Factors Determining Successful Exclusive Breastfeeding on Working Mothers in Indonesia: An Exploration by Using Positive Deviance Concept

Despite the fact that exclusive breastfeeding brings a lot of benefits for infants and mothers, breastfeeding rates in Indonesia remain low, standing only at 42% of all infants aged 0-5 months in 2012. This study aims to apply the positive deviance concept to explore the factors determining the success of exclusive breastfeeding among mothers in the high risk group in Indonesia. The study uses the cross-sectional, DHS 2017 data on 1.178 mothers with 0-5 months old infants in Indonesia. Chi-square and multiple logistic regression test with 95% confidence intervals are used in identifying the factors associated with exclusive breastfeeding. Maternal employment is shown to be the most significant risk factor in preventing mothers to breastfeed exclusively. Furthermore, the data suggest that, out of 376 working mothers, 45,5% can be identified as positive deviants – those succeeding in implementing exclusive breastfeeding. The study finds ANC visits, PNC visits, and economic status display significant association with exclusive breastfeeding among working mothers. In the sample, ANC visit is the dominant factor associated with exclusive breastfeeding (OR: 1,831; 95% CI: 1,075-3,118). Completion of ANC and PNC visits should be taken to consideration in improving exclusive breastfeeding rate among working mothers in Indonesia

Fulfilment of Minimum Acceptable Diet as Dominant Factor in Wasting in Children Aged 6–23 Months in Central Jakarta, Indonesia, 2019

AbstractWasting is a form of acute malnutrition characterized by significant and rapid weight loss resulting from inadequate food intake and infectious diseases. This study was to investigate the factors associated with wasting in children aged 6–23 months and the dominant factor among these. The study followed a cross-sectional study design. A total sample of 261 children was selected using multistage random sampling from 13 integrated healthcare centres in six administrative villages located in three sub-districts of Central Jakarta. Data was collected by measuring body weight and height and questionnaires completed through interviews carried out by trained data collectors. This study shows that the prevalence of wasting in children aged 6–23 months in Central Jakarta is 6.9%. Based on logistic regression analysis, fulfillment Minimum Acceptable Diet (MAD) (OR=3.2 90% CI 1.1-9.5) was found to be the dominant factor in wasting after controlling by mother's level of education (OR=1.7 90% CI 0.7–4.2) and the level of family income (OR=2.9; 90% CI 0.9-8.9). This research shows that there is a need for improvement of maternal behaviour in providing appropriate care for children. Based on this research, we recommend that intervention on appropriate breastfeeding and complementary feeding practices be strengthened, especially for mothers with low levels of education and family income.AbstrakWasting adalah salah satu bentuk malnutrisi akut yang ditandai dengan penurunan berat badan yang signifikan dan cepat akibat asupan makanan yang tidak memadai dan penyakit infeksi. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan wasting pada anak usia 6-23 bulan dan untuk mengetahui faktor dominan di antaranya. Penelitian menggunakan desain studi cross-sectional. Sampel berjumlah 261 anak dipilih dengan menggunakan multistage random sampling dari 13 puskesmas di enam kelurahan yang berada di tiga kecamatan di Jakarta Pusat. Pengumpulan data dilakukan dengan mengukur berat badan dan tinggi badan serta pengisian kuesioner melalui wawancara yang dilakukan oleh pengumpul data terlatih. Hasil penelitian menunjukkan bahwa prevalensi wasting pada anak umur 6–23 bulan di Jakarta Pusat sebesar 6,9%. Berdasarkan analisis regresi logistik, pemenuhan Minimum Acceptable Diet (MAD) (OR = 3,2 90% CI 1,1-9,5) ditemukan menjadi faktor dominan kejadian wasting selah dikontrol oleh tingkat pendidikan ibu (OR = 1,7 90% CI 0,7– 4.2) dan tingkat pendapatan keluarga (OR = 2.9; 90% CI 0.9-8.9). Penelitian ini menunjukkan perlunya peningkatan perilaku ibu dalam memberikan pengasuhan yang tepat kepada anak. Berdasarkan penelitian ini, kami merekomendasikan agar intervensi praktik pemberian ASI dan MP-ASI yang tepat diperkuat, terutama bagi ibu dengan tingkat pendidikan dan pendapatan keluarga yang rendah

