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Indah Sari Bancin; Ambia Nurdin; Dian Rahayu; Khairuman Khairuman

Jurnal Riset Rumpun Ilmu Kesehatan 2026 Pusat riset dan Inovasi Nasional

Stunting remains a major chronic nutritional problem in Indonesia, including Aceh, and has serious impacts on children’s physical growth and cognitive development. Prevention efforts require appropriate, practical, and sustainable nutritional interventions, including the use of local foods such as pumpkin, which is rich in beta-carotene, vitamin A, carbohydrates, and fiber, and can be combined with animal and plant protein sources. This study aimed to evaluate the effectiveness of an instant pumpkin-based porridge in improving the weight and height of children aged 6–24 months who are at risk of stunting in the Gunung Meriah Health Center area. The study used a quasi-experimental design with a nonequivalent control group involving 41 children divided into intervention and control groups. The intervention group received the instant porridge for 21 days. Data analyzed using paired t-tests and independent t-tests showed significant improvements in the intervention group’s weight and height (p<0.05). The pumpkin-based instant porridge proved effective as a local food–based nutritional intervention and has the potential to be integrated into supplementary feeding programs and regional nutrition policies with broader coverage and longer duration..

Az-zuhra Irmi Putri; Yenni Yenni; Sofa Inayatullah

Jurnal Riset Rumpun Ilmu Kesehatan 2026 Pusat riset dan Inovasi Nasional

Psoriasis is a chronic inflammatory skin disease characterized by keratinocyte hyperproliferation, inflammation, and neoangiogenesis, largely driven by dominant T helper 1 (Th1) and T helper 17 (Th17) immune responses. Psoriasis is associated with metabolic, psychological, cardiovascular, and arthritic comorbidities. Vitamin D plays an important role in the management of psoriasis. Calcitriol (1,25(OH)₂D₃), regulates keratinocyte proliferation, differentiation, and apoptosis. Vitamin D supports the formation of the cornified envelope as well as epidermal lipid and ceramide production, also acts synergistically with the epidermal calcium gradient to maintain barrier function. In addition to its epidermal effects, vitamin D exerts immunomodulatory actions by enhancing regulatory T cells and anti-inflammatory cytokines (interleukin (IL)-10, IL-4, transforming growth factor-beta (TGF-β)), while suppressing Th1/Th17 activity and production of pro-inflammatory cytokines (IL-2, IL-17, tumor necrosis factor-alpha (TNF-α)). These mechanisms highlight its potential role in psoriasis therapy. Topical vitamin D₃ analogues are effective for mild to moderate disease due to the high expression of vitamin D receptors in psoriatic keratinocytes. Oral supplementation has also been explored for its systemic immunomodulatory effects, although findings remain inconsistent.  

Fitri Handayani; Fithri Handayani Lubis

VitaMedica : Jurnal Rumpun Kesehatan Umum 2026 STIKES Columbia Asia Medan

This study aims to examine the relationship between occupational nutrition and employee productivity through a systematic literature review. The background of this research lies in the increasing attention to workplace health and the growing evidence that nutritional status can influence physical performance, cognitive function, and work outcomes. A total of 74 articles were initially identified from databases such as PubMed, ScienceDirect, Google Scholar, and Garuda, of which 12 met the inclusion criteria and were analyzed further. The findings indicate that adequate intake of macronutrients and micronutrients—particularly iron, protein, and B vitamins—correlates positively with productivity levels. Interventions such as nutritional education, iron supplementation, and structured meal programs at the workplace showed measurable effects in reducing absenteeism and fatigue while improving concentration and efficiency. The study concludes that occupational nutrition plays a vital role in supporting workforce performance and suggests its integration into workplace health policies. Theoretical and practical implications are discussed, along with recommendations for future research

