FORM5: PUBLIC HEALTH CENTRE STAFF QUESTIONNAIRE

PART 1: IDENTIFICATION / No
A / B / C / D
A: 1. Guntur, 2. Gajah B. Nomer form, C. Visit ..? D. Nomerresponden
Name / : / 6b.1.1.
Address / : / 6b.1.2.
Telephone number / : / 6b.1.3.
Place and date of birth / : / 6b.1.4.
Gender / 6b.1.5.
Education / : / 6b.1.6.
Profession / : / 6b.1.7.

Interviewer's name: ______Sign ______

Date of interview……………………………………... / 2 / 0
Visit number / 2nd / 3rd / 4th / d / d / m / m / y / y / y / y

Supervisor's name ………………………………………….Sign ………………………….

Date of checked ……….…………………...... ……… / 2 / 0
d / d / m / m / y / y / y / y

PART 2: PRACTICE

I want to ask you a little bit about yourself and your activities related to breastfeeding

How long have you been a health worker? / ….… year / 6b.2.1.
As a health worker, have you ever provide counseling/teaching about breastfeeding? / 1. Yes / 2. No, go to Part 2 / 6b.2.2.
Do you feel confident in providing counseling/teaching on exclusive breastfeeding? /
  1. Feel confidence.
  2. Feel not confidence
/ 6b.2.3.
When you educate a mother, what a given topic related to breastfeeding? / 6b.2.4.
  1. Benefits of breastfeeding
/ 1. Yes / 2. No / 6b.2.5.
  1. Early initiation of breastfeeding
/ 1. Yes / 2. No / 6b.2.6.
  1. Giving colostrum, not giving prelacteal food
/ 1. Yes / 2. No / 6b.2.7.
  1. Exclusive breastfeeding, only breast milk until the age of 6 months
/ 1. Yes / 2. No / 6b.2.8.
  1. Breastfeed often and as long as possible, at least 8 times a day
/ 1. Yes / 2. No / 6b.2.9.
  1. the mother should let her baby finish one breast before she offers the other breast
/ 1. Yes / 2. No / 6b.2.10.
  1. Good attachment and position
/ 1. Yes / 2. No / 6b.2.11.
  1. Breastfeeding difficulties: mbangkaki (engorgement), cracked nipples, sore nipple, etc.
/ 1. Yes / 2. No / 6b.2.12.
  1. Food portions for mothers
/ 1. Yes / 2. No / 6b.2.13.
  1. Other:
/ 1. Yes / 2. No / 6b.2.14.
1. Yes / 2. No / 6b.2.15.

PART 3: KNOWLEDGE

Now, I will say a few things related to breastfeeding. Please, give your statement what I say True or False. (Put a check mark √ in the column: true or false)

No / Statement / True / False
Babies need extra water or food at the age of 4 months / 0 / 1 / 6b.3.1.
Infant formulas may decrease the prevalence of exclusive breast-feeding / 1 / 0 / 6b.3.2.
formula samples may be given to mothersatdischarge / 0 / 1 / 6b.3.3.
If breastmilk isproduced only a little amount in the day 1 or 2, health officer may give a babyinfant formulas / 0 / 1 / 6b.3.4.
Newborns can survive for at least2 days without eating or drinking / 1 / 0 / 6b.3.5.
If the breast is full, milk production will decrease / 1 / 0 / 6b.3.6.
Good attachment if more areola is visible above the baby’s mouth than below / 0 / 1 / 6b.3.7.
Because a mother is tired at delivery, the baby needs to be separated from his mother / 0 / 1 / 6b.3.8.
Breastfeeding needs to be scheduled so that adequate milk production / 0 / 1 / 6b.3.9.
Suckling had no effect on milk production / 0 / 1 / 6b.3.10.
A thin milk is a sign that breast milk is not good enough / 0 / 1 / 6b.3.11.
After the baby is 4 months old, she needs to give complementary feeding / 0 / 1 / 6b.3.12.
Flat nipples always cause breastfeeding problems / 0 / 1 / 6b.3.13.
At the age of 1-2 days infants should be able to drink colostrum about 40-100 ml or half a cup a day / 0 / 1 / 6b.3.14.
Cracked nipples can be caused by frequent and duration of breastfeeding / 0 / 1 / 6b.3.15.
The best way to overcome mastitis is to stop breastfeeding / 0 / 1 / 6b.3.16.
Healthy baby weight will drop to 7-10 percent after birth and have to gain back up to birth weight at the age of 2 weeks / 1 / 0 / 6b.3.17.

SECTION 4: ATTITUDES

Give your opinion on the statement which I will read.

(please mark X in the bottom of the column strongly agree, agree, disagree or strongly disagree)

No / Statement / Strongly agree / agree / Disagree / Strongly disagree
Children who are breastfed are often thin and do not grow well / 1 / 2 / 3 / 4 / 6b.4.1.
milk formula can interfere exclusive breastfeeding practices / 4 / 3 / 2 / 1 / 6b.4.2.
If the baby does not gain weight after 2 weeks, she needs milk formula / 1 / 2 / 3 / 4 / 6b.4.3.
Breast milk alone can satisfy the baby until the age of 6 months / 4 / 3 / 2 / 1 / 6b.4.4.
If the mother needs to be stitched after the birth, the early initiation of breastfeeding can be delayed / 1 / 2 / 3 / 4 / 6b.4.5.
Early initiation of breastfeeding is very tiring / 1 / 2 / 3 / 4 / 6b.4.6.
When the mother feels her breastmilk is not enough, health officials may advise to use milk formula / 1 / 2 / 3 / 4 / 6b.4.7.
Sore or cracked nipples in breastfeeding is normal / 1 / 2 / 3 / 4 / 6b.4.8.
It is very difficult to establish exclusive breastfeeding practices to mother / 1 / 2 / 3 / 4 / 6b.4.9.
Health workers are allowed to give formula samples as a gift when she returned home after giving birth / 1 / 2 / 3 / 4 / 6b.4.10.
Breast engorgement cannot be prevented / 1 / 2 / 3 / 4 / 6b.4.11.
Babies who are exclusively breastfed less frequently exposed to infections than formula-fed infants / 4 / 3 / 2 / 1 / 6b.4.12.
Breastfeeding is more economical than formula feeding / 4 / 3 / 2 / 1 / 6b.4.13.
The baby's father feel ignored when Mother breastfeed their baby / 1 / 2 / 3 / 4 / 6b.4.14.
In order to be closed to the baby, father can give formula milk to the baby / 1 / 2 / 3 / 4 / 6b.4.15.
It would be embarrassing if breastfeeding in front of many people / 1 / 2 / 3 / 4 / 6b.4.16.
Many of the breast cannot produce enough milk for her baby / 1 / 2 / 3 / 4 / 6b.4.17.
Breastfeeding will make breasts saggy / 1 / 2 / 3 / 4 / 6b.4.18.
Exclusive breastfeeding may be cultural / 4 / 3 / 2 / 1 / 6b.4.19.
Breastfeeding can help the mother lose weight after giving birth / 4 / 3 / 2 / 1 / 6b.4.20.
Please observe and note interesting things during the interview

Thank you for taking the time to participate in this study.