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEPATUHAN IBU MENGONSUMSI TABLET BESI-FOLAT SELAMA KEHAMILAN

ABSTRACTThis review aims at compiling and summarizing findings of published studies that assessed factors associated with compliance of women to take recommended iron tablets during pregnancy. The review is done in 10 published studies (8 are 2002—2010 publications and 2 are 1993—1994 publications) indexed in Pubmed with the above objective. Low utilization of antenatal care/ANC services is found to be associated with low compliance as it prevents the women to receive recommended number of the iron tablets as well as decrease the opportunity of women to have encouragement from health staff to take the tablets. Supply of tablets becomes the issue since not all women receiving 30 tablets/ANC visits as recommended. Studies on influence of side-effects of taking the tablets to compliance show inconclusive findings. Some studies found the effect is very minimal, and can be managed appropriately especially among more educated women and among women with adequate counseling. Studies also indicated that support from family is important to reduce possibility of pregnant women forgot to take the tablets, the other major factor of the low compliance. Quality of counseling, e.g. clarity of the messages, is associated with compliance. In conclusion, improving support from ANC provider (such as sufficient tablet supply, clear message on the tablets benefits) and support from family may contribute to better compliance of women towards maternal iron supplementation.Keywords: compliance, iron supplementation, pregnancyABSTRAKReview ini bertujuan mengumpulkan temuan studi yang mengukur faktor yang berhubungan dengan kepatuhan ibu dalam mengonsumsi tablet besi selama kehamilan. Review dilakukan pada 10 studi (8 publikasi tahun 2002—2010, 2 publikasi tahun 1993—1994) yang terdaftar di Pubmed. Rendahnya partisipasi ibu hamil untuk memeriksakan kehamilannya/ANC berhubungan dengan rendahnya kepatuhan konsumsi tablet besi. Rendahnya kunjungan ANC membuat ibu tidak mendapat tablet dengan jumlah yang cukup dan mengurangi kesempatan ibu untuk mendapat dukungan dari petugas ANC untuk minum tablet besi sesuai anjuran. Suplai tablet juga menjadi penting karena tidak semua ibu mendapat 30 tablet pada setiap kunjungan ANC seperti seharusnya. Pengaruh efek samping konsumsi tablet besi terhadap kepatuhan ibu belum dapat disimpulkan. Pengaruh efek samping ditemukan sangat kecil dan dapat diatasi dengan baik terutama pada ibu dengan pendidikan yang lebih tinggi atau yang mendapat penyuluhan yang cukup. Studi juga menemukan bahwa dukungan keluarga sangat penting untuk membantu mengingatkan ibu untuk mengonsumsi tablet besi. Hal ini menjadi penting karena salah satu faktor utama rendahnya kepatuhan ibu adalah karena ibu lupa mengonsumsi tablet tersebut. Kualitas penyuluhan, misalnya kejelasan pesan dari petugas kesehatan, berhubungan dengan kepatuhan ibu. Sebagai kesimpulan, dukungan yang lebih baik pada ibu, baik dari petugas ANC (misalnya pemberian tablet besi dalam jumlah yang cukup, kejelasan pesan tentang manfaat tablet) maupun keluarga dapat berkontribusi pada kepatuhan yang lebih baik pada ibu hamil dalam mengonsumsi tablet besi.Kata kunci: kehamilan, kepatuhan, suplementasi tablet bes