Rizkiya Pratiwi Musa; Sulistiyah Sulistiyah

The Journal General Health and Pharmaceutical Sciences Research 2025 LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Background: Sectio Caesarea (SC) surgery causes an incision wound in the abdomen, requiring a complex tissue healing process. Nutrition is a primary systemic factor supporting cell regeneration and new tissue formation through the intake of protein, vitamins, and minerals. However, many postpartum mothers still practice dietary restrictions due to misconceptions about the wound healing process. Objective: To determine the relationship between nutritional fulfillment and wound healing duration in post-SC patients at Prof. Dr. R.D. Kandou General Hospital, Manado. Methods:This quantitative research used an observational analytic design with a cross-sectional approach. The sample consisted of 20 postpartum mothers after SC, selected using purposive sampling technique. Research instruments included a questionnaire and an observation sheet. Data were analyzed using Fisher's Exact Test (α=0.05). Results: The majority of respondents (55%) had good nutritional fulfillment, and 60% of respondents experienced rapid wound healing. Statistical test results showed a p-value = 0.005 (p < 0.05), indicating a significant relationship between nutritional fulfillment and wound healing duration. Respondents with good nutrition had a rapid wound healing percentage of 90.9%, while respondents with poor nutrition had a slow wound healing percentage of 77.8%. Conclusion: Adequate nutritional fulfillment plays a crucial role in accelerating the wound healing process after Sectio Caesarea surgery.

Lestari Lestari; Rizki Amelia Nasution

Jurnal Cakrawala Pendidikan dan Biologi 2025 Asosiasi Riset Ilmu Pendidikan Indonesia

The normal flora of chickens refers to the microbial communities that naturally inhabit the gastrointestinal tract and body surfaces of chickens, playing a crucial role in health, digestion, and immunity. This community consists of beneficial bacteria such as Lactobacillus, Bifidobacterium, and Bacillus, which assist in feed fermentation, vitamin synthesis, and inhibition of pathogenic growth. Additionally, the normal flora may include potential pathogenic bacteria such as Escherichia coli, Salmonella spp., and Campylobacter, which can cause diseases if microbial balance is disrupted. The diversity and balance of the microbiota are influenced by various abiotic factors, including feed quality, access to clean water, ambient temperature, humidity, and environmental hygiene. Biotic factors, such as microbial interactions, rearing systems, and contact with other animals, also play a significant role in determining microbial composition. Several studies have shown that the use of feed additives, such as probiotics and phytogenics, can enhance populations of beneficial bacteria while suppressing pathogenic bacteria. Extensive rearing systems, which provide chickens with more space and exposure to natural environments, tend to increase microbiota diversity compared to semi-intensive systems with more restricted conditions. Understanding these factors is essential for developing effective health management strategies and optimizing safe and sustainable poultry production.

Sohabiah, Sohabiah; Muhammad Rizqi

Jurnal Riset Rumpun Matematika dan Ilmu Pengetahuan Alam 2025 Pusat riset dan Inovasi Nasional

Chili pepper (Capsicum frutescent L.) is known as one of the high sources of vitamin C, which acts as an important natural antioxidant for human health because the body is unable to produce its own. This study aims to analyse vitamin C levels in chili pepper using the iodometric titration method quantitatively by taking a 5 gram sample of chili pepper and titrating it using 0,1 N iodine solution. The analysis results showed that the vitamin C content obtained was 0,0704% or equivalent to 70,4 mg/100g. This value is higher than some research results. This value is higher than some previous research results on fruits and chillies from other regions. This finding shows that chilli pepper has great potential as a source of vitamin C in supporting the fulfilment of people’s daily nutrition. In addition, the iodometric titration method is proven to be effective and efficient to be used in the analysis of vitamin C in foodstuffs. Therefore, chili pepper consumption can be a simple strategy in improving nutritional and preventing disease related to vitamin C deficiency.

Khaerunisa, Sabbihisna; Astuti, Rahayu Dyah; Setyaningsih, Sundari

Botani : Publikasi Ilmu Tanaman dan Agribisnis 2025 Asosiasi Riset Ilmu Tanaman Dan Hewani Indonesia

This study aims to determine the optimal pectinase enzyme concentration and hydrolysis duration for the most preferred physical, chemical, and organoleptic characteristics of kweni mango syrup. The research was conducted from October 2024 to August 2025 at the Integrated Laboratory and Basic Science Laboratory of the Agricultural Institute (INTAN) Yogyakarta using a Completely Randomized Design (CRD) with a factorial pattern consisting of two factors and two replications. The first factor was the pectinase enzyme concentration (0%, 0.25%, 0.50%, and 0.75%), and the second factor was the hydrolysis duration (0, 30, and 60 minutes). Observation parameters included yield, vitamin C, viscosity, pH, total soluble solids, and organoleptic attributes. Data were analyzed using ANOVA at a 5% significance level followed by Duncan’s Multiple Range Test (DMRT). The results showed significant effects of both pectinase enzyme concentration and hydrolysis duration on yield, viscosity, total soluble solids, and organoleptic characteristics (color, taste, aroma, and overall acceptability), while no significant effects were observed on vitamin C content and pH. The best formulation was obtained using 0.50% pectinase enzyme concentration with a hydrolysis duration of 30 minutes.

