Milk Supply Research Articles

The Effectiveness of Milk Supplementation on Weight and Height/Length in Stunted Toddles

Stunting or a short child was described as a toddler whose height was lower than the standard height for toddlers his age. Until now, the prevalence of stunted toddlers in Indonesia is still high. The prevalence of stunted toddlers at the Plaosan Community Health Center in the last 3 years showed an increase. The cause of stunting, apart from infection, is also related to nutritional deficiencies (micronutrients and macronutrients). The adverse effected of stunting in the short term are disruption of brain development, intelligenced, impaired physical growth, and metabolic disorders in the body. Supplementary feeded is one of the solutions in handling stunting. This study aims to determined the effectiveness of milk feeded on the weight and height/length of stunted toddlers. The typed of research used was pre-experimental with a one group pretest posttest design. The sample used a total population of 56 toddlers. The dependent variable in this studied was the weight and height/length of stunted toddlers, the independent variabled is the provision of milk for toddlers. Data collection used weight and height measurement sheets and milk feeded observation sheets. Comparative data analysis was conducted using the paired samples t test statistical test. The results of the study show that the average body weight before giving milk was 8737.5 mm and after giving milk 8923.2 mm. Body height/length before milk feeding was 804.6 mm and after milk feeding was 806.63 mm. Different test using paired samples t test obtaining the conclusion that there is a significant difference in the increase in body weight of toddlers with a significance level of 0.000 (p <0.05) and there is a significant difference in increasing the height of toddlers with a significance level of 0.000 (p <0.05). Conclution: Milk is effective to increase the weight and height/length of toddlers, so it is advisable for mothers of toddlers to get their children used to a glass of milk everyday.

The impact of exclusive breastfeeding on breastfeeding duration

BackgroundWhile breastfeeding is globally recommended, its duration still represents a public health issue. AimTo examine the association between the period of exclusive breastfeeding (EBF) and the duration of overall human milk nutrition, and to identify determinants associated with the duration of EBF and overall human milk nutrition length. Study designThe presented study is a cross-sectional study. A total of 209 healthy Polish women of Caucasian origin, aged 19–42 years, who were the mother of a child aged 3–12 months, were enrolled in the study. Data were collected from 2018 to 2020 using an anonymous questionnaire. Statistical analyses included one way ANOVA and liner regression. ResultsAfter birth almost all newborns were exclusively breastfed (96.7 %), but the supply of mother's milk declined as the children's ages increased. The duration of breastfeeding is strongly associated with EBF, especially until the child is six months old (p < 0.001). Mother's breastfeeding self-efficiency and her will for breastfeeding, comfortable latch, younger infant age, avoiding of a pacifier and excluding additional food may explain 36 % of variation of EBF duration (p < 0.001) and could be useful information for exclusive breastfeeding support. ConclusionsThe practice of exclusive breastfeeding strongly affects overall breastfeeding duration. The promotion of exclusive breastfeeding, rather than of overall breast milk supply, is crucial.

Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus Infection in Domestic Dairy Cattle and Cats, United States, 2024.

We report highly pathogenic avian influenza A(H5N1) virus in dairy cattle and cats in Kansas and Texas, United States, which reflects the continued spread of clade 2.3.4.4b viruses that entered the country in late 2021. Infected cattle experienced nonspecific illness, reduced feed intake and rumination, and an abrupt drop in milk production, but fatal systemic influenza infection developed in domestic cats fed raw (unpasteurized) colostrum and milk from affected cows. Cow-to-cow transmission appears to have occurred because infections were observed in cattle on Michigan, Idaho, and Ohio farms where avian influenza virus-infected cows were transported. Although the US Food and Drug Administration has indicated the commercial milk supply remains safe, the detection of influenza virus in unpasteurized bovine milk is a concern because of potential cross-species transmission. Continued surveillance of highly pathogenic avian influenza viruses in domestic production animals is needed to prevent cross-species and mammal-to-mammal transmission.

