Multilevel Analysis on the Determinants of Exclusive Breastfeeding at Gunung Anyar Community Health Center, Surabaya, Indonesia

Abstract

Background: Exclusive breastfeeding is provision of breast milk for infants from 0 to 6 months of age with no additional food or drink intake. Provision of medicine, vitamin, and mineral is allowable during the period of exclusive breastfeeding. There is a lack of studies examining factors associated with exclusive breastfeeding in Surabaya using multilevel analysis. This study aimed to examine factors associated with exclusive breastfeeding in Surabaya using multilevel analysis. Subjects and Method: This was an analytic observational study with a cross sectional design. The study was carried out at Gunung Anyar community health center (puskesmas), Surabaya, East Java, Indonesia. A total of 25 puskesmas was selected by stratified random sampling, covering both accredited and non-accredited puskesmas. A total of 8 lactating mothers from each puskesmas were selected by simple random sampling. The dependent variable was exclusive breastfeeding. The independent variables were subjective norm, leisure time for breastfeeding, attitude, husband support, family support, and health personnel support. The data were collected by questionnaire and analyzed by a multilevel logistic regression. Results: Exclusive breastfeeding was positively affected by positive subjective norm (b=4.31; 95% CI= 1.63 to 6.99; p=0.002), leisure time for breastfeeding (b=3.97; 95% CI= 1.12 to 6.81; p=0.006), positive attitude (b=3.01; 95% CI= 0.57 to 5.45; p=0.016), strong husband support (b=2.39; 95% CI= 0.29 to 4.51; p=0.026), strong family support (b=2.71; 95% CI= 0.46 to 4.97; p=0.018), and strong health personnel support (b=4.13; 95% CI= 1.28 to 6.99; p=0.005). Posyandu showed strong contextual effect on exclusive breastfeeding with intra-class correlation (ICC)= 69.47%. Conclusion:Exclusive breastfeeding is positively affected by positive subjective norm, leisure time for breastfeeding, positive attitude, strong husband support, strong family support, and strong health personnel support. Contextual effect at posyandu level should be taken into account when estimating factors affecting exclusive breastfeeding.

Exclusive breastfeeding practice and sources of support during COVID-19 pandemic in Indonesia

“…Family and friend supports was not significantly associated with exclusive breastfeeding. It is inconsistent with previous studies in Indonesia that showed family supports was positively associated with exclusive breastfeeding [33,38]. Family provides mothers the values and beliefs in breastfeeding practices [33].…”

“…It is inconsistent with previous studies in Indonesia that showed family supports was positively associated with exclusive breastfeeding [33,38]. Family provides mothers the values and beliefs in breastfeeding practices [33]. This different finding might happen because mothers are able to decide which family supports they should accept or reject, especially for the supports that mothers considered harmful to the breastfeeding practices and maintaining exclusive breastfeeding [39].…”

“…As the family is the closest environment for mother and infant, the family becomes the first setting for the motherinfant dyad in infant feeding practices, specifically breastfeeding after discharge from the health care facility [31,32]. The roles of family in providing the values and beliefs in breastfeeding practices [33]. Health professionals or health workers are more skilled and experienced, so they can help mothers with health risked circumstances that can result in delayed breastfeeding, for example, high-risk pregnancy, assisted delivery and long hospital stays, maternal illness, low-birthweight newborn babies, and preterm, ill [6].…”

Intention to Practice Exclusive Breastfeeding and its Associated Factors among Female College Students

“…Mothers who have strong subjective norms can increase breastfeeding. This subjective norm usually comes from people who are considered important and imitated by respondents, such as family, community leaders, officials, and people closest to them [11]. There is an assumption that what influences breastfeeding attitudes is the experience of breastfeeding, not subjective norms.…”

Pola Pertambahan Berat Badan Bayi Berdasarkan Status Menyusui Eksklusif dan Non-Eksklusif

“…Studi Fitri et al, dan Atika et al, menyimpulkan bahwa dukungan suami berhubungan dengan menyusui eksklusif pada ibu (p<0,05). 29,30 Arifah et al, juga menyimpulkan bahwa dukungan suami berhubungan dengan pemberian ASI eksklusif (p<0,001) dengan sebanyak 76,2% peran suami dalam keterlibatan pengasuhan anak, keterlibatan dalam proses persalinan (40,0%), keterlibatan dalam pengambilan keputusan (23,8%) dan pencarian informasi (16,2%). 31 Lima peran utama suami dalam mendukung keberhasilan pemberian ASI oleh ibu antara lain pengetahuan, sikap positif, keterlibatan suami dalam pengambilan keputusan, dukungan praktis dan emosional.…”