Noor Hujjatusnaini

Jurnal Pelayanan Masyarakat 2025 Lembaga Pengembangan Kinerja Dosen

This community service program aims to enhance students’ knowledge and awareness regarding natural cosmetic formulations through training on the development of a natural deodorant balm, “Nature DeoBalm.” The activity was conducted at the Entrepreneurship Laboratory of UIN Palangka Raya and involved fifth-semester students of the Biology Education Department as participants. The training integrates promotive and applicative approaches, combining theoretical education on the risks of synthetic deodorants with direct observation of the production process for natural deodorant balm. The program emphasized the use of safe, plant-based ingredients such as beeswax, coconut oil, shea butter, vitamin E, and essential oils, which are known for their antibacterial, moisturizing, and skin-protecting properties. The implementation included several stages: preparation, material presentation, demonstration of the formulation process, product observation, evaluation, and documentation. Results showed that students demonstrated increased understanding of natural cosmetic components, formulation techniques, and the benefits of natural deodorants. They also developed a heightened awareness of environmentally friendly personal care products and showed interest in exploring entrepreneurial opportunities in herbal-based cosmetics. This program highlights the importance of introducing natural cosmetic innovation in higher education environments as a way to build scientific literacy, practical skills, and entrepreneurial competence. Overall, the activity successfully provided meaningful learning experiences and promoted the utilization of natural ingredients as sustainable alternatives to synthetic deodorant products.

Wahyu Sasono; Karyantina, Merkuria; Suhartatik, Nanik

Agrobioteknologi 2025 Fakultas Teknologi dan Industri Pangan Unisri Surakarta

Jam is a paste-shaped food usually made from fruit which is quite popular from children to teenagers. Aloe vera is one of the 10 best-selling plant species in the world which was developed as a raw material in the pharmaceutical and food industries, especially in countries on the European continent. Inulin is a dietary fiber contained in various types of vegetables and fruits that are beneficial for digestive health. Purple sweet potato is used in the addition of jam because purple sweet potato contains vitamin A, B vitamins and antioxidants. The purpose of this study was to determine the concentration of inulin thickener and purple sweet potato extract with high antioxidant activity, and to determine the characteristics of the panelists' preference to jam. This study used a completely randomized design with the first factor being variations in the concentration of inulin as thickener 1, 2, and 3 g. The second factor was the addition of purple sweet potato extract (40, 50, and 60%). The results of this study indicated that the jam formulation with high antioxidant activity on variations in the concentration of 1 g of inulin thickener with the addition of 60% purple sweet potato extract. The jam formulation that was preferred by the panelists was found in variations in the concentration of 2 g of inulin with the addition of 40% purple sweet potato extract which had an overall value of 3,40 (neutral). Higher purple sweet potato extract, the higher the antioxidant activity of the jam. Purple sweet potato extract can be used as a source of antioxidants in jam making.

Salsabila Rahman; Ardi Mustakim

Jurnal Ventilator: Jurnal riset ilmu kesehatan dan Keperawatan 2025 Stikes Kesdam IV/Diponegoro Semarang, Indonesia

Aloe vera (L.) Burm.f. is a bioactive plant containing polysaccharides, anthraquinones, sterols, vitamins, minerals, and glycoproteins, contributing to wound healing through anti-inflammatory, antibacterial, antioxidant mechanisms, fibroblast stimulation, and accelerated re-epithelialization. This study employed a systematic literature review (SLR) of 37 peer-reviewed articles (2018–2025) to evaluate the biochemical potential of Aloe vera and its application as a basis for modern pharmaceutical topical formulations. Results revealed that acemannan increased fibroblast proliferation by up to 200, modulated TGF-1, enhanced type I and III collagen deposition, and accelerated re-epithelialization. Anthraquinones such as aloin and emodin exhibited antibacterial activity against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Nanoemulsion and nanogel formulations improved transdermal penetration up to threefold compared to conventional gels. These findings highlight Aloe vera’s potential as a wound healing agent and a basis for modern pharmaceutical topical preparations.