INTERPRETING FARMER ATTITUDE TO FOOD LOSS PHENOMENON IN THE FRESH MILK SUPPLY CHAIN IN BANYUMAS, INDONESIA

Food loss is currently a global problem for both developing and developed countries. Food loss is defined as the loss of a portion of food that is still raw but cannot be processed into a food product because the resulting material does not meet the desired quality. Food loss occurs in livestock production, and one focus is the milk supply chain. Food loss in milking usually occurs due to activities carried out during the harvest, post-harvest, and distribution processes. Food loss in the milk supply chain is caused by decreased milk quality and the farmer's attitude. Problems regarding the attitude of farmers that often occur are farmers' low attitude of responsibility to conduct something. This study aims to determine the effect of farmer attitudes to food loss in the milk supply chain. The method used was quantitative by collecting data from a survey of 46 milk farmers in Bayumas. Then, data were analyzed using the ANOVA approach. The results showed that demographics significantly affect farmers’ attitudes toward food loss in the milk supply chain. The food loss is due to farmers' treatments, including feeding, filtering milk into milk cans, and depositing milk in the shelter. Most farmers are over 50 and need more attention and knowledge about food loss in the milk supply chain. Therefore, it is necessary to conduct regular counseling programs for farmers in the supply chain regarding food loss mitigation. The stakeholders can provide the program to add new insights related to food loss. There should be intervention from the deposit shelter and cooperative in helping to increase farmers' awareness of food loss in quantity and quality.

Isolation and Identification of Pathogenic Bacteria in Pasteurized Powdered Milk Sold in Ogun, Lagos and Oyo, Southwest, Nigeria

Study’s Novelty/Excerpt This study provides novel insights into the bacteriological quality of powdered milk sold in Ogun, Lagos, and Oyo, Southwest Nigeria, by isolating and identifying bacterial species through 16S rRNA gene sequencing and evaluating their antibiotic resistance profiles. The research highlights the detection of potentially harmful bacteria, including Pseudomonas aeruginosa and Bacillus cereus, indicating issues related to inadequate storage or sanitation practices in the milk supply chain. These findings underscore the importance of rigorous microbial monitoring and improved hygiene standards to ensure the safety and extended shelf life of powdered milk products. Full Abstract Milk is a nutritious beverage enjoyed by people of all ages, but it also provides an ideal environment for the growth of various microorganisms. This study aimed to isolate and identify the bacteriological quality of powdered milk sold in Ogun, Lagos, and Oyo, Southwest Nigeria. Three samples from each of five different brands were analyzed by homogenizing 1g of each milk sample with 10ml of nutritional broth, followed by overnight incubation at 37°C. Subsequently, the bacteria were plated on nutrient agar, Mac-Conkey, and EMB, with further characterization through partial sequencing of 16S rRNA genes. The detected species were then evaluated against antibiotics including Acyclovir, Cefotaxime, Augmentin, Cefuroxime, Gentamicin, Erythromycin, Ofloxacin, Nitrofurantoin, Ciprofloxacin, Nalidixic acid, and Azithromycin. The molecular testing revealed the presence of Pseudomonas aeruginosa, Bacillus cereus, Brevibacillus agri, Lysinibacillus sphaericus, and Bacillus thuringiensis as the identified bacterial species. Pseudomonas aeruginosa exhibited sensitivity to Gentamicin and Cefuroxime, with Nitrofurantoin showing the highest sensitivity at 80.0%. Brevibacillus agri (LATC3) demonstrated sensitivity to Cefuroxime and Gentamicin, with a higher sensitivity of 55.00% to Gentamicin. Bacillus cereus (LAKG2 and LAC2) showed higher responsiveness to Ceftriaxone compared to Ofloxacin, Cefotaxime, Augmentin, Acyclovir, and Levofloxacin. These findings indicate the presence of potentially harmful organisms in the microbial populations of pasteurized milk, suggesting inadequate storage practices or insufficient sanitation of facilities and equipment post-production and packaging. Therefore, monitoring the microbial quality of pasteurized milk is essential to ensure safety and extend its shelf life.

