the studies published multiple articles. A longitudinal study where women were interviewed at three, six and fifteen months postpartum published 2 articles (25, 26) and a cross sectional multi-centre study which interviewed mothers of infants under the age of two years attending seven primary health centres in Abu Dhabi in 2017 published 7 articles (15, 19, 20, 21, 22, 23, 24). Overall, methodological quality was good, with all studies meeting threshold criteria of 75% (Mean Score 98%). Total number of participants was 6483 and sample sizes ranged from 45 to 1822 (Table 2). All studies included women of mixed parity, both nulliparous and multiparous. Studies consisted of Emirati (15, 16, 25, 33, 34, 35, 36, 37, 38, 39, 40, 41) and Non-Emirati women (33, 34, 35, 36, 37, 38, 40). Factors that impact breastfeeding practices in the UAE Following data analysis, three themes were identified: (1) supportive factors with balancing traditional practices; (2) health service provision for breastfeeding; and 3) socioeconomic influences. Themes Supportive factors with balancing traditional practices and modern recommendations Supportive factors included strong perceived breastfeeding support from family and friends (29, 41) rooming-in to support night-time breastfeeding and not being offered formula in hospitals, alongside staff education of women on breastfeeding benefits (34, 36, 39, 40, 41) with routine and timely follow-up (36, 38, 39). Religious and cultural norms encourage women to breastfeed (34, 40, 42) and women perceive it to be clean and easy to prepare (34). However, support is often lacking, such as insufficient maternity leave or workplace breastfeeding facilities (33). Living with extended family can be challenging, especially when elders’ advice conflicts with breastfeeding practices (41). Some grandmothers and mothers-in-law provide pre-lacteal feeds and additional foods like cereals, reinforcing the belief that mothers lack sufficient breastmilk (39). Nevertheless, family members, particularly husbands, are key sources of information and support for breastfeeding surpassing health professionals (25, 41). However, concerns regarding low milk supply and insufficient breastmilk lead to the introduction early complementary feeding (33). This is also compounded by the belief that infants could be thirsty in a hot climate and thus water is offered rather than breastmilk (41). Furthermore, traditional cultural practices that do not support exclusive breastfeeding are challenging for women. For example, offering infants substances such as honey, herbal infusions, tea, yogurt, dates, and water during the first few hours and days of an infant's life are practices rooted in cultural beliefs and customs (28). Cross-nursing and wet-nursing, where infants are fed by women who are not their mother, add complexity to exclusive breastfeeding. While these practices provide breastmilk and are culturally acceptable, working mothers who lack this support may resort to mixed feeding with formula (14, 28), potentially leading to early cessation of breastfeeding. Health service provision for breastfeeding Health service provision of support for exclusive breastfeeding was evident; the Ministry of Health issued an infant feeding policy which recommends six months of exclusive breastfeeding (39). Furthermore, many hospitals have BFHI accreditation, with an expectation of rooming in as part of the local policy in line with this (11, 37). All those around the woman who give support- husband, family, friends, and maid were influential to breastfeeding outcomes. The primary source of breastfeeding support was from family and household maid (25, 41). Lack of awareness about the importance of exclusive breastfeeding or recommended duration was common (41). While support from husbands is helpful, men are usually not fully involved in infant feeding (41). However, public perception of health care providers are not as supportive as their family (37, 39). Barriers include healthcare staff's insufficient knowledge, lack of rooming-in policies, and routine offering of formula, which undermine breastfeeding efforts (38, 40). Common issues affecting the initiation of breastfeeding include insufficient skin to skin contact, delayed first breastfeeding session and lack of rooming-in (19, 22, 37, 38). Additionally medical interventions such as Caesareans or separation from the baby at birth often contribute to delays in starting breastfeeding (19, 22, 38). These practices impact the ability to establish a successful breastfeeding relationship early on. Some mothers reluctance to ‘room in’ posed difficulties in implementing baby-friendly policies in hospitals (37). This reluctance often stemmed from cultural expectations. Support from healthcare professionals is crucial, yet there is a shortage of midwives who are key in providing breastfeeding support in various settings (34, 43). The lack of follow-up support after hospital discharge further hinders sustained breastfeeding (28, 29). These themes illustrate the complex factors contributing to delayed breastfeeding initiation in the UAE, emphasizing the need for targeted interventions in hospital practices and policy implementation to support early breastfeeding. Socioeconomic influences Four studies were encompassed in this theme (19, 22, 36, 37) covering issues such as older mother age, maternal obesity, Caesarean, high income, education, and employment. Breastfeeding challenges are exacerbated by maternal obesity. Maternal obesity was associated with delayed initiation (22, 36). The increasing preference for Caesarean was noted and the implications of this on early initiation of breastfeeding need to be considered (19, 22). Meta-Analysis Results With regards to estimates of breastfeeding rates, the prevalence of breastfeeding initiation within the first hour of birth were 62% (95% CI: [0.45 - 0.78], I 2 = 98.3%) (n=2009) (25, 33, 38, 39, 40) (Table 5). Pooled data from a different 5 studies indicated an estimated prevalence of 25% (95% CI: [0.18-0.31], I 2 = 93.9%) of women who initiated breastfeeding after one hour post birth (15, 25, 38, 39, 40)(n = 3565). Exclusive breastfeeding rates at three months were reported in only two studies which were 5%, (25)(n=94) and 50% (40)(n=399). Pooled data from three studies(15, 25, 40) (n=851) indicated an estimated rate of 73% of women with any breastfeeding at three months (95% CI: [0.42 - 0.96], I2 = 98.7%). At six months, the rates of exclusive breastfeeding were pooled from three studies (33, 35, 40) (n=1121) and the estimate was 29.5% (95% CI: [0.14, 0.477], I 2 = 97.5%). Estimated any breastfeeding rates at six months were 85.9% (95% CI: [0.74 - 0.94], I 2 = 94.3%) (35, 40) (n=849) (33, 35, 40). One study reported any breastfeeding rate which was 50% at 12 months postpartum (25) (n=52). Considering that definitions of breastfeeding vary across studies in our review, making comparisons more difficult (Supplementary Table 1). Reasons for Cessation Overall, the most common reasons for stopping breastfeeding were perceived insufficient breastmilk production and inadequate maternity leave (33, 34, 36, 37, 40). Other factors were lack of husband support (33), new pregnancy and that the infant weaned itself (25, 34, 39). Poor infant weight gain and infant feeding issues were highlighted (25, 35, 38). Sore or cracked nipples, pain and impaired infant sucking were also cited as reasons for cessation of breastfeeding in the studies (19, 22, 34, 35, 38). Early cessation was found to be related to the need to return to work (19, 34) and having insufficient time during the workday for breastfeeding (33). Other reasons for cessation were a personal decision, doctor or pharmacist advice, artificial milk advertisements (media) (34). More reasons for cessation were being advised not to breastfeed due to taking medications (34, 38), breastfeeding being too tiring or inconvenient or wanting to go on a weight loss diet (38). Lack of lactational amenorrhea and using contraception were also linked to mix feeding and early cessation (16). Discussion This is the first systematic review and meta-analysis, to our knowledge, conducted to analyze breastfeeding practice in the UAE. Our review found a 62% rate of early breastfeeding initiation in the UAE which is similar in both developed and developing countries (33, 42). Our review found a 29.5% rate of exclusive breastfeeding at six months in the UAE, which is considered fair by WHO definitions (as 0-11% as poor, 12-49% fair, 50-89% good and 90-100% very good) (43). Our review synthesizes evidence on what factors influences women's breastfeeding practices in the UAE. We compared our results with previous reviews, one review of the Middle East (44), Gulf Coop Countries (GCC) (45) and Saudi Arabia (42). Our findings were similar to the findings of Alzaheb et al who described factors associated with breastfeeding in the Middle East; mode of delivery, maternal employment, rooming-in, parity, pre-lacteal feeding, and other factors such as pregnancy planning, infants sex, breastfeeding substitute advertisements and night feeding (44) (45) (42). The cultural tradition of introducing other fluids such as honey and water can interfere with breastfeeding (12, 45). Including family and friends in prenatal education is essential as women often rely on their advice and support (23). The GCC review recommended implementing BFHI policies and conducting country-specific studies to enhance breastfeeding knowledge in the region (45). Ensuring that hospital staff do not introduce formula milk is important. Participatory Action Research (PAR) has been suggested as one method to drive change in clinical areas (46). Understanding cultural dynamics is crucial for midwives to effectively support and educate mothers (47, 48). Cultural competence involves tailoring interventions to fit the cultural contexts of patients served (47, 48). In the UAE, religious expectations, and legal mandates for breastfeeding for two years, yet many women are unaware of these supports (34). Midwives should integrate cultural and legal knowledge, inform mothers about supportive factors, and dispel myths with evidence-based information that respects cultural beliefs. Involving husbands, mothers-in-law, and other key figures in breastfeeding discussions can create a more supportive environment and improve adherence to recommended practices. Culturally competent midwives build trust and improve communication with patients (49). However, the shortage of midwives in the UAE (50) affects infant feeding support, highlighting the need for midwifery education to include culturally appropriate care skills to ensure high-quality, respectful care in diverse settings (49). The review identified returning to work as a major barrier to continued breastfeeding, underscoring the need for more research on the experiences of working women in the UAE. Non-supportive work environments are a common obstacle impeding breastfeeding efforts (7, 45, 51). While the cohort study (40) does not explicitly mention reasons for cessation of breastfeeding, it discusses the association between continued and exclusive breastfeeding at six months with factors such as breastfeeding self-efficacy, postpartum depression, and maternal employment. These findings suggest a critical need for interventions to address these issues, providing additional support for breastfeeding mothers. A lack of nurseries in most places of employment was identified as a barrier to continuing breastfeeding (16). Without convenient access to childcare facilities, working mothers face difficulties in maintaining breastfeeding which may lead to early weaning. Implementing workplace policies which are supportive of breastfeeding such as designated lactation rooms and flexible breaks for breastfeeding mothers could mitigate these issues. Targeted research and interventions addressing the unique needs of working mothers in the UAE is needed. A 2023 systematic review of Saudi women’s breastfeeding practices (42) identified common reasons for stopping breastfeeding such as misconceptions around breastmilk sufficiency and returning to work. In contrast, UAE studies suggest educating the whole family, not just childbearing