Keefektifan Program Kelompok Pendukung Ibu dalam Mengubah Perilaku Ibu Menyusui

Pemerintah Surakarta menyelenggarakan program kelompok pendukung ibu untuk meningkatkan cakupan ASI eksklusif. Penelitian cross sectional ini bertujuan menganalisis perbedaan pengetahuan, sikap, dan tindakan ASI eksklusif antara ibu-ibu yang mengikuti dan tidak mengikuti pada tahun 2014. Populasi penelitian adalah ibu-ibu yang memiliki bayi berusia 6-24 bulan. Besar sampel yaitu 384. Hasil uji Mann-Whitney menunjukkan bahwa pengetahuan dan sikap tentang ASI eksklusif pada ibu-ibu yang mengikuti program pendukung ibu lebih tinggi secara bermakna dibanding ibu-ibu yang tidak mengikuti (p=0,04 dan p=0,001). Uji Chi-Square menunjukkan bahwa tidak terdapat perbedaan tindakan yang bermakna pada kelompok tersebut (p=0,82). Regresi logistik dilanjutkan tes stratifikasi menunjukkan bahwa dukungan keluarga lain (selain suami) merupakan variabel perancu. Kesimpulannya yaitu ibu-ibu yang mengikuti program pendukung ibu memiliki pengetahuan dan sikap yang lebih tinggi secara bermakna dibanding yang tidak mengikuti. Surakarta government established mother support group program to increase covering of exclusive breastfeeding. This cross sectional study aimed to analyze the difference of knowledge, attitude, and practice of exclusive breastfeeding among mothers who followed and did not follow in 2014. The population was mothers whose babies aged 6-24 months old. Sample size was 384. The results of the Mann-Whitney test shows that knowledge and attitude about exclusive breastfeeding in mothers who follow mother support group program significantly higher than mothers who did not follow (p=0,04 and p=0,001). The chi-square test shows that there is not significant difference practice in those group (p=0,82). Logistic regression continued with stratification test showed that other family support (besides her husband) is a confounding variable. The conclusion shows that mothers who follow the program have significantly higher knowledge and attitude about exclusive breastfeeding than mothers who did not

Low Birthweight and Its Biopsychosocial and Economic Determinants: A New Evidence Using a Path Analysis Model from Jambi, South Sumatera

Background: Low birth weight (LBW) is a major maternal and child health problem, especially in developing countries. Children who are born with weight less than 2.5 kg are vulnerable for infections, malnutrition, psychological disorder, and decreased the intelligence, and dying, in their early childhood. Little is known about the association between LBW and the biopsychosocial and economic factors in Indonesia. This study aimed to determine the biopsycho­social and economic determinants of LBW in Jambi, South Sumatera. Subjects and Method: This was a case control study carried out at 20 community health centers in Jambi, South Sumatera, from December 2017 to January 2018. A total sample of 200 newborn infants consisting of 50 LBW and 150 normal birthweight newborn infants were selected for this study by fixed disease sampling. The dependent variable was birthweight. The independent variables were maternal age, maternal mid-upper arm circumference (MUAC), gestational age, infant sex, maternal gestational stress, maternal education, family income at gestational period, and sanitation. Data on birthweight and MUAC were taken from obstetric record. The other data were collected by questionnaire. The data were analyzed by path analysis. Results: The risk of LBW was increased by female sex (b= 0.99; 95% CI= -0.12 to 2.12; p= 0.081), and high maternal stress (b= 2.35; 95% CI= 0.70 to 4.01; p= 0.005). The risk of LBW decreased with gestational age ≥37 weeks (b= -5.06; 95% CI= -6.49 to -3.62; p= 0.000), and good sanitation (b= -1.04; 95% CI= -2.13 to 0.05; p= 0.062). Gestational age increased with nutritional status (b= 1.91; 95% CI= 0.94 to 2.89; p< 0.001), and family income (b= 1.50; 95% CI= 0.66 to 2.32; p= 0.000). Nutritional status increased with family income (b= 1.45; 95% CI= 0.55 to 2.33; p=0.001). Sanitation increased with family income (b= 0.71; 95% CI= 0.01 to 1.41; p= 0.046). Family income increased with education (b= 1.37; 95% CI= 0.57 to 2.18; p= 0.001). Education increased with maternal age (b= 1.03; 95% CI= 0.19 to 1.87; p= 0.015). Maternal stress decreased with family income (b= -1.34; 95% CI= -2.50 to -0.19; p= 0.022). Conclusion: The risk of LBW increased with gestational age <37 weeks, female sex, high maternal stress, and poor sanitation. LBW is indirectly affected by maternal age, nutritional status, maternal education and family income. Keywords: biopsychosocial, economic, determinant, LBW, Jambi

Exclusive Breastfeeding, Diarrhea, and Their Association with Motor Development in Children in 1000 Days First Life

