The financial need of feeding infants for the first six months of life in West Java Province of Indonesia and the implications of socioeconomic and mental health factors.

BACKGROUND: In Indonesia, nearly half of all children aged less than six months were not exclusively breastfed in 2017. This study aimed to compare the cost of providing direct or indirect exclusive breastfeeding 0-6 months, partial exclusive breastfeeding and commercial milk formula only. This study also assessed the maternal socioeconomic and mental health factors to providing exclusive breastfeeding. METHODS: Data were collected in 2018 via a cross-sectional survey of 456 mothers in Bandung City and Purwakarta District, West Java Province, Indonesia, who had children aged less than six months. We used micro-costing to calculate the cost of productivity, equipment, supplies, and training of mothers when providing direct exclusive breastfeeding, indirect exclusive breastfeeding, partial exclusive breastfeeding (a mix of breastfeed and commercial milk formula), and infant formula/commercial milk formula only. Logistic regression was used to determine the impact of several independent variables, including mother's level of depression, on exclusive breastfeeding. RESULTS: To provide direct exclusive breastfeeding, the cost per mother in the first six months is US$81.08, which is less expensive than indirect exclusive breastfeeding (US$171.15), partial exclusive breastfeeding (US$487.8) and commercial milk formula (US$494.9). We also found that education and age are associated with the decision to provide direct exclusive breastfeeding. Mothers who work will most likely provide indirect exclusive breastfeeding, commercial milk formula, or partial breastfeeding as opposed to direct exclusive breastfeeding. Finally, although severe depression symptoms have a positive relationship with the decision to provide commercial milk formula over direct exclusive breastfeeding, the evidence here is not strong. CONCLUSIONS: The total cost of providing only commercial milk formula is 6-times higher than the cost of direct exclusive breastfeeding. The presence of severe depression symptoms is positively related to mothers opting for other feeding methods aside of direct exclusive breastfeeding and indirect exclusive breastfeeding. This study shows that direct exclusive breastfeeding is economically preferable to other methods, supports policies to reduce the time cost of exclusive breastfeeding (e.g., paid maternity leave and maternal cash transfers), and addresses the importance of mother's mental health to ensure successful breastfeeding.

Understanding mobile application development and implementation for monitoring Posyandu data in Indonesia: a 3-year hybrid action study to build "a bridge" from the community to the national scale.

BACKGROUND: Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. METHODS: A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. RESULTS: (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs' knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. CONCLUSIONS: The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs' book. Hence, its implementation is promising for use at the national level.