Nisa et al./ Factor of Socio Demography and Obstetric that Influence
Factor of Socio Demography and Obstetric that Influence the Timeliness of Early Breastfeeding in Tegal Regency
Juhrotun Nisa1,2), Harsono Salimo3), Uki Retno Budihastuti4)
1 )Associate Degree of Midwifery Study Program, Harapan Bersama Polytechnic, Tegal 2)Masters in Public Health, Sebelas Maret University 3)Department of Pediatrics, Dr. Moewardi Hospital, Surakarta 4)Department of Obstetrics and Gynecology, Dr. Moewardi Hospital, Surakarta
ABSTRACT
Background: There are more than 10 million infants die world wide every year, 45 % of them are caused by malnutrition either directly or indirectly. Provision of mother‘s breast milk within the first hour of birth may reduce infant mortality in the first month by 22%. However, breastfeeding in the first hour of birth only reaches 43% of the total number birth. In South Asia the achievement of early initiation of breastfeeding is only 41% of the total births within the first hours of birth, whereas in Indonesia is only 34.5%. The study aimed to discover the factors that influence the timeliness of early initiation of breastfeeding in Tegal Regency. Subjects and Method: The type of the study was analytic observational with cross sectional approach in Tegal Regency that consisted of Pagiyanten Community Health Center, Pagerbarang Community Health Center, Bumijawa Community Health Center, Jatinegara Community Health Center and RSUD dr. Soeselo. The study was conducted in February up to March 2017 by using 121 samples of post partum mother, and the sampling technique used was exhaustive sampling method. The dependent variable in the study was time of early breastfeeding, whereas independent variables included maternal education, maternal occupation, family income, maternal knowledge, parity, ANC history and health workers‘ support. The data was measured by a set of questionnaires which was employed as the guidelines of interview and the result of the study was analyzed by using multiple logistic regression. Results: Factors that influenced the timeliness of early initiation of breastfeeding were maternal education ≥Senior High School (OR=3.90; 95% CI= 1.14 to 13.37; p=0.030), maternal occupation (OR= 7.93; 95% CI=1.68 to 37.52; p=0.009), ANC history ≥ 4 times (OR=3.48; 95% CI =0.82 to 14.81; p=0.092), and strong health workers‘ support (OR=12.58; 95% CI= 4.30 to 36.77; p<0.001) with the value of Negelkerker R square was 0.387. Conclusion: Factors that influenced the timeliness of early breastfeeding initiation included education, occupation, ANC history, and health workers‘ support.
Keywords: Socio demography, obstetric factor, early breastfeeding initiation.
Correspondence: Juhrotun Nisa. Associate Degree of Midwifery Study Program, Harapan Bersama Polytechnic. Jl. Mataram No. Pesurungan Lor Kota Tegal. Email: [email protected]. Mobile: +6285642905995.
BACKGROUND such as low birth weight and neonatal Neonatal nutrition (early breastfeeding infection (Khanal et al, 2015). initiation within the first hour of birth and Early initiation of breastfeeding is exclusive breastfeeding) is the primary considered as able to stimulate immune- intervention for the survival of newborns globulin and lymphocytes found in colos- during perinatal period. Early initiation of trums to prevent pathogen infection during breastfeeding is significantly related to the the maturation of normal intestine. Early decrease of all causes of neonatal mortality initiation of breastfeeding also may prevent e-ISSN: 2549-0257 (online) 89 Journal of Maternal and Child Maternal (2017), 2(2): 89-99 https://doi.org/10.26911/thejmch.2017.02.02.01 hypothermia on newborns (Khanal et al., Breastfeeding out of 945 births) (Dinkes 2015). Tegal, 2016). In South Asia the accomplishment of Another fact in Tegal regency showed early initiation of breastfeeding is only 41% that there were patients who did not know from total births within the first hour of yet the benefits of early initiation of breast- birth. Some countries in South Asia have feeding and considered the first breast milk the worst practice of early initiation of to come out (colostrums), which is yellow in breastfeeding in the world, those countries color, is dirty and should be disposed. include Pakistan 29% of the total birth, 41% Meanwhile in RSUD dr. Soesel0, the imple- of infants in India, 47% infants in Bang- mentation of early initiation of breast- ladesh dan 45% infants in Nepal. In feeding was not yet possible to be executed Indonesia based on Riskesdas 2013 it is on all patients, since there were some cases seen that the majority breastfeeding initia- where mothers and infants could not tion process occur within 1-6 hours of conduct rooming in. In addition, in some birth, which is 35.2% and less than 1 hour cases the implementation of early initiation (early initiation of breastfeeding) is 34.5% of breastfeeding was also conducted after (Sharma and Byrne, 2016; Kemenkes RI, the examination/ treatment on infants had 2014). completed. Early Initiation of Breastfeeding The study aimed to know the factor of within the first hour of birth is the easiest socio demography and obstetric that breastfeeding effort and the most com- influenced the timeliness of early initiation monly successful, since during the first of breastfeeding, which consisted of edu- hour of birth, mother has been physically cation, occupation, family income, maternal and psychologically ready to breastfeed, knowledge, parity, history of antenatal care supported by information/ counseling on and health workers‘ support. breastfeeding and support from healthcare service providers (health workers) SUBJECTS AND METHOD (Adugna, 2014). The design used in the study was non According to Liben and Yesuf (2016) experimental quantitative study by using parity and education may influence the analytic observational design with cross timeliness of early breastfeeding. In addi- sectional study that was the study design by tion, there are also antenatal care, know- simultaneously measuring and observing ledge, midwife‘s procedure, and midwife‘s (at the same time) between factor of risk/ support (Bimerew et al, 2016; Hidayat, exposure and disease. 2012; Sirajuddin et al, 2013). The subjects of the study were post In Tegal Regency the implementation partum mother who were still in the child- data of early initiation of breastfeeding was birth facility in Community Health Center just reported in 2016, the previous year was that owned Basic Emergency Obstetric Care not reported. The result of quarterly report (BEOC) namely Bumijawa, Jatinegara, showed not all infants get breast milk Pagerbarang, and Pagiyanten Community through early initiation of breastfeeding Health Center, and RSUD dr Soeselo, Tegal within the first hour of birth such as in Regency. Slawi Community Health Center was only The study was conducted in February 50.9% (481 infants get Early Initiation of up to March 2017 with the number of samples referred to Hair et al (1998) which
90 e-ISSN: 2549-0257 (online) Nisa et al./ Factor of Socio Demography and Obstetric that Influence was cited by Murti (2013) that states was obtained by respondent within a whole sample of multivariate analysis is recom- month, the categorical scale was, 0 Table 1 showed that the value of Cron- B. Univariate Analysis bach Alpha for knowledge was 0.75with Univariate analysis was used to explain or item total correlation value was more than describe figures or value of each variable 0.41, therefore the questionnaires for know- with the measurement of percent pro- ledge in the study was reliable, whereas the portion. Univariate analysis on socio demo- value of Cronbach Alpha for health workers‘ graphy and obstetric factors that influenced support was 0.74 ≥ 0.60 item total corre- timeliness of early breastfeeding in Tegal lation value was more than 0.35, therefore Regency included level of education, occu- the questionnaires of health workers‘ pational status, family income, maternal support in this study was reliable Data knowledge on early initiation of breast- quantitative analysis was conducted by feeding, maternal parity status, history of using multiple logistic regression. antenatal care, health workers‘ support in the practice of early initiation of breast- RESULTS feeding and the duration of early initiation A. Respondents‘ Characteristics of breastfeeding process. The result of Table 2 showed the study result of the socio univariate analysis can be seen in Table 3. demography and obstetric factors that Table 3 Showed that the result of influenced timeliness of early breastfeeding univariate analysis toward factors of socio in Tegal regency which was conducted on demography and obstetric that influenced 121 subjects of the study. It obtained the the timeliness of early breastfeeding in percentage of the majority age was on Tegal Regency were for socio demography reproductive age as much as 76.03% of post data, out of 121 respondents it was obtained partum mothers. that many of respondents‘ education level Table 2. Characteristics of study was less than high school which was 64.46- subjects based on age % or in other words there were 78 postpar- Study subjects n % tum mothers with less than high school age education, 80.99% of maternal occupa- <20 year or ≥35 29 23.97 tional status was housewife or in other year words mothers who did not work with the 20 œ 35 year 92 76.03 family monthly income was equal to or Total 121 100 more than regional minimum wage was 57.02% in which Tegal Regency‘s Regional 92 e-ISSN: 2549-0257 (online) Nisa et al./ Factor of Socio Demography and Obstetric that Influence Minimum Wage was Rp. 1.487.000. The