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co
u
r
s
e
co
n
ten
t,
ed
u
ca
to
r
q
u
alif
icatio
n
s
,
an
d
ass
ess
m
en
t
s
tr
ateg
ies
h
am
p
er
s
th
e
p
o
ten
tial
o
p
tim
izatio
n
o
f
b
r
e
astfe
ed
in
g
e
d
u
ca
tio
n
an
d
th
e
s
u
b
s
eq
u
en
t
s
u
p
p
o
r
t
p
r
o
v
id
ed
to
m
o
th
er
s
[
1
0
]
.
R
esear
ch
co
n
d
u
cted
in
th
e
Un
ited
Kin
g
d
o
m
in
d
icate
s
th
at
m
ed
ical
ed
u
ca
tio
n
n
ee
d
s
to
estab
lis
h
s
tan
d
ar
d
s
an
d
ad
e
q
u
ate
b
r
ea
s
tf
ee
d
in
g
teac
h
in
g
co
n
ten
t,
n
ec
ess
itatin
g
th
e
in
clu
s
io
n
o
f
d
e
d
icate
d
b
r
e
astf
ee
d
in
g
co
u
r
s
es [
1
1
]
.
T
h
e
f
ac
to
r
s
t
h
at
im
p
ed
e
o
p
tim
al
b
r
ea
s
tf
ee
d
in
g
ar
e
s
ig
n
if
ica
n
t,
with
r
esear
ch
in
d
icatin
g
t
h
a
t
b
etwe
en
3
0
%
an
d
8
0
%
o
f
m
o
th
e
r
s
p
e
r
ce
iv
e
th
eir
b
r
ea
s
t
m
ilk
s
u
p
p
l
y
as
in
s
u
f
f
icien
t.
T
h
is
p
er
ce
p
tio
n
o
f
ten
lead
s
to
p
r
em
atu
r
ely
in
tr
o
d
u
ci
n
g
f
o
r
m
u
la
m
ilk
b
ef
o
r
e
r
ec
eiv
in
g
a
p
r
o
f
ess
io
n
al
d
iag
n
o
s
is
[
1
2
]
.
A
p
r
ev
io
u
s
s
tu
d
y
also
r
ev
ea
led
th
at
m
ater
n
al
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
s
ig
n
if
ica
n
tly
in
f
lu
en
ce
s
m
o
th
er
s
'
p
er
ce
p
tio
n
o
f
t
h
eir
m
ilk
s
u
p
p
ly
a
n
d
im
p
ac
ts
b
r
ea
s
tf
ee
d
in
g
d
u
r
atio
n
[
1
3
]
.
Fu
r
th
er
m
o
r
e,
s
tu
d
ies
h
av
e
d
em
o
n
s
tr
ated
th
at
a
m
o
th
er
'
s
s
elf
-
ef
f
icac
y
co
n
ce
r
n
in
g
b
r
ea
s
tf
e
ed
in
g
s
u
b
s
tan
tially
in
f
lu
e
n
c
es
h
er
p
er
ce
p
tio
n
s
o
f
m
ilk
s
u
p
p
ly
,
af
f
ec
tin
g
b
r
ea
s
tf
ee
d
in
g
d
u
r
atio
n
.
C
u
r
r
e
n
tly
,
o
n
ly
2
3
.
3
%
o
f
m
o
th
e
r
s
p
r
ac
tice
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
,
wh
ile
cu
ltu
r
al
b
elief
s
f
r
eq
u
en
tly
ad
v
o
ca
te
f
o
r
th
e
u
s
e
o
f
f
o
r
m
u
la
m
ilk
b
ef
o
r
e
th
e
in
f
an
t
r
ea
ch
es
s
ix
m
o
n
t
h
s
o
f
ag
e
[
1
4
]
,
[
1
5
]
.
Ad
d
itio
n
ally
,
n
eg
ativ
e
p
ast
ex
p
er
ien
ce
s
r
elate
d
to
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
,
as
well
as
ad
v
er
s
e
en
co
u
n
ter
s
with
b
r
ea
s
tf
ee
d
in
g
,
ca
n
d
etr
im
en
t
ally
im
p
ac
t
s
u
b
s
eq
u
en
t
e
f
f
o
r
ts
to
ac
h
iev
e
e
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
[
1
6
]
.
Pro
f
ess
io
n
als
m
u
s
t
id
en
tify
th
ese
in
h
ib
itin
g
f
ac
to
r
s
to
f
ac
ilit
ate
m
o
th
er
s
'
en
g
ag
em
en
t
in
s
elf
-
d
ir
ec
ted
lear
n
in
g
r
eg
ar
d
in
g
ef
f
ec
tiv
e
b
r
ea
s
tf
ee
d
i
n
g
p
r
ac
tices.
T
o
en
ab
le
b
r
ea
s
tf
ee
d
in
g
m
o
t
h
er
s
to
s
u
cc
e
s
s
f
u
lly
en
g
ag
e
in
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
i
n
g
,
t
h
ey
m
u
s
t
r
ec
eiv
e
s
u
p
p
o
r
t
f
r
o
m
co
m
p
et
en
t
h
ea
lth
p
r
o
f
ess
io
n
als
wh
o
ca
n
g
u
id
e
th
e
m
th
r
o
u
g
h
t
h
e
l
ea
r
n
in
g
p
r
o
ce
s
s
o
f
b
r
ea
s
tf
ee
d
in
g
[
1
7
]
.
T
h
e
s
u
p
p
o
r
t
m
o
th
er
s
r
ec
eiv
e
d
u
r
in
g
th
e
b
r
ea
s
tf
ee
d
in
g
p
r
o
ce
s
s
c
an
b
e
s
ig
n
i
f
ican
tl
y
en
h
an
ce
d
b
y
im
p
lem
e
n
tin
g
s
elf
-
d
ir
ec
ted
lear
n
i
n
g
i
n
itiativ
es.
Acc
o
r
d
in
g
to
th
e
Ger
ald
Gr
o
w
M
o
d
el,
in
d
iv
id
u
als
at
th
e
in
itial
s
tag
es
o
f
s
elf
-
d
ir
ec
ted
lear
n
in
g
r
ely
s
ig
n
if
ican
tly
o
n
ed
u
ca
to
r
s
.
E
d
u
ca
to
r
s
s
er
v
e
as
co
ac
h
es in
th
is
ca
p
ac
ity
,
p
r
o
v
i
d
in
g
ess
en
tial
d
ir
ec
tio
n
r
e
g
ar
d
in
g
k
n
o
wled
g
e
an
d
s
k
ills
wh
ile
o
f
f
er
in
g
f
ee
d
b
ac
k
to
ad
d
r
ess
d
ef
icien
cies a
n
d
o
v
er
co
m
e
lear
n
in
g
h
u
r
d
les.
As i
n
d
iv
id
u
als p
r
o
g
r
ess
to
th
e
s
u
b
s
eq
u
en
t stag
e
o
f
th
is
lear
n
in
g
p
r
o
ce
s
s
,
ed
u
ca
to
r
s
m
u
s
t
ac
t
as
m
o
tiv
ato
r
s
wh
o
ass
is
t
in
d
ef
in
in
g
lear
n
in
g
o
b
jectiv
es,
id
en
tify
in
g
n
ec
ess
ar
y
lear
n
in
g
r
eso
u
r
ce
s
,
an
d
f
o
r
m
u
latin
g
s
u
itab
le
lear
n
in
g
s
tr
ateg
ies [
1
8
]
.
I
n
I
n
d
o
n
e
s
i
a
,
t
h
e
m
a
t
e
r
n
a
l
a
n
d
c
h
i
l
d
(
MC
H
)
H
a
n
d
b
o
o
k
i
s
a
g
o
v
e
r
n
m
e
n
t
-
p
r
o
v
i
d
e
d
r
e
s
o
u
r
c
e
a
i
m
e
d
at
d
i
s
s
e
m
i
n
a
t
i
n
g
n
u
t
r
it
i
o
n
a
l
i
n
f
o
r
m
a
t
i
o
n
a
n
d
a
d
v
o
c
a
t
i
n
g
f
o
r
e
x
c
l
u
s
i
v
e
b
r
e
as
t
f
e
e
d
i
n
g
;
h
o
we
v
e
r
,
i
t
s
e
f
f
e
ct
i
v
e
n
es
s
i
n
e
n
h
a
n
c
i
n
g
b
r
e
a
s
t
m
i
l
k
p
r
o
d
u
c
t
io
n
r
e
m
a
i
n
s
l
i
m
i
te
d
.
F
u
r
t
h
e
r
r
e
s
e
a
r
c
h
i
s
r
e
q
u
i
r
e
d
t
o
a
s
c
e
r
t
a
i
n
th
e
d
e
g
r
e
e
t
o
w
h
i
c
h
m
o
t
h
e
r
s
u
t
i
l
i
ze
t
h
i
s
h
a
n
d
b
o
o
k
f
o
r
i
n
f
o
r
m
a
t
i
o
n
r
e
g
a
r
d
i
n
g
c
h
i
l
d
n
u
t
r
i
t
i
o
n
[
1
9
]
.
