Public Health Education and Promotion Commons^™

Housing Stability And Diabetes Among People Living In New York City Public Housing, Sungwoo Lim, Sze Yan Liu, Melanie H. Jacobson, Eugenie Poirot, Aldo Crossa, Sean Locke, Jennifer Brite, Elizabeth Hamby, Zinzi Bailey, Stephanie Farquhar

Department of Public Health Scholarship and Creative Works

Public housing provides affordable housing and, potentially, housing stability for low-income families. Housing stability may be associated with lower incidence or prevalence and better management of a range of health conditions through many mechanisms. We aimed to test the hypotheses that public housing residency is associated with both housing stability and reduced risk of diabetes incidence, and the relationship between public housing and diabetes risk varies by levels of housing stability. Using 2004-16 World Trade Center Health Registry data, we compared outcomes (housing stability measured by sequence analysis of addresses, self-reported diabetes diagnoses) between 730 New York City public housing …

Pre-Testing Of The Who’S Educational Video: “How To Protect Yourself Against Covid-19”, Hilyatul Fadliyah, Manendra Muhtar, Munih Munih, Sylviasari Risgiantini, Weny Wulandary, Hadi Pratomo

Kesmas

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a public health emergency in many countries, including Indonesia. The World Health Organization (WHO) released an educational video, entitled "How to Protect Yourself Against COVID-19", which explained how to prevent the spread of COVID-19. This study is a qualitative study that aims to pre-test this video, based on the Information, Education, Communication (IEC) theory, by analyzing teenagers’ perceptions of the video. The design used was a Rapid Assessment Procedure (RAP), and the data were collected by conducting in-depth interviews with participants, through …

Impact Of Lockdown In India: A Case Study Comparing Kanataka With International Model, Stelvin Sebastian, Aby Paul, Jeeva Joseph, Joel Joby, Sanjo Saijan, Jobin Kunjumon Vilapurathu

Kesmas

The COVID-19 was declared a pandemic and a global health emergency by WHO, prompting various countries to implement early and stringent social distancing protocols through lockdown, to flatten the epidemic curve. The objective of the present study was to assess the impacts and effectiveness of the lockdown protocol in Karnataka and Punjab, compared with the implementation of this method in Australia and the UK. This study involved the collection of data from different authorized databases, in two phases. The first phase included the time starting with the first-reported index case through the 14th day after the declaration of lockdown, for …

Review Of Trial Therapies And Treatment For Covid-19: Lessons For Indonesia, Halma Zahro Mukhlida, Hilma Hasro Maulida, Gunanti Khairunnisa, Margaretha Josephine Mantrono, Risky Kusuma Hartono, Rindu Rindu, Eka R W Purnamasari, Rizky Fajar Meirawan

Kesmas

The infectious disease from Coronavirus Disease 2019, or COVID-19, has quickly spread world-wide since 2019. Therapies for managing COVID-19 have yet to be confirmed as medication for the severe sickness that the disease may cause. This study aimed to review the previous research of the efficacy of trial therapy and treatment to the patients in the hospital with COVID-19. Using PRISMA guidelines as a method for conducting a systematic literature review, a total of 67 articles were collected from several online journal databases. Various therapies were found that are effective in the treatment and management of COVID-19. In accordance with …

Studi Tinjauan Pustaka: Risiko Kejadian Kanker Paru Pada Penderita Tuberkulosis Paru., Fariha Ramadhaniah, Syahrizal Syarif

Jurnal Epidemiologi Kesehatan Indonesia

Indonesia merupakan satu dari lima negara di dunia dengan insiden kasus TB yang tinggi, sementara itu kanker paru di Indonesia merupakan kasus keganasan utama yang paling sering terjadi. Untuk melihat gambaran risiko kejadian kanker paru diantara penderita TB paru, dilakukan studi tinjauan pustaka pada sepuluh jurnal yang dipublikasikan melalui Pubmed pada tahun 2009-2019. Kriteria inklusi dalam pemilihan jurnal yaitu TB paru sebagai faktor risiko dan kanker paru primer sebagai outcome, sedangkan kriteria ekslusi adalah jurnal yang merupakan tinjauan pustaka sistematis, skrining, diagnosis, dan evaluasi hasil pengobatan yang berkaitan dengan infeksi TB dan kanker paru. Analisis deskriptif menunjukan subjek sebagian …

Karakteristik Ibu Melahirkan Sectio Caesaria Peserta Jaminan Kesehatan Nasional Di Rumah Sakit Profit X Di Sekitar Jakarta, Trisna Budy Widjayanti