ledge was measured whether it was good or postpartum mothers‘ level of knowledge on less good by using the average/ mean of early initiation of breastfeeding mostly was total value of knowledge possessed by post good or about 57.85%, in which the know- partum mothers. Table 3. Univariate analysis on factors influence the timeliness of early breastfeeding Characteristics Criteria n % Education The result of univariate analysis for and level of maternal knowledge about obstetric factor was as follow: maternal early initiation of breastfeeding, whereas parity in the study showed the result that obstetric factors included maternal parity most subjects had given birth more than status, history of antenatal care examina- once or multipara, it was as much as tion, and health workers‘ support in the 56.20% with the history of antenatal care practice of early initiation of breastfeeding. was more than 4 times or mothers had The result of bivariate analysis of the study regularly undergone antenatal care exa- was presented in Table 4. mination as much as 89.26%. The majority In table 4 which was about the result of health workers in the research location of bivariate analysis of socio demography had given strong support in the practice of and obstetric factors that influenced the breastfeeding early initiation, as much as timeliness of early breastfeeding in Tegal 52.07%, in which the majority of early Regency, it could be observed that the initiation of breastfeeding practices had practice of early initiation of breastfeeding been conducted timely or less/ equal to the within an hour or less was more likely first hour of birth, which was 63.64% conducted by mothers with less than high C. Bivariate Analysis school education which was as much as Bivariate analysis was conducted to know 42.97%, it was because the majority of the correlation between factors of socio respondents‘ education was less than high demography and obstetric with the time- school, whereas the value of p was 0.030. liness of early breastfeeding. Factors of The value was less than 0.05, meant mater- socio demography included level of educa- nal education had significant correlation tion, occupational status, family income, with the timeliness of early breastfeeding. e-ISSN: 2549-0257 (online) 93 Journal of Maternal and Child Maternal (2017), 2(2): 89-99 https://doi.org/10.26911/thejmch.2017.02.02.01 Table 4. The result of bivariate analysis of socio demography and obstetric factors that influenced the timeliness of early breastfeeding in Tegal Regency <1 hour ≥1 hour Variable Criteria p n % n % Education Maternal occupational status had the 0.489. The practice or early initiation of value of p as much as 0.009 thus there was breastfeeding within less than 1 hour after a correlation between maternal occupation birth was more likely conducted by multi- with the timeliness of early breastfeeding in para mothers of 37.19%. which mothers whose early initiation of Mothers who were regularly under- breastfeeding were conducted ≤ 1 hour after went pregnancy examination which was birth were mostly working at home, which antenatal care for more than 4 times during was 47.93%. their pregnancy were more likely to conduct Family income did not have any early initiation of breastfeeding within less correlation with the timeliness of early or equal to one hour, which was as much as breastfeeding, the value of p=0.713. The 57.85%. History of ANC examination had practice of early initiation of breastfeeding significant correlation with the timeliness within less or equal to 1 hour after birth was of early breastfeeding with the value of p more likely conducted by mothers whose was 0.092, the figure was considered close family income was higher than regional to significant. minimum wage, which was Rp 1,487,000. Support of health workers was the The value of p for the level of know- most dominant factor in the practice of ledge was 0.701, thus there was no correla- early breastfeeding, in which mothers who tion between maternal level of knowledge obtained strong support from health and the timeliness of early breastfeeding, workers in practicing early initiation of however the practice of early initiation of breastfeeding were likely to be timely in breastfeeding was more likely conducted by conducting early initiation of breastfeeding mothers with good knowledge, which was than mothers who obtained weak support, 38.84%. in which appropriate timing was less than 1 Maternal parity did not have signi- hour after birth. Health workers support ficant correlation with the timeliness of had significant correlation with the time- early breastfeeding since the value of p= 94 e-ISSN: 2549-0257 (online) Nisa et al./ Factor of Socio Demography and Obstetric that Influence liness of early initiation of breastfeeding toward the timeliness of early initiation