women, is crucial. Unlike Saudi Arabia, where formula feeding and stopping for contraceptive use were noted, these were less prevalent in the UAE (42). Theoretical approaches in interventions, incorporating familial and social factors, may enhance breastfeeding self-efficacy and intention (52, 53). Future educational programs should incorporate the theories of breastfeeding self-efficacy and planned behaviour to promote sustained breastfeeding practices (53). For instance, a Saudi Arabian study (n= 290), found that a tailored online intervention based on behaviour change models tripled exclusive breastfeeding rates at one month postpartum (66 % vs. 26 %, p-value <.001) (42). Recommendations Education on key breastfeeding practices such as rooming in, avoiding formula and early initiation is crucial. The review highlights the need for breastfeeding support to extend beyond hospitals into the community, addressing the current lack of support after discharge (28, 29). More research is needed on the experiences of women returning to work while breastfeeding is in the UAE, as current evidence is limited. Although small studies exist, a National Infant Feeding survey is lacking. A National Infant Feeding survey would provide accurate data, particularly in the Northern Emirates and rural areas, enabling targeted intervention. The review by Al Nuaimi et al recommended regular updates of key indicators of breastfeeding in each country of the GCC (45). Developing education in relation to informed choice for Caesarean is a recommendation (22) since Caesarean birth may delay breastfeeding initiation and shorten exclusive breastfeeding duration and is considered the most significant factor influencing breastfeeding success (54). Limitations The main limitation is type of study found. The studies were mainly cross sectional conducted at one time point and used non standardized data collection methods. Our review revealed a lack of studies specifically exploring nulliparous women and their breastfeeding experiences and needs. All studies retrieved had a mixed parity study population. Nulliparous and parous women may have different needs in relation to breastfeeding practices (55). This is an area which warrants further exploration in the UAE. Studies conducted at various timepoints would yield more valuable information about breastfeeding prevalence. Most studies were conducted in the capital – Abu Dhabi. There may be cultural nuances observed in more rural areas of the UAE which would be beneficial to understand. Further research is required in the Northern Emirates and rural areas. Conclusion This systematic review and meta-analysis, highlight good early breastfeeding rates in the UAE, but only fair exclusive breastfeeding rates at six months. To improve these rates, targeted interventions should address the various factors influencing breastfeeding. Key strategies include integrating cultural competence into midwifery education, involving family members in education and addressing workplace barriers. Focusing on these areas in future research and interventions is essential to support breastfeeding mothers and achieve WHO targets. Declarations Ethical Statement No ethical statement is required for a review of the literature. Consent for publication All authors agree/ consent to publish. Availability of Data All data generated during this review are included in this article. Declaration of Competing Interests The author (s) declared no potential conflicts of interests with respect to research, authorship or publication of this article. Funding No financial support was received for this research or authorship. Authors' contributions MOC/SM/PLW conceptualised the study, MOC/SM/ JA search, JA/KA data extraction, SM/MOC meta-analysis, original/ first draft MOC/SM, all authors reviewed and edited the final draft, PLW- Supervision/ Mentorship of the team, MOC Project Administration. Acknowledgements All authors acknowledge this as original work. This manuscript has not been previously published and is not considered for publication elsewhere. All authors have seen and approved the manuscript. Authors' information *Corresponding Author: Dr Maeve Anne O’Connell, Assistant Professor of Midwifery, Midwifery Department, Fatima College of Health Sciences, Abu Dhabi, Unites Arab Emirates. Email: [email protected] Research Interest: Perinatal Mental Health, Fear of Childbirth, Breastfeeding. Dr Shahla Meedya, Australian Catholic University, Sydney, Australia. Email: [email protected] Research Interest: Breastfeeding and Perinatal Mental Health Jenan Albaqali, Staff Nurse, Awali Hospital, Bahrain. Email: [email protected] Research Interest: Novice researcher Kadeeja Alraeesi, Student Midwife, Midwifery Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates. Email: [email protected] Research Interest: Novice Researcher Prof Patricia Leahy-Warren, Head of School of Nursing and Midwifery, University College Cork, Ireland. Research Interest: Breastfeeding, Parental and child health in the Community, and Perinatal Mental Health References Binns C, Lee M, Low WY. The long-term public health benefits of breastfeeding. Asia Pacific Journal of Public Health. 2016;28(1):7-14. Mortensen EL. Life course consequences of breastfeeding. 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Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates. Int Breastfeed J. 2018;13:26. Al-Shahwan MJ, Gacem SA, Hassan N, Djessas F, Jairoun AA, Al-Hemyari SS. A Study to Identify the Most Common Reasons to Wean among Breastfeeding Mothers in UAE. J Pharm Bioallied Sci. 2020;12(1):72-6. Ali HI, Magriplis E, Attlee A, Al Dhaheri AS, Cheikh Ismail L, Stojanovska L. Feeding Practices of Infants and Toddlers by Their Mothers in Selected Northern Emirates of the United Arab Emirates. Nutrients. 2022;14(18). Cheikh Ismail L, Al Dhaheri AS, Ibrahim S, Ali HI, Chokor FAZ, O'Neill LM, et al. Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020. BMC Public Health. 2022;22(1):319. Kaushal M, Sasidharan K, Kaushal A, Augustine P, Alex M. Increasing the exclusive breastfeeding rate in a private hospital in UAE through quality improvement initiatives. J Neonatal Perinatal Med. 2022;15(1):179-86. Omar AA, Abdul Hakeem S, Kahloon HB, Alhashmi A, AlSaadi RA, Carrick FR, et al. Factors associated with knowledge and practice of optimal breastfeeding among mothers in Dubai. Int J Health Plann Manage. 2022;37(2):963-78. Radwan H. Patterns and determinants of breastfeeding and complementary feeding practices of Emirati Mothers in the United Arab Emirates. BMC Public Health. 2013;13:171. Radwan H, Fakhry R, Metheny N, Baniissa W, Faris M, Obaid RS, et al. Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study. Int Breastfeed J. 2021;16(1):79. Radwan H, Sapsford R. Maternal Perceptions and Views About Breastfeeding Practices Among Emirati Mothers. Food Nutr Bull. 2016;37(1):73-84. Alahmed S, Meedya, S., Al Mutair, A., Fernandez, R. Saudi women's knowledge, attitude, and practices: A systematic review and meta-analysis2023; 34(1):[68 p.]. UNICEF Wa. The extension of the 2025 maternal, infant and young child nutrition targets to 2030. WHO and UNICEF Discussion paper. Geneva; 2017. Alzaheb RA. A Review of the Factors Associated With the Timely Initiation of Breastfeeding and Exclusive Breastfeeding in the Middle East. Clin Med Insights Pediatr. 2017;11:1179556517748912. Al-Nuaimi N, Katende G, Arulappan J. Breastfeeding Trends and Determinants: Implications and recommendations for Gulf Cooperation Council countries. Sultan Qaboos Univ Med J. 2017;17(2):e155-e61. Lehane E, Buckley C, Mulcahy H, McCarthy E, Cogan L, O’Connell R, et al. Evaluating the process of practice enhancement for exclusive breastfeeding (PEEB): a participatory action research approach for clinical innovation. International Breastfeeding Journal. 2024;19(1):39. Alahmed S, Win K, Frost S, Al Mutair A, Fernandez R, Meedya S. Cultural and linguistic appropriateness of a web-based Breastfeeding educational resource for Saudi women: consensus development conference approach. Nurse Education in Practice. 2023;71:103717. Tomori C. Overcoming barriers to breastfeeding. Best Practice & Research Clinical Obstetrics & Gynaecology. 2022;83:60-71. Solanke OaA, J. Nursing B-E-B, editor. BMJ Blogs2024. [cited 2024]. Available from: https://blogs.bmj.com/ebn/2024/06/09/culturally-appropriate-care-in-midwifery-education/. O'Connell MaS, G. . Midwifery in Abu Dhabi: a survey of midwives. Women and Birth 2023;36(4):439-44. Vilar-Compte M, Hernández-Cordero S, Ancira-Moreno M, Burrola-Méndez S, Ferre-Eguiluz I, Omaña I, et al. Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. International journal for equity in health. 2021;20(1):1-21. Ouyang Y-Q, Guo J, Zhou J, Zhouchen Y, Huang C, Huang Y, et al. Theoretical approaches in the development of interventions to promote breastfeeding: A scoping review. Midwifery. 2024:103988. Chipojola R, Chiu H-Y, Huda MH, Lin Y-M, Kuo S-Y. Effectiveness of theory-based educational interventions on breastfeeding self-efficacy and exclusive breastfeeding: A systematic review and meta-analysis. International journal of nursing studies. 2020;109:103675. Li L, Wan W, Zhu C. Breastfeeding after a cesarean section: A literature review. Midwifery. 2021;103:103117. Meedya S, Fahy K, Yoxall J, Parratt J. Increasing breastfeeding rates to six months among nulliparous women: A quasi-experimental study. Midwifery. 2014;30(3):e137-e44. Tables Table 1 Search Strategy Keywords: #1 "United Arab Emirate*"[All Fields] OR "UAE"[All Fields] OR "Emirates"[All Fields] #2 “breastfeed*”[All Fields] OR “breast-feed*”[All Fields] OR “breast feed*”[All Fields]OR “infant feeding”[All Fields] OR “infant and young child feeding”[All Fields] OR “lactation” [All Fields] #3 “duration”[All Fields] OR “experience”[All Fields] OR “support”[All Fields] OR “initiation”[All Fields] OR “intervention”[All Fields] OR “education”[All Fields] OR “advice”[All Fields] OR “rate”[All Fields] OR “service*”[All Fields] #4 #1 AND #2 AND #3 Table 2. Study characteristics of included and excluded studies Study Author, Year Design Study Setting Total N Included studies 6483 1 Ali et al, 2022 Ali HI, Magriplis E, Attlee A, Al Dhaheri AS, Cheikh Ismail L, Stojanovska L. Feeding Practices of Infants and Toddlers by Their Mothers in Selected Northern Emirates of the United Arab Emirates. Nutrients. 2022;14(18). Retrospective survey The Community [Emails with a link to the participant information sheet were sent to university students, informing them of the research and encouraging assistance to recruit family, friends, and community members that met the inclusion criteria (snowball design). To increase randomization and minimize selection bias, messages containing online promotion of the survey were sent through social media (including WhatsApp™, frequently used by this population) to undisclosed recipients lists to inform the targeted community.] 475 2 Al Ketbi et al, 2018 Al Ketbi MI, Al Noman S, Al Ali A, Darwish E, Al Fahim M, Rajah J. Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates. Int Breastfeed J. 2018;13:26. Cross Sectional Four primary health centers in Abu Dhabi 344 3 Al Sabbah et al, 2022 Al Sabbah H, Assaf EA, Taha Z, Qasrawi R, Radwan H. Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates. Front Nutr. 2022;9:872217. Cross Sectional Outpatient clinics in four hospitals and four health centers in Sharjah and Dubai, UAE 858 4 Al Shahwan et al, 2020 Al-Shahwan MJ, Gacem SA, Hassan N, Djessas F, Jairoun AA, Al-Hemyari SS. A Study to Identify the Most Common Reasons to Wean among Breastfeeding Mothers in UAE. J Pharm Bioallied Sci. 2020;12(1):72-6. Cross Sectional 820 5 Cheikh Ismail et al, 2020 Cheikh Ismail L, Al Dhaheri AS, Ibrahim S, Ali HI, Chokor FAZ, O'Neill LM, et al. Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020. BMC Public Health. 2022;22(1):319. Population-based cross sectional Primary health care centers and outpatient clinics at hospitals 276 6 Gardner et al, 2015 Gardner H, Green K, Gardner A. Infant Feeding Practices of Emirati Women in the Rapidly Developing City of Abu Dhabi, United Arab Emirates. Int J Environ Res Public Health. 