Improving the sustainability of milk production across different climate regions in China

Unprecedented climate change and ever-increasing demand for dairy products call for solutions that can ensure stable and sustainable milk production in different climate regions. Fully-enclosed dairy farms act as a promising option while its economic and environmental performance is poorly studied. Here, we evaluated the potential of improvement on milk yield and milk supply inequality among regions by developing fully-enclosed dairy farms throughout China, as well as their economic feasibility and environmental impacts. Results showed that: (1) fully-enclosed dairy farms present a 33 % higher milk yield per lactating cow together with a 38 % lower coefficient of variation in milk production across climate regions than semi-enclosed ones; (2) greenhouse gas and NH3 emissions of fully-enclosed dairy farms are effectively declined compared with semi-enclosed ones; (3) the inequality in fresh milk supply can be reduced by 51 % through strategically locating fully-enclosed dairy farms around cities; and (4) industrial optimization on the internal structure of fully-enclosed dairy farms is economically feasible across different climate regions in China, with an average improvement of 54 %. Our analysis suggests to develop fully-enclosed dairy farms surrounding urban areas for meeting milk demand alongside positive effects on environmental sustainability, which also offers a lens for the livestock sector to define better policies that improve the sustainability of milk production on the planet.

Mapping Flows in the Cassava, Rice, Milk, and Fish Supply Chains of the Eastern Democratic Republic of the Congo: Is There Any Quiet Revolution Taking Place?

By applying a stacked survey approach to farmers, processors, and intermediaries, this study estimates and maps aggregate flows of fresh and processed cassava, rice, milk, and fish within the Bukavu-Uvira-Kalemie economic corridor of the Eastern Democratic Republic of the Congo (DRC). To achieve this, we develop and implement a comprehensive accounting method to better capture the complex set of activities within all four supply chains as well as an alignment procedure to ensure consistency in flows across their stacks. Apart from operating beyond mere subsistence levels, the findings of this study indicate that much of the vibrant agri-food value chain (AVC) developments observed in other low- and middle-income countries (LMIC) are yet to occur in the Eastern DRC: processing levels and new product development are low; intermediaries remain very present in agri-food markets; food losses are high in the midstream segments; and advance payments to farmers have not disappeared. While these observations provide for a dissonant case study, it underscores the huge potential for future upgrading of AVC in the Eastern DRC.

Effect of brewer’s yeast or beta-glucan on breast milk supply following preterm birth: the BLOOM study – protocol for a multicentre randomised controlled trial

BackgroundMany individuals who experience preterm birth struggle with early breast milk supply, which can translate into suboptimal longer-term breastfeeding outcomes. Further investigations into the potential role of early non-pharmacological and pharmacological interventions in improving breast milk production soon after birth is growing. While natural galactagogues, such as brewer’s yeast, are widely perceived by women to be safer than pharmaceutical galactagogues and are taken by many women, evidence to support their efficacy is largely absent. The BLOOM study has been designed to determine the efficacy and safety of brewer’s yeast and beta-glucans, derived from Saccharomyces cerevisiae, when administered soon after birth for increasing early breast milk supply in mothers who have delivered preterm.MethodsThe BLOOM study is a multicentre, double-blinded, randomised controlled trial that will assess if brewer’s yeast or beta-glucan can increase early breast milk production following preterm birth. Target population are mothers of preterm infants born at less than 34 weeks’ gestation who intend to provide breast milk for their infant, are less than 72 h following birth and able to give informed consent. Participants will be randomly allocated into three parallel groups at 1:1:1 ratio (n = 33 per group) to receive either brewer’s yeast, beta-glucan or placebo capsules for seven days. The primary outcome is total expressed breast milk volume over a 24-hour period on day 7 of intervention. Participants and their infants will be followed until the infant reaches term corrected age or is discharged home from the neonatal unit (whichever occurs first).DiscussionThe use of brewer’s yeast as a galactagogue to enhance milk production is extremely common amongst breastfeeding mothers, however, there are no trials evaluating its efficacy and safety. This will be the first randomised controlled trial to evaluate the efficacy and safety of two commonly used galactagogues, brewer’s yeast and beta-glucan, compared with placebo in improving maternal breast milk supply following preterm birth. The trial will also evaluate whether early intervention with galactagogues soon after a preterm birth improves longer-term breastfeeding outcomes.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12622000968774 (registered on 8 July 2022) and UTN U1111-1278-8827.