O
n
t
h
e
o
t
h
e
r
h
a
n
d
,
t
h
e
I
n
d
o
n
e
s
i
a
n
M
i
n
i
s
t
r
y
o
f
H
e
al
t
h
h
as
n
o
t
y
e
t
e
s
t
a
b
l
is
h
e
d
b
r
e
as
t
f
e
e
d
i
n
g
g
u
i
d
e
l
i
n
es
f
o
r
h
e
a
lt
h
p
r
o
f
e
s
s
i
o
n
a
ls
.
T
h
is
g
a
p
i
s
s
i
g
n
i
f
i
c
a
n
t
g
i
v
e
n
t
h
e
n
e
e
d
f
o
r
a
m
o
r
e
s
ta
n
d
a
r
d
i
z
e
d
a
p
p
r
o
a
c
h
t
o
l
a
c
t
at
i
o
n
e
d
u
c
at
i
o
n
i
n
t
h
e
g
lo
b
a
l
l
i
t
e
r
a
t
u
r
e
[
2
0
]
.
T
h
u
s
,
e
s
t
a
b
l
i
s
h
i
n
g
t
h
e
s
e
g
u
i
d
el
i
n
e
s
i
n
I
n
d
o
n
e
s
i
a
i
s
o
f
u
t
m
o
s
t
i
m
p
o
r
t
a
n
c
e
i
n
o
r
d
e
r
t
o
e
m
p
o
w
e
r
b
r
e
a
s
t
f
e
e
d
i
n
g
m
o
t
h
e
r
s
,
e
n
h
a
n
c
e
t
h
e
i
r
s
e
l
f
-
e
f
f
ic
a
c
y
,
a
n
d
p
r
o
m
o
t
e
s
e
l
f
-
d
i
r
e
ct
ed
l
e
a
r
n
i
n
g
.
Hea
lth
p
r
o
f
ess
io
n
als
s
h
o
u
ld
i
m
p
lem
en
t
ev
id
e
n
ce
-
b
ased
b
r
e
astfe
ed
in
g
g
u
id
elin
es
an
d
o
f
f
e
r
ef
f
ec
tiv
e
lear
n
in
g
r
eso
u
r
ce
s
s
u
ch
as
telelac
tatio
n
p
r
o
g
r
a
m
s
o
r
in
f
o
r
m
atio
n
al
b
o
o
k
lets
.
Ad
d
itio
n
ally
,
th
ey
s
h
o
u
l
d
em
p
lo
y
e
f
f
ec
tiv
e
lear
n
in
g
s
tr
ateg
ies,
wh
ich
m
ay
in
clu
d
e
in
d
i
v
id
u
al
o
r
g
r
o
u
p
class
es
o
r
a
co
m
b
in
atio
n
o
f
b
o
th
,
to
en
h
an
ce
s
elf
-
d
ir
ec
te
d
lea
r
n
i
n
g
m
o
tiv
atio
n
am
o
n
g
b
r
ea
s
tf
e
ed
in
g
m
o
th
e
r
s
.
Hea
lth
ca
r
e
p
r
o
v
id
er
s
ar
e
r
eq
u
ir
ed
to
o
f
f
er
ev
id
en
ce
-
b
ased
g
u
id
a
n
ce
o
n
b
r
ea
s
tf
ee
d
in
g
an
d
d
eliv
er
ef
f
ec
tiv
e
b
r
ea
s
tf
ee
d
in
g
lear
n
in
g
r
eso
u
r
ce
s
s
u
c
h
as
telelac
tatio
n
s
er
v
ices
an
d
[
1
7
]
,
[
2
1
]
in
f
o
r
m
ati
v
e
b
o
o
k
lets
[
2
2
]
.
I
m
p
lem
e
n
tin
g
ef
f
ec
tiv
e
lear
n
in
g
s
tr
ateg
ies,
in
clu
d
in
g
in
d
iv
id
u
al
a
n
d
g
r
o
u
p
class
es
o
r
a
co
m
b
in
atio
n
,
e
n
h
an
ce
s
s
elf
-
d
ir
ec
ted
lear
n
in
g
m
o
tiv
atio
n
am
o
n
g
b
r
ea
s
tf
ee
d
in
g
m
o
th
e
r
s
[
2
3
]
.
Hea
lth
ca
r
e
p
r
o
v
id
er
s
ar
e
r
eq
u
i
r
ed
t
o
o
f
f
er
ev
id
e
n
ce
-
b
ased
g
u
id
an
ce
o
n
b
r
ea
s
tf
ee
d
in
g
a
n
d
d
eliv
e
r
ef
f
ec
tiv
e
b
r
ea
s
tf
ee
d
in
g
lear
n
in
g
r
eso
u
r
ce
s
,
s
u
ch
as
telelac
tatio
n
s
er
v
ices
an
d
in
f
o
r
m
ativ
e
b
o
o
k
lets
.
Du
r
in
g
th
e
en
g
a
g
em
en
t
p
h
as
e
o
f
th
e
s
elf
-
d
ir
ec
ted
lea
r
n
in
g
m
o
d
el,
b
r
ea
s
tf
ee
d
i
n
g
m
o
th
er
s
ex
h
ib
it
au
to
n
o
m
o
u
s
p
r
o
ce
s
s
es
s
u
ch
as
p
lan
n
in
g
an
d
m
o
n
ito
r
in
g
[
1
8
]
.
Fo
r
in
s
tan
ce
,
m
o
th
er
s
m
u
s
t
estab
lis
h
a
p
lan
to
b
r
ea
s
tf
ee
d
th
eir
in
f
a
n
ts
f
o
r
u
p
to
s
ix
m
o
n
th
s
ex
clu
s
iv
ely
.
A
s
y
s
tem
atic
r
ev
iew
h
as
in
d
icate
d
th
at
d
air
y
in
ter
v
en
tio
n
s
,
u
tili
zin
g
web
s
i
tes,
m
o
b
ile
ap
p
licatio
n
s
,
an
d
co
m
p
u
ter
k
i
o
s
k
s
f
o
r
m
o
n
i
to
r
in
g
b
r
ea
s
tf
ee
d
in
g
ac
tiv
ities
,
ef
f
ec
tiv
ely
ass
is
t
m
o
th
er
s
in
r
ec
o
r
d
in
g
b
r
ea
s
tf
ee
d
in
g
f
r
e
q
u
en
c
y
,
w
h
ich
ty
p
ically
r
an
g
es
f
r
o
m
eig
h
t
to
twelv
e
tim
es
d
aily
[
2
4
]
.
H
ea
lth
p
r
o
f
ess
io
n
als
m
u
s
t
r
ec
o
g
n
ize
an
d
c
o
m
p
r
eh
en
d
a
m
o
t
h
er
'
s
in
ten
tio
n
s
an
d
ef
f
o
r
ts
to
p
r
o
v
id
e
p
er
s
o
n
alize
d
s
u
p
p
o
r
t a
n
d
g
u
id
an
ce
th
r
o
u
g
h
o
u
t th
is
in
d
ep
e
n
d
en
t
b
r
ea
s
tf
ee
d
in
g
jo
u
r
n
ey
.
I
t
is
es
s
en
tial
f
o
r
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
to
d
ev
elo
p
s
elf
-
d
ir
ec
ted
lear
n
in
g
s
k
ills
to
a
ch
iev
e
an
ad
eq
u
ate
s
u
p
p
ly
o
f
b
r
ea
s
t
m
ilk
an
d
en
s
u
r
e
s
u
cc
ess
f
u
l
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
i
n
g
.
I
m
p
lem
e
n
tin
g
well
-
d
esig
n
ed
an
d
ef
f
ec
tiv
e
b
r
ea
s
tf
ee
d
in
g
e
d
u
ca
tio
n
al
g
u
id
elin
es
ca
n
h
elp
i
n
cr
ea
s
e
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
i
ca
cy
.
I
n
I
n
d
o
n
esia,
d
esp
ite
th
e
p
r
o
m
o
tio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
,
th
e
ab
s
en
ce
o
f
s
tan
d
ar
d
ized
b
r
ea
s
t
f
ee
d
in
g
g
u
id
elin
es
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
5
6
-
1
2
6
6
1258
p
r
esen
t
o
b
s
tacle
s
to
em
p
o
wer
in
g
b
r
ea
s
tf
ee
d
i
n
g
m
o
th
er
s
,
le
ad
in
g
to
lo
w
ex
cl
u
s
iv
e
b
r
ea
s
t
f
ee
d
in
g
r
ate
.
