Human breast milk contains numerous biomolecules. Human milk oligosaccharides (HMOs) are the third most abundant component of breast milk, after lactose and lipids. Amongst the synthetized HMOs, 2′-fucosyllactose (2′-FL) and lacto-N-neotetraose (LNnT) are widely studied and are considered safe for infant nutrition. Several studies have reported the health benefits of HMOs, which include modulation of the intestinal microbiota, anti-adhesive effect against pathogens, modulation of the intestinal epithelial cell response, and development of the immune system. The amount and diversity of HMOs are determined by the genetic background of the mothers (HMO secretors or non-secretors). The non-secretor mothers secrete lower HMOs than secretor mothers. The breastfed infants of secretor mothers gain more health benefit than those of non-secretor mothers. In conclusion, supplementation of infant formula with 2′-FL and LNnT is a promising innovation for infant nutrition.

PurposeA mother's working environment is believed to be a major determinant of exclusive breastfeeding (EBF) practice. We aimed to define the influence of a facility dedicated to breastfeeding and a breastfeeding support program at the workplace on breastfeeding practice.MethodsA cross-sectional study was performed in five workplaces. The inclusion criteria were female workers whose last child was between 6 and 36 months old. Observational data were obtained and a questionnaire was filled out. The World Health Organization definition for EBF was used.ResultsData from 186 subjects (74 office workers and 112 factory workers) were collected. Just over half (52%) of the mothers were between 20 and 46 years old, 75.3% had graduated from high school and university, 12.9% had more than two children and 36.0% owned a house. The prevalence of EBF during the last 6 months was 32.3%. A proper dedicated breastfeeding facility was available for 21.5% of the mothers, but only 7.5% had been in contact with a breastfeeding support program. The presence of a dedicated breastfeeding facility increased EBF practice almost threefold, by an odds ratio (OR) of 2.74 and a 95% confidence interval (CI) of 1.34-5.64 (p<0.05). Knowledge of the breastfeeding support program increased EBF practice by almost six times (OR, 5.93; 95% CI, 1.78-19.79) (p<0.05).ConclusionOur findings suggest that Governments should make it obligatory for employers to offer a breastfeeding support program and a dedicated breastfeeding facility at the workplace as these simple measures significantly increase EBF.

Due to increased number of women workers in Indonesia in the last decade, numbers of women living as a worker and a housewife have increased. This also increases the potential risk of breastfeeding discontinuation. Three months of maternal leave policy and inadequate lactation promotion support in workplace have been identified as factors that hinder lactating practices. The World Health Organization recommendation of 6 months of exclusive breastfeeding and joined regulation of three Indonesia ministers (Ministry of Health, Ministry of Labour, and Ministry of Women Empower) have failed to improve the exclusive breastfeeding rate among female workers in Indonesia due to the lack of a standardized guideline on lactation promotion at workplace. In addition, very limited or no studies have been conducted to evaluate the impact of workplace-based lactation intervention programs on exclusive breastfeeding rate among female workers. This is because the relationship of lactation with working performance and productivity could not motivate employer to invest in workplace-based lactation promotion facility or program.

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow’s milk and processed to adjust for the nutritional needs of infants. However, cow’s milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow’s milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

The rate of Caesarean delivery is rising dramatically worldwide, and also nationally. The number of Caesarean births exceeds the WHO recommended rate. This study aims to provide an overview of current increasing trend of Caesarean section, including elective procedure, and its risk. A review was conducted using online database, surveillance reports, and national surveys to identify studies with topics of prevalence, trend, indications, and risks of Caesarean delivery. Overall, there is an increase of Caesarean section in global, Asia, and Indonesia setting. We found an increase of 8% from 2013 to 2018 based on population survey, and increase of elective Caesarean surgery, particularly in tertiary care. We listed the possible health risks in short term, long term among mothers and child. Advanced maternal age, higher socio-economic status, higher educational level, residing in urban area, and ownership of health insurance were found to be factors associated with maternal choice on Caesarean delivery. The information presented is important to raise awareness among policy makers aimed to develop a national strategy in reducing the rate of Caesarean delivery.

