Analysis of Factors Affecting the Behavior of Exclusive Breastfeeding in the Work Area of Werwaru Puskesmas Moa Lakor District

Exclusive breastfeeding is not only the best food for babies, but is important for the health of breastfeeding mothers and provides optimal growth for babies. Exclusive breastfeeding for babies aged 0 to 6 months and continued until the child is 2 years old can encourage healthy growth and development. This study aims to analyze the factors that influence exclusive breastfeeding behavior in the working area of the Werwaru Health Center, Moa Lakor District. This type of research is a quantitative analytic study with a cross sectional design. Respondents in this study were obtained using the proportional sampling method as many as 73 toddlers aged 6-24 months from the Werwaru Health Center, Moa Lakor District, which consisted of 6 villages (Werwaru, Klis, Pakty, Upyour, Syota, and Comfort) using a questionnaire and measuring instruments. anthropometry. Data processing was carried out using SPSS and for data analysis using statistical tests using univariate, bivariate and multivariate analysis tests. The results showed that internal factors that had an effect partially were knowledge while simultaneously namely perceptions of exclusive breastfeeding behavior in the Working Area of the Werwaru Health Center, Moa Lakor District. Meanwhile, external factors that have a partial effect are work and those that have a simultaneous effect are the support of the closest people to the behavior of exclusive breastfeeding in the Working Area of the Werwaru Health Center, Moa Lakor District. Suggestions for the government of Southwest Maluku Regency through the Werwaru Health Center, Moa Lakor District, to be able to improve the exclusive breastfeeding program by disseminating information on the benefits of exclusive breastfeeding in the morning for pregnant and lactating women so that mothers' knowledge increases.


INTRODUCTION
The growth and development of the baby requires a very important food intake, namely breast milk (ASI).According to the United Nations Children's Funds and the World Health Organization, children should only be given breast milk for six months and solid food given after the child is six months old and continue to be given breast milk until the child is two years old.According to WHO, data on exclusive breastfeeding globally has not increased significantly, namely around 44% of infants aged 0 to 6 months worldwide who received exclusive breastfeeding during the period 2015 to 2018 of the 50% target of breastfeeding. 1 The rate of breastfeeding mothers in the world who give exclusive breastfeeding is only 64.7%.WHO and UNICEF report that in 2018, globally the rate of exclusive breastfeeding is quite low, namely 41%.In Indonesia, the Basic Health Research data conducted in 2018 showed that the rate of exclusive breastfeeding only reached 37%. 2 Exclusive breastfeeding is not only the best food for babies but is important for the health of breastfeeding mothers and provides optimal growth for babies.Nutrition has an important role in brain development from conception to 3 years of age.WHO (2019), 1 noted that in 2016, around 45% of children died due to malnutrition, 155 million children under 5 years of age were stunted or short in stature, 52 million children were wasted and around 41 million children were overweight.WHO further explained that providing optimal nutrition according to the child's age will reduce morbidity and mortality and reduce the risk of disease infection.
Exclusive breastfeeding for babies aged 0 to months and continued until the child is 2 years old can encourage healthy growth and development.The first two years of life are referred to as the most critical period of human survival because growth and development as well as human health are strongly influenced by nutritional intake.According to a report by the World Health Organization (WHO), there are around 1.5 million children who die due to improper feeding, 15% of babies worldwide are only given exclusive breastfeeding for 4 months and are often accompanied by inappropriate and inappropriate complementary feeding.safe.Nearly 90% of under-five deaths that occur in developing countries and 40% more deaths are caused by diarrhea and acute respiratory infections, where these diseases can be prevented by exclusive breastfeeding.
Factors that can influence mothers in giving ASI are age, level of education, factors of lack of knowledge of mothers about breastfeeding and child health factors, factors of socio-cultural changes such as working mothers, increased promotion of formula milk as a substitute for ASI, factor of lack of staff health so that people are less informed about the benefits of breastfeeding.To solve this problem, breastfeeding mothers must know the importance of the benefits of breastfeeding.Therefore, counseling

ABSTRACT
Exclusive breastfeeding is not only the best food for babies, but is important for the health of breastfeeding mothers and provides optimal growth for babies.Exclusive breastfeeding for babies aged 0 to 6 months and continued until the child is 2 years old can encourage healthy growth and development.This study aims to analyze the factors that influence exclusive breastfeeding behavior in the working area of the Werwaru Health Center, Moa Lakor District.This type of research is a quantitative analytic study with a cross sectional design.Respondents in this study were obtained using the proportional sampling method as many as 73 toddlers aged 6-24 months from the Werwaru Health Center, Moa Lakor District, which consisted of 6 villages (Werwaru, Klis, Pakty, Upyour, Syota, and Comfort) using a questionnaire and measuring instruments.anthropometry.Data processing was carried out using SPSS and for data analysis using statistical tests using univariate, bivariate and multivariate analysis tests.The results showed that internal factors that had an effect partially were knowledge while simultaneously namely perceptions of exclusive breastfeeding behavior in the Working Area of the Werwaru Health Center, Moa Lakor District.Meanwhile, external factors that have a partial effect are work and those that have a simultaneous effect are the support of the closest people to the behavior of exclusive breastfeeding in the Working Area of the Werwaru Health Center, Moa Lakor District.Suggestions for the government of Southwest Maluku Regency through the Werwaru Health Center, Moa Lakor District, to be able to improve the exclusive breastfeeding program by disseminating information on the benefits of exclusive breastfeeding in the morning for pregnant and lactating women so that mothers' knowledge increases.Key words: Exclusive breastfeeding, Toddlers, Health centers. is needed for breastfeeding mothers, including counseling and giving leaflets about the benefits of breastfeeding.