T
h
is
r
esear
ch
en
d
ea
v
o
r
s
ee
k
s
to
elicit
in
s
ig
h
ts
f
r
o
m
h
ea
lth
p
r
o
f
ess
io
n
als
o
n
s
tr
ateg
ies
t
o
b
o
ls
ter
m
ater
n
al
co
n
f
id
en
ce
in
b
r
ea
s
tf
ee
d
i
n
g
t
h
r
o
u
g
h
s
elf
-
d
ir
ec
ted
lear
n
in
g
an
d
to
g
a
u
g
e
th
eir
c
u
r
r
e
n
t
co
m
p
r
eh
en
s
io
n
u
s
in
g
th
e
two
-
r
o
u
n
d
Delp
h
i m
eth
o
d
.
2.
M
E
T
H
O
D
T
h
e
r
esear
ch
in
v
o
l
v
ed
two
r
o
u
n
d
s
o
f
th
e
Delp
h
i
m
eth
o
d
to
ad
d
r
ess
is
s
u
es
r
elate
d
to
th
e
s
elf
-
ef
f
icac
y
m
o
d
el
b
ased
o
n
s
elf
-
d
ir
ec
ted
lear
n
in
g
f
o
r
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
th
r
o
u
g
h
th
e
in
v
o
l
v
em
en
t
o
f
h
ea
lth
p
r
o
f
ess
io
n
als.
T
h
e
Delp
h
i
m
eth
o
d
,
a
wid
ely
u
s
ed
f
o
r
ec
asti
n
g
ap
p
r
o
ac
h
,
aim
s
to
ac
h
iev
e
co
n
s
en
s
u
s
am
o
n
g
ex
p
er
ts
o
n
u
n
r
eso
lv
ed
is
s
u
es.
A
s
y
s
tem
atic
p
r
o
ce
s
s
estab
lis
h
ed
a
v
ar
iab
le
p
o
o
l,
in
cl
u
d
in
g
co
n
ce
p
t
a
n
aly
s
is
,
o
p
en
-
e
n
d
ed
q
u
esti
o
n
s
,
an
d
a
th
o
r
o
u
g
h
liter
atu
r
e
r
ev
iew
[
2
5
]
.
T
h
e
co
n
ce
p
tu
al
m
o
d
el
f
o
r
u
n
d
er
s
tan
d
i
n
g
s
el
f
-
d
ir
ec
ted
lear
n
in
g
en
co
m
p
ass
ed
p
r
io
r
k
n
o
wled
g
e,
p
er
s
o
n
al
attr
ib
u
tes,
au
to
n
o
m
o
u
s
p
r
o
ce
s
s
es,
an
d
g
u
id
elin
es
f
o
r
s
tr
u
ctu
r
in
g
a
lear
n
in
g
ex
p
er
ien
ce
.
Ad
d
itio
n
ally
,
a
co
m
p
r
eh
en
s
iv
e
s
ea
r
ch
o
f
elec
tr
o
n
ic
d
atab
ases
was
u
n
d
er
tak
e
n
,
f
o
cu
s
in
g
o
n
r
ele
v
an
t
k
e
y
wo
r
d
s
a
n
d
s
p
ec
if
ic
d
atab
ases
.
T
o
co
m
p
r
e
h
en
s
iv
e
ly
ex
p
lo
r
e
th
e
s
elf
-
ef
f
icac
y
m
o
d
el
with
in
th
e
co
n
tex
t
o
f
s
elf
-
d
i
r
ec
ted
lear
n
i
n
g
f
o
r
b
r
ea
s
tf
ee
d
i
n
g
m
o
th
er
s
,
a
s
y
s
tem
atic
s
ea
r
ch
o
f
elec
tr
o
n
ic
d
ata
b
ases
was
co
n
d
u
cted
f
r
o
m
in
ce
p
tio
n
to
Ma
y
3
,
2
0
2
3
.
T
h
e
d
ata
b
ases
in
clu
d
ed
Pu
b
Me
d
,
W
eb
o
f
Scien
ce
,
an
d
Sco
p
u
s
.
T
h
e
s
ea
r
ch
s
tr
ateg
y
en
c
o
m
p
ass
ed
th
e
t
itle
an
d
ab
s
tr
ac
t
f
ield
s
.
I
t
i
n
v
o
lv
ed
th
e
k
ey
wo
r
d
s
:
(
b
r
ea
s
tf
ee
d
in
g
OR
b
r
ea
s
tf
ee
d
OR
lacta
tio
n
)
a
n
d
(
b
r
ea
s
tf
ee
d
in
g
s
elf
-
e
f
f
icac
y
OR
s
elf
-
ef
f
icac
y
)
an
d
s
elf
-
d
ir
ec
ted
lear
n
in
g
OR
s
elf
-
r
eg
u
latio
n
)
OR
(
attr
ib
u
te
p
e
r
s
o
n
al
OR
au
to
n
o
m
o
u
s
p
r
o
ce
s
s
)
O
R
(
h
ea
lth
p
r
o
f
ess
io
n
als)
OR
(
em
p
o
wer
m
en
t)
.
Sch
war
tz
(
1
9
9
0
)
a
n
d
H
o
f
s
ted
e
(
2
0
0
1
)
wer
e
ea
r
l
y
co
n
tr
ib
u
to
r
s
to
d
ef
in
i
n
g
Asi
an
co
m
m
u
n
ity
c
u
ltu
r
es.
Giv
en
th
e
cu
ltu
r
al
s
im
ilar
ities
b
etwe
en
T
h
ailan
d
an
d
I
n
d
o
n
esia,
th
e
r
esear
ch
er
s
u
tili
ze
d
th
e
s
u
b
-
th
em
es
an
d
g
o
al
s
tr
u
ctu
r
e
with
in
b
r
ea
s
tf
ee
d
in
g
in
s
tr
u
ct
io
n
in
T
h
ailan
d
as
a
r
ef
er
e
n
ce
f
r
am
ewo
r
k
f
o
r
d
ev
elo
p
in
g
b
r
ea
s
tf
ee
d
in
g
g
u
i
d
elin
es
f
o
r
h
ea
lth
p
r
o
f
ess
io
n
a
ls
to
g
u
id
e
m
o
th
er
s
to
war
d
s
e
lf
-
d
ir
ec
ted
lear
n
in
g
[2
6
]
.
Fu
r
th
er
m
o
r
e
,
th
e
p
r
im
ar
y
ter
m
"b
r
ea
s
tf
ee
d
in
g
"
was
s
e
ar
ch
ed
o
n
web
s
ites
s
u
ch
as
W
HO,
T
h
e
New
Yo
r
k
C
ity
Mo
th
er
Gu
id
e
to
B
r
ea
s
tf
ee
d
in
g
Pre
n
atal
C
u
r
r
icu
lu
m
,
I
n
Dis
ch
ar
g
e
Plan
n
in
g
an
d
T
e
ac
h
in
g
in
Ma
ter
n
al
New
b
o
r
n
Nu
r
s
in
g
,
Qu
ee
n
s
lan
d
C
lin
ical
Gu
id
e,
Pro
ject
On
t
ar
io
,
b
r
ea
s
tf
ee
d
in
g
.
id
,
B
r
ea
s
tf
ee
d
in
g
Pro
to
co
l
f
o
r
Hea
lth
C
ar
e
Pro
v
id
er
T
o
r
o
n
to
Pu
b
lic
Hea
lth
,
Der
b
y
s
h
ir
e
Hea
lth
ca
r
e,
an
d
B
C
W
o
m
en
'
s
Ho
s
p
ital
Hea
lth
ca
r
e
[
2
7
]
-
[
3
4
]
.
T
h
e
r
esear
ch
p
r
o
ce
s
s
in
v
o
lv
e
d
d
r
af
tin
g
a
v
ar
iab
le
p
o
o
l
,
wh
er
eb
y
th
e
r
esu
lts
o
f
a
n
o
p
en
-
e
n
d
ed
s
elf
-
ef
f
icac
y
m
o
d
el
b
ased
o
n
s
elf
-
d
ir
ec
ted
lear
n
i
n
g
f
o
r
b
r
ea
s
tf
ee
d
in
g
m
o
t
h
er
s
an
d
a
liter
atu
r
e
r
ev
iew
wer
e
s
y
n
th
esized
.
Prim
ar
y
v
ar
ia
b
les
wer
e
f
o
r
m
u
lated
,
in
cl
u
d
in
g
h
ea
lth
p
r
o
f
ess
io
n
als
g
u
id
in
g
b
r
ea
s
tf
ee
d
in
g
,
p
r
io
r
k
n
o
wled
g
e,
p
er
s
o
n
al
attr
ib
u
t
es,
an
d
au
t
o
n
o
m
o
u
s
p
r
o
ce
s
s
es.
T
er
tiar
y
in
d
icato
r
s
wer
e
th
en
d
er
iv
ed
f
r
o
m
p
r
ev
io
u
s
r
esear
ch
f
in
d
in
g
s
.