Tifani Hadi Tri Wahyuni

VitaMedica : Jurnal Rumpun Kesehatan Umum 2025 STIKES Columbia Asia Medan

Anemia in pregnant women remains a global public health problem, particularly in developing countries. Iron supplementation is the main intervention recommended for the prevention and management of anemia during pregnancy. This literature review aims to analyze the effectiveness of iron supplementation in preventing anemia among pregnant women using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Article searches were conducted through scientific databases and the attached journals, with a publication range from 2019 to 2024. The selection process resulted in 10 articles that met the inclusion criteria. Narrative synthesis showed that iron supplementation, whether administered alone or combined with vitamin C or other supportive nutritional interventions, was effective in increasing hemoglobin levels in pregnant women. Adherence to supplementation and nutritional education support were significant factors influencing the success of the intervention.

Mutiara Febriana; Suharsih Suharsih; Nurbaity Situmorang

Jurnal Kesehatan dan Kedokteran 2025 Lembaga Pengembangan Kinerja Dosen

Elevated blood pressure above the normal range is a hallmark of a medical condition known as hypertension. It is estimated that as the population ages, the number of hypertension cases will also increase. If this condition is properly managed early, it can be controlled. Controlling daily eating habits is one of the most effective non-pharmacological methods for lowering blood pressure. Therefore, finding alternative food sources that can naturally lower blood pressure is crucial. Red dragon fruit (Hylocereus polyrhizus), which is high in fiber, potassium, and antioxidants such as vitamins B, C, and E, is one possible option. These nutrients are important for maintaining blood vessel flexibility and controlling hypertension. The purpose of this study was to determine the effect of red dragon fruit juice consumption on blood pressure in the Paku Village Community Health Center (Puskesmas Pembantu) operational area. A single-group pre-experimental design was used in this study. A paired-sample t-test was used to assess the data. Based on the findings, the average systolic blood pressure was 184 mmHg before consuming red dragon fruit juice and decreased to 164 mmHg after the intervention. With a t-value of 23.4, a correlation of 0.96, and a p-value of 0.000 (p < 0.05), this decrease was statistically significant. Meanwhile, the average diastolic blood pressure dropped from 101 mmHg to 84 mmHg, with a correlation of 0.961, a t-value of 18.65, and a p-value of 0.000 (p < 0.05). These results indicate that consuming red dragon fruit juice significantly lowers blood pressure, with an average decrease in systolic pressure of 20 mmHg and diastolic pressure of 17 mmHg.

Rachel Bintang; Ghalib Syukrillah Syahputra; Sri Budiasih

Jurnal Inovasi Riset Ilmu Kesehatan 2025 Pusat Riset dan Inovasi Nasional

Thick leaf (Glochidion superbum) is a medicinal plant traditionally utilized by the community of East Panjang Island for the treatment of wounds, pain, and ulcers. This research was conducted to isolate the major compounds present in the ethyl acetate fraction of thick leaf and to assess its antioxidant activity using the DPPH method. The plant leaves were first cleaned, dried, and powdered, followed by maceration extraction using methanol, which resulted in an extract yield of 16.42%. The crude extract was fractionated by column chromatography using EtOAc and MeOH eluents with ratios of 9:1 (K1), 4:1 (K2), 1:4 (K3), and 1:9 (K4). UV–Vis spectrophotometric analysis showed an absorption peak at 288 nm, indicating the presence of phenolic compounds, identified as ferulic acid. Antioxidant testing using the DPPH method showed IC₅₀ values for fractions K1, K2, K3, and K4 of 12.981, 5.159, 9.658, and 10.971 µg/mL, respectively, with vitamin C as a positive control (3.563 µg/mL). Fraction K2 showed the strongest antioxidant activity. These results indicate that thick leaf contains ferulic acid with very strong antioxidant activity and has potential as a natural antioxidant source.

