Optimalisation the Role of Health Workers in the Success of Breastfeeding

. WHO recommends exclusive breastfeeding for the first 6 months. Deaths that occur in toddlers can be reduced by up to 13% through exclusive breastfeeding and giving additional food other than breast milk after the baby is six months old and continues to provide breast milk for 2 years. Factors that play a role in the success of the breastfeeding process include knowledge, motivation, education, maternal health problems, promotion of formula milk, family support, and health workers. The role of health workers is closely related to the existence of health facilities that have policies that support breastfeeding. Nurses and midwives are health workers who accompany mothers who have just given birth almost 24 hours a day while they are still being treated in the hospital. AMC Muhammadiyah Hospital as a pro-ASI hospital provides support in the form of early breastfeeding initiation, combined care, breastfeeding counseling, breastfeeding rooms, and lactation clinics. Based on this description, health workers need to master information related to the breastfeeding process. The method used is counseling and training regarding the process of breastfeeding. The activity began with a pre-test and ended with a post-test. The activity was attended by 27 female health workers with an age range of 21-47 years. The average pre-test score was 68 and the post-test score was 90. There was an increase in the pre-test and post-test average scores by 22. This proves that the provision of materials and training can increase participants' knowledge and skills regarding the breastfeeding process.


Introduction
Breast milk is natural food in the form of liquid with the best nutritional content and is suitable for the needs of babies to grow and develop properly.The first breast milk is in the form of a clear yellowish liquid (colostrum) which is very good for babies because it contains substances that are immune to disease.(1)(2) WHO (World Health Organization) recommends that mothers give exclusive breastfeeding for the first 6 months, giving only breast milk without other food and drinks including water (except medicine, vitamin and mineral drops).Breastfeeding can be continued until the age of 2 years with additional complementary foods (MP-ASI).(3)(4).
The Indonesian government has issued and established a policy to reduce infant mortality, by increasing exclusive breastfeeding when babies have just been born.This has been regulated in Government Regulation Number 33 of 2012 concerning exclusive breastfeeding.
Deaths that occur in children under five can be reduced by up to 13% through the way mothers breastfeed their babies exclusively.The duration of breastfeeding is six months and continues to provide breast milk for 2 years.Then additional food other than breast milk is given after the baby is six months old.(3)(2) (5) The United Nations Children's Fund (UNICEF) said that as many as 30.000infant deaths in Indonesia and 10 million deaths of children under five in the world each year can be prevented through the provision of exclusive breastfeeding because it can protect babies against childhood diseases such as diarrhea and pneumonia.Its long-term benefits can lower blood pressure and cholesterol and reduce the prevalence of obesity and type-2 diabetes.In addition, breastfeeding also contributes to maternal health, reduces the risk of ovarian and breast cancer, and the risk of fatal postpartum hemorrhage.(6)(7) Several aspects play an important role in the success of the breastfeeding process, including knowledge, motivation, education about the breastfeeding process, maternal health problems, promotion of formula milk, family support, and health workers.(8)(9) (10) The role of health workers in health facilities is very important in supporting optimal exclusive breastfeeding.The role of health workers is closely related to the existence of health facilities that have policies that support breastfeeding.Nurses and midwives are health workers who accompany mothers who have just given birth almost 24 hours a day while they are still being treated in hospital.(3)(6) AMC Muhammadiyah Hospital is a business unit of UMY as a pro-ASI hospital in Yogyakarta, AMC Muhammadiyah Hospital provides breastfeeding support in the form of providing breastfeeding-friendly facilities including early breastfeeding initiation (IMD), implementing combined care, breastfeeding counseling, breastfeeding rooms, and lactation clinics.AMC Muhammadiyah Hospital is located in the center of Yogyakarta city.Due to its strategic location, AMC Muhammadiyah Hospital is very easy to reach, both using public and private transportation.AMC Muhammadiyah Hospital needs to optimize health workers who understand lactation management.Based on this description, health workers, especially nurses and midwives, need to master information related to the breastfeeding process.

Methodology
This activity is expected to increase the knowledge of health workers in lactation management at the start of the baby's birth, so it is necessary to transfer knowledge in the form of counseling and training.The preparatory stage includes coordination with the training section regarding the time and method of implementation.In addition, coordination was also carried out with resource persons so that material could be prepared and pre-test and post-test questions could be prepared.The implementation stage consists of a pre-test before giving material to measure the level of knowledge of the participants.Submission of material was done using the counseling method with material on the key to success of breastfeeding and lactation management material for working mothers.Each topic was given within 20 minutes.Discussion to accommodate questions from participants was done in 20 minutes followed by roleplay.The last step was the post-test to find out the level of knowledge of the participants after getting the material.

Results and Discussion
The activity which was carried out offline was attended by 27 female health workers at the AMC Muhammadiyah Hospital, with an age range of 21 years to 47 years.From Table 1, it can be seen that the majority of participants are in the age range of 21-30 years.AMC Muhammadiyah Hospital has potential human resources for health workers to develop.Based on previous studies, the age of health workers does not significantly affect knowledge or skills in the breastfeeding process (11).
Participants seemed enthusiastic about participating in the training.This can be seen from the great interest of the participants in the discussion sessions and during the role play as the key to successful breastfeeding.Documentation of roleplay implementation is presented in Figure 1.Roleplay is carried out in groups consisting of the role of the patient, the role of health workers, and the observer.They take turns doing this role, and the observer must provide input.Apart from getting input from the observer, the participants also receive input from the facilitator.Group training methods and role pay are effective in increasing skills in the health sector.(11)From the graph, it can be seen that there is an increase in scores after giving material and roleplay accompanied by a facilitator.The average pre-test score is 68 and the post-test score is 90.There is an increase in the pre-test and post-test average scores by 22.This proves that the provision of materials and training can increase participants' knowledge and skills regarding the breastfeeding process.Based on existing research, in general, knowledge of health workers in developing countries regarding breastfeeding techniques is still lacking.Health workers have good knowledge about the benefits of breastfeeding and breastfeeding practices, but knowledge about common breastfeeding problems and practical steps for breastfeeding is still low.Training is needed to increase knowledge about breastfeeding practices.(12)

Conclusions
The community service activities on the Optimalisation of the Role of Health Workers in the Success of the Breastfeeding Process can increase the knowledge of health workers at the AMC Muhammadiyah Hospital.This is evidenced by an increase in the average score of 22 from pre-test to post-test.

Figure 2 .
Figure 2. Distribution of Pre-test and Post-test.

Table 1 .
Characteristic of participants based on age.