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The aim of the study was to identify determinants of exclusive breastfeeding (EBF) at the individual, family, community, and organizational level. This study was a secondary analysis of data from a multilevel promotion of EBF program in two rural public health centers (PHCs) in the Demak district, Central Java, Indonesia. The program was a quasi-experimental study with a pretest-posttest control group. A total of 599 participants were enrolled, consisting of 163 mother infant pairs, 163 fathers, 163 grandmothers, 82 community leaders, and 28 midwives. EBF duration and its determinants were measured and analyzed using Cox proportional-hazard model. Mothers with a high level of breastfeeding knowledge had the greatest EBF duration. Mothers who had a knowledge score >80 had a 73 % (HR 0.27, 95 % CI 0.15, 0.48) greater chance of EBF compared to mothers who had a knowledge score of <60. Factors which shortened EBF duration were grandmother's lack of support for EBF (HR 2.04, 95 % CI 1.33, 3.14), received formula samples at discharge (HR 1.99, 95 % CI 1.25, 3.16), and maternal experience of breast engorgement (HR 1.97, 95 % CI 1.32, 2.94). High maternal breastfeeding knowledge was the only factor associated with longer duration of EBF. Barriers to EBF were breast engorgement, receiving formula samples at discharge, and a grandmother's lack of support for EBF.

Multilevel promotion can prolong the duration and increase the prevalence of EBF.

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Background: Breastfeeding among postpartum mothers has been a problem due to low milk supply. As a result, mothers often decide to give formula milk or other additional foods, which might affect to the infant’s growth and development.Objective: This study aims to investigate the effect of Moringa Oliefera on the levels of prolactin and breast milk production (baby’s weight and sleep duration) in postpartum mothers. Methods: Quasi-Experimental study with Non Equivalent control group design. There were 30 respondents recruited by purposive sampling, consisted of 15 respondents in intervention group and  15 respondents in the control group. This study was conducted from November until December 2016 in Four Midwive Independent Practice (BPM) in the working area of the Health Center of Tlogosari wetan Semarang. Data were analyzed using Independent t-test.Results: Findings showed that there was a mean difference of prolactin level in the intervention group (231.72 ng / ml), and the control group (152.75 ng / ml); and a significant effect on increasing the levels of prolactin (p = 0.002). The mean of baby’s weight in the intervention group was 3783.33 grams, and in the control group was 3599.00 grams. However, there was no significant effect of moringa oleifera on baby’s weight (p = 0.313> 0.05). While the mean difference on sleep duration was 128.20 minutes in the intervention group and 108.80 minutes in the control group. There was a significant effect on baby’s sleep duration (p= 0.000).Conclusion: There were significant effects of moringa oleifera on mother’s prolactin and sleep duration of the baby. However, there was no significant effect on baby’s weight. Thus, it can be suggested that moringa oleifera can be used as an alternative treatment to increase breast milk production and prolactin hormones. Midwives should promote the benefits of moringa leaves as one of alternative supplements.