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEPATUHAN IBU MENGONSUMSI TABLET BESI-FOLAT SELAMA KEHAMILAN

ABSTRACTThis review aims at compiling and summarizing findings of published studies that assessed factors associated with compliance of women to take recommended iron tablets during pregnancy. The review is done in 10 published studies (8 are 2002—2010 publications and 2 are 1993—1994 publications) indexed in Pubmed with the above objective. Low utilization of antenatal care/ANC services is found to be associated with low compliance as it prevents the women to receive recommended number of the iron tablets as well as decrease the opportunity of women to have encouragement from health staff to take the tablets. Supply of tablets becomes the issue since not all women receiving 30 tablets/ANC visits as recommended. Studies on influence of side-effects of taking the tablets to compliance show inconclusive findings. Some studies found the effect is very minimal, and can be managed appropriately especially among more educated women and among women with adequate counseling. Studies also indicated that support from family is important to reduce possibility of pregnant women forgot to take the tablets, the other major factor of the low compliance. Quality of counseling, e.g. clarity of the messages, is associated with compliance. In conclusion, improving support from ANC provider (such as sufficient tablet supply, clear message on the tablets benefits) and support from family may contribute to better compliance of women towards maternal iron supplementation.Keywords: compliance, iron supplementation, pregnancyABSTRAKReview ini bertujuan mengumpulkan temuan studi yang mengukur faktor yang berhubungan dengan kepatuhan ibu dalam mengonsumsi tablet besi selama kehamilan. Review dilakukan pada 10 studi (8 publikasi tahun 2002—2010, 2 publikasi tahun 1993—1994) yang terdaftar di Pubmed. Rendahnya partisipasi ibu hamil untuk memeriksakan kehamilannya/ANC berhubungan dengan rendahnya kepatuhan konsumsi tablet besi. Rendahnya kunjungan ANC membuat ibu tidak mendapat tablet dengan jumlah yang cukup dan mengurangi kesempatan ibu untuk mendapat dukungan dari petugas ANC untuk minum tablet besi sesuai anjuran. Suplai tablet juga menjadi penting karena tidak semua ibu mendapat 30 tablet pada setiap kunjungan ANC seperti seharusnya. Pengaruh efek samping konsumsi tablet besi terhadap kepatuhan ibu belum dapat disimpulkan. Pengaruh efek samping ditemukan sangat kecil dan dapat diatasi dengan baik terutama pada ibu dengan pendidikan yang lebih tinggi atau yang mendapat penyuluhan yang cukup. Studi juga menemukan bahwa dukungan keluarga sangat penting untuk membantu mengingatkan ibu untuk mengonsumsi tablet besi. Hal ini menjadi penting karena salah satu faktor utama rendahnya kepatuhan ibu adalah karena ibu lupa mengonsumsi tablet tersebut. Kualitas penyuluhan, misalnya kejelasan pesan dari petugas kesehatan, berhubungan dengan kepatuhan ibu. Sebagai kesimpulan, dukungan yang lebih baik pada ibu, baik dari petugas ANC (misalnya pemberian tablet besi dalam jumlah yang cukup, kejelasan pesan tentang manfaat tablet) maupun keluarga dapat berkontribusi pada kepatuhan yang lebih baik pada ibu hamil dalam mengonsumsi tablet besi.Kata kunci: kehamilan, kepatuhan, suplementasi tablet bes