Receiving screened donor human milk as part of a community-based lactation support programme reduces parental symptoms of anxiety and depression.

Infant feeding decisions and maternal mental health are closely tied. Donor human milk (DHM) protects premature infant health and development and can reduce hospital stays. Recent qualitative research has highlighted that having the option for an infant to receive DHM can also support parental wellbeing through reducing concerns about infant health and supporting feeding preferences. However, no quantitative study has examined this relationship. In this study, anxiety and depression scores were measured before and after receiving DHM using the Hospital Anxiety and Depression Scale for 80 parents (77 mothers, 3 fathers) who had sought DHM from a community-facing milk bank. Reasons for seeking DHM included maternal cancer, maternal and infant health complications, insufficient glandular tissue, and low milk supply. Open-ended questions explored the experience of receiving milk. Milk bank records were used to match details of milk given (volume, duration, exclusivity, lactation support given) with survey responses. Both anxiety and depression scores significantly reduced after receiving milk. Although greater lactation support and longer duration of milk predicted a greater decrease in scores, in a regression analysis, only volume of milk given remained a significant predictor. Almost all parents agreed that being able to access DHM supported their wellbeing predominantly through reducing anxieties around infant health but also through feeding choices being respected and the support given atdifficult times. The findings add important considerations to the literature considering when and for whom DHM should be used and the complex interplay between infant feeding and mental health.

New York state, regional and county level nitrogen and phosphorus balances for harvested cropland

New York (NY) state is one of five states that collectively produce &amp;gt;50% of the annual milk supply within the United States. The local environment allows farmers to integrate crop and livestock systems, facilitating cycling of manure nutrients back to cropland. Thus, dairy provides NY with benefits, opportunities, and challenges in terms of environmental sustainability, climate resiliency, and a circular agricultural economy. Improved balancing of crop nitrogen (N) and phosphorus (P) needs and supply with manure and fertilizer, is key for a circular agricultural economy. The objectives of this study were to calculate and evaluate (1) regional and county level N and P balances of harvested cropland; and (2) contribution of manure to a circular agricultural economy for NY. Nutrient balances were calculated for 2017 (most recent Census year) as the difference in the amount of nutrient input through purchased fertilizer and recoverable manure, and the amount removed in harvested crops. Atmospheric N deposition and legume N fixation, and manure nutrient losses during collection, transfer, storage, and treatment were estimated too. The 2017 P balance was 10 kg P ha−1 (9 lb. P ac−1). The N balance was between 39 kg N ha−1 (35 lb. N ac−1) and 95 kg N ha−1 (85 lb. N ac−1), depending on the proportion of legume cropland assumed to receive manure. Redistribution and application of manure to meet P-removal on non-legume cropland only leaves a surplus of 3 kg P ha−1 (3 lb. P ac−1). Applying surplus manure to legume and non-legume cropland results in a slight, state-level, P deficit. In both scenarios, the large N deficit that cannot be met through legume N fixation alone indicates purchased fertilizer is required. These results show NY’s ability to capitalize on the value of manure without excessive risk to the environment. Greater circularity of agricultural production in NY will need to consider benefits and trade-offs of applying manure to legume cropland. As milk production increases in the state, implementation of advanced manure treatment, storage, and manure application and livestock feeding practices will be needed to increase the circularity and sustainability of the agricultural sector in NY.