Jurnal Epidemiologi Kesehatan Indonesia

Program Jaminan Kesehatan Nasional (JKN) memudahkan akses ibu melahirkan Sectio Caesaria (SC) di RS. Dalam tahun 2014-2017 persalinan SC menempati urutan 10 jumlah kasus dan klaim tertinggi. WHO menetapkan angka optimum SC sebesar 15% sebagai salah satu standar kualitas pelayanan persalinan ibu. Tujuan penelitian ini untukmengidentifikasi karakteristik sosial ekonomi dan klinis dari ibu yang melahirkan SC yang berhubungan dengan penggunaan JKN di Rumah Sakit Profit (RSP) X di sekitar Jakarta. Penelitian menggunakan desain Cross Sectional dengan total sampel sebanyak 385 ibu melahirkan SC yang diambil dari rekam medis pada periode januari 1- 31 Desember 2018. Karakteristik sosial ekonomi dan klinis …

How Much Can Mexican Healthcare Providers Learn About Breastfeeding Through A Semi-Virtual Training? A Propensity Score Matching Analysis, Mireya Vilar-Compte, Rafael Pérez-Escamilla, Meztli Moncada, Diana Flores

Department of Public Health Scholarship and Creative Works

Background: Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world. Methods: Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered …

Identifying The Weak Foundation Of Public Health Resilience Fornational Disaster Policy In Indonesia’S Mid-Term Developmentagenda 2015–2019: A Policy Content Analysis, Gita Miranda Warsito, Meiwita Budiharsana, Sharyn Burns

Kesmas

Indonesia is one of the most susceptible nations toward natural disasters in the world. Since 1992, approximately 37 tsunami incidents have occurred inIndonesia, with at least 1,244 cases of natural disasters during 2018. Despite the overwhelming impact of disasters on Indonesia, Public Health Resilience,as an approach to disaster countermeasures, has been poorly elaborated in Indonesia’s development agenda (National Mid-term Development Plan (NMDP),or Rencana Pembangunan Jangka Menengah Nasional (RPJMN), 2015 - 2019). By utilizing the method of policy content analysis, this study aimed to analyzethe policy background of Public Health Resilience against disasters in the NMDP 2015 - 2019 and National …

Benson's Relaxation Therapy And Sleep Quality Among Elderlyat A Social Institution In Inakaka, Indonesia, Nur Baharia Marasabessy, Lucky Herawati, Irhamdi Achmad

Kesmas

Serious sleep disturbances among elderlies include attention or memory disorders, depression and often fall. A quasi experimental study design with pre-posttest with control group was performed to determine effect of Benson’s relaxation therapy on sleep quality among the elderly, and influences of sex, age anddisease suffered differences. Of a total of 46 elderlies from a Social Institute in Ambon, 29 were taken for the treatment group and 19 for the control group.The treatment group was interfered with Benson’s breathing relaxation for 14 days. Sleep quality was measured using Pittsburg sleep quality index form. Datawere analyzed using independent t-test and multivariate …

Effects Of Climbing Choice, Demographic, And Climate On Walking Behavior, Febriani Fajar Ekawati, Frank Francis Eves

Kesmas

Walking is a public health recommendation to increase physical activity. Although walking for transport is associated with health benefits, it is frequently avoided when a mechanized alternative is available and when the weather or individuals’ available resources are unfavorable. The present quasi-experimental study used chosen walking speed to estimate the use of resources by pedestrians and investigated 730 pedestrians’ behavior when approaching a choice point between a short stair and a ramp at an exit from a university campus toward the local train station on six separate days. Results revealed that individuals who climbed the stairs walked faster than those …

Religious Leader’S Support Toward Individual At Risk Ofhiv/Aids To Attend Voluntary Counselling And Testing Service, Imelda Februati Ester Manurung, Chatarina Umbul Wahyuni, Ari Probandari

Kesmas

Religious leader is a figure who is believed to have the gift of healing. A person with illness will follow any advice the religious leader gives for his/her recovery.Based on the phenomenon, religious leader is a potential local figure to give support for individuals at risk of human immunodeficiency virus (HIV) andacquired immune deficiency syndrome (AIDS). This study aimed to determine factors related to religious leader’s support toward individuals at risk of HIV andAIDS to attend voluntary counselling and testing (VCT) service. This study was an observational analytical with cross-sectional design. The population of thisstudy was religious leader in Kupang …

Myths About Menstrual Personal Hygiene Among Female Adolescents, Tyas Diah Palupi, Terry Y.R. Pristya, Randy Novirsa

