title: Exclusive Breastfeeding and the Acceptability of Donor Breast Milk for Sick, Hospitalized Infants in Kupang, Nusa Tenggara Timur, Indonesia: A Mixed-Methods Study.
abstract: BACKGROUND
  The eastern Indonesian province of Nusa Tenggara Timur (NTT) has an infant mortality rate of 45 per 1000, higher than the national average (28/1000). Exclusive breastfeeding, important for improving newborn and infant survival, is encouraged among hospitalized infants in Kupang, the provincial capital of NTT. However, barriers to hospitalized infants receiving breast milk may exist.
  
  
  OBJECTIVE
  This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang, NTT. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored.
  
  
  METHODS
  A mixed-methods study using a convergent parallel design was conducted. A convenience sample of 74 mothers of hospitalized infants and 8 hospital staff participated in semi-structured interviews. Facility observational data were also collected. Analysis was conducted using Davis's barrier analysis method.
  
  
  RESULTS
  Of the 73 questionnaires analyzed, we found that 39.7% of mothers retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Expressing was associated with maternal reported exclusive breastfeeding χ(2) (1, N = 73) = 6.82, P = .009. Staff supported breastfeeding for sick infants, yet mothers could only access infants during set nursery visiting hours. No mothers used DBM, and most mothers and staff found the concept distasteful.
  
  
  CONCLUSIONS
  Increasing mothers' opportunities for contact with infants is the first step to increasing exclusive breastfeeding rates among hospitalized infants in Kupang. This will facilitate mothers to express their breast milk, improve the acceptability of DBM, and enhance the feasibility of establishing a DBM bank.
authors.affiliation: School of Medicine, University of Tasmania, Hobart, Australia linda.murray@utas.edu.au.
authors.forename: Linda
authors.initials: L
authors.lastname: Murray
authors.affiliation: School of Medicine, University of Nusa Cendana, Kupang, Indonesia.
authors.forename: Simplicia Maria
authors.initials: SM
authors.lastname: Anggrahini
authors.affiliation: School of Medicine, University of Nusa Cendana, Kupang, Indonesia.
authors.forename: Rahel Rara
authors.initials: RR
authors.lastname: Woda
authors.affiliation: School of Sociology, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ayton
authors.affiliation: School of Medicine, University of Tasmania, Hobart, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Beggs
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data*; D061186:Breast Milk Expression / Q000523:psychology / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D007214:Indonesia; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008875:Middle Aged; D017784:Milk Banks; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
keywords: Indonesia; breastfeeding; child health; donor breast milk; infant health; malnutrition