Connection Initiation Breastfeeding Early (IBE) and Giving Exclusive Breast Milk at Permata Madina General Hospital Panyabungan City

ABSTRACT


INTRODUCTION
Estimated 2 million baby new born and died every year. On data that has released by UNICEF year 2020, In Indonesia, the infant mortality rate is still very high, namely 5% of infant deaths worldwide and the number of babies who die is 20 per 1000 live births. The results showed that Breastfeeding Initiation Early childhood (IBE) can save 20% of infants who die before the age of 1 month. Based on Government Regulation Number 20 of 2019, the definition of exclusive breastfeeding is breast milk that is given to babies from birth to 6 months of age without adding and replacing them with other food or drinks, except for vitamin supplements, drugs, and minerals. The benefits of breastfeeding will increase if the baby is only given breast milk for the first six months of life. Exclusive breastfeeding has a major contribution to the growth and development and endurance of children. Exclusively breastfed children will grow and develop optimally and not get sick easily. That matter in accordance with a number of study and global facts. The Lancet Breast feeding global study Series , 2019 has prove: 1) Breast-feed Exclusive lower number mortality due to infection as much as 80% in infants less than 3 months old; 2) As much 31.30% (82%) from 37.9% the child is sick, because he does not receive breast milk Exclusive. Invest in preventing LBW, Stunting and increasing IBE and Exclusive Breastfeeding contribute in reduce the risk of obesity and chronic disease. Not breastfeeding is associated with an economic loss of about $304 billion annually or 0-48% of Gross National Income.
According to the results of research by Fikri and Syafii, mothers who provide immediate breastfeeding are 2 to 7 times more likely to exclusively breastfeed compared to mothers who do not . According to the results of research Ayu, et al. showed that there was a significant difference between the success of IBE and the duration of breastfeeding. According to research, mothers who do IBE will be successful exclusive breastfeeding for babies they. However, in reality there are still mothers who failed give breast milk exclusive despite having done IBE.
Referring to the findings about connection between exclusive breastfeeding and BMI is the reason for researchers to conduct this study.

METHOD
This research uses analytical research method with case control study design . Case control research is an analytical study that concerns how risk factors are studied using a retrospective approach, the comparison of cases and controls is 1: 1. The time of the study was carried out in January 2022 . The population of this study were all pediatric patients aged 6-12 months who were treated in the neonates ward of the General Hospital Permata Madina. The total sample of 51 people was divided into 25 control samples and 26 case samples, using judgmental sampling or purposive sampling .
Researchers select respondents based on the ability of respondents to provide information which adequate to answer research questions by taking into account the inclusion and exclusion criteria, with the inclusion criteria that mothers who have babies aged 6-12 months are cared for in the Neonatal Room at Permata Madina General Hospital, Panyabungan City and willing to participate in the study after receiving an explanation (PSP). Meanwhile, the exclusion criteria were that the mother and baby pair were seriously ill and the mother had forgotten the BMI problem. The relationship between early initiation of breastfeeding (IBE) and exclusive breastfeeding using the 2 hypothesis test . The limit of meaning is when p 0.05 with a 95% confidence interval. Data analysis was carried out using the SPSS ( Statistical Product and Service Solution) program . Characteristics of the age of mothers who have babies aged 7-12 months in the Neonatus Room at Permata Madina General Hospital, Panyabungan City in 2022, divided into 3 age groups, with a minimum value of 17 years, a maximum of 39 years, an average of 28 years, the median 28 year, mode 29 year, standard deviation ±5,383 years, data is normally distributed. Based on table and picture on show that 90% of mothers who have babies aged 6-12 months are aged 21 to 35 years. Age 20 years is considered a risky age for pregnancy, besides mentally and psychologically considered still not yet mature and mature enough to face pregnancy and birth. The age group of 21-35 years is the best age group for pregnancy both physically and mentally. Age > 35 years is considered a risk for pregnancy, because reproductive health begins to decline.

RESULTS AND DISCUSSION
As many as 64% of multiparous mothers, there is a relationship between parity and breastfeeding exclusive showing experience breastfeeding mothers play a role in their actions to provide breast milk exclusive. Thing This is in line with Notoatmojo's theory, that the influence of one's own experience and that of others on knowledge can affect behavior moment this or then.
Mothers who have babies aged 6 -12 have high school education, 60%. When viewed from the level of education, high school education is not included in the category of higher education low, but medium. A Mothers who are highly educated do not necessarily have exclusive breastfeeding behavior. The higher the education level, the mother usually has a lot of activities outside the home such as work, while the less educated mother stays at home and has more opportunities to breastfeed her baby.