2015;12(9):10923-40. Cross sectional Tertiary Hospital: Postnatal Ward 125 7 Gardner 2018 Gardner H, Green K, Gardner AS, Geddes D. Observations on the health of infants at a time of rapid societal change: a longitudinal study from birth to fifteen months in Abu Dhabi. BMC Pediatr. 2018;18(1):32. Cross sectional Tertiary Hospital: Postnatal Ward 125* 8 Kaushal et al, 2022 Kaushal M, Sasidharan K, Kaushal A, Augustine P, Alex M. Increasing the exclusive breastfeeding rate in a private hospital in UAE through quality improvement initiatives. J Neonatal Perinatal Med. 2022;15(1):179-86. Quality improvement prospective study Hospital in Dubai 9 Omar et al, 2022 Omar AA, Abdul Hakeem S, Kahloon HB, Alhashmi A, AlSaadi RA, Carrick FR, et al. Factors associated with knowledge and practice of optimal breastfeeding among mothers in Dubai. Int J Health Plann Manage. 2022;37(2):963-78. Cross sectional 4 Primary Health Centers in Dubai 668 10 Radwan 2013 Radwan H. Patterns and determinants of breastfeeding and complementary feeding practices of Emirati Mothers in the United Arab Emirates. BMC Public Health. 2013;13:171. Cross sectional Primary Health Care Centers in Abu Dhabi, Al Ain and Dubai 593 11 Radwan et al 2016 Radwan H, Sapsford R. Maternal Perceptions and Views About Breastfeeding Practices Among Emirati Mothers. Food Nutr Bull. 2016;37(1):73-84. Qualitative Maternal and Child Health, and Public Health Centers (PHC) in Abu Dhabi, Dubai and Al Ain. 45 12 Radwan et al 2021 Radwan H, Fakhry R, Metheny N, Baniissa W, Faris M, Obaid RS, et al. Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study. Int Breastfeed J. 2021;16(1):79. Prospective cohort Maternity wards of ten hospitals in four Emirates (Abu Dhabi, Dubai, Sharjah, and Fujairah). 457 13 Taha et al 2018 Taha Z, Garemo M, Nanda J. Patterns of breastfeeding practices among infants and young children in Abu Dhabi, United Arab Emirates. Int Breastfeed J. 2018;13:48 Cross sectional Seven governmental community and healthcare centers from diverse geographic areas of Abu Dhabi. 1822* 14 Taha et al 2019 Taha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Prevalence and Associated Factors of Caesarean Section and its Impact on Early Initiation of Breastfeeding in Abu Dhabi, United Arab Emirates. Nutrients. 2019;11(11) Cross sectional Seven governmental community and healthcare centers from diverse geographic areas of Abu Dhabi. 1624* 15 Taha et al 2020 Taha Z, Ali Hassan A, Wikkeling-Scott L, Eltoum R, Papandreou D. Assessment of Hospital Rooming-in Practice in Abu Dhabi, United Arab Emirates: A Cross-Sectional Multi-Center Study. Nutrients. 2020;12(8) Cross sectional Seven governmental community and healthcare centers from diverse geographic areas of Abu Dhabi. 1822* 16 Taha et al 2020 a Taha Z, Garemo M, Nanda J. Complementary feeding practices among infants and young children in Abu Dhabi, United Arab Emirates. BMC Public Health. 2020;20(1):1308. Cross sectional Seven governmental community and healthcare centers from diverse geographic areas of Abu Dhabi. 1822* 17 Taha et al 2021 Taha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi, the United Arab Emirates. Int J Womens Health. 2021;13:539-48 Cross sectional Seven governmental community and healthcare centers from diverse geographic areas of Abu Dhabi. 1822* 18 Taha et al 2022 Taha Z, Al Dhaheri AI, Wikkeling-Scott L, Ali Hassan A, Papandreou D. Determinants of Delayed Initiation of Breastfeeding: A Cross-Sectional Multicenter Study in Abu Dhabi, the United Arab Emirates. Int J Environ Res Public Health. 2022;19(15) Cross sectional Seven governmental community and healthcare centers from diverse geographic areas of Abu Dhabi. 1822* 19 Taha et al 2022 a Taha Z, Garemo M, El Ktaibi F, Nanda J. Breastfeeding Practices in the United Arab Emirates: Prenatal Intentions and Postnatal Outcomes. Nutrients. 2022;14(4). Cross sectional Seven governmental community and healthcare centers from diverse geographic areas of Abu Dhabi. 1799* Excluded studies Reason for exclusion 1 MOHAP 2018 UAE MoHaP. National Health Survey 2017/2018. MOHAP. 2018. National Survey Not a peer reviewed publication and available data was estimated. Not clear which women in the survey gave birth in the UAE. 2 Al Ghazal 2015 Al Ghazal, H., Rashid, S., & Ruf, E. (2015). The Sharjah baby-friendly campaign: a community-based model for breastfeeding promotion, protection, and support. Breastfeeding Medicine , 10 (9), 437-441. Health Promotion Report Was not eligible upon reading the full text, presents results of a health promotion campaign rather than breastfeeding practices or prevalence. *where multiple publications from the same study included, the largest subset was counted as the study population Table 3. Results of Quality Appraisal using the Mixed Methods Appraisal Tool (MMAT) Author Included Year Criteria from the Mixed Methods Appraisal Tool (MMAT) Overall Appraisal Value* 1.1 1.2 1.3 1.4 1.5 2.1 2.2 2.3 2.4 2.5 3.1 3.2 3.3 3.4 3.5 4.1 4.2 4.3 4.4 4.5 5.1 5.2 5.3 5.4 5.5 Ali 2022 1 1 1 1 1 5 (100%) Al Ketbi 2018 1 1 1 1 1 5 (100%) Al Sabbah 2022 1 1 1 1 1 5 (100%) Al-Shahwan 2020 1 1 1 1 1 5 (100%) Cheikh Ismail 2022 1 1 1 1 1 5 (100%) Gardner 2015 1 1 1 1 1 5 (100%) Gardner 2018 1 1 1 1 1 5 (100%) Kaushal 2022 1 1 1 0 1 4 (80%) Omar 2022 1 1 1 1 1 5 (100%) Radwan 2013 1 1 1 1 1 5 (100%) Radwan 2021 1 1 1 1 1 5 (100%) Radwan 2016 1 1 1 1 1 5 (100%) Taha 2018, 2019, 2020, 2020a, 2021, 2022, 2022 a 1 1 1 1 1 5 (100%) *1 awarded for yes, 0 awarded for no Table 4 Breastfeeding Rates Study Author, Year Emirate Nationality Total N (%) Prenatal Intention to Breastfeed n (%) Initiating Breastfeeding n (%) EBF at 3 months n (%) ABF at 3 months n (%) EBF at 6 months n (%) ABF at 6 months n (%) EBF at 12 months n (%) ABF at 12 months n (%) Ali 2022 Northern Emirates (Ajman, Umm Al Quwain, Al Fujairah, Ras Al Khaimah UAE Nationals and Non-Nationals 475 (100%) Not reported 222 (47%) Not reported Not reported 222 (47%) 440 (93%) Not reported Not reported Al Ketbi 2018 Abu Dhabi UAE Nationals and Non-Nationals 354 (100%) Not reported 193 (55%) Not reported Not reported 46 (13%) Not reported Not reported Not reported Al Sabbah et al, 2022 Dubai and Sharjah Emirati or Arab 858 [492 in Dubai and 366 in Sharjah] (100%) Not reported 214 (26%)* Not reported Not reported Not reported 124 (14%) Not reported as proportion Not reported Al Shahwan 2020 Sharjah and Ajman UAE National and Non National 820 (100%) Not reported Not reported Not reported Not reported Not reported Not reported Not reported Not reported Cheikh Ismail 2020 Dubai, Abu Dhabi and Sharjah UAE National and Non National 276 (100%) Not reported Not reported 135 (45%) (94%) 11 (4%) 185 (67%) 1% 152 (55%) Gardner 2015 Abu Dhabi Emirati National 125 (100%) 116 (93%) 120 (96%) 5 (5%) 88 (70%) 0 (0%) 53 (42%) 0 (0%) ** 26 (21%) ** Kaushal 2022 Dubai UAE National and Non- National n/a Not reported Not reported Not reported Not reported Not reported Not reported Not reported Not reported Omar 2022 Dubai UAE National and Non-National 668 (100%) Not reported 503 (75%) Not reported Not reported Not reported Not reported Not reported Not reported Radwan 2013 Dubai and Abu Dhabi/ Al Ain UAE National 593 (100%) Not reported 583 (98%) Not reported Not reported Not reported Not reported Not reported Not reported Radwan 2016 Dubai, Abu Dhabi and Al Ain UAE National 45 (100%) Not reported 45 (100%) Not reported Not reported Not reported Not reported Not reported Not reported Radwan 2021 Dubai, Abu Dhabi, Sharjah and Al Fujairah UAE National and Non-National 457 (100%) Not reported 316 (69%) 201 (50%) 372 (81%) 100 (22%) 201 (44%) Not reported Not reported Taha 2022 Abu Dhabi UAE National and Non-National 1822 (100%) 1655 (91%) 1741 (96%) Not reported 154 (8%) 27 (1%) Not reported Not reported 8 (0%) *EBF= Exclusive breastfeeding, ABF= Any breastfeeding. Table 5. Meta-analysis for breastfeeding outcomes Outcomes Number of Studies Proportion of Women (%) CI I 2 Breastfeeding outcomes Breastfeeding initiation in one hour 5 studies (25, 33, 38, 39, 40) 62.4 0.45 - 0.78 98.3% Breastfeeding initiation in more than an hour 5 studies (15, 25, 38, 39, 40) 24.6 0.18 - 0.31 93.9% Any breastfeeding at three months 3 studies (15, 25, 40) 72.9 0.42 - 0.96 98.7% Exclusive breastfeeding at six months 3 studies (33, 35, 40) 29.5 0.14 - 0.477 97.5% Any Breastfeeding at six months 2 studies (35, 40) 85.9 0.74 - 0.94 94.3% Supplementary File and Table Supplementary File and Table 1 are not available with this version. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 May, 2025 Read the published version in International Breastfeeding Journal → Version 1 posted Editorial decision: Revision requested 20 Dec, 2024 Reviews received at journal 10 Dec, 2024 Reviews received at journal 03 Dec, 2024 Reviewers agreed at journal 13 Nov, 2024 Reviewers agreed at journal 05 Nov, 2024 Reviewers agreed at journal 04 Nov, 2024 Reviewers invited by journal 02 Nov, 2024 Editor assigned by journal 30 Oct, 2024 Submission checks completed at journal 30 Oct, 2024 First submitted to journal 11 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5245373","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":375420466,"identity":"356e9d8f-31df-4b24-b6c8-2a3a1d950cd3","order_by":0,"name":"MAEVE ANNE O'CONNELL","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYCgAGT72BiBlYEG8Fh42ngMgLRKkaJFIANG4tei2Hz4m8aHmTh4/e/PDx4U7bHjYJJ9f3fCjQIKBv707AZsWszNpaZIzjj0rluw5Zmw880waD5t0TtnNHqDDJM6c3YBVy4EcY2MetsOJG27ksEnzth0GaUm7wQPUYiCRi13L+fefjf/8O5y4H6LlP9BhZ9Ju/sGn5UYO42PGNqAtEmAtB4DeZz92G68tN54ZPuztO5w44wzQL7xtycBAzmG7LWMgwYPTL+eTHxz48e1wYn87MMR42+zk+NmPP7v55o+NHH97L1Yt2ACPAZgkVjkIsD8gRfUoGAWjYBQMfwAA9y1g7Sy9K/EAAAAASUVORK5CYII=","orcid":"","institution":"Fatima College of Health Sciences Abu Dhabi, UAE","correspondingAuthor":true,"prefix":"","firstName":"MAEVE","middleName":"ANNE","lastName":"O'CONNELL","suffix":""},{"id":375420467,"identity":"e579933c-c10c-4f93-977e-ee1b8e6a0db2","order_by":1,"name":"Shahla Meedya","email":"","orcid":"","institution":"Australian Catholic University","correspondingAuthor":false,"prefix":"","firstName":"Shahla","middleName":"","lastName":"Meedya","suffix":""},{"id":375420468,"identity":"daae1d98-1e42-435f-9ef9-d477fb7fafac","order_by":2,"name":"Jenan Al Baqali","email":"","orcid":"","institution":"Awali Hospital Bahrain","correspondingAuthor":false,"prefix":"","firstName":"Jenan","middleName":"Al","lastName":"Baqali","suffix":""},{"id":375420469,"identity":"c04b91c0-1edf-4e26-9ada-5c42a28cb120","order_by":3,"name":"Kadeeja Alraeesi","email":"","orcid":"","institution":"Fatima College of Health Sciences Abu Dhabi, UAE","correspondingAuthor":false,"prefix":"","firstName":"Kadeeja","middleName":"","lastName":"Alraeesi","suffix":""},{"id":375420470,"identity":"d8d5b7cb-8c36-4c3f-a6da-25cb8f1a5181","order_by":4,"name":"Patricia Leahy-Warren","email":"","orcid":"","institution":"University College Cork","correspondingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"","lastName":"Leahy-Warren","suffix":""}],"badges":[],"createdAt":"2024-10-11 10:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5245373/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5245373/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13006-025-00728-2","type":"published","date":"2025-05-16T15:58:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68849628,"identity":"cee7a1ae-14e7-4f3d-98a7-c02da74789e8","added_by":"auto","created_at":"2024-11-12 16:51:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":99471,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1. \u0026nbsp;Prisma Flowchart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.1.png","url":"https://assets-eu.researchsquare.com/files/rs-5245373/v1/786e5778f350fda93218fbbd.png"},{"id":68849627,"identity":"2d5f043f-5279-48d2-9267-57488f807662","added_by":"auto","created_at":"2024-11-12 16:51:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34916,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1. PRISMA Flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5245373/v1/a75630ff7cc52a8b2762a093.png"},{"id":83068011,"identity":"a5d57b9a-5907-4ed2-afc1-05853abfbc5c","added_by":"auto","created_at":"2025-05-19 16:09:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3203100,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5245373/v1/319da741-eee6-41a2-aadc-70229d7887f1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A systematic review and meta-analysis of breastfeeding rates and practices in the United Arab Emirates (UAE)","fulltext":[{"header":"Statement of Significance","content":"\u003ch2\u003e\u003cstrong\u003eProblem or Issue\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eBreastfeeding is recommended for optimal infant outcomes. Breastfeeding rates are thought to be suboptimal, but actual rates are not known in the UAE.