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To run the program exclusive breast milk, nursing mothers should have a good knowledge. One way to gain knowledge is to give nutritional counseling. This study Aimed to influence nutritional counseling on exclusive breast milk and Nutritional Status of the knowledge and attitude of nursing mothers in the district health centers Lubuk Pakam. This research is a quasi experiment nonequivalent control group design. Research work carried out in the region district health centers Lubukpakam (treatment group) and PHC Tanjung Morawa (the control group). The treatment group was given nutritional counseling intervention for 3 months given as many as three sessions. The study was conducted in March 2016 to August 2016. The results Showed prior to the intervention of knowledge in both groups did not Differ (p=0.290), after intervention were significantly different (p=0.000).

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Volume 2 • Issue 1 • 100010 J Nutr Weight Loss an open access journal OMICS International Research Article Journal of Nutrition Weight Loss Journal of Nutrition Weight Loss Masthalina and Agustina. J Nutr Weight Loss 2017 2:1 DOI: 10.4172/AWMD.1000104 Keywords: Knowledge Attitude Nutrition counseling Growth Introduction Infa nt nutritional status is determined starting from early pregnancy through breastfeeding. National Movement Acceleration Nutrition Improvement in Order Tousand Day One Life is very important in our eforts to create human resources Indonesia healthy intelligent and productive. Te nutrition problem has long been the world’s attention. Te term frst 1000 days of life which is 270 days during pregnancy and 730 days from birth until the age of 2 years One program 1000 First Day of Life is giving exclusive breastfeeding in infants 0 months to 6 months. Exclusive breastfeeding is the only food that is best for babies because it has the most complete nutritional composition for infant growth and development 1. According to data from the National Health Survey Susenas in 2010 is known to as many as 33.6 of infants in Indonesia are getting exclusive breastfeeding. Tis means there are still about 2/3 of a baby in Indonesia are still not getting exclusive breastfeeding exclusive so it is necessary to increase the exclusive breastfeeding campaign and encourage local governments and the private sector for support. Tere are several factors that lead to low coverage exclusive breastfeeding in Indonesia such as the dissemination of information among health care workers and people who are not optimal which is only about 60 of people know information about breastfeeding and there are only about 40 of trained health workers who can provide counselling breastfeeding 2. Exclusive breastfeeding granting to infants aged 6 months of globally reported less than 40. Nationwide coverage breastfeeding for infants up to age 6 months fuctuated i.e. 24.3 in 2008 then increased in 2009 to 34.3 and decreased in 2010 to 33.6 1. Globally there has been a general decline in the practice of breastfeeding both of the amount and duration of the last few decades. Possible reasons for refusing to breastfeed including a lack of trust that children get enough increase the mother’s work the load demand which makes them to be separated from their babies for longer hours decreased social support discomfort in the breast-feeding in public and the promotion of intense of commercial infant formula. Te results of rapid assessment Ministry of Health in 2011 found many government and private hospitals that receive sponsorship and gifs from formula companies it is certainly weaken eforts to increase the success of exclusive breastfeeding coverage in Indonesia. Exclusive breastfeeding granting exclusive success nationally only 33.6 and 35 according to the WHO Global Data Bank in 2012 so that the active role of the whole society are absolutely necessary to improve the success of the promotion of exclusive breast milk in Indonesia 3. Exclusive breastfeeding granting prevalence in North Sumatra according Riskesdas 37.6 this suggests granting exclusive breastfeeding is still up 50 of the area of North Sumatra while the prevalence of breast feeding only last 24 hours at age 0 months 52.7 age 1 month 48.7 46.0 at 2 months 3 months of age was 42.2 41.9 at 4 months 5 months old 36.6 and 30.2 at 6 months. Tus the prevalence of granting exclusive breastfeeding increased exclusive breastfeeding age of the baby decreased 4. Most of Indonesia’s population