T
h
e
in
d
icato
r
p
o
o
l
u
n
d
e
r
wen
t
m
o
d
if
icatio
n
s
th
r
o
u
g
h
r
esear
ch
g
r
o
u
p
m
ee
tin
g
s
u
n
til a
co
n
s
en
s
u
s
was r
ea
ch
ed
.
2
.
1
.
Co
nd
uct
ing
a
pa
nel o
f
Delphi
ex
pert
s
T
h
e
Delp
h
i
m
e
th
o
d
is
wid
ely
ac
k
n
o
wled
g
e
d
f
o
r
its
ab
ilit
y
to
estab
lis
h
co
n
s
en
s
u
s
o
n
u
n
r
eso
lv
e
d
is
s
u
es.
T
h
is
r
esear
ch
u
s
ed
th
e
Delp
h
i
m
eth
o
d
to
d
ev
elo
p
a
s
elf
-
ef
f
icac
y
m
o
d
el
f
o
r
s
elf
-
d
ir
ec
ted
b
r
ea
s
tf
ee
d
in
g
ed
u
ca
tio
n
.
T
h
is
a
p
p
r
o
ac
h
u
n
d
er
s
co
r
es
th
e
ess
en
tial
r
o
le
o
f
h
ea
lth
p
r
o
f
ess
io
n
als
in
p
r
o
v
id
in
g
co
m
p
r
e
h
en
s
iv
e
b
r
ea
s
tf
ee
d
in
g
g
u
id
a
n
ce
a
n
d
p
r
o
m
o
tin
g
s
elf
-
d
ir
ec
ted
lear
n
in
g
to
s
u
p
p
o
r
t
m
o
th
e
r
s
ef
f
ec
tiv
el
y
.
I
t
was
im
p
er
ativ
e
to
en
lis
t
co
m
p
eten
t
e
x
p
er
ts
to
u
p
h
o
ld
th
e
in
teg
r
ity
o
f
th
e
Del
p
h
i
co
n
s
u
ltatio
n
p
r
o
ce
s
s
.
Pan
e
lis
ts
wer
e
r
eq
u
ir
ed
to
f
u
lf
il sp
ec
if
ic
cr
iter
ia:
i
)
p
o
s
s
ess
io
n
o
f
a
s
en
io
r
p
r
o
f
ess
io
n
al
d
eg
r
ee
,
a
m
aster
'
s
d
eg
r
ee
,
o
r
a
h
ig
h
er
ac
ad
em
ic
q
u
alif
icatio
n
;
ii
)
a
m
in
im
u
m
o
f
f
iv
e
y
ea
r
s
o
f
ex
p
er
ien
ce
i
n
p
r
ac
tical
ap
p
licatio
n
,
teac
h
i
n
g
,
o
r
r
esear
ch
;
iii
)
ex
p
er
tis
e
in
b
r
ea
s
tf
ee
d
in
g
;
an
d
iv
)
v
o
lu
n
tar
y
co
m
m
itm
e
n
t
to
p
ar
ticip
atin
g
in
a
m
in
im
u
m
o
f
two
r
o
u
n
d
s
o
f
ex
p
er
t
co
n
s
u
ltatio
n
.
I
n
d
iv
i
d
u
als
m
ee
tin
g
th
e
f
ir
s
t
th
r
ee
c
r
iter
ia
wer
e
ap
p
r
o
ac
h
e
d
a
n
d
p
r
o
v
id
ed
with
an
o
v
er
v
iew
o
f
th
e
s
tu
d
y
'
s
o
b
jectiv
es,
s
ig
n
if
ican
ce
,
an
d
p
r
o
s
p
ec
tiv
e
r
o
l
es.
T
h
o
s
e
in
ag
r
ee
m
en
t
wer
e
s
u
b
s
eq
u
en
tly
in
v
ited
t
o
b
ec
o
m
e
p
ar
t o
f
t
h
e
p
an
el.
I
n
lin
e
with
th
e
p
r
ec
ed
e
n
t
s
et
b
y
p
r
ev
io
u
s
s
tu
d
ies
[
3
5
]
,
[
3
6
]
,
2
0
ex
p
er
ts
wer
e
en
g
a
g
ed
as
p
a
n
elis
ts
in
th
is
s
tu
d
y
.
2
.
2
.
I
m
ple
m
ent
ing
t
he
Delphi ex
pert
co
ns
ulta
t
io
n
T
h
e
ex
p
e
r
t
co
n
s
u
ltatio
n
p
r
o
c
ess
in
v
o
lv
ed
s
en
d
in
g
in
d
i
v
id
u
al
q
u
esti
o
n
n
air
es
v
ia
Go
o
g
l
e
Fo
r
m
s
to
Delp
h
i
p
an
el
m
em
b
er
s
wh
o
wer
e
u
n
ac
q
u
ain
ted
with
ea
ch
o
th
er
.
T
h
e
r
esear
ch
g
r
o
u
p
ca
r
ef
u
lly
an
aly
ze
d
th
e
ex
p
er
ts
'
f
ee
d
b
ac
k
an
d
ad
j
u
s
ted
th
e
in
d
icato
r
s
to
m
ee
t
r
eten
tio
n
cr
iter
ia,
cr
ea
tin
g
a
n
ew
q
u
esti
o
n
n
air
e.
T
h
is
n
ew
q
u
esti
o
n
n
air
e
was
th
en
d
is
tr
ib
u
ted
,
an
d
ea
ch
r
o
u
n
d
o
f
co
n
s
u
ltatio
n
h
ad
a
two
-
wee
k
in
ter
v
al.
T
h
e
s
tu
d
y
co
n
d
u
cte
d
two
r
o
u
n
d
s
o
f
Delp
h
i
ex
p
er
t
co
n
s
u
ltatio
n
s
f
r
o
m
Ma
y
to
No
v
em
b
er
2
0
2
3
,
r
e
p
ea
tin
g
th
e
p
r
o
ce
s
s
u
n
til ex
p
e
r
t
o
p
in
io
n
s
wer
e
alig
n
ed
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
E
mp
o
w
erin
g
b
r
ea
s
tfeed
in
g
mo
th
ers
:
H
ow
s
elf
-
d
ir
ec
ted
lea
r
n
in
g
b
o
o
s
ts
…
(
Dewi A
r
ia
n
i
)
1259
T
h
e
p
r
elim
in
ar
y
co
n
s
u
ltatio
n
q
u
esti
o
n
n
air
e
c
o
n
s
is
ts
o
f
th
r
ee
s
ec
tio
n
s
aim
ed
at
g
ath
er
in
g
co
m
p
r
eh
e
n
s
iv
e
in
f
o
r
m
atio
n
.
I
n
tr
o
d
u
ctio
n
to
th
e
cu
r
r
en
t
s
tu
d
y
:
i
)
T
h
is
s
ec
tio
n
p
r
o
v
i
d
e
s
a
d
etailed
s
tu
d
y
b
ac
k
g
r
o
u
n
d
,
in
clu
d
in
g
its
p
u
r
p
o
s
e,
th
eo
r
etica
l
f
r
am
ewo
r
k
,
an
d
f
u
n
d
a
m
en
tal
co
n
ce
p
t
;
ii
)
E
x
p
e
r
t
au
th
o
r
ity
d
etails:
T
h
is
s
ec
tio
n
co
llects
g
en
er
al
in
f
o
r
m
atio
n
an
d
p
r
o
f
e
s
s
io
n
al
p
ar
ticu
lar
s
ab
o
u
t
th
e
ex
p
er
ts
in
v
o
lv
ed
in
th
e
s
tu
d
y
,
e
n
co
m
p
ass
in
g
th
ei
r
g
en
d
e
r
,
ag
e
,
lev
el
o
f
ed
u
ca
tio
n
,
y
ea
r
s
o
f
ex
p
er
ie
n
ce
,
a
n
d
p
r
im
ar
y
ar
ea
s
o
f
ex
p
er
tis
e
;
iii
)
Op
en
-
en
d
e
d
q
u
esti
o
n
n
air
e
c
o
n
s
u
ltatio
n
:
T
h
is
s
ec
tio
n
o
r
g
a
n
izes
r
esp
o
n
s
es
u
s
in
g
co
m
m
o
n
k
ey
wo
r
d
s
o
r
th
em
es.
B
y
a
n
a
ly
zin
g
th
ese
f
in
d
in
g
s
an
d
co
n
d
u
ctin
g
an
ex
te
n
s
iv
e
liter
atu
r
e
r
ev
iew,
we
ca
n
id
en
tify
to
p
ics th
at
r
e
q
u
ir
e
s
p
e
cif
ic
atten
tio
n
d
u
r
in
g
th
e
r
esear
ch
o
n
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
ic
ac
y
(
B
SE)
.