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eWhat is already known\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eCultural, antepartum, intrapartum, and postpartum practices can affect the initiation of breastfeeding. Parity may have an impact on breastfeeding.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eWhat this paper adds\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA pooled estimate of breastfeeding initiation rate as well as estimated exclusive breastfeeding rates at 3 and 6 months and a summary of the evidence regarding influencing factors and practices. Highlights the need for extended provision of breastfeeding support in the community postpartum.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eBreastfeeding is widely recognized as the optimal method of infant feeding with short and long term benefits for mother and baby\u0026nbsp;(1, 2). The World Health Organization\u0026nbsp;(3, 4)\u0026nbsp;and United Nations Children’s Fund (UNICEF) recommend initiating breastfeeding within one hour of birth, exclusively breastfeeding (EBF) for at least six months and up to two years\u0026nbsp;(3, 5).\u0026nbsp;EBF has been defined as offering only breast milk including expressed breast milk to infants up to six months of age; with exception of oral rehydration salts, nutritional supplements (vitamins \u0026amp; minerals) and medications if needed (WHO, 2008).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGlobally, breastfeeding has been shown to improve both physical and mental health outcomes for mother and infant, irrespective of the country’s income level\u0026nbsp;(2, 6). The Sustainable Development Goals (SDGs) emphasise the importance of breastfeeding as a preventative measure to save babies' lives (United Nations (UN), 2015)\u0026nbsp;(7). However, the aggressive marketing of formula which often violates the WHO International Code of Marketing of Breastmilk Substitutes, poses a significant challenge to breastfeeding initiation and continuation\u0026nbsp;(8). The latest Lancet breastfeeding Series calls for a collective commitment to improving breastfeeding practices at the population level rather than the responsibility of women\u0026nbsp;(8).\u003c/p\u003e\n\u003cp\u003eIn the United Arab Emirates (UAE), rapid modernisation since its foundation in 1971 has led to shifts in traditional practices, including increased promotion of formula feeding and other infant food. The UAE government, however, has made efforts to prioritise breastfeeding in its national policies. The UAE’s National Strategy 2017-2021 aimed to increase breastfeeding rates from 34% to 50% for infants up to six months(9). Recent media launches introduced the new UAE Nutrition Strategy (2022-2030), which continues to prioritize breastfeeding, although an English version of the strategy is not yet publicly available (10, 11). UAE Federal Law mandates breastfeeding, with provisions for paid maternity leave of ninety days and an allowance of two continuous hours per day for breastfeeding upon return to work for six months\u0026nbsp;(10, 11).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors influencing breastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen’s decision to initiate and continue breastfeeding are influenced by a variety of physical\u0026nbsp;(12)\u0026nbsp;and psychosocial factors\u0026nbsp;(13). A systematic review and meta-analysis of factors influencing breastfeeding in high income countries\u0026nbsp;(12)\u0026nbsp;reported smoking, mode of birth, parity, dyad separation, maternal education, and maternal breastfeeding education for determining initiation and duration of breastfeeding.\u0026nbsp;Moreover, the context of a woman’s life, including her intentions, self-efficacy, and support systems, play a critical role in breastfeeding outcomes (13). However, breastfeeding intention as the strongest predictor of breastfeeding initiation and continuation, can be influenced by women’s attitude, support and advice \u0026nbsp;from family, friends and health professionals, sociocultural norms and social media\u0026nbsp;(11).\u003c/p\u003e\n\u003cp\u003eIn the UAE, breastfeeding is deeply intertwined with religious beliefs and cultural expectations among Muslim women, for whom motherhood and breastfeeding are seen as privileges and religious duties (11). Breastfeeding also offers a natural family planning method through lactational amenorrhea (14). Despite this, exclusive breastfeeding remains suboptimal in the UAE. Historically high breastfeeding rates have declined over the past thirty years, with recent studies showing a prevalence of 44% in Abu Dhabi (15), 31% in Dubai, and 22% in Sharjah (16). According to a review by Taha in 2017\u0026nbsp;(11), a National UAE 1988 infant feeding study reported that 88% of mothers breastfed, but mix feeding has predominated since the 1970s.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA National Survey by MOHAP conducted in 2017-18 reported that 92% of the 2361 women surveyed had ever breastfed (12). However, the survey does not clearly define or calculate breastfeeding practices and notes that 61% of respondents gave birth in the UAE, leaving 39% who did not, which could skew the breastfeeding data specific to the UAE (12). Therefore, the report provides only an estimation rather than an accurate assessment.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003ePurpose of the Review\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThis systematic review aimed to estimate breastfeeding rates and synthesize evidence on factors influencing women’s breastfeeding practices in the UAE. By pooling data from various studies, the review provides evidence to inform policy and planning, potentially guiding interventions to improve breastfeeding rates.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eType of study and registration of protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42023427736) and adheres to the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) statement\u0026nbsp;(2021)\u0026nbsp;(17)\u0026nbsp;to support transparent reporting and aid the reader assess trustworthiness\u0026nbsp;(18).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eInclusion and Exclusion criteria\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThis review was based on studies including adult women over 18 years old who ever breastfed residing in the UAE. We included all published peer-reviewed primary research articles in the English language, including observational studies, cross sectional studies, cohort studies, prevalence studies, case control studies, randomized controlled trials and qualitative studies where data specific to breastfeeding could be extracted.\u0026nbsp;Non-research letters, abstracts and editorials, seminar reviews and case studies/series reporting cases were excluded.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eSearch Strategy and Selection Procedures\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe MEDLINE (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched for relevant articles from 2013 to 1\u003csup\u003est\u003c/sup\u003e August 2023. A search strategy developed with a health librarian (VC) was used (Table 1). Records were imported into ENDNOTE library. Two researchers (MOC and SM) screened the studies and considered eligibility for the review. Reference lists of relevant articles were also hand searched for potential eligible studies.\u003c/p\u003e\n\u003cp\u003eResults were compiled (n=28), and duplicates (n=1) removed (Figure 1). Where there was more than one study on the same cohort of patients (same population), data were extracted from the study that described the whole population rather than a subset\u0026nbsp;(15, 19, 20, 21, 22, 23, 24, 25, 26).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll titles and abstracts were read carefully to confirm if they fulfilled the eligibility criteria. Following this, twenty-one full text articles were retrieved as potentially relevant. Discrepancies were discussed (MOC and SM), and a third reviewer (PLW) was available to help reach consensus. At this stage, two studies were excluded, see Table 2, ‘Characteristics of Included and Excluded Studies’ and the reason noted. Al Ghazal et al 2015 was deemed outside the remit of the review\u0026nbsp;(27). \u0026nbsp;National survey which was located on handsearching\u0026nbsp;(28)\u0026nbsp;was excluded upon discussion since it was not clear which women in the survey gave birth in the UAE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe final list of included studies (n=19) was then verified by two reviewers (MOC and SM). No disagreements arose during this process.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eData extraction\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eTwo reviewers (MOC and SM) independently extracted the following data based on the summary table.\u003c/p\u003e\n\u003cp\u003eThere was no need to consult a third reviewer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAppraisal of methodological quality of studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMethodological quality was assessed using the Mixed Method Appraisal Tool (MMAT) s\u0026nbsp;(29), consisting of seven questions.\u0026nbsp;The reviewers (SM, MOC) independently classified the first two questions which are screening questions about having a clear research question. Then, they classified the other five questions which are more specific based on study design. If the answer to the question was a yes, it scored one point, and if absent, it scored zero\u0026nbsp;(30, 31). The score of 5 was the highest score if the first two screening questions were answered yes, otherwise the appraisal could not be processed for further evaluation (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eFor the prevalence, quantitative analysis was performed where data was available and pooled for a meta-analysis using a random effects model in JBI Summari.\u0026nbsp;The meta-analysis was conducted based on five categories: breastfeeding initiation, any breastfeeding at three, exclusive and any breastfeeding at six months.\u0026nbsp;Effect sizes were expressed as odds ratios with calculated 95% confidence intervals. The presence of heterogeneity was tested using the standard I\u003csup\u003e2\u0026nbsp;\u003c/sup\u003estatisticaltest with a significance level of 90%. A forest plot was created to estimate prevalence of breastfeeding initiation at birth, after one hour, at three months, six months and 12 months (Supplementary files).\u003c/p\u003e\n\u003cp\u003eFor the related factors, narrative findings were synthesized through initially reading and re-reading the studies then using ‘Elicit software’ which is a novel tool designed to assist in evidence synthesis and text extraction (32) to tabulate concepts. Three themes emerged after this analysis. Themes were discussed and agreed between authors and presented as a narrative synthesis.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003e\u003cstrong\u003eCharacteristics of eligible studies\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe search of electronic databases led to the retrieval of 198 study titles, 38 duplicates were removed, resulting in 160 articles. The reading of titles and abstracts led the exclusion of 130 articles. Twenty nine papers were submitted to full text analysis, 19 papers representing 12 studies met eligibility criteria and were included in the present systematic review (15, 16, 19, 20, 21, 22, 23, 24, 25, 26, 33, 34, 35, 36, 37, 38, 39, 40, 41). (Figure 1).