Kesmas

Poor personal hygiene during menstruation among adolescents can lead to urinary tract infection, reproductive tract infection, and skin irritation. This studyaimed to determine the relationship between belief in myths and personal hygiene during menstruation. Cross-sectional quantitative study was conductedusing a sample of 119 10th grade female students from Tangerang 13 State Senior High School selected through purposive sampling. Logistic regressionanalysis was used in this study to determine the relationship between myths and personal hygiene after age of menarche, attitude, socioeconomic status,information, and maternal education were controlled. In the bivariate selection, modeling was completed by entering confounding and interaction variablesthen reducing …

Adaptation And Validation Of The Tamil (Sri Lanka) Version Ofthe Montreal Cognitive Assessment, Pethirupillai Amal Dinesh Coonghe, Pushpa Fonseka, Sampasivamoorthy Sivayogan, Ajantha Keshavaraj, Rahul Malhotra, Truls Ostbye

Kesmas

The study aimed to develop the Tamil (Sri Lanka) version of the Montreal Cognitive Assessment (MoCA) and investigate its reliability and validity as a briefscreening tool for mild cognitive impairment (MCI). Tamil-speaking Sri Lankan elderly with normal cognition and MCI were recruited from a neurology clinic.Adaptation of the English MoCA to the Tamil (Sri Lanka) involved context-specific content modification and translation. The content validity, reliability, sensitivity,and specificity of the tool were evaluated. Study participants were 184 older adults, comprising 85 with normal cognition and 99 neurologist-diagnosed MCI.The tool had high internal consistency (Cronbach's alpha = 0.83). Receiver operating characteristic curve …

Adverse Effect Of Aerosol Pesticide On Lung Dysfunction Amongpaddy Farmers In Purworejo, Central Java, Indonesia, Fajaria Nurcandra, Renti Mahkota, Tri Yunis Miko Wahyono

Kesmas

The World Health Organization estimated that chronic obstructive pulmonary disease (COPD) will be the highest non-communicable disease worldwide by2030, and pesticide exposure is one of major risk factors. This study aimed to determine effect of pesticide exposure on lung dysfunction among paddyfarmers. A case-control study was performed on April - May 2016 in Purworejo. The case group comprised 66 farmers suffering from lung dysfunction during2015 based on medical records, while the control group comprised 59 neighboring farmers showing normal lung function. Both case and control groups weretested using a spirometer and COPD assessment test (CAT) questionnaire. Logistic regression analysis of …

Correlation Of Knowledge And Beliefs To Adherence With Antibiotic Use In Adult Patients At A Private Hospital In Sidoarjo, Muhammad Hasan Wattiheluw, Fauna Herawati, Setiasih Setiasih, Rika Yulia

Kesmas

Infectious diseases are one of the top ten causes of death in the world. Antibiotic therapy is administered for infectious diseases, but if bacteria are exposed to antibiotics continuously, then the bacteria are able to adapt to the medication, thereby resulting in antibiotic resistance. This condition results in an increase in mortality, long hospitalization period, and increased cost of antibiotic therapy and health services. Adherence to using antibiotics may be influenced by knowledge and beliefs about them. This study aimed to understand correlation between knowledge and belief with adherence to antibiotic use at a private hospital in Sidoarjo. This cross-sectional …

Screening For Iron-Deficiency Anemia In The Pediatric Population (Ages 1-17) In Gonaïves, Haiti, Cara Rose Fratianni

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this pilot project is to screen for iron-deficiency anemia in pediatric patients (ages 1-17) in a primary school in Gonaïves, Haiti. Patients with anemia will be treated with oral supplemental iron for a period of four weeks according to WHO guidelines (WHO, 2011). All students will be treated empirically for helminths per WHO guidelines, unless treated elsewhere in the last six months (WHO, 2017). Nutritional status will also be assessed using MUAC according to WHO guidelines (2017).

Background Summary: Malnutrition contributes significantly to the problem of iron-deficiency anemia, with one in four children exhibiting stunting …

Baseline Health Assessment Of A Rural Delta Community, Sydney Mitchell

Honors Theses

The Lower Mississippi Delta is characterized by poverty, chronic health issues, health disparities, and food insecurity. The rural Delta communities are primarily African American, experiencing disproportionately higher rates of poverty, job loss, and chronic health problems. Historically, chronic health issues have persisted in these areas over time, including obesity, hypertension, and diabetes, which have only seemed to increase in this region. The food environment in this rural region tends to assist in the creation of the largely obesogenic population which, in turn, contributes to the increased prevalence of diabetes and hypertension and a lower quality of life. Many residents in …