Du
r
in
g
t
h
e
s
ec
o
n
d
r
o
u
n
d
o
f
Delp
h
i
ex
p
e
r
t
co
n
s
u
ltatio
n
,
t
h
e
q
u
esti
o
n
n
air
e
r
ein
tr
o
d
u
ce
d
th
e
s
tu
d
y
,
en
co
m
p
ass
in
g
its
b
ac
k
g
r
o
u
n
d
,
s
ig
n
if
ican
ce
,
p
u
r
p
o
s
e,
th
eo
r
etica
l
m
o
d
el,
an
d
co
n
ce
p
t.
A
s
em
i
-
o
p
e
n
co
n
s
u
ltatio
n
f
o
r
m
was
em
p
lo
y
ed
to
ev
alu
ate
t
h
e
im
p
o
r
tan
ce
o
f
all
le
v
el
in
d
icato
r
s
,
u
s
i
n
g
a
5
-
p
o
in
t
L
ik
e
r
t
s
ca
le,
r
an
g
in
g
f
r
o
m
'
v
er
y
im
p
o
r
tan
t'
(
5
p
o
in
ts
)
to
'
v
er
y
u
n
im
p
o
r
tan
t'
(
1
p
o
i
n
t)
.
Ad
d
itio
n
ally
,
b
lan
k
s
ec
tio
n
s
wer
e
p
r
o
v
i
d
ed
alo
n
g
s
id
e
e
ac
h
in
d
icato
r
t
o
allo
w
ex
p
er
ts
to
ex
er
cise
th
eir
d
is
cr
etio
n
an
d
o
f
f
e
r
r
ec
o
m
m
en
d
atio
n
s
as d
ee
m
ed
n
ec
ess
ar
y
.
C
o
m
m
u
n
icatio
n
was
f
ac
ilit
ated
th
r
o
u
g
h
a
G
o
o
g
le
f
o
r
m
,
wit
h
r
em
in
d
e
r
s
d
is
s
em
in
ated
v
ia
W
h
atsAp
p
an
d
telep
h
o
n
e
at
ea
ch
r
o
u
n
d
.
T
h
e
r
esear
ch
r
ec
ei
v
e
d
ap
p
r
o
v
al
f
r
o
m
th
e
E
th
ical
C
o
m
m
itte
e
o
f
th
e
Facu
lty
o
f
Me
d
icin
e,
Un
iv
er
s
ity
o
f
B
r
awijay
a,
Ma
lan
g
,
with
r
ef
er
en
ce
letter
6
3
7
/UN
1
0
.
F0
8
.
1
1
.
3
1
/PP
/2
0
2
3
.
2
.
3
.
St
a
t
is
t
ica
l m
et
ho
ds
SP
SS
v
er
s
io
n
2
4
.
0
was
u
s
ed
to
an
aly
ze
d
escr
ip
tiv
e
s
tatis
tics
.
T
h
r
o
u
g
h
o
u
t
th
e
s
tu
d
y
,
i
tem
s
wer
e
ad
d
ed
to
th
e
to
p
ic
lis
t a
u
to
m
at
ically
if
7
0
% o
r
m
o
r
e
p
ar
ticip
an
ts
r
ated
th
em
as
“
im
p
o
r
tan
t.
”
C
o
n
v
er
s
ely
,
item
s
wer
e
ex
clu
d
ed
f
r
o
m
t
h
e
lis
t
au
to
m
atica
lly
if
7
0
%
o
r
m
o
r
e
p
ar
ticip
an
ts
d
ee
m
ed
th
em
“
u
n
im
p
o
r
tan
t.
”
I
tem
s
with
o
u
t
a
co
n
s
en
s
u
s
am
o
n
g
p
ar
ticip
an
ts
wer
e
r
ev
is
ed
b
ased
o
n
th
eir
f
ee
d
b
ac
k
an
d
p
u
t
to
an
o
th
er
v
o
te
d
u
r
i
n
g
th
e
th
ir
d
r
o
u
n
d
o
f
th
e
s
tu
d
y
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
s
tu
d
y
f
in
d
i
n
g
s
p
r
esen
t
T
a
b
le
1
,
wh
ich
p
r
o
v
id
es
an
o
v
er
v
iew
o
f
th
e
d
em
o
g
r
ap
h
ics
an
d
ex
p
er
tis
e
o
f
th
e
e
x
p
er
ts
wh
o
p
ar
ticip
ate
d
in
th
e
Delp
h
i
r
o
u
n
d
s
.
Fu
r
t
h
er
m
o
r
e,
T
a
b
le
2
(
s
ee
in
A
p
p
e
n
d
ix
)
d
elin
ea
tes
th
e
f
o
u
r
d
im
e
n
s
io
n
s
o
f
th
e
s
elf
-
ef
f
icac
y
m
o
d
el
g
r
o
u
n
d
e
d
in
s
elf
-
d
ir
ec
ted
lear
n
in
g
.
Fig
u
r
e
1
v
is
u
ally
d
ep
icts
th
e
s
elf
-
ef
f
icac
y
m
o
d
el
b
ased
o
n
s
elf
-
d
ir
ec
ted
lear
n
in
g
s
p
ec
if
ical
ly
tailo
r
ed
f
o
r
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
.
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
th
e
ex
p
er
ts
p
ar
ticip
atin
g
i
n
th
e
De
lp
h
i r
o
u
n
d
s
V
a
r
i
a
b
l
e
s
R
o
u
n
d
1
N
=
2
1
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o
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n
d
2
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=
2
0
M
i
d
w
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f
e
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u
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se
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s
i
c
i
a
n
P
e
d
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a
t
r
i
c
M
i
d
w
i
f
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e
c
t
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r
e
r
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C
LC
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i
d
w
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e
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se
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h
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d
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t
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r
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B
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A
g
e
(
y
r
s)
25
-
35
6
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2
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3
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1
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T
wen
ty
-
f
o
u
r
e
x
p
er
ts
wer
e
in
v
ited
to
t
h
e
Delp
h
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s
tu
d
y
,
b
u
t
o
n
ly
2
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r
o
lled
(
8
3
.
3
%).
I
n
th
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s
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n
d
r
o
u
n
d
,
9
5
%
(
2
0
/2
1
)
p
ar
ticip
at
ed
.
T
h
e
ex
p
er
ts
wer
e
v
ar
io
u
s
s
tak
eh
o
ld
er
s
in
in
cr
ea
s
in
g
s
elf
-
ef
f
icac
y
b
ased
o
n
s
elf
-
d
ir
ec
ted
lear
n
in
g
f
o
r
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
.
T
h
e
f
in
al
r
esu
lt
f
r
o
m
two
r
o
u
n
d
s
was
f
o
r
m
alize
d
in
to
a
s
elf
-
ef
f
icac
y
m
o
d
el
b
ased
o
n
s
elf
-
d
ir
ec
ted
lear
n
in
g
f
o
r
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
,
i.e
.
,
h
ea
lth
p
r
o
f
ess
io
n
als
g
u
id
e
b
r
ea
s
tf
ee
d
in
g
,
p
r
io
r
k
n
o
wled
g
e,
p
er
s
o
n
al
attr
ib
u
tes,
an
d
a
u
to
n
o
m
o
u
s
p
r
o
ce
s
s
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g
th
eo
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y
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im
p
ac
tin
g
lear
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er
s
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m
o
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,
ac
co
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n
t
ab
ilit
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u
tili
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tio
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f
r
eso
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ce
s
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d
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g
n
itiv
e
s
tr
ateg
ies
.
R
ec
o
g
n
izin
g
th
e
d
iv
er
s
ity
in
lear
n
er
s
'
s
elf
-
d
ir
ec
tio
n
an
d
ef
f
ec
tiv
el
y
n
av
ig
ati
n
g
o
n
lin
e
lear
n
in
g
en
v
ir
o
n
m
en
ts
is
p
ar
am
o
u
n
t.
E
m
p
lo
y
in
g
ef
f
ec
tiv
e
s
tr
ateg
i
es
to
s
u
r
m
o
u
n
t
o
b
s
tacle
s
an
d
ac
q
u
ir
e
c
r
ed
ib
le
in
f
o
r
m
a
tio
n
is
im
p
er
ativ
e.
L
ea
r
n
in
g
s
tr
ateg
ies,
r
ef
lectiv
e
wr
itin
g
,
c
o
m
m
u
n
icatio
n
tech
n
iq
u
es,
tim
e
m
a
n
ag
em
e
n
t,
an
d
m
o
tiv
atio
n
ar
e
all
in
d
is
p
en
s
ab
le
in
o
n
lin
e
ed
u
ca
t
i
o
n
.
Su
cc
ee
d
in
g
in
o
n
lin
e
lear
n
in
g
n
ec
ess
itates
lear
n
er
s
to
t
ak
e
ch
a
r
g
e
o
f
th
eir
p
ac
e,
m
o
n
ito
r
c
o
m
p
r
e
h
en
s
io
n
,
an
d
ef
f
icien
tly
lev
er
a
g
e
r
eso
u
r
ce
s
.
