الفهرس 
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Abstract
In Egypt the distribution of feeding modalities of neonates in neonatal intensive care units (NICU) have not be surveyed. Furthermore the effect of different feeding patterns in neonatal intensive care units and the different marketing tactics used by infant milk formula companies to the staff and parents to offer these formulas are not clearly defined.
Also the differences in health outcomes of neonates according to feeding modality are not documented. Such data is important in order to study the cost effectiveness of most feeding modality to assist us in designing interventions for improving neonatal health in Egypt.
So, the present study was designed to study NICU practices regarding the effect of marketing practices on the mode of feeding, growth and the health outcomes of neonates in these NICUs.
The Selected governorates for the study included Zagazig -Elmansoura –Damieta. We identified the NICUs meeting inclusion criteria inside each of the selected governorates (totalling 61 NICUs) so that they may be representative of the different sectors of service delivery in the country including the Ministry of Health (MoH) hospitals, Insurance hospitals and private hospitals.
All neonates present at time of the visit of each (NICU) were included in the study in line with the criteria adopted by the study investigators.
The studied group comprised 367 who received only expressed breast milk or/and breastfeeding, 328 fed only infant milk formula (IMF) and 205 received mixed breast milk and artificial cow’s based formula feeds. They comprised 484 are male and 416 are female. Infant milk formula feeding was highest in Mansoura NICUs compared to the other two governorates. In Zagazig and Damitta about one half received only expressed breast milk, while one quarter received mixed feeding and another one quarter received only IMF.
Neonates who were fed IMF only (deprived of any breast milk) showed a statistically significantly higher rate of exposure to antibiotics and antiepleptics. Neonates who were fed IMF only had diarrhea, eczema and gastrointestinal distention compared to those on expressed breast milk or partially breast milk fed.
The total expenditure in Mansoura NICUs was significantly higher for the IMF fed group of neonates compared to the NICUs of Damitta and Zagazig. While in Zagazig and Damitta the total expenditure was significantly lower for the breast fed and partially breast milk fed groups.
There was no significant differences in the mode of feeding in the gestational age from 28 to38 weeks.
Marketing practices for promotion IMF practices were significantly higher in Zagazig for furniture and pens. They were significantly higher in Damitta for calendars and pens. where in Mansoura it was significantly higher for gifts as watches, sponsoring of prepaid vacations for doctors and their families and equipment as ceiling fans or air conditons.
Marketing code violations to health staff and health facility (articles 5 and 6) were highest in Mansoura NICUs especially for displays of posters (that mothers could see), calendars and gifts to staff that were used as advertisement in the health facility to promote IMF products of the companies.
The highest company exerting code violation of marketing were present in Mansoura NICUs mostly by Nestle product followed by Nutricia and Whyth and but also by Milupa. While code violation by company was highest by Weyth company in Damitta. Nutricia company also showed significant violations being highest in Mansoura NICUs.