Purpose: To help pediatrician utilize probiotic use correctly, it is important for them to keep updated about new knowledge through various sources and methods. This study aimed to evaluate clinical behavior and factors influencing pediatricians to consider probiotic recommendation in infants and toddlers patients. Patients and methods:A cross-sectional study conducted to 99 pediatricians attended Probiotic Summit in Jakarta on July 2018. Data collection aimed to gather characteristics of the subject's age, employment and affiliation status and years having pediatric practice through self-administered questionnaire. The current knowledge, clinical behavior and others factors influencing pediatricians to consider recommendation collected using modified 12-items questionnaire by Legare et al, 2014Results: about 99 pediatricians participated in the study; of which 58 subjects worked in private hospital and 41 subjects were government hospital-based pediatricians. Majority of subjects were aged between 40-60 years old and 71% had been worked in pediatric clinical practice for more than 10 years. Almost all of subjects showed confident with scientific evidences (99%) and agreement on ethical importance of probiotic in infants and toddlers (98%), which was reflected to their positive prescribing consideration. From self-assurance perspective, 97% of subjects convinced with probiotic usage in infants and toddler, and hence consider to prescribe probiotic to their patients [OR (CI95%):0.50 (0.12-1.99); P=0.02). The multivariate analysis comparing the outcome variables to subject's consideration to prescribe found that knowledge (P=0.05), ethical consideration (P<0.001), self-assurance (P<0.001), clinical behavior (P<0.001), and attitude (P<0.001) were factors that strongly associated with subject's consideration to prescribing probiotic to their patients. Conclusion:Knowledge, scientific evidences and ethical point of view were key factors influencing pediatricians to recommend probiotic to their patients. and even direct information via interaction with representatives from nutrition companies [9,10]. CME interventions have limited impact [11].Studies show that the prescribing pattern of physicians strongly depend on a series complex factors, including personal motivation as well as external factors such as requests from patients [12]. Doctors' prescription patterns are not standardized but are dynamic and individual [13][14][15].This study aimed to evaluate the attitude of pediatricians to recommend probiotics, specifically to infants and toddlers. Material and methodsData were collected from 99 pediatricians attending a Probiotic Summit in Jakarta in July 2018. Data collection aimed to gather information on the age, employment and affiliation status, and years in pediatric practice through a questionnaire.Basrowi RW (2019) Factors influencing probiotics recommendation among pediatricians in Indonesia

Background: Amongst the Health Care Professionals, midwife has a strategic role in taking care of both mother and child in contributing to their survival, health, and wellbeing. The retaining midwife’s knowledge and quality of care through training on specific skills is strongly needed. This study aimed to evaluate the knowledge retention among midwives after the provision of digestive health, nutrition, and parenting education sessions at immediate and three months after the education.Methods: A serial pre-post intervention experimental study was conducted from January to July 2016 to evaluate the knowledge before (pre-test), immediate after (post-test), and three months after the provision of three sessions of digestion health, nutrition, and parenting (character building) topics by the experts which covered from several areas in Indonesia. The improvement of the sufficient knowledge proportion time by time was analyzed by using McNemar test.Results: The low immediate response rate (77.2%) and very low response after the 3-month follow-up (26.4%) were revealed during the study. At baseline, less than 50% of the subjects had sufficient knowledge on digestive health, nutrition, and parenting. At immediate after and after three months, there were significant improvements in the proportion of sufficient knowledge in nutrition and parenting topics. However, there was a declining of sufficient knowledge at after 3 months group compared to immediate group.Conclusion: The knowledge retention from the continuing health education among widwives in Indonesia decreased after 3 months.

Background:  Early nutritional intervention with partially-hydrolyzed whey-based formula (PHF-W) instead of standard cow’s milk formula (CMF) has been found to reduce the risk of atopic dermatitis (AD) development in non-exclusively breastfed infants with familial heredity of AD.Objective:  To estimate the 6-year economic impact of this nutritional intervention in non-exclusively breastfed Indonesian urban infants with family history of AD.Methods:  A mathematical model simulated AD incidence and burden of using PHF-W vs. CMF in the target population from birth to age 6. The model integrated literature, current cost and market catalogues, and expert clinician opinion. Modeled outcomes included AD risk, time spent post-AD diagnosis, days without flare, quality-adjusted life-years, and costs.Results: Using PHF-W instead of CMF resulted in an estimated absolute 14% (95% CI: 4%, 23%) AD risk reduction, a 0.69 year (95% CI: 0.26, 1.13) per-child reduction in time spent post-AD diagnosis, a 38 (95% CI: 12, 67) increase in days without AD flare, and a 0.046 gain in quality-adjusted life-years. The AD-related 6-year cost estimates when feeding high-risk urban infants with PHF-W were Indonesian Rupiah (IDR) 8,695,057 (95% CI: IDR 4,519,447, IDR13,995,605) and IDR13,139,569 (95% CI: IDR 7,098,794, IDR 19,216,068) per child, respectively, resulting in a net per-child difference of IDR 4,444,512 (95% CI: IDR1,893,080, IDR 8,557,946) favoring PHF-W.Conclusion: PHF-W for the first 17 weeks of non-exclusively breastfed Indonesian urban infants with a hereditary risk of AD demonstrated a reduction in AD incidence, increased days without flare, and increased quality-adjusted life-years and net cost reductions.