lives in villages and nearly 50 had low education. So that knowledge of mothers about the importance of exclusive breast milk is very minimal. Ignorance is the mother also afects the attitude of the mother in giving exclusive breast milk therefore the knowledge of mothers on exclusive breast milk needs to be improved. Lack of knowledge of mothers about the benefts of exclusive breast milk and a false perception of the exclusive breastfeeding will afect the practice of the mother to give exclusive breast milk to the baby. Terefore mothers should be appropriately informed about exclusive breastfeeding 5. Corresponding author: Herta Masthalina Department of Nutrition Health Polytechnic Medan Negara SimpangTanjung Garbus Lubuk Pakam Sumatera Utara-5514 Indonesia Tel: 6281237154151 E-mail: herta_tobingyahoo.co.id Received March 10 2017 Accepted April 20 2017 Published May 02 2017 Citation: Masthalina H Agustina Z 2017 Effect of Nutrition Counseling Knowledge and Attitude toward Mother Breast Feeding and Baby Growth in Sub Lubuk Pakam. J Nutr Weight Loss 1: 104. Copyright: © 2017 Masthalina H et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium provided the original author and source are credited. Abstract To run the program exclusive breast milk nursing mothers should have a good knowledge. One way to gain knowledge is to give nutritional counseling. This study Aimed to infuence nutritional counseling on exclusive breast milk and Nutritional Status of the knowledge and attitude of nursing mothers in the district health centers Lubuk Pakam. This research is a quasi experiment nonequivalent control group design. Research work carried out in the region district health centers Lubukpakam treatment group and PHC Tanjung Morawa the control group. The treatment group was given nutritional counseling intervention for 3 months given as many as three sessions. The study was conducted in March 2016 to August 2016. The results Showed prior to the intervention of knowledge in both groups did not Differ p0.290 after intervention were signifcantly different p0.000. While the average weight gain in infants in the frst months of 1.25 kg treatment group the control group of 1.19 kg and the second month 1.44 in the intervention group and the control group 1 kg. Based paired tests conducted indicate that there is infuence nutritional counseling on knowledge and attitudes in the intervention group. Effect of Nutrition Counseling Knowledge and Attitude toward Mother Breast Feeding and Baby Growth in Sub Lubuk Pakam Herta Masthalina 1 Zein Agustina 2 1 Department of Nutrition Health Polytechnic Medan Negara Simpang Tanjung Garbus Lubuk Pakam Indonesia 2 Alumni of study program D-IV Nutrition Department of Ministry of Health polytechnic Medan

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Citation: Masthalina H Agustina Z 2017 Effect of Nutrition Counseling Knowledge and Attitude toward Mother Breast Feeding and Baby Growth in Sub Lubuk Pakam. J Nutr Weight Loss 2: 104. Page 2 of 8 Volume 2 • Issue 1 • 100010 J Nutr Weight Loss an open access journal Based on the background the researchers want to investigate about “Efects of Nutrition Counselling on breastfeeding knowledge and attitudes about giving exclusive breast milk and infant nutritional status in the Region District Health Clinics Lubuk Pakam. Methods Te study design is quasi-experimental with non-equivalent control group design. In the treatment group nutritional counselling and attitudes and knowledge measured by a questionnaire. In the control group was not given nutritional counselling intervention. Research conducted at the sub-district Puskesmas Lubuk Pakam and sub-district Puskesmas Tanjung Morawa. Te overall data collection was conducted in March 2016 to August 2016. Te population in this study are all mothers with babies 0 months to 3 months and breastfeeding exclusively living in sub-district Puskesmas Lubuk Pakam as the intervention group and sub-district Puskesmas Tanjung Morawa. Te subjects of the study were taken with inclusion criteria are the mother did not work until 3 months postpartum the baby who got exclusive breastfeeding the baby born did not have the defect or congenital defect agreed to be the respondent. While exclusion criteria are not willing to follow Early Breastfeeding Initiation IMD during labor infant or postpartum sufer severe illness. Te number of samples were 60 mothers divided into 2 groups: those who received intensive nutrition counselling were 30 mothers and control group who did not