Dev
elo
p
in
g
s
tr
ateg
ies
to
ad
d
r
ess
o
n
lin
e
ed
u
ca
tio
n
'
s
d
is
tin
ctiv
e
ch
allen
g
es is
im
p
er
ativ
e
f
o
r
s
u
cc
ess
[
1
8
]
,
[
2
5
]
.
I
n
I
n
d
o
n
esia,
th
e
in
ter
n
et
u
s
ag
e
r
ate
am
o
n
g
wo
m
e
n
h
as
r
ea
c
h
ed
4
9
.
1
%
[
4
0
]
,
p
r
esen
tin
g
a
s
ig
n
if
ican
t
o
p
p
o
r
tu
n
ity
to
e
n
h
an
ce
s
elf
-
d
ir
ec
ted
lea
r
n
in
g
(
SDL)
c
o
n
ce
r
n
in
g
t
h
e
p
e
r
s
o
n
al
attr
i
b
u
tes
o
f
m
o
t
h
er
s
.
B
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
ca
n
i
m
p
r
o
v
e
th
eir
SDL
b
y
c
r
itical
ly
co
m
p
ar
in
g
in
f
o
r
m
atio
n
a
cq
u
ir
ed
f
r
o
m
s
o
cial
m
ed
ia
p
latf
o
r
m
s
,
s
u
c
h
as
Face
b
o
o
k
,
o
n
lin
e
v
id
eo
s
,
p
o
d
ca
s
ts
,
an
d
em
ails
,
with
g
u
i
d
an
ce
r
e
ce
iv
ed
f
r
o
m
h
ea
lth
p
r
o
f
ess
io
n
als
[4
1
]
.
Fu
r
th
er
m
o
r
e,
it
is
ess
en
tial
to
u
tili
ze
ef
f
ec
tiv
e
co
m
m
u
n
icatio
n
ch
an
n
els
to
d
is
s
em
i
n
ate
b
r
ea
s
tf
ee
d
in
g
-
r
elate
d
in
f
o
r
m
a
tio
n
,
in
clu
d
in
g
v
ar
io
u
s
m
u
ltime
d
ia
p
latf
o
r
m
s
.
T
h
is
SDL
ap
p
r
o
ac
h
aim
s
to
clar
if
y
th
e
d
iv
er
s
e
s
o
u
r
ce
s
o
f
b
r
ea
s
tf
ee
d
i
n
g
in
f
o
r
m
atio
n
[4
2
]
.
Hea
lth
p
r
o
f
ess
io
n
als
s
h
o
u
ld
f
o
cu
s
o
n
d
ev
elo
p
in
g
ac
c
u
r
ate
a
n
d
r
el
iab
le
in
f
o
r
m
atio
n
al
r
es
o
u
r
ce
s
th
r
o
u
g
h
telelac
tatio
n
s
er
v
i
ce
s
,
b
r
ea
s
tf
ee
d
in
g
b
o
o
k
lets
,
an
d
s
o
cial
m
ed
ia
p
latf
o
r
m
s
,
all
ac
ce
s
s
ib
le
to
b
r
ea
s
tf
ee
d
in
g
m
o
t
h
er
s
,
en
ab
li
n
g
th
em
to
ed
u
ca
te
th
em
s
elv
es o
n
o
p
tim
al
b
r
ea
s
tf
ee
d
in
g
p
r
ac
tices
[
2
1
]
,
[
2
2
]
.
Hea
lth
p
r
o
f
ess
io
n
als
f
ac
ilit
ate
ef
f
ec
tiv
e
b
r
ea
s
tf
ee
d
in
g
ed
u
ca
t
io
n
s
tr
ateg
ies
f
o
r
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
,
u
tili
zin
g
in
d
iv
id
u
alize
d
in
s
tr
u
ctio
n
,
g
r
o
u
p
s
ess
io
n
s
,
an
d
a
h
y
b
r
id
ap
p
r
o
ac
h
th
at
co
m
b
i
n
es
in
d
iv
id
u
al
an
d
g
r
o
u
p
lear
n
in
g
e
x
p
er
ien
ce
s
.
T
h
e
p
r
im
ar
y
o
b
jectiv
e
o
f
s
el
f
-
d
ir
ec
ted
lear
n
i
n
g
is
to
em
p
o
w
er
in
d
iv
id
u
als
to
cu
ltiv
ate
in
tr
in
s
ic
m
o
tiv
atio
n
,
estab
lis
h
p
er
s
o
n
al
g
o
als,
ass
ess
th
eir
p
r
o
g
r
ess
,
an
d
id
e
n
tif
y
v
alid
a
n
d
r
elia
b
le
ed
u
ca
tio
n
al
s
tr
ateg
ies an
d
r
eso
u
r
ce
s
[
2
3
]
,
[
1
8
]
.
3
.
4
.
Aut
o
no
m
o
us
pro
ce
s
s
es i
n self
-
direct
ed
lea
rning
Au
to
n
o
m
o
u
s
p
r
o
ce
s
s
es
in
s
el
f
-
d
ir
ec
ted
lear
n
i
n
g
ar
e
s
tag
es
wh
er
e
in
d
iv
id
u
als
ca
n
id
en
ti
f
y
an
d
s
et
lear
n
in
g
g
o
als,
p
lan
ac
tiv
ities
to
ac
h
iev
e
g
o
als
,
a
n
d
lea
r
n
i
n
d
ep
en
d
en
tly
ac
c
o
r
d
i
n
g
to
le
ar
n
in
g
n
ee
d
s
[
1
8
]
.
B
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
to
b
e
ab
le
to
s
elf
-
d
ir
ec
ted
lear
n
in
g
b
r
ea
s
tf
ee
d
in
g
n
ee
d
to
b
e
ta
u
g
h
t
h
o
w
to
ass
ess
ef
f
ec
tiv
e
L
AT
C
H
[
4
3
]
,
ev
alu
ate
th
e
f
r
eq
u
e
n
cy
o
f
b
r
e
astfe
ed
in
g
8
-
1
0
tim
es
p
er
d
ay
[
2
4
]
,
em
p
ty
th
e
b
r
ea
s
ts
r
eq
u
ir
es
r
o
u
tin
e
f
r
eq
u
en
cy
a
n
d
d
u
r
atio
n
o
f
b
r
ea
s
tf
ee
d
i
n
g
,
wh
ich
will
in
c
r
ea
s
e
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
,
esp
ec
ially
in
th
e
f
ir
s
t
m
o
n
th
t
o
g
et
en
o
u
g
h
b
r
ea
s
t
m
ilk
[
1
2
]
,
[
4
4
]
,
if
th
e
m
o
th
er
is
wo
r
r
ied
th
at
h
er
b
ab
y
is
n
o
t
g
ettin
g
en
o
u
g
h
b
r
ea
s
t
m
ilk
.
Hea
lth
p
r
o
f
ess
io
n
als
n
ee
d
to
teac
h
th
e
m
o
th
e
r
to
ev
alu
ate
th
e
n
u
m
b
e
r
o
f
wet
d
iap
er
s
an
d
s
to
o
ls
p
er
d
ay
a
s
v
alid
p
ar
am
ete
r
s
in
m
ea
s
u
r
in
g
th
e
a
d
eq
u
ac
y
o
f
b
r
ea
s
t
m
ilk
[
1
2
]
,
[
4
5
]
.
I
n
ad
d
itio
n
to
th
is
,
h
ea
lth
p
r
o
f
ess
io
n
als
m
ay
u
tili
ze
an
ad
d
itio
n
al
d
iar
y
d
esig
n
f
o
r
d
o
cu
m
en
tin
g
b
r
ea
s
tf
ee
d
in
g
d
ata,
as
it
h
as
d
em
o
n
s
t
r
ated
ef
f
ec
tiv
en
ess
in
e
n
h
an
cin
g
th
e
in
ten
s
ity
o
f
b
r
ea
s
tf
ee
d
in
g
p
r
ac
tices
[
2
4
]
.
I
n
s
u
f
f
icien
t
b
r
ea
s
t
m
ilk
is
a
s
o
u
r
ce
o
f
co
n
ce
r
n
f
o
r
m
o
t
h
er
s
wh
en
b
r
ea
s
tf
ee
d
in
g
an
d
r
eq
u
ir
es
p
r
o
p
er
ass
es
s
m
en
t
as
th
e
k
ey
t
o
s
u
cc
ess
f
u
l
b
r
ea
s
tf
ee
d
in
g
.
B
r
ea
s
tf
ee
d
in
g
s
u
p
p
o
r
t
in
t
h
e
f
ir
s
t
wee
k
o
f
b
r
ea
s
tf
ee
d
in
g
n
ee
d
s
to
b
e
a
c
o
n
ce
r
n
f
o
r
p
r
o
f
ess
io
n
al
s
taf
f
in
m
ain
tain
in
g
s
tim
u
latio
n
o
f
t
h
e
b
r
ea
s
t m
ilk
s
u
p
p
ly
to
p
r
ev
e
n
t th
e
p
r
o
v
is
io
n
o
f
f
o
r
m
u
la
m
ilk
an
d
th
e
p
er
ce
p
tio
n
o
f
in
s
u
f
f
icien
t
b
r
ea
s
t m
ilk
[
1
2
]
.