Magdalena Akse
Nationally, the coverage of babies receiving exclusive breastfeeding in 2019 was 67.74%, with the highest percentage of coverage of exclusive breastfeeding in province of West Nusa Tenggara (86.26%), while the province of Maluku was 43.35%.In 2019, nationally the percentage of newborns who received early initiation of breastfeeding (IMD) was 75.58%, with the highest percentage of newborns receiving IMD being Southeast Sulawesi (94.92%) while Maluku province was 34.97%. 3is shows that the exclusive breastfeeding program in Maluku province has not been implemented optimally, and one of the factors that are still low in exclusive breastfeeding is the low number of babies getting IMD.Even though exclusive breastfeeding and IMD have been regulated by the government in Government Regulation Number 33 of 2012.This government regulation instructs regional governments and the private sector to work together to support exclusive breastfeeding and early breastfeeding initiation (IMD).Through this regulation, the government formalizes women's right to breastfeed (including in the workplace) and prohibits the promotion of breastmilk substitutes.Exclusive breastfeeding and IMD aims to meet the nutritional needs of infants and prevent malnutrition in toddlers.The government advises regions to provide special facilities for breastfeeding mothers in the workplace so that mothers can continue to breastfeed their babies. 3sed on data from the Indonesian Ministry of Health, babies who received exclusive breastfeeding in 2019 in Maluku province amounted to 43.35%, with the percentage of newborns receiving IMD of 34.97% (Kemenkes RI, 2020).In Southwest Maluku Regency, the number of babies who were exclusively breastfed was 209 (34.1%) out of 613 babies, while there were 404 (65.9%) babies who were not exclusively breastfed (BPS Maluku Barat Daya, 2019).Based on data from the Werwaru Health Center, the number of babies who received exclusive breastfeeding was 14 people (14.43%) while those who did not get exclusive breastfeeding were 83 people (85.57%) so efforts were needed to increase the success of the exclusive breastfeeding program.The low coverage of exclusive breastfeeding can be caused by a lack of public understanding and even health workers about the benefits and importance of exclusive breastfeeding for infants aged 0-6 months, there is intensive promotion of formula milk, lack of support from family or closest people, monitoring is difficult, recording and inaccurate reporting, there is still a lack of ASI counselors in the field and there is still a low level of Early Breastfeeding Initiation (IMD) (Profil Dinkes Kabupaten MBD, 2019).The mother's perception of a lack of milk production on the grounds that she is tired from work is known as the ASI syndrome.ASI syndrome can inhibit exclusive breastfeeding which causes the mother to switch from breast milk to tea water.Maternal health conditions are also the cause of low exclusive breastfeeding.The high number of breastfeeding mothers whose health conditions are impaired has resulted in low exclusive breastfeeding.

MATERIALS AND METHODS
The type of research used in this study was a quantitative research method with a cross-sectional design to analyze the factors that influence exclusive breastfeeding behavior in the working area of the Werwaru Health Center, Moa Lakor District.The research implementation time is planned to be carried out for four months starting from the research proposal seminar to completing the report.The sample in this study were 73 toddlers aged 6-24 months from the Werwaru Community Health Center, Moa Lakor District, which consisted of 6 villages (Werwaru, Klis, Pakty, Upyour, Syota, and Comfortable).The research instruments used were questionnaires and anthropometric measuring instruments.Data analysis used statistical tests using univariate analysis tests, bivariate analysis tests, and multivariate analysis tests.

Univariate analysis
Based on the table above the frequency distribution of the knowledge variable is good as many as 29 (39.7%) of respondents, while those that are not good are 44 (60.3%) of respondents.Furthermore, the good perception variable was 32 (43.8%), while those who assessed the perception as unfavorable were 41 (56.2%) respondents.Furthermore, the work variable, as many as 21 (28.8%)respondents who did not work and 52 (71.2%) who worked.Then for the support variable of the closest person, as many as 19 (26.0%) of the respondents who received support, while those who did not receive the support of the closest person, were as many as 54 (74.0%) of the respondents.