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As many as 66% of respondents do not work. Mothers who do not work have more opportunities to give exclusive breastfeeding, but in this study the percentage of exclusive breastfeeding was lower (32 % ) compared to the percentage of mothers who did not work. Mother's occupation can affect the opportunity and knowledge of mothers about exclusive breastfeeding, mothers who work outside the home have better access to various information, including getting information about exclusive breastfeeding.
The demographic characteristics of family income are divided into 2, under the minimum wage and in on minimum wage, where UMR city connection on year 2022 as big as Rp2,552,609,94 . The table above shows 58.0% income families below the minimum wage. According to Sumadji and Radja, exclusive breastfeeding can ease the economy family. Thing this because mother those who give exclusive breastfeeding do not need to buy formula milk, in addition to giving exclusive breastfeeding the baby will be healthier so as to reduce medical costs. From the results of this study, it was found that the number of samples who received IBE was as big as 26 sample (52%) and the remaining 24 samples (48%) did not get IBE. Table 2 shows the results of hypothesis testing using the chi square test, where the p value of 0.04 is obtained . Because the value of p< 0.05 , it can be concluded that the implementation of IBE has a relationship with breastfeeding exclusive.
To determine the magnitude of the relationship, the Odds Ratio (RO) was calculated. Based on Table 5.2, then score OR is 5,63 _ with IK 95% 1.64-19.23 means OR lies between 1.64-19.23. In the interpretation of the OR results show connection which strong, so that on study this show Exclusive breastfeeding has a strong relationship with the implementation of IBE (OR=5.62). Mothers who carry out IBE have 6 times more opportunities to give exclusive breastfeeding than mothers who do not carry out IBE.
When the baby is placed on the chest to suckle, the baby will feel warmth from skin mother so that it can lower risk Dead due to hypothermia. During feeding, the baby will coordinate sucking, swallowing and breathing. When that, possible Mother has passed colostrum. Babies who get colostrum will get antibodies and intestinal cell growth factors, antibodies in breast milk can increase resistance to infection. Various literature mention that quick after baby born must placed on the mother's chest by attaching the baby to the mother's breast, in this case not for providing nutrition but so that the baby can learn to suckle and recognize the mother's nipple, besides the stimulation of suction from the baby will stimulate the posterior pituitary gland to secrete the hormone oxytocin to accelerate the release of breast milk. Even though the milk hasn't come out yet, this interaction will make the baby feel calm and comfortable, besides that oxytocin hormone could reduce postpartum bleeding and accelerate uterine contraction.
Weakness on study type This is prone to time and information bias. Data collection using questionnaires that are subjective in nature, so that the truth of the data is very dependent on the honesty and memory of the respondents as well as the honesty and sensitivity of the interviewer ( observer ) at the time of observation and filling out the questionnaire which of course will greatly affect the data and information generated. In addition, researchers do not examine whether the mother's breastfeeding technique is correct or not, the baby is breastfed directly or using a pacifier, this is important because breastfeeding techniques affect milk production. Researchers also do not researching role family in the success of exclusive breastfeeding, this becomes important because the family can provide encouragement to mothers to give exclusive breastfeeding.

CONCLUSION
Based on the research that has been done, it can be concluded that: 1) Early breastfeeding is related to the success of breastfeeding Exclusively (p = 0.04), sucking from the baby will affect the release of the hormones oxytocin and prolactin, besides that the baby also learns to breastfeed, so there is a possibility that early breastfeeding will affect the production and expenditure of breast milk. 2) Factor which may affect exclusive breastfeeding are the demographic characteristics of the mother, namely age, parity, education, employment status, and income family. 3) Each respondent has a different character from other respondents so that the possibility of the success of exclusive breastfeeding is influenced by each respondent's character. 4) Mothers who do IM D have a 5 times greater chance of giving breast milk exclusive than mother which no To do IBE, opportunity 5 times is obtained from the OR value that is means having a good relationship strong. Int Jou of PHE  160 With existence deficiency and weakness from study this, writer provide suggestions for further research to be able to conduct further research on the failure factors of exclusive breastfeeding for mothers who have had an IBE, in addition to including the role of the family, breastfeeding techniques, and breastfeeding methods (using a pacifier or directly) in the factors affecting exclusive breastfeeding. Health agencies are expected to provide information about the relationship between IBE and the success of exclusive breastfeeding to pregnant women and provide encouragement to do IBE, besides that each health agency is expected to provide information and encouragement to mother.