On
ly
5
%
o
f
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
ex
p
e
r
ien
ce
i
n
s
u
f
f
icien
t
b
r
ea
s
t
m
ilk
s
u
p
p
ly
d
u
e
to
p
ath
o
lo
g
ical
d
is
o
r
d
er
s
[
1
2
]
,
[
4
6
]
.
Gen
er
all
y
,
f
o
r
m
u
la
f
ee
d
in
g
is
m
o
r
e
p
r
ev
alen
t
am
o
n
g
f
am
ilies
with
h
ig
h
er
ec
o
n
o
m
ic
s
tatu
s
,
in
f
an
ts
wh
o
s
e
m
o
th
er
s
ar
e
n
o
t
in
th
e
h
o
m
e,
an
d
th
o
s
e
with
o
u
t
s
ib
lin
g
s
.
I
t
is
ess
e
n
tial
to
en
h
a
n
ce
th
e
k
n
o
wled
g
e
o
f
m
o
th
e
r
s
an
d
f
a
m
ilies
r
eg
ar
d
in
g
th
e
s
ig
n
i
f
ican
ce
o
f
b
r
ea
s
t
m
ilk
f
o
r
th
e
d
ev
el
o
p
m
en
t
a
n
d
g
r
o
wth
o
f
in
f
an
ts
,
as
well
a
s
to
m
iti
g
ate
h
ea
lth
ca
r
e
co
s
ts
[
4
7
]
.
Dir
ec
t
b
r
ea
s
tf
ee
d
in
g
at
th
e
b
r
e
ast
f
o
s
ter
s
a
h
ig
h
er
s
en
s
itiv
ity
b
etwe
e
n
m
o
th
er
an
d
in
f
an
t,
at
least
in
th
e
s
h
o
r
t
ter
m
,
co
m
p
ar
e
d
to
b
o
ttle
f
ee
d
in
g
[
4
8
]
.
R
esear
ch
in
d
icate
s
th
at
tr
an
s
itio
n
in
g
to
th
e
s
y
r
in
g
e
f
ee
d
in
g
m
eth
o
d
s
ig
n
if
ican
tly
im
p
r
o
v
es
b
r
ea
s
tf
ee
d
in
g
s
u
cc
ess
r
ates,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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I
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t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
5
6
-
1
2
6
6
1262
r
ed
u
ce
s
h
ea
r
t
r
ates,
p
r
ev
en
ts
n
ip
p
le
co
n
f
u
s
io
n
,
an
d
f
a
cilitates
a
f
aster
ad
ap
tatio
n
to
b
r
ea
s
tf
ee
d
in
g
at
th
e
b
r
ea
s
t
in
p
r
eter
m
i
n
f
an
ts
[
4
9
]
.
T
h
e
e
m
p
lo
y
m
e
n
t
o
f
n
ip
p
le
s
h
ield
s
i
m
m
ed
iately
f
o
llo
win
g
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ir
th
,
t
h
e
u
s
e
o
f
p
ac
if
ier
s
,
an
d
th
e
p
e
r
ce
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tio
n
o
f
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ad
eq
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ate
b
r
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t
m
ilk
s
u
p
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ly
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n
tr
ib
u
te
to
th
e
lo
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r
ates
o
f
e
x
c
lu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
in
th
e
Un
ited
States
[
50
]
.
Fo
r
m
o
th
er
s
u
n
ab
le
t
o
b
r
ea
s
tf
ee
d
d
ir
ec
tly
,
u
s
in
g
b
r
ea
s
t
p
u
m
p
s
ca
n
b
e
a
n
ef
f
ec
tiv
e
alter
n
ativ
e
f
o
r
m
ain
tai
n
in
g
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
d
u
r
atio
n
;
h
o
wev
er
,
f
u
r
th
e
r
in
v
esti
g
at
io
n
is
n
ec
ess
ar
y
to
u
n
d
er
s
tan
d
th
e
c
o
n
tex
t
a
n
d
i
m
p
licatio
n
s
o
f
p
u
m
p
in
g
o
n
s
u
b
s
eq
u
en
t
b
r
ea
s
tf
ee
d
in
g
o
u
tco
m
es
[
5
1
]
.
Mo
t
h
er
s
wh
o
estab
lis
h
a
s
tr
o
n
g
b
r
ea
s
tf
ee
d
in
g
attac
h
m
e
n
t
ar
e
ass
o
ciate
d
with
en
h
an
ce
d
g
r
o
wth
i
n
lo
w
b
ir
th
weig
h
t
(
L
B
W
)
in
f
an
ts
an
d
in
cr
ea
s
ed
e
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
r
ates [
5
2
]
T
h
e
s
y
s
tem
atic
r
e
v
iew
f
in
d
in
g
s
in
d
icate
t
h
at
v
a
r
io
u
s
b
r
ea
s
tf
ee
d
in
g
ch
allen
g
es
ar
e
p
r
ev
alen
t
am
o
n
g
in
d
iv
id
u
als
s
ee
k
in
g
s
u
p
p
o
r
t.
No
tab
le
is
s
u
es
in
clu
d
e:
i)
E
x
p
er
ien
ce
s
o
f
b
r
ea
s
tf
ee
d
in
g
d
i
f
f
icu
lties
at
a
r
ate
o
f
2
4
.
5
%;
ii)
Per
ce
p
tio
n
s
o
f
in
s
u
f
f
icien
t
b
r
ea
s
t
m
ilk
an
d
in
a
d
e
q
u
ate
weig
h
t
g
ai
n
in
in
f
an
ts
at
1
5
.
7
%;
iii)
A
lack
o
f
k
n
o
wled
g
e
an
d
ex
p
er
ien
ce
r
elate
d
to
b
r
ea
s
tf
ee
d
in
g
at
1
7
.
8
%;
iv
)
An
ato
m
ical
co
n
ce
r
n
s
s
u
ch
as
f
lat,
h
o
llo
w,
o
r
s
m
all
n
ip
p
les
at
7
.
7
%;
v
)
A
d
d
itio
n
al
co
m
p
licatio
n
s
r
ep
o
r
t
ed
in
clu
d
e
b
r
ea
s
t
p
ain
at
3
.
9
%
,
en
g
o
r
g
em
en
t
an
d
f
u
lln
ess
o
f
th
e
b
r
ea
s
ts
at
1
0
.
8
%,
er
y
th
em
a
o
f
th
e
b
r
ea
s
ts
at
2
6
.
1
%,
an
d
m
asti
tis
at
5
.
6
% [
5
3
].
Hea
lth
p
r
o
f
ess
io
n
als
n
ee
d
to
p
o
s
s
ess
th
e
n
ec
ess
ar
y
b
r
ea
s
tf
ee
d
in
g
co
m
p
eten
cies
to
d
e
v
elo
p
ed
u
ca
tio
n
p
r
o
g
r
a
m
s
tailo
r
ed
to
th
ese
id
en
tifie
d
n
ee
d
s
.
Su
c
h
p
r
o
g
r
a
m
s
s
h
o
u
ld
p
r
o
v
id
e
a
d
eq
u
ate
s
u
p
p
o
r
t
th
at
p
r
o
m
o
tes
s
elf
-
d
ir
ec
ted
lear
n
in
g
in
b
r
ea
s
tf
ee
d
in
g
p
r
ac
tices.
S
u
f
f
icien
t
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
p
o
s
itiv
ely
co
r
r
elate
s
with
en
h
an
ce
d
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
an
d
a
n
ex
ten
d
ed
d
u
r
atio
n
o
f
e
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
[
1
2
]
.
4.
CO
NCLU
SI
O
N
I
n
co
n
clu
s
io
n
,
p
r
o
v
id
in
g
h
ea
lth
p
r
o
f
ess
io
n
als
with
co
m
p
r
eh
en
s
iv
e
g
u
i
d
an
ce
o
n
b
r
ea
s
tf
ee
d
in
g
is
im
p
er
ativ
e
to
b
o
ls
ter
th
eir
s
elf
-
ef
f
icac
y
in
th
is
d
o
m
ain
.
T
h
i
s
p
r
o
ce
s
s
s
h
o
u
ld
b
e
u
n
d
er
p
in
n
ed
b
y
s
elf
-
d
ir
ec
te
d
lear
n
in
g
.
C
u
ltiv
atin
g
s
elf
-
d
ir
e
cted
lear
n
in
g
am
o
n
g
h
ea
lth
p
r
o
f
ess
io
n
als
h
as
th
e
p
o
te
n
tial
to
en
h
an
ce
t
h
eir
p
er
s
o
n
al
attr
ib
u
tes
an
d
in
d
e
p
e
n
d
en
t
p
r
o
ce
s
s
es,
th
er
eb
y
p
o
s
itiv
ely
im
p
ac
tin
g
th
e
ex
p
er
ien
c
es
o
f
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
.