Background: The right nutrition during 1,000 day window has a profound impact on a child’s ability to grow, learn, and thriveand eventually a lasting effect on a country’s health and prosperity. Nutrition during pregnancy and the first two years of a child’s life provides the essential building blocks for brain development, healthy growth, and a strong immune system. Diarrhea disease is the second leading cause of death in children under five years old. It is both preventable and treatable. Each year diarrhea kills around 525 000 children under five worldwide. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia, and helps for a quicker recovery during illness. Breast milk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Little is known about the effect of exclusive breastfeeding and diarrhea on the neurodevelopment of children under five in Indonesia. This study aimed to estimate the effect of exclusive breastfeeding and diarrhea on the neuro­development of children under two years in Indonesia. Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted in Pontianak, West Kalimantan, in January 2018. A sample of 138 children under two years (≥ 6-24 months) along with their mothers was selected for this study. The dependent variable was motor development. The independent variables were exclusive breastfeeding and diarrhea. Motor development was measured by development pre-screening questionnaire (KPSP). The other variables were measured by questionnaire and health record. The data were analyzed by logistic regression. Results: The likelihood of normal motor development in children under two years increased with exclusive breastfeeding, and it was statistically significant (OR= 2.17; 95% CI= 1.01 to 4.65; p= 0.036). The likelihood of normal motor development decreased with the incidence of diarrhea (OR= 0.79; 95% CI= 0.33 to 1.09; p= 0.596) but not statistically significant. Conclusion: Exclusive breastfeeding is beneficial to increase the likelihood of normal motor development in children under two years. Keywords: motor development, exclusive breastfeeding, diarrhe

Biopsychosocial and Institutional Factors Associated with Exclusive Breastfeeding Among Working Mothers in Klaten, Central Java

Background: Breast milk has an important role in health maintenance and survival of infants. It is acknowledged as the best food for infant. The World Health Organization has recommended exclusive breastfeeding (EBF) for infants until 6 months of age. However, many working mothers did not provide EBF to their infants. This study aimed to examine biopsychosocial and institutional factors associated with exclusive breastfeeding among working mothers, using health belief model and PRECEDE-PROCEED model.Subjects and Method: This study was observational analytic with cross sectional design. It was conducted in Klaten District, Central Java, from March to April, 2017. A sample of 120 working mothers was selected for this study by simple random sampling. The dependent variable was exclusive breastfeeding. The independent variables were maternal education, perceived benefit, perceived barrier, self efficacy, family support, health personnel support, and availability of lactation room at workplace. The data were collected by a pre-tested questionnaire. Logistic regression was employed for data analysis.Results: Maternal education (OR=4.2; 95% CI = 1.09 to 11.51; p=0.001), availability of lactation room at workplace (OR=4.11; 95% CI= 1.21 to 14.29; p=0.001), family support (OR=6.25; 95% CI= 1.45 to 15.96; p<0.001), health personnel support (OR=3.76; 95% CI = 1.43 to 16.06; p=0.002), perceived benefit (OR=2.30; 95% CI = 1.09 to 12.87; p=0.044), self-efficacy (OR= 3.57; 95% CI = 1.21 to 14.29; p=0.002) had positive effect on EBF. Perceived barrier (OR=0.18; 95% CI = 0.64 to 0.76; p<0.001) had negative effect on the provision of EBF.Conclusion: Maternal education, availability of lactation room at workplace, family support, health personnel support, perceived benefit, self-efficacy have positive effect on EBF. Perceived barrier has negative effect on the provision of EBF among working mothers.Keywords: biopsychosocial factors, exclusive breastfeeding, PRECEDE-PROCEED model, health belief modelCorrespondence: Desi Ekawati. Masters Program in Public Heath, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta, Central Java. Email: [email protected]. Mobile: +6285725123320.Journal of Health Promotion and Behavior (2017), 2(3): 197-206https://doi.org/10.26911/thejhpb.2017.02.03.0

Does Ambient Tobacco Smoke Exposure Increase The Risk of Preterm Birth? A New Multivariate Evidence from Surakarta, Indonesia

Background: A handful of studies have reported a positive association between exposure to environmental tobacco smoke and an increased risk for preterm birth. However, such studies using data from Indonesian population are lacking. This study aimed to estimate the effect of ambient tobacco smoke exposure on the risk of preterm birth, after controlling for the effects of maternal age, parity, and maternal middle upper arm circumference (MUAC). Subjects and Methods: This was a case control study conducted at Dr. Moewardi Hospital, Surakarta, Indonesia, using retrospective data in March 2018 and concurrent data in April and May 2018. A total sample of 200 newborn infants were selected for this study, comprising 50 preterm newborn infants and 150 term newborn infants. The dependent variable was prematurity. The independent variables included environmental tobacco smoke exposure during pregnancy, maternal age, parity, and maternal MUAC. Data were collected by a set of questionnaire. MUAC was measured by MUAC tape. The data were analyzed by multiple logistic regression model. Results: Ambient tobacco smoke exposure increased the risk of preterm birth (OR= 4.16; 95% CI= 1.51 to 11.47; p= 0.006). This estimate has accounted for the effects of confounding factors, including maternal age <20 or ≥35 years (OR= 4.84; 95% CI= 1.91 to 12.22; p= 0.001), parity ≥4 (OR=5.89; 95% CI= 2.39 to 14.47; p<0.001), and MUAC ≥23.5 cm (OR= 0.14; 95% CI= 0.05 to 0.34; p<0.001). Nagelkerke R2= 56.9%. Conclusion: Ambient tobacco smoke exposure increases the risk of preterm birth, after controlling for the effect of maternal age, parity, and MUAC. Keywords: tobacco smoke, maternal age, parity, MUAC, preterm birt