(124) GENITOURINARY SYNDROME OF LACTATION (GSL): A NEW PERSPECTIVE ON POSTPARTUM AND LACTATION-RELATED GENITOURINARY SYMPTOMS

Abstract Introduction Genitourinary syndrome of menopause (GSM) is a well-documented and researched condition characterized by a range of genitourinary symptoms in peri- and postmenopausal women. Similar to GSM, postpartum and lactating women experience significantly reduced estrogen and androgen levels. However, there is limited research on the occurrence and impact of similar symptoms during the postpartum and breastfeeding period, as well as possible treatment options. Objective The aim of this project was to review the available literature for genitourinary health in the postpartum breastfeeding population and summarize the key findings and potential treatment options. Methods We performed a comprehensive literature review utilizing several databases and the following keywords individually or in combination “physiology of postpartum” or “physiology of lactogenesis” or “vulvovaginal health” or “vaginal atrophy” or “vaginal dryness” or “dyspareunia” or “urinary incontinence” or “lactation” or “breastfeeding” or “vaginal estrogen.” Full text review of 75 articles was performed, and ultimately 50 articles were included in this review. Results During lactation, high levels of prolactin inhibit estrogen and androgen secretion via negative feedback mechanisms (1). These hormonal changes lead to an increased prevalence (of up to 50% higher) of vulvovaginal atrophy in lactating and breastfeeding women compared to non-breastfeeding women (2,3). The shift in hormones also contributes to increased rates (~30% higher) of dyspareunia (4–7), likely due to a lack of vaginal lubrication (up to 46%) among breastfeeding women (8). Decreased sexual desire is also common and reported to be experienced by up to 46% of postpartum women (8). Despite these highly prevalent and potentially devastating symptoms, there is a lack of consistent screening at postpartum visits and no treatment guidelines available to healthcare providers. Similar to GSM, vaginal lubricants can be used by breastfeeding women with vaginal dryness. However, for lactating women with refractory vaginal dryness or significant vulvovaginal changes, vaginal estrogen or DHEA therapy may be considered. Studies have shown minimal or no transfer of estrogen to breast milk even at high concentrations, and no reduction in breast milk supply (9–11), likely because vaginal estrogen is not a systemic dose. Studies on vaginal estrogen therapy in postpartum women are limited, but one randomized placebo-controlled trial showed excellent compliance and a subjective improvement in women utilizing vaginal estrogen (12). Conclusions Postpartum breastfeeding women experience similar physiology and symptoms to the postmenopausal phase, as seen in GSM. We propose the introduction of a novel term to describe the genitourinary changes seen in breastfeeding individuals: Genitourinary Syndrome of Lactation (GSL). The creation and diagnostic use of a syndrome, such as GSL, will equip healthcare providers with an all-encompassing term to bring awareness to the symptoms experienced by postpartum breastfeeding individuals. This awareness can lead to improved screening and treatment guidelines for the high numbers of breastfeeding individuals suffering from these genitourinary changes. Disclosure No.

Building resilience in the infant formula milk supply chain

In recent years, Infant Formula Milk (IFM), a vital source of nutrition for infants lacking breast milk in their first two years, has been plagued by diverse and severe global supply chain disruptions. These challenges have triggered shortages, compromised product quality, and threatened food security, leading to dire health consequences and even fatalities among infants. However, despite the criticality of IFM, current research is lacking in terms of how to build or improve the resilience of IFM supply chains. This paper presents a detailed framework for building a resilient IFM supply chain. A key pillar of this framework is a comprehensive analysis of potential hazards. Using the Hazard and Operability Analysis (HAZOP) method, 91 potential hazards were identified across the entire IFM supply chain. Subsequently, a clustering method identified 17 critical risks with irreversible consequences for infant health and supply chain flow. Finally, mitigation strategies that combine traditional approaches with 4.0 technology-enabled solutions are proposed. Adapting this framework can provide valuable insights for IFM supply chain stakeholders, enabling them to secure the vital flow of this life-sustaining product and safeguard the health and well-being of infants.