get nutrition counselling as many as 30 people sampling was done by screening in accordance with the criteria inclusion respectively in the two groups were 30. Counselling in the intervention group conducted afer the sample has been prepared and flls out the form identity data. Afer that the sample pre-test questionnaires flling in the form of knowledge and attitude questions respectively amounted to 20 grains. Counselling is divided into three sessions. Intensive counselling session I made on day 1 through day 7. Session 2 reinforcement sessions and counselling is performed on days 8 to 14 of this session aims at strengthening on what the mother knew of researchers appropriate recommendations. Session 3 is an independent practice session conducted on 15 days to 28 days mothers are given the opportunity to practice independently of the instruction is recommended. At this session the target is no longer visit except on days of 28 counsellors will be doing an assessment of the output counselling. Rate output in the form of counselling post-test this is done to see if there are diferences in knowledge and attitudes of nursing mothers afer being given nutritional counselling. Questionnaires knowledge and attitudes of each numbered 20 of the questions. Prior to this research questionnaires were conducted validity and reliability of the 30 samples with the same inclusion criteria. Validity test results stating that the data is a question of attitude if r countr table then declared valid questions from 25 questions then obtained 20 valid questions with a Cronbach alpha reliability test results 0.6980.600 then the data is said to be reliable. Validity test results to the results obtained knowledge questions from 25 questions that 20 valid questions with a Cronbach alpha reliability test results of 0.6250.600 then the data is said to be reliable. Results Characteristics of the study subjects Tis study is followed by a sample of 30 samples in the treatment group and 30 samples in the control group. Prior to the study sample were asked to fll a form of identity. Results of research for the treatment group and the control characteristics of nursing mothers were alike. Tests of signifcance by the chi square test obtained value of p0.05. Based on this it is said that the characteristic of nursing mothers in the treatment group and the control group were not signifcantly diferent or the same Table 1. Diference score knowledge and attitudes before and afer treatment in both groups Average score of knowl edge on both groups before and afer intervention were statistically diferent. Knowledge in the treatment group before and afer the intervention increased by 9.00 point the increase was statistically signifcantly diferent p0.000. Knowledge in the control group before and afer intervention decreased by 2.70 point the decrease was statistically signifcantly diferent p0.039. Average score of attitude in both groups before and afer intervention were statistically diferent. Te attitude of the treatment group before and afer the intervention increased by 9.06 points the increase was statistically signifcantly diferent p0.000. Te attitude in the control group before and afer intervention decreased by 2.77 point the decrease was statistically signifcantly diferent p0.033 Tabl e 2. Comparison of Knowledge and Attitudes in the Second Group Knowledge Before giv ing the intervention to the subject frst the knowledge of exclusive breastfeeding is assessed. Table 3 describes the mean score of knowledg e in both groups before the intervention is diferent. Variable Intervention group Control group p-value Age years 0.623 • 20-24 4 13.3 5 16.7 • 25-29 14 46.7 17 58.7 • 30-34 7 23.3 6 20.0 • 35-39 5 16.7 2 6.7 Capital Education 0.753 • Junior 4 13.3 6 20.0 • High School 22 73.3 21 70.0 • College 4 13.3 3 10.0 Work 0.18 • Employees 2 6.7 7 23.3 • Housewife 18 60.0 16 53.35 • Self 10 33.3 7 23.3 Table 1: Characteristics of the studied form of age occupation education and nursing mothers. Group Variable Mean N Std. Deviation P-value Treatment Knowledge Before 80.83 30 12.04 0 After 89.83 30 5.79 Changes in 9 30 8.03 Attitude Before 77.86 30 13.28 0 After 86.83 30 5 79 Changes in 9.06 30 9.87 Control Knowledge Before 77.2 30 14.22 0.039 After 74.5 30 11.98 Changes in 2.7 30 6.82 attitude Before 76.33 30 13.43 0.033 After 73.56 30 10.14 Changes 2.77 30 6.77 P0.05 Paired Samples Test Table 2: Distribution of average score breastfeeding knowledge and attitude granted before and after intervention in two groups.

