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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.

Background: Adolescent overweight and obesity (AOO) is a global public health problem and risk for noncommunicable diseases. Understanding context-specific risks is crucial for interventions. Objective: Determine the prevalence of AOO in the Indonesian National Health Survey (INHS) 2013, assess the 5-year trend from 2013 to 2018, and identify risks. Methods: We selected adolescents aged 10 to 19 years (n = 174 290) from the INHS 2013 and used hierarchical logistic regression to identify gender-specific risks for those aged 15 to 19 years (n = 77 534). Change in AOO was assessed by comparison to INHS 2018 reports. Results: The national AOO prevalence increased over 5 years by 48% in young adolescents (13-15 years) and 85% in older ones (16-18 years). High prevalence areas included the urban location of Jakarta (20.9%) and the remote rural region of Papua (19.4%). Overall, AOO risks were being sedentary, male, lower education, married, younger adolescent, and school enrollment, with urban residence and higher wealth being persistent risks for all analyses. Data for depressive symptoms were available for older adolescents whose additional risks were being sedentary, depressive symptoms, and high-fat diet. Male risks were being sedentary and lower education, and female risks were being married, depressive symptoms, high-fat intake, and lower education. Higher intake of fruits and vegetables and fewer sweets did not protect against AOO if a high-fat diet was consumed. Conclusions: Adolescent overweight and obesity in Indonesia is rapidly increasing, especially in older adolescents and males, and with gender-specific risks. Customized multisectoral interventions to identify strategies for lifestyle change are urgently needed.

Background: Musa balbisiana Colla, known as Jantung Pisang Klutuk/Pisang Batu, is considered as a traditional food that can increase breast milk production. Little is known about its benefit in Indonesia. Thus, to examine the impact of musa balbisiana colla on the production of breast milk is needed.Objective: This study aims to examine the effect of the extract of banana flower (Musa balbisiana Colla) to increase milk production of breastfeeding mothers.Methods: This  was a quasy-experimental study with pre-posttest control group design. This study was conducted in the working area of the Health Center (Puskesmas) of Pesantren II in January – February 2017. There were 16 respondents were recruited by accidental sampling, divided to intervention group (8 respondents) and control group (8 respondents). Randomization was performed to select the respondent in each group. The quantity of milk production was measured based on the volume of milk production, while the quality of milk production was based on the levels of prolactin in early (pre) and late (post) using Electro chemilumi-nescence Immunoassay (ECLIA) method. Independent t-Test was used to analyze the data.Results: Findings showed that the mean of the volume of the breast milk production in the experiment group was 470.681 ml, and in the control group was 364.650 ml with SD 113.502. While the mean of prolactin levels in the experiment group was 35.337 nanogram, and in the control group was -38.381 nanogram. There was a significant effect of consuming Musa balbisiana Colla extract on the volume of breast milk production (p-value 0.003) and prolactin levels (p-value 0.001) (<0.05).Conclusion: There was a significant effect of banana flower (Musa balbisiana Colla) extract on breast milk production and prolactin level in breastfeeding mothers. The findings of this study could be used to be alternative daily menu for postpartum mothers and a solution for midwives to deal with those who have inadequate production of breast milk and low prolactin levels.

Background : Nutritional problems of lack of vegetables and fruits are common in primary school-aged children and have not been well socialized.Comics became one of the media that is very popular by children who have now been widely used as a medium of learning as well as entertainment. Provision of nutrition education through comic media is expected to increase knowledge and attitude about vegetables and fruits especially for elementary school children. Objective : To know the effect of nutrition education through comic media to knowledge and attitude about vegetables and fruit.Method : This research usedquasy experimental design method with pre test post test group control design.The sample consisted of 32 treatment groups and 32 control groups. The collected data are psychosocial factor data (knowledge, attitude). The data were collected by using questionnaires filled in by respondents.The result of bivariate analysis using Man-Whitney test.Results : There was a difference in knowledge increase in the treatment group and the control group before and after nutrition education through comic media (p <0,005) but there was no difference in attitude increase between the two groups (p> 0,005).Conclusion : Comic media on fruits and vegetables enhances knowledge and attitude in both groups. There is a difference in the improvement of the fraud between the treatment group and the control group. There was no difference in attitude improvement between the treatment group and the control group. ABSTRAKLatar Belakang : Permasalahan gizi kurangnya sayur dan buah banyak terjadi pada anak usia sekolah dasar dan belum tersosialisasi dengan baik. Komik menjadi salah satu media yang sangat digemari oleh anak-anak yang kini telah banyak dimanfaatkan sebagai media pembelajaran sekaligus hiburan. Pemberian edukasi gizi melalui media komik diharapkan dapat meningkatkan pengetahuan dan sikap tentang sayur dan buah khususnya bagi anak sekolah dasar.Tujuan : Mengetahui pengaruh pemberian edukasi gizi melalui media komik terhadap pengetahuan dan sikap tentang sayur dan buah.Metode : Penelitian ini menggunakan metode quasy experimental design dengan rancangan pre test post test control group design. Sampel terdiri dari 32 kelompok perlakuan dan 32 kelompok kontrol. Data yang dikumpulakan yaitu data faktor psikososial (pengetahuan, sikap). Pengumpulan data dilakukan dengan menggunakan kuesioner yang diisi sendiri oleh responden. Hasil analisis bivariat dengan menggunakan uji Man-Whitney.Hasil : Terdapat perbedaan peningkatan pengetahuan pada kelompok perlakuan dan kelompok kontrol sebelum dan sesudah pemberian edukasi gizi melalui media komik (p<0,005) namun tidak terdapat perbedaan peningkatan sikap antara kedua kelompok (p>0,005).