Nurlaeli F; Retno Dewi Prisusanti

Antigen : Jurnal Kesehatan Masyarakat dan Ilmu Gizi 2025 LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Anemia in pregnancy remains a common public health problem and may lead to adverse outcomes for both the mother and the fetus, highlighting the need for effective and practical interventions. This study aimed to analyze the effect of cassava leaf (Manihot esculenta) consumption on hemoglobin levels among second-trimester pregnant women at UPT Puskesmas Rum Balibunga. A quasi-experimental study with a pretest–posttest design without a control group was conducted. The sample consisted of 30 second-trimester pregnant women with mild anemia, selected using purposive sampling. The intervention involved daily consumption of cassava leaves for 14 consecutive days. Hemoglobin levels were measured before and after the intervention using standardized examination tools. The results demonstrated a significant increase in hemoglobin levels following cassava leaf consumption, with a mean increase of 1.2 g/dL. These findings suggest that cassava leaves, which are rich in iron, vitamin C, and protein, can enhance hemoglobin synthesis and serve as a local food-based nutritional intervention. Therefore, cassava leaf consumption can be recommended as an alternative or complementary strategy for preventing and managing anemia among second-trimester pregnant women in primary healthcare settings. 

Rachmawati, Danar Nanda; Susilo, Eko Adi; Herdina Nafiana

Jurnal Pengabdian Masyarakat Terapan 2025 Lembaga Pengembangan Kinerja Dosen

This Community Service (PkM) activity focuses on the implementation of Quail Cultivation Counseling as a strategic effort to advance entrepreneurship among the Millennial Farmer Generation in Krebet Hamlet, Srengat, Blitar. This activity was motivated by the high economic potential of Quail and the need to improve the entrepreneurial competence of the younger generation in the livestock sector. The main goal of the program is to transform traditional cultivation into a structured, efficient, and sustainable modern business unit. The implementation method combines theoretical knowledge transfer with practical assistance in the field. The counseling material includes three pillars: 1) Business Scale Management, including capital management and strategies for increasing livestock population; 2) Quality Management and Livestock Health, emphasizing cage sanitation, feed, and quality vitamins; and 3) Marketing strategies to expand the distribution network. The results of the activities showed high effectiveness. Quantitatively, 80% of Millennial Farmer participants succeeded in implementing post-extension livestock population increases. Qualitatively, this activity fosters awareness, motivation, and a strategic entrepreneurial mindset so that participants are able to face production and market challenges. With this strategic practice, quail businesses are expected to increase profitability and competitiveness. This PKM serves as a catalyst in supporting economic independence and entrepreneurial development of the younger generation in the agribusiness sector.

Imroatus Sholikhah; Yuyun Nailufar

Jurnal Riset Ilmu Farmasi dan Kesehatan 2025 Asosiasi Riset Ilmu Kesehatan Indonesia

Tomato (Solanum lycopersicum) extract is known to contain potent antioxidant compounds such as lycopene, vitamin C, and flavonoids that can protect reproductive cells from oxidative stress. This study aims to analyze the effectiveness of tomato extract in improving the quality of spermatozoa in white rats (Rattus norvegicus) exposed to cigarette smoke, which is a major source of free radicals. The research applied a literature review approach by identifying, selecting, and analyzing related studies published between 2013 and 2023 from the Google Scholar and Academia.edu databases. Ten eligible studies were included for synthesis. The results show that the administration of tomato extract at doses ranging from 20 to 60 mg/kgBW/day significantly increased sperm motility, morphology, and viability in rats exposed to cigarette smoke. The improvement was associated with the antioxidant effect of lycopene, which protects Leydig cells and maintains testosterone production. These findings suggest that tomato extract has significant potential as a natural antioxidant therapy to prevent oxidative damage and reproductive disorders caused by cigarette smoke exposure.