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Citation: Masthalina H Agustina Z 2017 Effect of Nutrition Counseling Knowledge and Attitude toward Mother Breast Feeding and Baby Growth in Sub Lubuk Pakam. J Nutr Weight Loss 2: 104. Page 3 of 8 Volume 2 • Issue 1 • 100010 J Nutr Weight Loss an open access journal Te treatment group had a mean score of 80.83 and the knowledge of the control group had a mean score of knowledge amounted to 77.20. Diferences between the mean score of knowledge before the intervention in both groups did not difer signifcantly p0.05. Afer being given the intervention the mean score of knowledge in the treatment group and the control group amounted to 89.93 74.50. Diferences between the mean knowledge score afer intervention in both groups difered signifcantly p0.05 Table 3. Attitude Before giving the intervention to the subject frst the knowledge of exclusive breastfeeding is assessed. Te earn score of knowledge explains the attitude of the two groups before the intervention is diferent. Te treatment group had a mean score of 77.86 and the attitude of the control group had a mean score of knowledge amounted to 76.33. Attitude diferences between the mean scores did not difer signifcantly p0.05. Afer being given the intervention the mean score of attitude in the treatment group and the control group amounted to 86.93 and 73.57. Diferences between the mean knowledge score afer intervention in both groups difered signifcantly p0.05 Table 4. Granting exclusive breastfeeding Results showed subjects who received nutritional counseling more 83.3 giving an exclusive breastfeeding. Table 5 shows the results of the analysis of relative risk means 1563 subjects who received nutritional counseling will likely give exclusive breastfeeding 1.563 times than subjects who did not receive nutritional counseling. Tis study is comparable to studies conducted Ochola et al. in Kenya respondents who receive more intensive counseling that provides exclusive breastfeeding 23.9 for 6 months than the group of respondents who received counseling semi-intensive 2 6. Te provision of exclusive breastfeeding a dedication of a mother to her child there are many factors that cause the mother did not give Exclusive breastfeeding exclusive to their children include fatigue while breastfeeding breast milk is not enough the decision of the mother the mother returned to work and others Table 5 7. Growth Figure 1 describes the average growth rate of weight gain samples intervention group and the control group. If seen from the graph the average weight gain is higher intervention group than the control group. In the frst month the average increases in the intervention group of 1.25 kg and in the second month at 1.44 kg. Te average weight gain in the control group is the frst month in the second month 1.19 kg to 1 kg. Discussion Te level of knowledge Question and pre-test knowledge by researchers who immediately gave questions to the baby’s mother afer the researchers gave an explanation of the agreement to conduct nutritional counselling by visiting a sample home this activity provided more intensive counselling. Samples that meet the inclusion criteria and approve activities to be carried out frst to sign a consent form as proof of the willingness of information and media samples. Counselling activity began with intensive sessions 7 days and then the reinforcement 2 visits performed on day 8 and day 14. In the practice sessions are no longer visited independent samples the samples are given the opportunity to practice independently instructions given on exclusive breastfeeding counselling exclusively. Counselling is done directly by the researcher who was accompanied by skilled cadres Posyandu. Implementation of counselling is done by using a fip chart display exclusive breastfeeding materials discussions as well as material on the attachment of the correct feeding position. At the beginning of counselling sample averages are still not sure about the correct position of the attachment of breastfeeding and still do not understand the signifcance of giving exclusive breast milk. In the treatment group the average knowledge before and afer an increase 9.00 point this increase was statistically signifcant p0.000. Tis study is in line with research Ambarwati et al. in Semarang showed that the women who received intensive counselling had a higher level of knowledge than mothers who got regular counselling from midwife. Improved knowledge due to the treatment of nutritional education. Education with counselling methods that put mothers as subjects rather than as objects would put a great interest for counselling it motivates the mother to fnd out more about the defnition and benefts of early initiation of breastfeeding breast care feeding position and latch the baby insufcient breastfeeding benefts expressing milk how to express the milk storage and presentation of breast milk way the dangers of formula 8. Notoatmodjo say that health education can be done in various ways namely education training counselling consultation and through the media all fve of these methods has advantages and disadvantages 9. Te average knowledge in both groups Table 4 before being given the intervention were not statistically diferent p0.290 afer the intervention given an average knowledge statistically diferent p0.000. Tis study is in line with research Taufqurahman et al. afer being given counselling assistance to mothers of babies 0-6 months in the group given the intervention and the control group there were signifcant diferences p0.000 10. Afer being given treatment interventions to increase knowledge padakelompok by 9.0 points while the control group decreased to 2.7 point. Research Fikawati states that increased exclusive breastfeeding knowledge is one of the key success factors in the granting of exclusive breastfeeding 11. Variable Group Mean SD p-value Before Intervention Treatment 80.83 12.04 0.29 Control 77.2 14.22 After Intervention Treatment 89.83 5.79 0.000 Controls 74.5 11.98 Table 3: Distribution comparison of knowledge on second group scores before and after intervention. Variable Group Mean SD p-Value Intervention Treatment 77.86 13.28 0.658 Control 76.33 13.43 After Intervention Treatment 86.93 7.57 0000 Controls 73.57 10.15 Table 4: Distribution comparison of scores on the second group attitude before and after intervention. Group Exclusive breastfeeding granting p-value- RR95 CI Exclusive breastfeeding Not Exclusive breastfeeding 0.026 1.563 1.078 2.264 Treatment 25 83.3 5 16.7 Control 16 53.3 14 46.7 Table 5: Distribution granting exclusive breastfeeding.

