Does Contextual Factor of the Integrated Family Health Post Affect Exclusive Breastfeeding? A Multilevel Evidence from Surakarta, Central Java

Abstract

Background: Exclusive breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants. Breast milk is rich in nutrients and anti-bodies and contains the right quantities of fat, sugar, water and protein. Routine nutrition status monitoring services for children under five in lower-income countries are generally delivered through fixed-post sites (ie, within the health facility) and enhanced by outreach (the integrated family health post) for populations living in rural or remote areas with limited access to fixed services. This study aimed to determine the effect of maternal nutritional status, parity, employment status, family income, health personnel support, subjective norm, on exclusive breastfeeding in Surakarta, Central Java, accounting for the contextual effect of the integrated family health post (“posyandu”). Subjects and Method: This was an cross sectional study conducted in Banjarsari sub-district, Surakarta, Central Java, from October 17 to November 7, 2017. Twenty five community health centers were selected bystratified random sampling. Of the “posyandus” selected, 200 lactating mothers were selected by simple random sampling. The dependent variable was exclusive breastfeeding. The independent variables were maternal nutritional status, parity, employment status, family income, subjective norm, and health personnel support. The data were collected using a set of questionnaire and analyzed by multilevel logistic regression in Stata 13. Results: The likelihood of exclusive breastfeeding increased with better maternal nutritional status (b= 1.65; 95% CI= 0.14 to 3.17; p= 0.032), multi parity (b= 1.72; 95% CI= 0.57 to 2.86; p= 0.003), working outside the house (b= -2.94; 95% CI= -3.99 to -1.88; p= 0.001), higher family income (b= -1.94; 95%CI= -3.13 to -0.76; p= 0.001), strong health personnel support (b= 1.13; 95% CI= 0.02 to 2.25; p= 0.046), and positive subjective norm (b= 1.20; 95% CI= 0.14 to 2.25; p= 0.025). Posyandu showed strong contextual effect on exclusive breastfeeding with intra-class correlation (ICC)= 28.87%. Conclusion: The likelihood of exclusive breastfeeding increases with more active posyandu at the higher contextual level, in addition to better maternal nutritional status, multi parity, working outside the house, higher family income, strong health personnel support, and positive subjective norm, at the lower individual level. Keywords: exclusive breastfeeding, multilevel analysis, socioeconomic factors, health personnel support, posyandu