\u003c/p\u003e\n\u003cp\u003eOf the twelve studies, one was a retrospective survey\u0026nbsp;(35), nine were cross sectional\u0026nbsp;(16, 25, 26, 33, 34, 36, 38, 39, 41)\u0026nbsp;, one was a quality improvement study\u0026nbsp;(37), and one was a longitudinal cohort study\u0026nbsp;(40). There was one qualitative study\u0026nbsp;(41). Two of the studies published multiple articles. A longitudinal study where women were interviewed at three, six and fifteen months postpartum published 2 articles\u0026nbsp;(25, 26)\u0026nbsp;and a cross sectional multi-centre study which interviewed mothers of infants under the age of two years attending seven primary health centres in Abu Dhabi in 2017 published 7 articles\u0026nbsp;(15, 19, 20, 21, 22, 23, 24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, methodological quality was good, with all studies meeting threshold criteria of 75% (Mean Score 98%). Total number of participants was 6483 and sample sizes ranged from 45 to 1822 (Table 2). All studies included women of mixed parity, both nulliparous and multiparous. Studies consisted of Emirati\u0026nbsp;(15, 16, 25, 33, 34, 35, 36, 37, 38, 39, 40, 41)\u0026nbsp;and Non-Emirati women\u0026nbsp;(33, 34, 35, 36, 37, 38, 40).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFactors that impact breastfeeding practices in the UAE\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eFollowing data analysis, three themes were identified: (1)\u0026nbsp;supportive factors with\u0026nbsp;balancing traditional practices; (2) health service provision for breastfeeding; and 3) socioeconomic influences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupportive factors with balancing traditional practices and modern recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupportive factors included strong perceived breastfeeding support from family and friends (29, 41) rooming-in to support night-time breastfeeding and not being offered formula in hospitals, alongside staff education of women on breastfeeding benefits (34, 36, 39, 40, 41) with routine and timely follow-up (36, 38, 39). Religious and cultural norms encourage women to breastfeed (34, 40, 42) and women perceive it to be clean and easy to prepare (34). However, support is often lacking, such as insufficient maternity leave or workplace breastfeeding facilities\u0026nbsp;(33).\u003c/p\u003e\n\u003cp\u003eLiving with extended family can be challenging, especially when elders’ advice conflicts with breastfeeding practices\u0026nbsp;(41).\u0026nbsp;Some grandmothers and mothers-in-law provide pre-lacteal feeds and additional foods like cereals, reinforcing the belief that mothers lack sufficient breastmilk\u0026nbsp;(39). Nevertheless, family members, particularly husbands, are key sources of information and support for breastfeeding surpassing health professionals\u0026nbsp;(25, 41). However, concerns regarding low milk supply and insufficient breastmilk lead to the introduction early complementary feeding (33). This is also compounded by the belief that infants could be thirsty in a hot climate and thus water is offered rather than breastmilk\u0026nbsp;(41). Furthermore,\u0026nbsp;traditional cultural practices that do not support exclusive breastfeeding are challenging for women. For example, offering infants substances such as honey, herbal infusions, tea, yogurt, dates, and water during the first few hours and days of an infant's life are practices rooted in cultural beliefs and customs (28). Cross-nursing and wet-nursing, where infants are fed by women who are not their mother, add complexity to exclusive breastfeeding. While these practices provide breastmilk and are culturally acceptable, working mothers who lack this support may resort to mixed feeding with formula\u0026nbsp;(14, 28), potentially leading to early cessation of breastfeeding.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eHealth service provision for breastfeeding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eHealth service provision of support for exclusive breastfeeding was evident; the\u0026nbsp;Ministry of Health issued an infant feeding policy which recommends six months of exclusive breastfeeding (39). Furthermore, many hospitals have BFHI accreditation, with an expectation of rooming in as part of the local policy in line with this\u0026nbsp;(11, 37).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll those around the woman who give support- husband, family, friends, and maid were influential to breastfeeding outcomes. The primary source of breastfeeding support was from family and household maid\u0026nbsp;(25, 41). Lack of awareness about the importance of exclusive breastfeeding or recommended duration was common\u0026nbsp;(41). While support from husbands is helpful, men are usually not fully involved in infant feeding\u0026nbsp;(41).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, public perception of health care providers are not as supportive as their family\u0026nbsp;(37, 39).\u0026nbsp;Barriers include healthcare staff's insufficient knowledge, lack of rooming-in policies, and routine offering of formula, which undermine breastfeeding efforts (38, 40).\u003c/p\u003e\n\u003cp\u003eCommon issues affecting the initiation of breastfeeding include insufficient skin to skin contact, delayed first breastfeeding session and lack of rooming-in\u0026nbsp;(19, 22, 37, 38).\u0026nbsp;Additionally medical interventions such as Caesareans or separation from the baby at birth often contribute to delays in starting breastfeeding \u0026nbsp;(19, 22, 38). These practices impact the ability to establish a successful breastfeeding relationship early on.\u003c/p\u003e\n\u003cp\u003eSome mothers reluctance to ‘room in’ posed difficulties in implementing baby-friendly policies in hospitals\u0026nbsp;(37). This reluctance often stemmed from cultural expectations.\u003c/p\u003e\n\u003cp\u003eSupport from healthcare professionals is crucial, yet there is a shortage of midwives who are key in providing breastfeeding support in various settings (34, 43). The lack of follow-up support after hospital discharge further hinders sustained breastfeeding (28, 29).\u003c/p\u003e\n\u003cp\u003eThese themes illustrate the complex factors contributing to delayed breastfeeding initiation in the UAE, emphasizing the need for targeted interventions in hospital practices and policy implementation to support early breastfeeding.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eSocioeconomic influences\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eFour studies were encompassed in this theme\u0026nbsp;(19, 22, 36, 37)\u0026nbsp;covering issues such as older mother age, maternal obesity, Caesarean, high income, education, and employment. Breastfeeding challenges are exacerbated by maternal obesity. Maternal obesity was associated with delayed initiation\u0026nbsp;(22, 36). The increasing preference for Caesarean was noted and the implications of this on early initiation of breastfeeding need to be considered\u0026nbsp;(19, 22).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeta-Analysis Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith regards to estimates of breastfeeding rates, the prevalence of breastfeeding initiation within the first hour of birth were\u0026nbsp;62% (95% CI: [0.45 - 0.78], \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 98.3%) (n=2009)\u0026nbsp;(25, 33, 38, 39, 40)\u0026nbsp;(Table 5).\u0026nbsp;\u0026nbsp;Pooled data from a different 5 studies indicated an estimated prevalence of 25% (95% CI: [0.18-0.31], \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 93.9%) of women who initiated breastfeeding after one hour post birth\u0026nbsp;(15, 25, 38, 39, 40)(n = 3565). Exclusive breastfeeding rates at three months were reported in only two studies which were 5%,\u0026nbsp;(25)(n=94) and 50%\u0026nbsp;(40)(n=399). Pooled data from three studies(15, 25, 40)\u0026nbsp;(n=851) indicated an estimated rate of 73% of women with any breastfeeding at three months (95% CI: [0.42 - 0.96], I2 = 98.7%). At six months, the rates of exclusive breastfeeding were pooled from three studies\u0026nbsp;(33, 35, 40)\u0026nbsp;(n=1121) and the estimate was 29.5% (95% CI: [0.14, 0.477], I\u003csup\u003e2\u003c/sup\u003e = 97.5%). Estimated any breastfeeding rates at six months were 85.9% (95% CI: [0.74 - 0.94], \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 94.3%)\u0026nbsp;(35, 40)\u0026nbsp;(n=849)\u0026nbsp;(33, 35, 40). One study reported any breastfeeding rate which was 50% at 12 months postpartum\u0026nbsp;(25)\u0026nbsp;(n=52).\u0026nbsp;Considering that definitions of breastfeeding vary across studies in our review, making comparisons more difficult\u0026nbsp;(Supplementary Table 1).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eReasons for Cessation\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOverall, the most common reasons for stopping breastfeeding were perceived insufficient breastmilk production and inadequate maternity leave\u0026nbsp;(33, 34, 36, 37, 40). Other factors were lack of husband support\u0026nbsp;(33), new pregnancy and that the infant weaned itself\u0026nbsp;(25, 34, 39). Poor infant weight gain and infant feeding issues were highlighted\u0026nbsp;(25, 35, 38). Sore or cracked nipples, pain and impaired infant sucking were also cited as reasons for cessation of breastfeeding in the studies\u0026nbsp;(19, 22, 34, 35, 38). Early cessation was found to be related to the need to return to work\u0026nbsp;(19, 34)\u0026nbsp;and having insufficient time during the workday for breastfeeding\u0026nbsp;(33). Other reasons for cessation were a personal decision, doctor or pharmacist advice, artificial milk advertisements (media)\u0026nbsp;(34).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMore reasons for cessation were being advised not to breastfeed due to taking medications (34, 38), breastfeeding being too tiring or inconvenient or wanting to go on a weight loss diet (38). Lack of lactational amenorrhea and using contraception were also linked to mix feeding and early cessation (16).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first systematic review and meta-analysis, to our knowledge, conducted to analyze breastfeeding practice in the UAE. \u0026nbsp; Our review found a 62% rate of early breastfeeding initiation in the UAE which is similar in both developed and developing countries\u0026nbsp;(33, 42). Our review found a 29.5% rate of exclusive breastfeeding at six months in the UAE, which is considered fair by WHO definitions (as 0-11% as poor, 12-49% fair, 50-89% good and 90-100% very good)\u0026nbsp;(43). Our review synthesizes evidence on what factors influences women's breastfeeding practices in the UAE. We compared our results with previous reviews, one review of the Middle East\u0026nbsp;(44), Gulf Coop Countries (GCC)\u0026nbsp;(45)\u0026nbsp;and Saudi Arabia\u0026nbsp;(42). Our findings were similar to the findings of Alzaheb et al who described factors associated with breastfeeding in the Middle East; mode of delivery, maternal employment, rooming-in, parity, pre-lacteal feeding, and other factors such as pregnancy planning, infants sex, breastfeeding substitute advertisements and night feeding\u0026nbsp;(44)\u0026nbsp;(45)\u0026nbsp;(42).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe cultural tradition of introducing other fluids such as honey and water can interfere with breastfeeding\u0026nbsp;(12, 45). Including family and friends in prenatal education is essential as women often rely on their advice and support\u0026nbsp;(23). The GCC review recommended implementing BFHI policies and conducting country-specific studies to enhance breastfeeding knowledge in the region\u0026nbsp;(45). Ensuring that hospital staff do not introduce formula milk is important. \u0026nbsp;Participatory Action Research (PAR) has been suggested as one method to drive change in clinical areas\u0026nbsp;(46).