Achieving sufficient milk supply supports mothers to cope with premature birth.

To explore whether and how expressing breast milk is perceived as helpful in coping with negative emotions due to premature birth by mothers of very low birth weight (VLBW) infants. Qualitative interviews and a retrospective cross-sectional questionnaire with mothers of VLBW infants were conducted and analysed using an exploratory sequential mixed-method design. Hypotheses were built using qualitative content analysis and quantitatively tested using multivariate regression analysis. Interviews with 12 mothers and questionnaires of 518 mothers were analysed. Coping with prematurity by expressing milk was seen as a way to maintain the caregiving role for the mothers, where three relevant factors arouse: making up for what happened, providing the best for their infant and fear of low milk supply. Quantitative analysis showed that mothers with a high milk supply (Coef. = 1.1, p < 0.000) and more feelings of guilt due to premature birth (Coef. = -0.1; p = 0.015) perceived expressing breast milk significantly more as a resource for coping. This study adds knowledge on how expressing breast milk for their VLBW infant may support mothers in coping with premature birth, by revealing the association with milk supply and feelings of guilt due to premature birth.

Digital mentoring on expressing breast milk for working mothers

Background/Aims Working mothers may find it difficult to maintain exclusive breastfeeding; this challenge can be addressed through expressing breast milk. However, barriers to expressing breast milk include perceived insufficient milk supply and a lack of knowledge on pumping, storing and giving breast milk to babies. This study's aim was to identify the effectiveness of expressed breast milk assistance, through the ASIPku mobile application, among working mothers in North Sulawesi, Indonesia. Methods This quasi-experimental study involved 100 participants (intervention: n=50, control: n=50), selected using cluster randomised trials. Questionnaires were used to assess exclusive breastfeeding and use of the app in the intervention group. Chi-squared tests were used for data analysis. Results Assistance using mobile applications had a significant effect on exclusive breastfeeding among working mothers in North Sulawesi (P&lt;0.001). Conclusions Digital mentoring was effective in improving the rate of exclusive breastfeeding. By providing information on expressing breast milk, these apps can be used to support women and make exclusive breastfeeding more accessible to working mothers.

GALACTAGOGUE HERBS: A QUALITATIVE STUDY AND REVIEW

Women often face challenges in their efforts to breast-feed their infants. One of these challenges may be a real or perceived insufficient milk supply. Presented here are some results from a qualitative study of self-care in pregnancy, birth and lactation among a purposeful sample of childbearing women in British Columbia. Twenty-three women were interviewed at one to four months postpartum, and were asked to share their experiences with childbirth and postpartum self-care. Interviews were tape recorded and transcribed. All 23 women were breast-feeding. Four women reported insufficient milk supply, whereas 14 women used galactagogue substances including herbal remedies, food items and pharmaceutical drugs to enhance their milk supply. Eleven women (48% of the sample) were using any of five galactagogue herbs, in many cases prophylactically. Each herb is reviewed and discussed here: blessed thistle (Cnicus benedictus), fennel (Foeniculum vulgare), fenugreek (Trigonella foenicum-graecum) raspberry leaf (Rubus idaeus), and stinging nettle (Urtica dioica). This study reveals that galactagogue herb use is an element of postpartum self-care for some women, and it also identifies a need for clinical testing of the herbs. A larger-scale survey of galactagogue herb use would be beneficial to the state of knowledge, as would clinical trials and case reports on the more popular herbs.

Transforming milk supply chains with blockchain: enhancing visibility and cost reduction

Transforming milk supply chains with blockchain: enhancing visibility and cost reduction

"A Vulnerable Time To Be a Young Family in an Emergency": Qualitative Findings From an Exploration of an Emergency Perinatal and Infant Feeding Hotline in Louisiana.