Something To Celebrate?: Demoting Dairy In Canada's National Food Guide, Maneesha Deckha

Journal of Food Law & Policy

In early 2019, the Canadian Government released the much-anticipated new Canada Food Guide. It is a food guide that de-emphasizes dairy products and promotes plant-based eating. Notably, in the new version, milk and milk products are de-listed as one of the previously four essential food groups. On the surface, it seems that the federal government is promoting veganism and helping to bring about a friendlier future for animals and humans harmed by being producers and consumers of dairy, as the new Guide may seriously contract the currently robust Canadian dairy industry and its powerful lobby. On closer inspection, the messaging …

¡Sí, Yo Puedo Vivir Sano Con Diabetes! A Self-Management Randomized Controlled Pilot Trial For Low-Income Adults With Type 2 Diabetes In Mexico City, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Roberta Delvy, Sangchoon Jeon, Soraya Burrola-Méndez, Mariana Pardo-Carrillo, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system.

Objectives: We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City.

Methods: Participants were recruited at public …

Orthorexia Nervosa In College Students: Eating Disorder History, Gender, And Dieting Behaviors, Katrina Agger, Brittany Moran, Zhiping Yu Phd, Rnd, Ldn

Showcase of Osprey Advancements in Research and Scholarship (SOARS)

Objective: College students are at higher risk for the development of orthorexia nervosa (ON), a term used to describe the pathological obsession with healthy eating. This study aimed to assess how the factors of eating disorder (ED) history, gender, and dieting behaviors affect the ON in this population.

Methods: Students 18 years or older in a southeastern university were invited to take an online survey. Survey questions include Bratman Orthorexia Test (BOT), Eating Attitude Test-26 (EAT-26) and participant characteristics.

Results: 411 students (ages 18-65, BMI 15.1-55.5, female 75.2%, white 75.6%, graduate students 16.1%) have completed the survey. Comparing to students …

Effects Of Diabetes On The Output Of Farmer And Its Policy Implications, Syed Asif Ali Naqvi, Bilal Hussain, Syed Ale Raza Shah, Muhammad Sohail Amjad Makhdum

Kesmas

This study investigated the impact of diabetes on work performance of different farming communities from Punjab, Pakistan. This study was based on cross-sectional data. A representative sample of 374 farmers was collected from five selected districts. Three types of respondents were analyzed in the study e.g.,laborer, small and large growers. Poisson and logistic regression techniques were used for the sake of analysis. According to the investigated results for thelabor category, respondents with more age, less qualification, low earning per month (Rupees), and having positive record of family diabetes, would havemore leave per month. In the same way, findings for small …

Qualitative Exploration Of Experiences And Consequences Of Health-Related Stigma Among Indonesians With Hiv, Leprosy, Schizophrenia And Diabetes, Sarju Sing Rai, Irwanto Irwanto, Ruth M.H. Peters, Elena V. Syurina, Annisa Ika Putri, Altana Mikhakhanova, Denise Naniche, Marjolein B.M. Zweekhorst

Kesmas

Health-related stigma causes a negative impact on the lives of affected people and undermines the effectiveness of public health programs. This study aimedto explore experiences and consequences of stigma among people affected by four health conditions relevant in Indonesia– HIV (Human ImmunodeficiencyVirus), leprosy, schizophrenia and diabetes. In this qualitative study 40 people affected by the four health conditions in Jakarta and West Java, Indonesia–,were interviewed between March and June 2018. Data were analyzed thematically by following an integrative inductive-deductive approach. The experiencesand consequences of people with stigma were similar, but such experience were more severe among people affected by HIV, …

Health Risk Behaviors: Smoking, Alcohol, Drugs, And Dating Among Youths In Rural Central Java, Zahroh Shaluhiyah, Syamsulhuda Budi Musthofa, Ratih Indraswari, Aditya Kusumawati

Kesmas

Adolescents are more likely to adopt risky health behaviors, such as smoking, alcohol use, and sexual activity. This study examined the links betweensmoking, alcohol use, and risky dating behavior and analyzed how these factors influenced risky dating and other behaviors. It is expected that this studywould be used as a foundation for developing appropriate integrated intervention for multiple risk behaviors among youths. This study was an explanatory research study with a cross-sectional approach. It involved 160 youths aged 15-24 years randomly selected from purposive villages. Participants completedself-administrated questionnaires with an enumerator present. Data were analyzed using univariate, chi-square, and multiple …

Evaluation Of Program For Overcoming Intestinal Worm Infections Among Children, Henny Febriyanti, Haerawati Idris