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnderstanding cultural dynamics is crucial for midwives to effectively support and educate mothers\u0026nbsp;(47, 48). Cultural competence involves tailoring interventions to fit the cultural contexts of patients served\u0026nbsp;(47, 48). In the UAE, religious expectations, and legal mandates for breastfeeding for two years, yet many women are unaware of these supports (34). Midwives should integrate cultural and legal knowledge, inform mothers about supportive factors, and dispel myths with evidence-based information that respects cultural beliefs. Involving husbands, mothers-in-law, and other key figures in breastfeeding discussions can create a more supportive environment and improve adherence to recommended practices. Culturally competent midwives build trust and improve communication with patients\u0026nbsp;(49). However, the shortage of midwives in the UAE\u0026nbsp;(50)\u0026nbsp;affects infant feeding support, highlighting the need for midwifery education to include culturally appropriate care skills to ensure high-quality, respectful care in diverse settings\u0026nbsp;(49).\u003c/p\u003e\n\u003cp\u003eThe review identified returning to work as a major barrier to continued breastfeeding, underscoring the need for more research on the experiences of working women in the UAE. Non-supportive work environments are a common obstacle impeding breastfeeding efforts\u0026nbsp;(7, 45, 51). While the cohort study\u0026nbsp;(40)\u0026nbsp;does not explicitly mention reasons for cessation of breastfeeding, it discusses the association between continued and exclusive breastfeeding at six months with factors such as breastfeeding self-efficacy, postpartum depression, and maternal employment. These findings suggest a critical need for interventions to address these issues, providing additional support for breastfeeding mothers. A lack of nurseries in most places of employment was identified as a barrier to continuing breastfeeding\u0026nbsp;(16). Without convenient access to childcare facilities, working mothers face difficulties in maintaining breastfeeding which may lead to early weaning. Implementing workplace policies which are supportive of breastfeeding such as designated lactation rooms and flexible breaks for breastfeeding mothers could mitigate these issues. Targeted research and interventions addressing the unique needs of working mothers in the UAE is needed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA 2023 systematic review of Saudi women’s breastfeeding practices\u0026nbsp;(42)\u0026nbsp;identified common reasons for stopping breastfeeding such as misconceptions around breastmilk sufficiency and returning to work. In contrast, UAE studies suggest educating the whole family, not just childbearing women, is crucial. Unlike Saudi Arabia, where formula feeding and stopping for contraceptive use were noted, these were less prevalent in the UAE\u0026nbsp;(42). Theoretical approaches in interventions, incorporating familial \u0026nbsp; and social factors, may enhance breastfeeding self-efficacy and intention\u0026nbsp;(52, 53). Future educational programs should incorporate the theories of breastfeeding self-efficacy and planned behaviour to promote sustained breastfeeding practices\u0026nbsp;(53). For instance, a Saudi Arabian study (n= 290), found that a tailored online intervention based on behaviour change models tripled exclusive breastfeeding rates at one month postpartum (66 % vs. 26 %, p-value \u0026lt;.001)\u0026nbsp;(42). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEducation on key breastfeeding practices such as rooming in, avoiding formula and early initiation is crucial. The review highlights the need for breastfeeding support to extend beyond hospitals into the community, addressing the current lack of support after discharge (28, 29).\u003c/p\u003e\n\u003cp\u003eMore research is needed on the experiences of women returning to work while breastfeeding is in the UAE, as current evidence is limited. Although small studies exist, a National Infant Feeding survey is lacking. A National Infant Feeding survey would provide accurate data, particularly in the Northern Emirates and rural areas, enabling targeted intervention. The review by Al Nuaimi et al recommended regular updates of key indicators of breastfeeding in each country of the GCC\u0026nbsp;(45).\u003c/p\u003e\n\u003cp\u003eDeveloping education in relation to informed choice for Caesarean is a recommendation\u0026nbsp;(22)\u0026nbsp;since Caesarean birth may delay breastfeeding initiation and shorten exclusive breastfeeding duration and is considered the most significant factor influencing breastfeeding success\u0026nbsp;(54).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe main limitation is type of study found. The studies were mainly cross sectional conducted at one time point and used non standardized data collection methods. Our review revealed a lack of studies specifically exploring nulliparous women and their breastfeeding experiences and needs. All studies retrieved had a mixed parity study population. Nulliparous and parous women may have different needs in relation to breastfeeding practices\u0026nbsp;(55). This is an area which warrants further exploration in the UAE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudies conducted at various timepoints would yield more valuable information about breastfeeding prevalence. Most studies were conducted in the capital – Abu Dhabi. There may be cultural nuances observed in more rural areas of the UAE which would be beneficial to understand. Further research is required in the Northern Emirates and rural areas.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis systematic review and meta-analysis, highlight good early breastfeeding rates in the UAE, but only fair exclusive breastfeeding rates at six months. To improve these rates, targeted interventions should address the various factors influencing breastfeeding. Key strategies include integrating cultural competence into midwifery education, involving family members in education and addressing workplace barriers. Focusing on these areas in future research and interventions is essential to support breastfeeding mothers and achieve WHO targets.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo ethical statement is required for a review of the literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors agree/ consent to publish.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated during this review are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author (s) declared no potential conflicts of interests with respect to research, authorship or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo financial support was received for this research or authorship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMOC/SM/PLW conceptualised the study, MOC/SM/ JA search, JA/KA data extraction, SM/MOC meta-analysis, original/ first draft MOC/SM, all authors reviewed and edited the final draft, PLW- Supervision/ Mentorship of the team, MOC Project Administration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors acknowledge this as original work. This manuscript has not been previously published and is not considered for publication elsewhere. All authors have seen and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e*Corresponding Author: Dr Maeve Anne O\u0026rsquo;Connell, Assistant Professor of Midwifery, Midwifery Department, Fatima College of Health Sciences, Abu Dhabi, Unites Arab Emirates. Email: [email protected] Research Interest: Perinatal Mental Health, Fear of Childbirth, Breastfeeding.\u003c/p\u003e\n\u003cp\u003eDr Shahla Meedya, Australian Catholic University, Sydney, Australia. Email: [email protected] Research Interest: Breastfeeding and Perinatal Mental Health\u003c/p\u003e\n\u003cp\u003eJenan Albaqali, Staff Nurse, Awali Hospital, Bahrain. Email: [email protected] Research Interest: Novice researcher\u003c/p\u003e\n\u003cp\u003eKadeeja Alraeesi, Student Midwife, Midwifery Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates. Email: [email protected] Research Interest: Novice Researcher\u003c/p\u003e\n\u003cp\u003eProf Patricia Leahy-Warren, Head of School of Nursing and Midwifery, University College Cork, Ireland. Research Interest: Breastfeeding, Parental and child health in the Community, and Perinatal Mental Health\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBinns C, Lee M, Low WY. The long-term public health benefits of breastfeeding. Asia Pacific Journal of Public Health. 2016;28(1):7-14.\u003c/li\u003e\n\u003cli\u003eMortensen EL. Life course consequences of breastfeeding. The Lancet Global Health. 2015;3(4):e179-e80.\u003c/li\u003e\n\u003cli\u003eBinns CW, Lee MK. 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Midwifery. 2014;30(3):e137-e44.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Search Strategy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKeywords:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e#1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026quot;United Arab Emirate*\u0026quot;[All Fields] OR \u0026quot;UAE\u0026quot;[All Fields] OR \u0026quot;Emirates\u0026quot;[All Fields]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e#2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;breastfeed*\u0026rdquo;[All Fields] OR \u0026ldquo;breast-feed*\u0026rdquo;[All Fields] OR \u0026ldquo;breast feed*\u0026rdquo;[All Fields]OR \u0026ldquo;infant feeding\u0026rdquo;[All Fields] OR \u0026ldquo;infant and young child feeding\u0026rdquo;[All Fields] OR \u0026ldquo;lactation\u0026rdquo; [All Fields]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e#3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;duration\u0026rdquo;[All Fields] OR \u0026ldquo;experience\u0026rdquo;[All Fields] OR \u0026ldquo;support\u0026rdquo;[All Fields] OR \u0026ldquo;initiation\u0026rdquo;[All Fields] OR \u0026ldquo;intervention\u0026rdquo;[All Fields] OR \u0026ldquo;education\u0026rdquo;[All Fields] OR \u0026ldquo;advice\u0026rdquo;[All Fields] OR \u0026ldquo;rate\u0026rdquo;[All Fields] OR \u0026ldquo;service*\u0026rdquo;[All Fields]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e#4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e#1 AND #2 AND #3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2. Study characteristics of included and excluded studies\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Author, Year\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDesign\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Setting\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal N\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIncluded studies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e1\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAli et al, 2022\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAli HI, Magriplis E, Attlee A, Al Dhaheri AS, Cheikh Ismail L, Stojanovska L. Feeding Practices of Infants and Toddlers by Their Mothers in Selected Northern Emirates of the United Arab Emirates. Nutrients. 2022;14(18).\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRetrospective survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eThe Community\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[Emails with a link to the participant information sheet were sent to university students, informing them of the research and encouraging assistance to recruit family, friends, and community members that met the inclusion criteria (snowball design).\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTo increase randomization and minimize selection bias, messages containing online promotion of the survey were sent through social media (including WhatsApp\u0026trade;, frequently used by this population) to undisclosed recipients lists to inform the targeted community.]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e2\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAl Ketbi et al, 2018\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAl Ketbi MI, Al Noman S, Al Ali A, Darwish E, Al Fahim M, Rajah J. Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates. Int Breastfeed J. 2018;13:26.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross Sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFour primary health centers in Abu Dhabi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e3\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAl Sabbah et al, 2022\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAl Sabbah H, Assaf EA, Taha Z, Qasrawi R, Radwan H. Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates. Front Nutr. 2022;9:872217.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross Sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOutpatient clinics in four hospitals and four health centers in Sharjah and Dubai, UAE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e858\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e4\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAl Shahwan et al, 2020\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAl-Shahwan MJ, Gacem SA, Hassan N, Djessas F, Jairoun AA, Al-Hemyari SS. A Study to Identify the Most Common Reasons to Wean among Breastfeeding Mothers in UAE. J Pharm Bioallied Sci. 2020;12(1):72-6.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross Sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e5\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCheikh Ismail et al, 2020\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCheikh Ismail L, Al Dhaheri AS, Ibrahim S, Ali HI, Chokor FAZ, O\u0026apos;Neill LM, et al. Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9\u0026thinsp;months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020. BMC Public Health. 2022;22(1):319.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePopulation-based cross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrimary health care centers and outpatient clinics at hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e6\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGardner et al, 2015\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGardner H, Green K, Gardner A. Infant Feeding Practices of Emirati Women in the Rapidly Developing City of Abu Dhabi, United Arab Emirates. Int J Environ Res Public Health. 2015;12(9):10923-40.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTertiary Hospital: Postnatal Ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e7\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGardner 2018\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGardner H, Green K, Gardner AS, Geddes D. Observations on the health of infants at a time of rapid societal change: a longitudinal study from birth to fifteen months in Abu Dhabi. BMC Pediatr. 2018;18(1):32.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTertiary Hospital: Postnatal Ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e125*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e8\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKaushal et al, 2022\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKaushal M, Sasidharan K, Kaushal A, Augustine P, Alex M. Increasing the exclusive breastfeeding rate in a private hospital in UAE through quality improvement initiatives. J Neonatal Perinatal Med. 2022;15(1):179-86.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQuality improvement prospective study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHospital in Dubai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e9\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOmar et al, 2022\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOmar AA, Abdul Hakeem S, Kahloon HB, Alhashmi A, AlSaadi RA, Carrick FR, et al. Factors associated with knowledge and practice of optimal breastfeeding among mothers in Dubai. Int J Health Plann Manage. 2022;37(2):963-78.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 Primary Health Centers in Dubai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e10\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRadwan 2013\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan H. Patterns and determinants of breastfeeding and complementary feeding practices of Emirati Mothers in the United Arab Emirates. BMC Public Health. 2013;13:171.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrimary Health Care Centers in Abu Dhabi, Al Ain and Dubai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e593\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e11\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRadwan et al 2016\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan H, Sapsford R. Maternal Perceptions and Views About Breastfeeding Practices Among Emirati Mothers. Food Nutr Bull. 2016;37(1):73-84.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQualitative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMaternal and Child Health, and Public Health Centers (PHC) in Abu Dhabi, Dubai and Al Ain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e12\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRadwan et al 2021\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan H, Fakhry R, Metheny N, Baniissa W, Faris M, Obaid RS, et al. Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study. Int Breastfeed J. 2021;16(1):79.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProspective cohort\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMaternity wards of ten hospitals in four Emirates (Abu Dhabi, Dubai, Sharjah, and Fujairah).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e13\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTaha et al 2018\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTaha Z, Garemo M, Nanda J. Patterns of breastfeeding practices among infants and young children in Abu Dhabi, United Arab Emirates. Int Breastfeed J. 2018;13:48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeven governmental community and healthcare centers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efrom diverse geographic areas of Abu Dhabi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1822*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e14\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTaha et al 2019\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTaha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Prevalence and Associated Factors of Caesarean Section and its Impact on Early Initiation of Breastfeeding in Abu Dhabi, United Arab Emirates. Nutrients. 2019;11(11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeven governmental community and healthcare centers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efrom diverse geographic areas of Abu Dhabi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1624*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e15\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTaha et al 2020\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTaha Z, Ali Hassan A, Wikkeling-Scott L, Eltoum R, Papandreou D. Assessment of Hospital Rooming-in Practice in Abu Dhabi, United Arab Emirates: A Cross-Sectional Multi-Center Study. Nutrients. 2020;12(8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeven governmental community and healthcare centers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efrom diverse geographic areas of Abu Dhabi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1822*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTaha et al 2020 a\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTaha Z, Garemo M, Nanda J. Complementary feeding practices among infants and young children in Abu Dhabi, United Arab Emirates. BMC Public Health. 2020;20(1):1308.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeven governmental community and healthcare centers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efrom diverse geographic areas of Abu Dhabi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1822*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e17\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTaha et al 2021\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTaha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi, the United Arab Emirates. Int J Womens Health. 2021;13:539-48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeven governmental community and healthcare centers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efrom diverse geographic areas of Abu Dhabi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1822*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e18\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTaha et al 2022\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTaha Z, Al Dhaheri AI, Wikkeling-Scott L, Ali Hassan A, Papandreou D. Determinants of Delayed Initiation of Breastfeeding: A Cross-Sectional Multicenter Study in Abu Dhabi, the United Arab Emirates. Int J Environ Res Public Health. 2022;19(15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeven governmental community and healthcare centers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efrom diverse geographic areas of Abu Dhabi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1822*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e19\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTaha et al 2022 a\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTaha Z, Garemo M, El Ktaibi F, Nanda J. Breastfeeding Practices in the United Arab Emirates: Prenatal Intentions and Postnatal Outcomes. Nutrients. 2022;14(4).\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCross sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeven governmental community and healthcare centers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efrom diverse geographic areas of Abu Dhabi.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1799*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eExcluded studies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason for exclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e1\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMOHAP 2018\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUAE MoHaP. National Health Survey 2017/2018. MOHAP. 2018.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNational Survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNot a peer reviewed publication and available data was estimated. Not clear which women in the survey gave birth in the UAE.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e2\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAl Ghazal 2015\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAl Ghazal, H., Rashid, S., \u0026amp; Ruf, E. (2015). The Sharjah baby-friendly campaign: a community-based model for breastfeeding promotion, protection, and support.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eBreastfeeding Medicine\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e, \u003cem\u003e10\u003c/em\u003e(9), 437-441.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth Promotion Report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWas not eligible upon reading the full text, presents results of a health promotion campaign rather than breastfeeding practices or prevalence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*where multiple publications from the same study included, the largest subset was counted as the study population\u003c/p\u003e\n\u003cp\u003eTable 3. Results of Quality Appraisal using the Mixed Methods Appraisal Tool (MMAT)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIncluded Year\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"25\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCriteria from the Mixed Methods Appraisal Tool (MMAT)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall \u0026nbsp; \u0026nbsp; Appraisal Value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAli\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAl Ketbi\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAl Sabbah\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAl-Shahwan\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCheikh Ismail\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGardner\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGardner\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKaushal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOmar\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan 2021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan 2016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTaha\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2018, 2019, 2020,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2020a,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2021,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*1 awarded for yes, 0 awarded for