Birthmark Doula Collective, a cooperative that provides doula and lactation services in the Greater New Orleans area, mounted an emergency response after two Category 4 storms: Hurricane Laura (2020) and Hurricane Ida (2021). The response included activating a no-cost emergency perinatal and infant feeding hotline. Both disasters coincided with a resurgence of COVID-19 infections in Louisiana. The aim of this study is to understand how an emergency perinatal and infant feeding hotline supported infant and young child feeding in emergencies during hurricanes in Louisiana. This study used a cross-sectional, retrospective qualitative design in a population with low breastfeeding rates. We conducted a content analysis of 97 hotline call logs from Hurricanes Laura and Ida, focus groups with lactation support providers who staffed the hotline during either storm (n = 5), and interviews with mothers who called during Hurricane Ida (n = 2). Focus groups and interviews lasted 30 and 60 minutes, respectively. Transcripts were analyzed using thematic analysis techniques. Call logs revealed infant feeding needs (e.g., mastitis, low milk supply, relactation, and infant formula requests) and non-infant feeding needs (e.g., infant supplies, perinatal and infant care referrals, shelter information). Infant formula was the most requested supply during both hurricanes. Maternal participants discussed family vulnerabilities during Hurricane Ida. Staff described training and strategies to provide support while maintaining their own well-being. Providing a free emergency hotline service is one way to support pregnant and postpartum people and their families seeking infant feeding advice, supplies, and support in the immediate aftermath of a disaster.

Milk supply chain as a reservoir of antimicrobial-resistant Staphylococcus species

Milk supply chain as a reservoir of antimicrobial-resistant Staphylococcus species

Analysis of the Dairy Milk Supply Chain at Sapi Juara Farm, Bogor Regency

Pamijahan District in Bogor Regency, West Java, is known as one of the main sources of milk supply for dairy cows in the region. Dairy cow's milk is a product that has high and stable demand and selling value. Supply Chain Management (SCM) at Sapi Juara Farm in Pamijahan District involves the distribution of dairy cow's milk which includes product flow, information and finance. This study aims to understand the SCM of dairy milk at Sapi Juara Farm, including product flow, information and finance, as well as efficiency as measured through marketing margin and farmer's share. This research uses quantitative descriptive methods with primary data obtained from interviews. The results of the analysis show that there is a flow of dairy milk products, a flow of information from farmers to various actors in the supply chain, and a flow of funds that includes costs and profits from nine distribution channels that influence the performance of the supply chain based on the payment system. From the analysis of the profit share value, it can be seen that the SCM for dairy cow milk in Pamijahan District is running efficiently. It is hoped that SCM in Pamijahan District can be more efficient to avoid losses at each stage or link in the chain and stabilize milk prices in the market, while improving the welfare of farmers, especially at Sapi Juara Farm.

Ensuring neonatal human milk provision: A framework for estimating potential demand for donor human milk

Using donor human milk (DHM) for preterm infants, where the mother's milk is unavailable, protects infants against potentially fatal necrotising enterocolitis. When used optimally, DHM can support mothers to establish breastfeeding. Understanding the relationship between clinical choices for DHM provision and the resulting demand is important. For policymakers, it informs decision-making around the provision of DHM based on cost-benefit analyses. For milk banks, it helps plan for required capacity, donor recruitment and supply-side collections. This study presents a framework for estimating DHM potential demand for infants born preterm, which allows for various sources of secondary population data, different feeding protocols and policy options for DHM provision. A Monte Carlo Simulation (MCS) is developed which follows the framework, simulating annual births (based on historical data) and incorporating uncertainty related to infant and maternal populations. A case study on human milk banking serves as the basis for the application of the framework and the modelling approach. Our model estimates the overall demand for DHM in England and Wales, the local level demand for NHS Trusts in England and provides an indication of the associated uncertainties. Our study provides a useful tool to enrich the strategic and operational level decision-making environment, benefitting both policymakers and milk bankers by providing a better understanding of the impact of policy decisions on the future development of the milk bank infrastructure.