Biopsychosocial and Economic Determinants of Low Birth Weight in Jambi, South Sumatera: Path Analysis

Background: Low birthweight (LBW) is one of the main risk factors of neonatal mortality and morbidity. As such, it is an important public health issue particularly in developing countries. Worldwide, LBW shares around 15-20% of birth outcome. In Indonesia, LBW shares about 10.2% of birth outcome. In theory, the risk factors of LBW include not only biological aspect but also psychosocial and economic aspects. This study sought to estimate the biopsychosocial and economic determinants of LBW in Jambi, South Sumatera, using path analysis approach.Subjects and Method: This was an analytic observational study with case control design. The study was carried out at 20 community health centers in Jambi, South Sumatera, from December 2017 to January 2018. A total sample of 200 newborn infants consisting of 50 LBW and 150 normal birthweight newborn infants were selected for this study by fixed disease sampling. The dependent variable was birthweight. The independent variables were gestational age, infant sex, maternal mid-upper arm circumference (MUAC), maternal gestational stress, maternal education, family income at gestational period, and sanitation. Data on birthweight and MUAC were taken from obstetric record. The other data were collected by questionnaire. The data were analyzed by path analysis.Results: The risk of LBW decreased with gestational age ≥37 weeks (b= -5.06; 95% CI= -6.49 to -3.62; p<0.001), male sex (b= -0.99; 95% CI= -2.12 to -0.12; p= 0.081), low maternal stress (b= -2.35; 95% CI= 14.01 to -0.70; p= 0.005), and good sanitation (b= -1.04; 95% CI= -2.13 to -0.05; p= 0.062). Gestational age increased with family income (b= 1.74; 95% CI= 0.96 to 2.52; p<0.001). Low maternal stress was positively affected by high family income (b= 1.34; 95% CI= 0.197 to 2.50; p= 0.022). Good sanitation was positively affected by high family income (b= 0.71; 95% CI= 0.01 to 1.41; p= 0.046). High family income was positively affected by high education level (b= 1.37; 95% CI= 0.57 to 2.18; p= 0.001)Conclusion: The risk of LBW decreases with gestational age ≥37 weeks, male sex, low maternal stress, and good sanitation. LBW is indirectly affected by maternal education and family income.Keywords: biopsychosocial, economic, determinant, LBWCorrespondence: Iga Trisnawati. Masters Program in Public Health, Uiversitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: +6282377277992Journal of Maternal and Child Health (2018), 3(1): 385-394https://doi.org/10.26911/thejmch.2017.03.01.0

Does Contextual Factor of the Integrated Family Health Post Affect Exclusive Breastfeeding? A Multilevel Evidence from Surakarta, Central Java

Background: Exclusive breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants. Breast milk is rich in nutrients and anti-bodies and contains the right quantities of fat, sugar, water and protein. Routine nutrition status monitoring services for children under five in lower-income countries are generally delivered through fixed-post sites (ie, within the health facility) and enhanced by outreach (the integrated family health post) for populations living in rural or remote areas with limited access to fixed services. This study aimed to determine the effect of maternal nutritional status, parity, employment status, family income, health personnel support, subjective norm, on exclusive breastfeeding in Surakarta, Central Java, accounting for the contextual effect of the integrated family health post (“posyandu”). Subjects and Method: This was an cross sectional study conducted in Banjarsari sub-district, Surakarta, Central Java, from October 17 to November 7, 2017. Twenty five community health centers were selected bystratified random sampling. Of the “posyandus” selected, 200 lactating mothers were selected by simple random sampling. The dependent variable was exclusive breastfeeding. The independent variables were maternal nutritional status, parity, employment status, family income, subjective norm, and health personnel support. The data were collected using a set of questionnaire and analyzed by multilevel logistic regression in Stata 13. Results: The likelihood of exclusive breastfeeding increased with better maternal nutritional status (b= 1.65; 95% CI= 0.14 to 3.17; p= 0.032), multi parity (b= 1.72; 95% CI= 0.57 to 2.86; p= 0.003), working outside the house (b= -2.94; 95% CI= -3.99 to -1.88; p= 0.001), higher family income (b= -1.94; 95%CI= -3.13 to -0.76; p= 0.001), strong health personnel support (b= 1.13; 95% CI= 0.02 to 2.25; p= 0.046), and positive subjective norm (b= 1.20; 95% CI= 0.14 to 2.25; p= 0.025). Posyandu showed strong contextual effect on exclusive breastfeeding with intra-class correlation (ICC)= 28.87%. Conclusion: The likelihood of exclusive breastfeeding increases with more active posyandu at the higher contextual level, in addition to better maternal nutritional status, multi parity, working outside the house, higher family income, strong health personnel support, and positive subjective norm, at the lower individual level. Keywords: exclusive breastfeeding, multilevel analysis, socioeconomic factors, health personnel support, posyand