no\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Breastfeeding Rates\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Author, Year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmirate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNationality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrenatal Intention to Breastfeed\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitiating Breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBF at 3 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eABF at 3 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBF at 6 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eABF at\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEBF at 12 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eABF\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eat 12 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAli\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNorthern Emirates (Ajman, Umm Al Quwain, Al Fujairah, Ras Al Khaimah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE Nationals and Non-Nationals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e475 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e222 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e222 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e440 (93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAl Ketbi 2018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbu Dhabi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE Nationals and Non-Nationals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e354 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e193 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAl Sabbah et al, 2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDubai and Sharjah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmirati or Arab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e858\u003c/p\u003e\n \u003cp\u003e[492 in Dubai and 366 in Sharjah] (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e214 (26%)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported as proportion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAl Shahwan 2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSharjah and Ajman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National and Non National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e820 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCheikh Ismail 2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDubai, Abu Dhabi and Sharjah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National and Non National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e276 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e135 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e(94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e185 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e152 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGardner 2015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbu Dhabi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmirati National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e125 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e116 (93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120 (96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26 (21%)\u003c/p\u003e\n \u003cp\u003e**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKaushal \u0026nbsp;2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDubai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National and Non- National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOmar 2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDubai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National and Non-National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e668 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e503 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan 2013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDubai and Abu Dhabi/ Al Ain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e593 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e583 (98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan 2016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDubai, Abu Dhabi and Al Ain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadwan 2021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDubai, Abu Dhabi, Sharjah and Al Fujairah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National and Non-National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e457 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e316 (69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e201 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e372 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e201 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTaha 2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbu Dhabi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUAE National and Non-National\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1822 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1655 (91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1741 (96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e154 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*EBF= Exclusive breastfeeding, ABF= Any breastfeeding.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Meta-analysis for breastfeeding outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"79%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Number of\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStudies\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion of Women \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Breastfeeding outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39%;\"\u003e\n \u003cp\u003eBreastfeeding initiation in one hour\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e5\u0026nbsp;studies\u0026nbsp;(25, 33, 38, 39, 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e0.45 - 0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e98.3%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39%;\"\u003e\n \u003cp\u003eBreastfeeding initiation in more than an hour\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e5\u0026nbsp;studies\u0026nbsp;(15, 25, 38, 39, 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e0.18 - 0.31\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e93.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39%;\"\u003e\n \u003cp\u003eAny breastfeeding at three months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e3 studies\u0026nbsp;(15, 25, 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e72.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e0.42 - 0.96\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e98.7%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39%;\"\u003e\n \u003cp\u003eExclusive breastfeeding at six months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e3 studies (33, 35, 40)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e0.14 - 0.477\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e97.5%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39%;\"\u003e\n \u003cp\u003eAny Breastfeeding at six months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e2 studies\u0026nbsp;(35, 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e85.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15%;\"\u003e\n \u003cp\u003e0.74 - 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e94.3%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Supplementary File and Table","content":"\u003cp\u003eSupplementary File and Table 1 are not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-breastfeeding-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ibfj","sideBox":"Learn more about [International Breastfeeding Journal](http://internationalbreastfeedingjournal.biomedcentral.com/)","snPcode":"13006","submissionUrl":"https://submission.nature.com/new-submission/13006/3","title":"International Breastfeeding Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5245373/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5245373/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary objectives of this study were to estimate breastfeeding rates, identify factors influencing breastfeeding, and explore breastfeeding practices among women in the United Arab Emirates (UAE).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSystematic review and meta-analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA systematic review and meta-analysis of relevant published peer-reviewed literature in the MEDLINE (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases from 2013 to 1st August 2023. When statistical pooling was not possible, results were synthesized narratively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwelve studies were included. Pooled data from five studies (n=2009) indicated that 62% of women initiated breastfeeding within the first hour after birth (95% CI: [0.45 - 0.78], I2 = 98.3%). At three months, pooled data from three studies (n=851) showed that 73% of these women were still breastfeeding (95% CI: [0.42 - 0.96], I2 = 98.7%). At six months, the rate of exclusive breastfeeding, based on pooled data from three studies (n=1121), was 29.5% (95% CI: [0.14 - 0.477], I2 = 97.5%). Significant heterogeneity was observed, suggesting that the results should be interpreted with caution. Three key themes emerged from the analysis: (1) balancing supportive factors with traditional practices, (2) the role of health service provision in breastfeeding, and (3) the influence of socioeconomic factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review highlights the importance of integrating cultural competence into healthcare strategies to better support breastfeeding mothers. Additionally, a national infant feeding survey is recommended to address the existing knowledge gaps in the UAE.\u003c/p\u003e","manuscriptTitle":"A systematic review and meta-analysis of breastfeeding rates and practices in the United Arab Emirates (UAE)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-12 16:51:39","doi":"10.21203/rs.3.rs-5245373/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-20T15:32:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-10T09:11:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-03T21:49:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66451382439179680543402623253441443798","date":"2024-11-13T15:08:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43298897222363613440970562231380958944","date":"2024-11-05T15:10:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126836324098865796955059067354966051587","date":"2024-11-04T17:13:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-02T16:27:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-30T19:25:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-30T19:24:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Breastfeeding Journal","date":"2024-10-11T10:26:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-breastfeeding-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ibfj","sideBox":"Learn more about [International Breastfeeding Journal](http://internationalbreastfeedingjournal.biomedcentral.com/)","snPcode":"13006","submissionUrl":"https://submission.nature.com/new-submission/13006/3","title":"International Breastfeeding Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f90c5d97-1090-43c5-8a03-faa04859d25a","owner":[],"postedDate":"November 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T16:05:29+00:00","versionOfRecord":{"articleIdentity":"rs-5245373","link":"https://doi.org/10.1186/s13006-025-00728-2","journal":{"identity":"international-breastfeeding-journal","isVorOnly":false,"title":"International Breastfeeding Journal"},"publishedOn":"2025-05-16 15:58:12","publishedOnDateReadable":"May 16th, 2025"},"versionCreatedAt":"2024-11-12 16:51:39","video":"","vorDoi":"10.1186/s13006-025-00728-2","vorDoiUrl":"https://doi.org/10.1186/s13006-025-00728-2","workflowStages":[]},"version":"v1","identity":"rs-5245373","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5245373","identity":"rs-5245373","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}