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Citation: Masthalina H Agustina Z 2017 Effect of Nutrition Counseling Knowledge and Attitude toward Mother Breast Feeding and Baby Growth in Sub Lubuk Pakam. J Nutr Weight Loss 2: 104. Page 4 of 8 Volume 2 • Issue 1 • 100010 J Nutr Weight Loss an open access journal Attitude Counselling given leads to the attitude of mothers to practice exclusive breastfeeding administration. Statement as much as 20 grains contain about attitudes in the provision of exclusive breastfeeding correct feeding position as well as the use of breast milk when mothers cannot breastfeed directly. Samples answered questions attitudes in accordance with what was done. Te resulting scores in the intervention group experienced an increase in both categories from 16 to 25 people in contrast to the control group who experienced a decline in both categories until the number of 16 to 13 people. Te score diference due to the absence of counselling gained by the control group. Research conducted by Abdullah and Ayubi expressed breastfeeding infants exclusively dealing with the attitude of the mother. Confdence to give exclusive breastfeeding is the main asset in the success of breastfeeding. Te results were obtained respondents Exclusive breastfeeding has a supportive attitude as much as 66.7 and that does not support as much as 33.3 12. Te resulting scores in both groups before the intervention there were 16 samples with a good attitude category it is judged on the application of behavioural mothers do. However afer the intervention group were counselled on score changes can be seen by 30 of samples. Te increase in the total score is also based counselling has been given and then the sample was asked to independently practice exclusive breastfeeding. Application of the results of the counselling attitude can also be seen from the sample gives an exclusive breastfeeding baby or formula feeding. At the time of the study researchers found that there are samples that give milk accompanied by milk formula. Tis is because the sample is a working mom and admitted it is difcult to divide time between work and breastfeeding. Attitudes cannot be seen but can be interpreted in advance of behaviours that are closed. Attitudes are emotional reactions to social stimuli. According to Newcomb attitude is a readiness or willingness to act which predisposes the action of behaviour not the implementation of a particular motif. Attitude is a readiness to react to certain objects in the environment as an appreciation of the object 9. Attitudes may change if given konselingan assistance to mothers so that behaviour can provide exclusive breastfeeding 13. Provision exclusive breastfeeding and growth Exclusive breastfeeding granting exclusive in both groups more in the treatment group amounted to 83.3 and in the control group by 53.3 Research Ochola et al. states to strengthen mother gave exclusive breastfeeding need for intensive counselling at home the research group receiving intensive counselling exclusively breastfed as much as 89 while the group receiving semi intensive as much as 87 6. In the intervention group and the control group there are diferences in weight gain every month. Diferences in weight gain both groups are not too far away the frst month of the average increase in the intervention group of 1.25 kg and in the second at 1.44 kg while the control group the average weight gain in the frst month of 1.19 kg and the second month of 1 kg. Te increase in infant weight in the treatment groups are still in the stage of normal as well as research Hunsberger et al. that exclusive breastfeeding is a protective factor for overweight in infants 14. When seen in infant growth period is what determines the success to provide nutrition to infants. While Khamzah reported normal growth patterns among infants fed breast milk with formula milk at 4 months to 6 months of age babies fed formula gained weight which tends to be faster than breast-fed