Tesis

Strategi meningkatkan cakupan ASI eksklusif enam bulan dengan konseling melekat dan pendampingan serta evaluasi kandungan makronutrien ASI = The strategy to increase exclusive breastfeeding rates by close counseling and monitoring along with evaluation of breastmilk’s macronutrient

Latar belakang: Air susu ibu (ASI) merupakan makanan ideal seorang bayi. Berdasarkan Riskesdas 2010, angka keberhasilan ASI eksklusif di Indonesia hanya 15,3%. Berdasarkan penelitian di RSCM, dua faktor yang memengaruhi keberhasilan menyusui eksklusif adalah faktor keyakinan ibu dan dukungan suami/keluarga. Dengan mengoptimalkan keduanya, diharapkan cakupan menyusui eksklusif meningkat. Tujuan: Mengetahui angka keberhasilan menyusui eksklusif selama 6 bulan dengan 10 langkah menuju keberhasilan menyusui (LMKM) disertai konseling melekat dan pendampingan serta melihat gambaran kecukupan ASI, kandungan makronutrien, dan perubahan ASI dari awal sampai akhir menyusui. Metode: Seratus ibu hamil trimester tiga, dari 4 Puskesmas di Jakarta, diikutsertakan dalam penelitian dan diikuti secara kohort prospektif selama 6 bulan. Diterapkan 10 LMKM dengan konseling melekat dan pendampingan serta dilakukan analisis makronutrien ASI. ASI diperah pada 5 menit pertama, kedua dan ketiga, masing-masing 3 ml (mewakili ASI awal, tengah dan akhir). Pemeriksaan ini dilakukan pada usia bayi 2 minggu, 1, 2, 4, dan 6 bulan. Pertumbuhan bayi dipantau tiap bulan. Hasil: Sebanyak 91 subjek berhasil menyelesaikan penelitian dengan angka keberhasilan ASI eksklusif 84%. Sebanyak 87,9% bayi mempunyai status gizi normal, namun 57 dari total 84 bayi yang menyusu eksklusif mengalami weight faltering karena kuantitas ASI yang kurang. Sedangkan kualitas ASI menunjukkan hasil yang sangat baik dengan jumlah energi 76–86 kcal/100ml. Adapun gambaran makronutrien ASI dari 2 minggu sampai 6 bulan yaitu karbohidrat meningkat, protein menurun, lemak relatif stabil. Sedangkan kandungan ASI awal sampai ASI akhir adalah kadar karbohidrat menurun, protein relatif stabil dan lemak meningkat. Simpulan: Penerapan konseling melekat dan pendampingan bersama 10 LMKM serta evaluasi makronutrien ASI, menghasilkan angka menyusui eksklusif 84% sehingga dapat digunakan sebagai strategi meningkatkan cakupan ASI eksklusif.
Kata kunci: ASI eksklusif, konseling melekat, pendampingan, 10 LMKM, makronutrien ASI



Background: Human breastmilk is ideal food for babies. Based on Basic Health Survey (Riskesdas) 2010, the exclusive breastfeeding rates in Indonesia was only 15.3%. Based on a preliminary study at Cipto Mangunkusumo Hospital, the reasons of mother ceased breastfeeding were unsure about adequacy of her breastmilk and lack of family support. By optimalizing both, breastfeeding rates will be hopefully increased. Objectives: To know the breastfeeding rates after application of the WHO’s 10 steps to successful breastfeeding with close counseling and monitoring. Moreover, to know the adequacy of breastmilk, measure the macronutrient of breastmilk, and its change from foremilk to hindmilk. Methods: The cohort of 100 third trimester pregnant women who agreed to participate in the study were recruited consecutively from 4 community health center in Jakarta. The 10 steps with close counseling and monitoring were directly applied. The macronutrient of breastmilk was then analyzed using MIRIS human milk analyzer. Three ml of breast milk was expressed every 5 minutes (represented fore-transitional-hind milk) and collected at 2 weeks, 1, 2, 4, and 6 months old. The growth was monitored monthly. Results: At 6 months, 91 infants still breastfed but only 84% were exclusively. 87.9% were in normal nutritional status, but 57 from total 84 exclusively breastfed had weight faltering due to inadequate quantity of breastmilk. On the other hand, breastmilk’s quality is excellent with energy from 76–86 kcal/100ml. From 2 weeks to 6 months, carbohydrate in breastmilk tends to increased, protein tends to decreased and fat level is relative stable. From foremilk to hindmilk, the level of carbohydrate tends to decreased, protein level is relative stable, and fat tends to increased. Conclusion: The application of 10 steps to successful breastfeeding, close counseling and monitoring, then measuring macronutrient of breastmilk produce breastfeeding rates of 84%, so they could be used as strategy to increase breastfeeding rates.
Keywords: Exclusive breastfeeding, close counseling and monitoring, 10 steps to successful breastfeeding, macronutrient of the breastmilk