T
h
r
o
u
g
h
s
elf
-
em
p
o
wer
m
en
t,
b
r
ea
s
tf
ee
d
in
g
m
o
t
h
er
s
ca
n
attain
th
e
s
k
ills
an
d
k
n
o
wled
g
e
to
ef
f
ec
tiv
ely
n
u
r
tu
r
e
th
eir
in
f
an
ts
,
ad
d
r
ess
ch
allen
g
es,
a
n
d
ac
ce
s
s
ap
p
r
o
p
r
iate
s
u
p
p
o
r
t
an
d
ass
is
tan
ce
.
Sev
er
al
p
r
ep
ar
ato
r
y
m
ea
s
u
r
es
m
u
s
t
b
e
u
n
d
er
ta
k
en
to
en
g
a
g
e
in
S
DL
r
eg
ar
d
in
g
b
r
ea
s
tf
ee
d
in
g
ef
f
ec
tiv
ely
.
T
h
ese
m
ea
s
u
r
es
in
clu
d
e
tr
ain
in
g
b
r
e
astfe
ed
in
g
f
ac
ilit
ato
r
s
,
ev
alu
a
tin
g
th
e
r
ea
d
i
n
ess
o
f
in
d
iv
i
d
u
als
to
lear
n
ab
o
u
t
b
r
ea
s
tf
ee
d
in
g
,
an
d
d
ev
elo
p
in
g
ed
u
ca
tio
n
al
m
ater
ials
tailo
r
ed
ex
p
licitly
to
SDL.
I
t
is
ess
en
tial
to
cr
ea
te
v
alid
ated
SDL
b
r
ea
s
tf
ee
d
in
g
m
o
d
u
les
an
d
to
im
p
lem
e
n
t
ef
f
ec
tiv
e
lear
n
in
g
s
tr
ateg
ies
th
at
ca
ter
to
th
e
u
n
iq
u
e
n
ee
d
s
o
f
b
r
ea
s
tf
ee
d
in
g
m
o
th
e
r
s
.
Ad
d
itio
n
ally
,
it
is
n
ec
ess
ar
y
to
p
r
ep
ar
e
th
e
r
elev
a
n
t
lea
r
n
in
g
r
eso
u
r
ce
s
to
s
u
p
p
o
r
t
th
e
im
p
lem
en
tatio
n
o
f
SDL
an
d
estab
li
s
h
b
r
ea
s
tf
ee
d
in
g
s
u
p
p
o
r
t
g
r
o
u
p
s
.
Fu
r
th
er
m
o
r
e,
t
h
e
ass
ess
m
en
t
o
f
k
n
o
wled
g
e,
s
k
ills
,
an
d
t
h
e
ac
h
iev
em
en
t
o
f
SDL
co
m
p
ete
n
cies
r
elate
d
t
o
b
r
ea
s
tf
ee
d
in
g
m
u
s
t
b
e
co
n
d
u
cte
d
.
T
h
e
ev
alu
atio
n
o
f
SDL
-
ce
n
tr
ic
b
r
ea
s
tf
ee
d
in
g
ed
u
ca
tio
n
s
h
o
u
l
d
in
v
o
lv
e
o
b
tain
in
g
f
ee
d
b
ac
k
f
r
o
m
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
,
p
r
o
f
ess
io
n
als,
an
d
s
tak
eh
o
ld
er
s
th
r
o
u
g
h
o
u
t
th
e
p
r
o
ce
s
s
.
T
h
is
s
h
o
u
ld
en
co
m
p
ass
b
o
th
th
e
r
esu
lts
an
d
th
e
o
v
er
all
ass
ess
m
en
t
o
f
t
h
e
SDL
b
r
ea
s
tf
ee
d
in
g
i
n
itiativ
e,
alo
n
g
s
id
e
th
e
im
p
lem
en
tatio
n
o
f
q
u
ality
ass
u
r
an
ce
m
ea
s
u
r
es to
en
s
u
r
e
ed
u
ca
tio
n
a
l e
f
f
ec
tiv
en
ess
.
T
o
p
r
ac
tice
s
elf
-
d
ir
ec
ted
lear
n
i
n
g
o
f
b
r
ea
s
tf
ee
d
in
g
,
p
r
e
p
ar
atio
n
s
ar
e
n
ee
d
ed
,
s
u
ch
as
tr
ain
in
g
o
f
b
r
ea
s
tf
ee
d
in
g
f
ac
ilit
ato
r
s
,
ass
es
s
m
en
t
o
f
r
ea
d
in
ess
to
lear
n
to
b
r
ea
s
tf
ee
d
,
b
r
ea
s
tf
ee
d
in
g
m
ater
ials
f
o
cu
s
ed
o
n
SDL,
d
e
v
elo
p
m
e
n
t
o
f
v
alid
ated
SDL
b
r
ea
s
tf
ee
d
in
g
m
o
d
u
les,
ef
f
ec
tiv
e
lear
n
in
g
s
tr
ateg
ies
th
at
a
r
e
ap
p
r
o
p
r
iate
to
t
h
e
n
ee
d
s
o
f
b
r
ea
s
tf
ee
d
in
g
m
o
t
h
er
s
,
p
r
e
p
ar
in
g
b
r
ea
s
tf
ee
d
in
g
lear
n
in
g
r
eso
u
r
ce
s
n
ee
d
ed
f
o
r
th
e
im
p
lem
en
tatio
n
o
f
SDL,
f
o
r
m
atio
n
o
f
b
r
ea
s
tf
ee
d
in
g
s
u
p
p
o
r
t
g
r
o
u
p
s
,
ass
es
s
m
en
t
o
f
k
n
o
wled
g
e,
s
k
ills
an
d
ac
q
u
is
itio
n
o
f
SDL
b
r
ea
s
tf
ee
d
in
g
ab
ilit
ies,
ev
alu
a
tio
n
o
f
SDL
-
b
ased
b
r
ea
s
tf
ee
d
in
g
e
d
u
ca
tio
n
b
y
p
r
o
v
id
in
g
f
ee
d
b
ac
k
f
r
o
m
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
s
,
p
r
o
f
ess
io
n
als an
d
s
tak
eh
o
l
d
er
s
in
th
e
p
r
o
ce
s
s
,
r
esu
lts
an
d
ass
ess
m
en
t o
f
SDL
b
r
ea
s
tf
ee
d
in
g
,
a
n
d
co
n
d
u
ctin
g
q
u
ality
ass
u
r
an
ce
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
ex
p
r
ess
th
eir
s
in
ce
r
e
g
r
atitu
d
e
to
all
th
o
s
e
wh
o
s
u
p
p
o
r
ted
th
is
s
tu
d
y
,
in
cl
u
d
in
g
th
e
p
ar
ticip
an
ts
an
d
th
e
en
tire
ac
a
d
em
ic
co
m
m
u
n
ity
o
f
Un
iv
er
s
i
tas B
r
awijay
a.
RE
F
E
R
E
NC
E
S
[
1
]
L.
R
.
W
a
t
i
,
D
.
S
a
r
g
o
w
o
,
T.
N
u
r
se
t
a
,
L.
Zu
h
r
i
y
a
h
,
a
n
d
B
.
R
a
h
a
r
d
j
o
,
“
C
o
r
r
e
l
a
t
i
o
n
s
a
mo
n
g
m
a
t
e
r
n
a
l
a
n
d
i
n
f
a
n
t
f
a
c
t
o
r
s,
l
e
a
d
e
x
p
o
s
u
r
e
,
a
n
d
s
e
r
u
m
p
r
o
l
a
c
t
i
n
l
e
v
e
l
s
d
u
r
i
n
g
l
a
c
t
a
t
i
o
n
:
A
c
r
o
ss
-
sec
t
i
o
n
a
l
st
u
d
y
i
n
I
n
d
o
n
e
s
i
a
,
”
J
o
u
rn
a
l
o
f
Pre
v
e
n
t
i
v
e
Me
d
i
c
i
n
e
a
n
d
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
5
6
,
n
o
.
5
,
p
p
.
4
2
2
–
4
3
0
,
S
e
p
.
2
0
2
3
,
d
o
i
:
1
0
.
3
9
6
1
/
j
p
m
p
h
.
2
3
.
2
3
8
.
[
2
]
R
.
G
a
l
i
p
e
a
u
,
A
.
B
a
i
l
l
o
t
,
A
.
Tr
o
t
t
i
e
r
,
a
n
d
L
.
Le
mi
r
e
,
“
Ef
f
e
c
t
i
v
e
n
e
ss
o
f
i
n
t
e
r
v
e
n
t
i
o
n
s
o
n
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