of with the value of p < 0.001. breastfeeding in Tegal Regency. The value D. Multivariate analysis of Negelkerker R square was 0.387, which Table 5 show the result of multivariate meant socio demography and obstetric analysis by using multiple logistic regres- factors influenced the timeliness of early sion on socio demography and obstetric initiation of breastfeeding as much as factors that influenced the timeliness of 38.7%, meanwhile 61.3% was influenced by early breastfeeding in Tegal Regency with other factors which were not studied in the the result that socio demography and study. obstetric factors had significant effect Table 5. The result of multivariate analysis of socio demography and obstetric factors that influenced the timeliness of early breastfeeding in Tegal Regency. 95% CI Variables OR p Lower Upper Maternal education ≥ Senior High School 3.90 1.14 13.37 0.030 Working at home mothers 7.93 1.68 37.52 0.009 Family income ≥ Rp. 1.487.000 0.83 0.32 2.21 0.713 Good maternal knowledge 0.83 0.31 2.18 0.701 Primipara maternal parity 0.69 0.25 1.95 0.489 History of ANC ≥ 4 times 3.48 0.82 14.81 0.092 Strong health workers‘ support 12.58 4.30 36.77 <0.001 N Observation= 121 -2 log likelihood= 118.42 Negelkerker R²= 38.70% Constant = -4.08 Based on the OR value of each variable, Family income did not have correlation from the result of analysis by using multiple with the timeliness of early breastfeeding, logistics regression test it could be however mothers who came from family explained that: Mothers whose level of whose income was higher than regional education was higher or equal to high minimum wage (Rp 1,487,000) would school education had 3.90 times possibility possibly reduce by 0.83 times of the early to be more timely in conducting early breastfeeding timeliness compared to those initiation of breastfeeding compared to who came from family whose income was those whose level of education was lower lower than regional minimum wages (Rp. than high school. The correlation was 1.487.000). The correlation was statistically statistically significant (OR=3.90; 95% CI= insignificant (OR=0.83; 95% CI= 0.32 to 1.14 to 13.37; p=0.030). 2.21; p=0.713). Mothers who worked at home had 7.93 Maternal knowledge did not have times possibility to be more timely in early correlation with the timeliness of early initiation of breastfeeding than those who breastfeeding, however mothers with good worked outside. The correlation is statisti- knowledge would reduce by 0.83 times of cally significant (OR=7.93; 95% CI =1.68 to early breastfeeding timeliness compared to 37.52; p= 0.009). mothers with less knowledge. The corre- e-ISSN: 2549-0257 (online) 95 Journal of Maternal and Child Maternal (2017), 2(2): 89-99 https://doi.org/10.26911/thejmch.2017.02.02.01 lation was statistically insignificant (OR= reduce the timeliness of early initiation of 0.83; 95% CI =0.31 to 2.18; p=0.701). breastfeeding by 4.08 times. Maternal parity did not have correlation with the timeliness of early DISCUSSION breastfeeding however primipara mothers Early initiation of breastfeeding is one of had the possibility to reduce by 0.69 time of the government programs that has been the early breastfeeding timeliness com- regulated in the article 9 of —Government pared to multipara mothers. The corre- Regulation of the Republic of Indonesia No. lation was statistically insignificant (OR= 33/ 2012 about Exclusive Breastfeeding“ 0.69; 95% CI =0.25 to 1.95, p= 0.489). however not all newborn infants undergo Mothers who regularly underwent early initiation of breastfeeding timely. antenatal care more than 4 times during Factors affecting in the implementation their pregnancy would possibly increase by timing of early initiation of breastfeeding 3.48 times of the timeliness of early initia- are as follow: tion of breastfeeding compared to those A. The correlation of education with who underwent antenatal care less than 4 the timeliness of early breast- times. The correlation was statistically close feeding to significant (OR=3.48; 95% CI=0.82 to Education had an influence toward the 14.81; p= 0.092). timeliness of early breastfeeding in which Strong support from health workers in mothers whose level of education was implementing early initiation of breast- higher than high school had 3.90 times feeding had the possibility to increase by possibility to be timely in conducting early 12.58 times of the timeliness of early initia- initiation of breastfeeding compared to tion of breastfeeding, compared weak those whose level of education was lower health workers‘ support. The correlation than high school. The result of the study is was statistically significant (OR= 12.58; in accordance with Sirajuddin, Abdullah, 95% CI= 4.30 to 36.77; p<0.001). Lumula (2013) who studied about —The Based on Hosmer and Lemeshow test a Determinants of Early Initiation of Breast- significance value was obtained which was feeding“, the result of the study finds that 0.32 or bigger than .