Kesmas

Prevalence of intestinal worm infection in generall is extremely high in Indonesia among the poor population with poor sanitation. One of the government programs to address this problem is the distribution of medicines to prevent intestinal worm infections. However, the coverage of the achievement for this program is still low in several areas of public health centers in Palembang. Therefore, this study was conducted to evaluate the efficacy of the national program for preventing intestinal worm infections. The qualitative research design used evaluation model approach Context, Input, Process, and Product (CIPP) model. This study was conducted in one of health …

Entomological Index And Home Environment Contribution­ ­To Dengue Hemorrhagic Fever In Mataram City, Indonesia, Tri Baskoro Tunggul Satoto, Nur Alvira Pascawati, Tri Wibawa, Roger Frutos, Sylvie Maguin, I Kadek Mulyawan, Ali Wardana

Kesmas

Indonesia is a member of Southeast Asia Regional Office (SEARO) ranked the first in dengue hemorrhagic fever (DHF) problem based on incidence rate (IR) and case fatality rate (CFR). Several provinces in Indonesia experience an outbreak, one of which is the Mataram City in West Nusa Tenggara Province. Mataram City is an endemic area of DHF because the DHF cases are always found in three consecutive years with the number of cases that fluctuate and tend to increase. This study aimed to obtain factors that could be used to improve early warning systems in controlling DHF. This study used a …

Utilization Of Family Planning Contraceptives Among Women Inthe Coastal Area Of South Buru District, Maluku, 2017, Christiana Rialine Titaley, Ninik Sallatalohy

Kesmas

Maluku Province is one among provinces in Indonesia with a contraceptive prevalence rate (CPR) lower than the national average. This study aimed toexamine factors associated with the utilization of family planning contraceptives among women of reproductive age living in the coastal area of South BuruDistrict, Maluku, Indonesia. Data were derived from a household health survey conducted in five subdistricts in South Buru, e.g., Namrole, Leksula, Waesama,Kapala Madan and Ambalau Subdistricts on November 2017 by the Faculty of Medicine, Pattimura University in Ambon. Information on contraceptive usewere collected from 390 married women aged 20 - 49 years. Bivariate and multivariate logistic …

Determinants Of Stunted Children In Indonesia: A Multilevel Analysis At The Individual, Household, And Community Levels, Febri Wicaksono, Titik Harsanti

Kesmas

This study aimed to examine the risk factors of childhood undernutrition in Indonesia. Determinants of childhood stunting were examined by using the 2013 Indonesia Basic Health Research Survey dataset. A total of 76,165 children aged under 5 years were included in this study. The analysis used multivariate multilevel logistic regression to determine adjusted odds ratios (aORs). The prevalence of stunting in the sample population was 36.7%. The odds of stunting increased significantly among the under-five boys, children living in slum area, and the increase of household member (aOR = 1.11, 95 %CI: 1.06–1.15; 1.09, 95%CI: 1.04–1.15; and 1.03, 95%CI: 1.02–1.04 …

A Qualitative Study Of The Genesis Of A Community Food Pantry For Students Of Higher Education, Elizabeth Fast

Theses and Dissertations

Objective: The purpose of this case study was to understand the development of a food pantry for students of higher education at a Midwestern university.

Methods: The researchers recruited 11 individuals on the food pantry’s board using a snowball sampling method to participate in a 30-minute interview about the food pantry’s development from conception to implementation. The interviews were transcribed and then qualitatively analyzed by two researchers. The researchers coded interviews separately to identify frequent commonalities between participant responses. The researchers then organized the codes into themes, which were then summarized in the results of this study.

Results: The first …

Appalachian Environmental Health Literacy: Building Knowledge And Skills To Protect Health, Anna G. Hoover, Annie Koempel, W. Jay Christian, Kimberly I. Tumlin, Kelly G. Pennell, Steven Evans, Malissa Mcalister, Lindell E. Ormsbee, Dawn Brewer

Journal of Appalachian Health

Environmental health literacy (EHL) is an emerging, multidisciplinary field that promotes understanding of how environmental exposures can affect human health. After discussing the regional relevance of environmental health knowledge and skills, this article describes three ongoing Appalachian projects that are focused on measuring and building EHL.

Association Between Breastfeeding And Child Stunting In Mexico, Ana Paola Campos, Mireya Vilar-Compte, Summer Sherburne Hawkins

Department of Public Health Scholarship and Creative Works

Background: Globally, the prevalence of child stunting has been decreasing over the past decades. How-ever, in low-and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective: To examine the association between breastfeeding (defined as never breastfed, any breast-feeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico. Methods: Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed-and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings: Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breast-feeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions: According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.