Bivariate analysis
The effect of patient knowledge on exclusive breastfeeding behavior in the working area of the Werwaru health center, Moa Lakor district: Based on Table 2 above, it shows that respondents who did not provide exclusive breastfeeding with a sufficient level of knowledge were 25 respondents (34.2%) greater than respondents with less knowledge of 23 respondents (31.5%).Respondents who gave exclusive breastfeeding with a sufficient level of knowledge were 4 respondents (5.5%) smaller when compared to respondents with less knowledge of 21 respondents (28.8%).
The results of the chi square test obtained a p value of 0.006 (<0.05) so that there was a significant relationship between education level and exclusive breastfeeding in the working area of the Werwaru Health Center, Southwest Maluku Regency.

The influence of patient perceptions on exclusive breastfeeding behavior in the working area of the Werwaru health center, Moa
Lakor district: Based on Table 3 above, it shows that the respondents who did not give exclusive breastfeeding with a negative perception of 34 respondents (46.5%) were greater than the respondents with a  The results of the chi-square test obtained a p-value of 0.019 (<0.05) so that there is a significant relationship between work and exclusive breastfeeding in the working area of the Werwaru Health Center, Maluku Regency.
The effect of the support of the closest people on the use of ARV treatment in HIV patients at the Ambon city health center: Based on Table 5 above, shows that there were 40 respondents (65.7%) who did not give exclusive breastfeeding and stated that the people closest to them supported exclusive breastfeeding.Respondents who gave exclusive breastfeeding and stated that health workers supported exclusive breastfeeding were 6 respondents (8.2%) when compared to respondents who stated that health workers did not support exclusive breastfeeding as many as 19 respondents (26.0%).The results of the chi-square test obtained a p-value of 0.000 (<0.05) so that there is a significant relationship between the support of the closest people and exclusive breastfeeding in the working area of the Werwaru Health Center, Southwest Maluku Regency.

Multivariate analysis
Table 6 shows that for internal factors, the knowledge variable has a p-value of 0.023 (<0.05), which means that knowledge affects exclusive breastfeeding with an RP value of 0.227.The perception variable has a p-value of 0.004 (<0.05), which means that perception has an effect on exclusive breastfeeding with an ARP value of 5.065.For external factors, together they do not affect exclusive breastfeeding.

Effect of patient knowledge on exclusive breastfeeding behavior
Based on bivariate analysis, there is a relationship between knowledge and exclusive breastfeeding with a p-value of 0.006 (<0.05).The results of this study are in line with Nurleli's research (2017) and Wahyuningsih's research (2020) 4 (in Qomarasari, 2023) which shows that there is a relationship between knowledge and exclusive breastfeeding behavior.The results of this study are also supported by the results of Qomarasari's research (2023) which states that there is a significant relationship between knowledge and exclusive breastfeeding behavior where the p value is 0.005.
According to Notoatmodjo (2007) 5 states that knowledge basically comes from experience, but can also come from information conveyed by people and other media.Knowledge is very important for the formation of one's actions.Knowledge about exclusive breastfeeding and motivation to give exclusive breastfeeding which is still lacking greatly influences the mother's behavior.This is because mothers still use local cultural knowledge about feeding babies.

The influence of perceptions on exclusive breastfeeding behaviour
Based on bivariate analysis, there is a relationship between perception and exclusive breastfeeding with a p-value of 0.001 (<0.05).This is in accordance with the research of Yuliana et al (2022) 6 which states that there is a significant relationship between mothers' perceptions and exclusive breastfeeding in the working area of the Cahya Maju Lempuing Health Center OKI in 2021.
The mother's perception of the insufficiency of breast milk to satisfy her baby causes the mother to stop breastfeeding her baby.Wrong perceptions about exclusive breastfeeding can affect the behavior of exclusive breastfeeding.Insufficient milk production causes the baby to experience dissatisfaction after breastfeeding, crying or being fussy is the main reason for mothers not to give exclusive breastfeeding.To avoid insufficient milk production, mothers often provide additional food in the form of formula milk.
positive perception of 14 respondents (19.2%).Respondents who gave exclusive breastfeeding with a negative perception of 7 respondents (9.6%) were smaller when compared to respondents with positive perceptions of 18 respondents (24.7%).
The results of the chi square test obtained a p value of 0.001 (<0.05) so that there is a significant relationship between mother's perceptions and exclusive breastfeeding in the working area of the Werwaru Health Center, Southwest Maluku Regency.
The influence of the patient's occupation on the behavior of exclusive breastfeeding in the working area of the Werwaru health center, Moa Lakor district: Based on

Table 2 : The effect of patient knowledge on exclusive breastfeeding behavior in the work area of the Werwaru health center, Moa Lakor district.
SSource: Primary Data, 2023.

Table 4
above, shows that 9 respondents (12.3%) did not provide exclusive breastfeeding and did not work, compared to 39 respondents (53.4%) who worked.Respondents who gave exclusive breastfeeding and did not work as many as 12 respondents (16.4%) were smaller when compared to respondents who worked, namely as many as 13 respondents (17.8%).