=0.05, thus it was education is related to the implementation concluded that the formulated multiple of early initiation of breastfeeding, suffi- logistic regression equation model was cient education give 5.9 times bigger feasible or appropriate and possible to influence toward the implementation of interpret. early initiation of breastfeeding than less Based on the regression equation it education. could be predicted that if less educated The higher one‘s education the higher mothers (0), employed mothers (0), one‘s power of reasoning toward every mothers with income less than Rp. information given therefore it is easier to 1.487.000 (0), mothers with less knowledge take action. Mothers with higher education (0), mothers who had given birth more than are more open minded to receive new once/ multipara (0), mothers who seldom knowledge, therefore the practice of early underwent pregnancy examination (0) and initiation of breastfeeding on mothers with obtained weak support in implementing higher level of education is likely to be early initiation of breastfeeding would successfully conducted before the firat hour 96 e-ISSN: 2549-0257 (online) Nisa et al./ Factor of Socio Demography and Obstetric that Influence of birth compared to on mothers with lower still have to carry the responsibility at education (Sirajuddin et al, 2013). home, hence mothers‘ time and energy are B. The correlation of occupation with spent to handle their duty, including house the timeliness of early breast- chores. The condition affects the preg- feeding nancy, as the result mothers are not ready Maternal occupational status was related to for early initiation of breastfeeding (Lakew the timeliness of early breastfeeding. et al, 2015). Unemployed mothers had possibility as C. The correlation of family income much as 7.93 times in the timeliness of and the timeliness of early breast- early initiation of breastfeeding compared feeding to working mothers. The study is in Family income did not have any correlation accordance with the study conducted by with the timeliness of early initiation of Lakew et al. in 2015 entitled —Socio-medical breastfeeding. In which high family income determinants of timely breastfeeding had negative correlation which meant that initiation in Ethiopia: Evidence from the mothers who came from family with high 2011 nation wide Demographic and Health income or more the Rp 1,487,000 had the Survey“. The study revealed the result that more possibility to reduce the timeliness in on working mothers there is 23% possibility conducting early initiation of breastfeeding to be untimely in conduct early initiation of by 0.83 times. The study is supported by a breastfeeding“. study conducted by Sharma dan Byrne Working mothers are more possible to (2016) about, —Early initiation of breast- experience stress during their pregnancy feeding: a systematic literature review of because of their professional demand. The factors and barriers in South Asia“, in stress endured by mothers may affect the which the respondents in Srilanka showed condition of mothers as well as the fetus. the result that the delay in early initiation of The condition may get carried through the breastfeeding was likely conducted in rich process of delivery, hence during the imple- families and more practices of early initia- mentation of breastfeeding early initiation tion of breastfeeding were conducted by the result is not as it is expected such as women from poor families. It is because asphyxia baby and can not undergo early those who come from poor family back- initiation of breastfeeding or else the baby ground are more easily to direct in imple- fails in getting the mother‘s nipple because menting new knowledge, whereas those of unstable condition (Lakew et al, 2015). who come from rich families demand Unemployed mother can be considered practical and quick treatment . as mothers who only play their roles as D. Correlation of parity with the homemakers. They have plenty time at timeliness of early breastfeeding home without any obligation to work Maternal knowledge did not have corre- outside. Housewives are likely to have a lot lation with the timeliness of early breast- of time to conduct pregnancy care and give feeding. The course of correlation of know- attention to their pregnancy, including the ledge in the study was not different from readiness to give breast milk since early the family income that was negative, it through early initiation of breastfeeding. means that mothers with good knowledge Meanwhile working mothers are demanded have the possibility to reduce the timeliness to do the activity outside the home more or of early initiation of breastfeeding by 0.83 less 