Exclusive Breastfeeding Intention among Pregnant Women

Exclusive breastfeeding intention is a mother’s intention to provide her baby only breast milk since the infant was born until at the age of 6 months. Intention in prenatal period is the direct affirmation of exclusive breastfeeding. This study aimed to find out the most dominant factor related to exclusive breastfeeding intention among pregnant women at a mother and child hospital in South Tangerang. A cross-sectional study design was conducted primarily. The samples were 143 pregnant women on their third trimester pregnancy selected by purposive sampling. Intention was measured by the Infant Feeding Intention scalequestionnaire. Meanwhile, attitude, subjective norms, and perceived behavioral control were measured by the modified Breastfeeding Attrition Prediction Tool questionnaire. Data were analyzed using the multivariate logistic regression analysis. It was 61.5% mother had strong exclusive breastfeeding intention. Perceived behavioral control dominantly influenced the exclusive breastfeeding intention (p value = 0.007; Odds Ratio 3.030; 95% CI = 1.361-6.746). The other factors influencing intention were attitude, exposure to exclusive breastfeeding from social media, health workers’ support, previous breastfeeding experienceand mothers’ occupation. A mother with high perceived behavioral control has three times more likely to have ‘high exclusive breastfeeding intention’ than those having the low ones.AbstrakIntensi pemberian ASI eksklusif adalah intensi ibu untuk memberikan hanya ASI pada bayinya sejak dilahirkan hingga berusia enam bulan. Intensi pada periode prenatal merupakan penentu langsung pemberian ASI eksklusif. Penelitian ini bertujuan mengetahui faktor paling dominan berhubungan dengan intensi pemberian ASI eksklusif pada ibu hamil di sebuah rumah sakit ibu dan anak di Kota Tangerang Selatan. Penelitian dengan desain studi potong lintang dilakukan secara primer. Sampel berjumlah 143 ibu hamil trimester ketiga dipilih secara purposive sampling. Intensi pemberian ASI eksklusif diukur menggunakankuesioner the Infant Feeding Intentions scale. Sedangkan sikap, norma subjektif dan persepsi kontrol perilaku dinilai menggunakan modifikasi kuesioner Breastfeeding Attrition Prediction Tool. Data dianalisis menggunakan analisis regresi logistik ganda. Sebanyak 61,5% ibu memiliki intensi kuat memberikan ASI eksklusif. Persepsi kontrol perilaku paling dominan berhubungan dengan intensi pemberian ASI eksklusif, (p=0,007; Odds Ratio 3,030; 95% CI 1,361-6,746). Faktor lainnya yang berhubungan dengan intensi adalah sikap, keterpaparan ibu terhadap ASI eksklusif dari media sosial, dukungan tenaga kesehatan, pengalaman menyusui sebelumnya, dan pekerjaan ibu dengan persepsi kontrol perilaku tinggi berpeluang tiga kali lebih besar memiliki ‘intensitinggi’ untuk memberikan ASI eksklusif dibandingkan ibu berpersepsi kontrol perilaku rendah

DOES BREASTFEEDING INTENTION AMONG PREGNANT MOTHERS ASSOCIATED WITH EARLY INITIATION OF BREASTFEEDING?

Background: Early initiation of breastfeeding is defined as breastfeed started immediately after birth delivery up to one hour , and it will lead to  successfull exclusive breastfeeding. Skin-to-skin contact during early initiation of breastfeeding gives positive health impact to both mother dan baby. However, national coverage of early initiation of breasfeeding in Indonesia was 34,5% in 2014 which was lower than global coverage (50%). Objective: To examine the relationship of  of  breastfeeding intention among pregnant mothers towards early initiation of breastfeeding in two Mother and Child Hospitals, in South Tangerang. Methods: A prospective study conducted in August-November 2016. A sample of 152 third trimester pregnant mothers were from the 2 selected hospitals, taken by purposive sampling.  Early breastfeeding initiation (EBI) was measured by interview based structured questionnaire and breastfeeding intention measured by The Infant Feeding Intention scale (IFI). Results: A total of 56.6% of mothers breastfeed  during 1 hour after delivery. EBI was done by 71.1% of mothers with high breastfeeding intention. It was the most dominant variable related to early breastfeeding (p = 0.000; OR=5.249;95%CI:2.321-11.870) after controlling other variables. Conclusion: Mother with high breastfeeding intention 5 times more likely to initiate breastfeeding, than those having the low ones. Early promotive, preventive and intervention can be done by measuring breastfeeding intentions during pregnancy. Further research is needed to analyze breastfeeding  initiation towards exclusive breastfeeding.