babies. Afer the frst 6 months breast-fed infants tend to be slimmer than the formula-fed infants 15. Research conducted Saadia Ijaz et al. said the baby was a normal growth of about 17.6 do not get exclusive breast milk while the baby is growing abnormally not get exclusive breastfeeding much as 37.5 16. Te growth of Exclusive breast-fed infants is normal because the content of the nutrients found in breast milk has been meeting the needs of babies up to the age of 6 months 17. Conclusion Tere are signifcant diferences between the knowledge and attitude of the mother before the intervention and afer intervention. Diferences in scores of knowledge and attitude occurred because of interventions for the intervention group and the control group was not given. Recommendation To further increase the knowledge of breastfeeding and improve the delivery of exclusive breastfeeding the role of health professionals is necessary to support the success of exclusive breastfeeding exclusively in a region the provision of information and health promotion will be able to improve the health of the region. References 1. Fitri DI Chundrayetti E Semiarty R 2014 Breast feeding relationship with infant growth 6 months in Nanggalo health center. J Fak Kedokt Unand 3:136-140. 2. Menko K 2012 Guideline for the National Nutrition Movement Program Movement in the First Thousand Life Movement of 1000 HPK Movements. Jakarta: MOH RI. 3. Kurniawan B Sakit R Lamongan M 2013 Determinants of successful exclusive breast milk delivery. J Kedokt Brawijaya 267: 346-365. 4. Ministry of Health RI Kemenkes RI 2013 Basic Health Research: Jakarta. 5. Ratnaningsih E 2016 Exclusive breast-feeding and breastfeeding supplementary foods to infant nutritional status 6-12 months. IJC 2: 1-7. 6. Ochola SA Labadarios D Nduati RW 2012 Impact of counseling on exclusive breast-feeding practices in a poor urban setting in Kenya : A randomized controlled trial. Publich Heal Nutr J 16: 1732-1740. 7. Brown CRL Dodds L Legge A Bryanton J Semenic S 2014 Factors infuencing the reasons why mothers stop breastfeeding. Can J Public Health 179-186. 8. Ambarwati R Muis SF Susanti P 2012 Intensive lactation counseling and exclusive breast milk ASI for up to 3 months. Media Med Indones 46: 201-208. 9. Notoatmodjo S 2005 Education and health behavior. Jakarta: Rineka Cipta. 10. Taufqurrahman Mastahlina H Suhaema Handayani S 2015 Effect of mentally breastfeeding on mother knowledge attitudes and measures in exclusive breastfeeding and underfve nutrition status. Nutrition Research Kes I: 44-53. 11. Fikawati S Syafq A 2009 Causes of success and failure of exclusive breast- feeding practices. J Kesehat Masy Nas 4. Figure 1: Graph of the average weight gain samples intervention group and the control group.

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Citation: Masthalina H Agustina Z 2017 Effect of Nutrition Counseling Knowledge and Attitude toward Mother Breast Feeding and Baby Growth in Sub Lubuk Pakam. J Nutr Weight Loss 2: 104. Page 5 of 8 Volume 2 • Issue 1 • 100010 J Nutr Weight Loss an open access journal 12. Abdullah GI Ayubi D 2013 Determinants of exclusive mother’s breeding conditions to workers’ mothers. J Kesehat Masy Nas 7: 298-303. 13. Mangasaryan N Martin L Brownlee A Ogunlade A Rudert C et al. 2012 Breastfeeding promotion support and protection: Review of six country programmes. J Nutr 4: 990-1014. 14. Hunsberger M Lanfer A Reeske A Veidebaum T Russo P et al. 2012 Infant feeding practices and prevalence of obesity in eight European countries – the IDEFICS study. Publich Heal Nutr J 16: 219-227. 15. Khamzah SN 2012 The myriad of wonds of breast milk you should know. yogyakarta: Flashbook. 16. Ijaz S Ijaz T Afzal RK Afzal MM Nukhtar O et al. 2015 Infants-feeding practices and their relationship with socio-economic and health conditions in Lahore Pakistan. Adv Life Sci 2: 158-164. 17. Soetjiningsih 2012 Child growth: Jakarta EGC Medical Book.

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