7 hours a day, afterward those mothers times compared to mothers with less e-ISSN: 2549-0257 (online) 97 Journal of Maternal and Child Maternal (2017), 2(2): 89-99 https://doi.org/10.26911/thejmch.2017.02.02.01 knowledge. The study is in accordance with F. Correlation of ANC history with a study conducted by Sirajuddin, Abdullah, the timeliness of early breast- Lumula in 2013 entitled —Determinant of feeding the Implementation Early Breastfeeding The history of antenatal care (ANC) exami- Initiation“, that showed the result that nation correlated with the timeliness of knowledge does not have contribution early breastfeeding. Mothers who regularly toward the implementation of early initia- conducted pregnancy examination which tion of breastfeeding. It is because mothers was ≥ 4 times, had the possibility to with good knowledge have a big chance to increase the timeliness of early breast- conduct an action and maternal attitude feeding by 3.48 times compared to those greatly determines whether she will who conducted pregnancy examination < 4 undergo early initiation of breastfeeding or times. The study is in accordance with a not. It is influenced by maternal situation study conducted by Bimerew et al. in 2016 and condition who is still exhausted after entitled —Prevalence of timely breastfeed- giving birth hence the process of breast- ing initiation and associated factors in feeding early initiation is not implemented Dembecha district, North West Ethiopia: a and mothers postponing giving breast milk cross-sectional study“. The result of the to their infants. study showed that mothers who conduct E. The correlation of parity with the antenatal visits more than four times will timeliness of early breastfeeding. give breast milk immediately after birth 3.1 Maternal parity did not have correlation times bigger than those who conduct with the timeliness of early breastfeeding antenatal visits less than four times. It is with negative course of correlation. Primi- because in accordance with 10T pregnancy para mothers had the possibility to reduce examination standard pregnant women will the timelines of breastfeeding early initia- get counseling during dialogues, therefore tion by 0.69 times compared to multipara maternal knowledge on early initiation of mothers. The study is in accordance with breastfeeding will be improved. Midwives‘ the study conducted by Hidayat in 2012 appropriate approach will help mothers in about —The Comparison of Early Initiation deciding whether they will conduct early of Breastfeeding Implementation based on initiation of breastfeeding or not. Pregnant Women‘s Level of Knowledge“, G. The correlation of health workers‘ that showed the similar result that parity support with the timeliness of does not have significant correlation with early breastfeeding the implementation of breastfeeding early Health workers‘ support had significant initiation. It is because primipara mothers correlation with the timeliness of early are likely to give the best for their infants, breastfeeding. Health workers‘ support is yet they do not have enough experience in the most dominant factor in the timeliness giving breast milk immediately, whereas of early breastfeeding. Strong health worker multipara mothers are likely to have support had 12.58 times bigger possibility prepared breast milk immediately, since to conduct timely early initiation of breast- they already have experience and are feeding than weak health workers‘ support. supported by counseling during antenatal The study is in accordance with a study care. conducted by Raharjo (2014). The result shows the role of midwives in significant way related to mothers‘ practice in doing 98 e-ISSN: 2549-0257 (online) Nisa et al./ Factor of Socio Demography and Obstetric that Influence early initiation of breastfeeding. Encou- Kementerian Kesehatan RI. Situasi ragement and motivation from health dan Analisis ASI Ekslusif. Jakarta. workers helps mothers to take a stand in Pekan ASI 1-7 Agustus. early initiation of breastfeeding practice. Khanal V, Scott J, Lee A, Karkee R, Binns C, Based on the result of the study on (2015). Factors associated with Early socio demography and obstetric factor that Initiation of Breastfeeding in Western influence the timeliness of early breast- Nepal. International Journal of Envi- feeding in Tegal Regency it can be con- ronmental Research and Public cluded that factors that can influence the Health. 12:9562-9574. timeliness of early breastfeeding include Lakew Y, Tabar L, Haile D (2015). Socio- maternal education ≥ SMA, maternal medical determinants of timely occupation at home, history of ANC ≥ 4 breastfeeding initiation in Ethiopia: times and strong support from health Evidence from the 2011 nation wide workers. Demographic and Health Survey. 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