Cholifatul Laili Ziamona; Sartari Entin Yuletnawati

Jurnal Ilmu Kesehatan 2025 Lembaga Pengembangan Kinerja Dosen

Recurrent aphthous stomatitis (RAS) is a common inflammatory condition of the oral mucosa characterized by round or oval ulcers with well-defined reddish borders and a shallow base covered by a grayish or yellowish fibrinous pseudomembrane. RAS is generally classified into three clinical types—minor, major, and herpetiform based on the size, number, and duration of the lesions. Several factors contribute to its occurrence, including bacterial infections such as Streptococcus sanguis, immune system dysfunctions, and nutritional deficiencies involving iron, vitamin B12, and folic acid. Other potential triggers include local trauma, hormonal or endocrine imbalances, psychological stress, and allergic reactions. Among these, anemia due to deficiencies in iron, folate, or vitamin B12 is considered an important etiopathogenic factor, although its exact role has not been fully clarified. The management of RAS primarily focuses on symptom relief, promoting faster ulcer healing, and preventing recurrence through both topical and systemic approaches. Effective treatment often includes improving nutritional intake, maintaining oral hygiene, and addressing underlying systemic or psychological conditions. Understanding the multifactorial causes of RAS is crucial in developing comprehensive strategies for prevention and long-term management of this recurrent oral lesion.

Khaleel Ibrahim Ismael

International Journal of Health and Medicine 2025 Asosiasi Riset Ilmu Kesehatan Indonesia

Oxidative stress-induced apoptosis and chromatin instability are usually associated with male infertility and undermine the sperm DNA integrity. Recently, Vitamin K₂ (menaquinone) became a bioactive compound whose regulation action can be found in both apoptosis and transcriptional signaling. This study examines how Vitamin K₂ can be protective in the regulation of apoptotic pathways and stability in sperm chromatin by an integrative experimental and in silico analysis. Vitamin K₂ levels, DNA fragmentation level of infertile men's serum and semen samples (Aniline Blue), and the expression levels of apoptosis-associated genes (BAX, BCL-2, and CASP-3) in the samples were examined by qRT-PCR. The characterization of Vitamin K₂ binding affinity to apoptotic proteins was done using dynamics simulations. Findings showed that high levels of Vitamin K₂ had a significant positive correlation with reduced levels of DNA fragmentation and good control of apoptotic genes with reduced BAX and CASP-3 and increased expression of BCL-2. In general, the results indicate Vitamin K₂ as a potential regulator of sperm death and chromatin integrity that provides new therapeutic understanding on how male infertile patients can be treated.

Kadhum, Nadia H.

International Journal of Health and Medicine 2025 Asosiasi Riset Ilmu Kesehatan Indonesia

Cytokines and Vitamin K in crohn’s disease patients have been evaluated to discover the conceivable via biomarkers of diagnosed patients compared to control. Sera samples of Eighty patients and control of both genders. forty patients diagnosed crohn’s which the span of age between (20-36) years and 40 healthy volunteers as a control with span age (18-39) years. The patient were guests to Marjan hospital in Babylon city during the period (1/July/2025 to 1/September/2025). The current results showed a significant difference in statistic marks at (P<0.05). Vitamin K in patients below control. There is significance different between values of patients and controls in Magnesium, Calcium, Vitamin K, InterL10 and Toll-like receptor 4. According to word axel, there is magnitude significant relationship among cytokine InterL10 and Toll-like receptor 4, Magnesium, Calcium, & Vitamin K. The cytokines both InterL10 and Toll-like receptor 4 patients’ levels larger than control levels. Calcium and Magnesium which there is significance variance between both patients and Control

Ummi Rakida; Fauziah Fauziah; Nurul Sakdah

Nursing Applied Journal 2025 LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Exclusive breastfeeding, sometimes known as ASI, is the practice of giving infants only breast milk, along with vitamins, supplements, and prescription medications for illnesses, and no other liquids or solid foods, either directly from the breast or expressed. The purpose of this study was to determine the relationship between maternal awareness of pumping and the effectiveness of exclusive breastfeeding at the Lampulo Community Health Center. This study used a cross-sectional methodology and an analytical quantitative design. 53 breastfeeding mothers constituted the study population. There were 53 respondents in total, and the sampling strategy used the total sampling method. A 20-question survey taken from Desriati Sinaga's 2024 study served as the instrument. The Lampulo Community Health Center in Banda Aceh conducted this study from May 19 to June 25, 2025. The Chi-square test results showed a p-value of 0.001 < 0.05. Based on the research findings, maternal awareness of expressing breast milk is related to the success of exclusive breastfeeding at the Lampulo Community Health Center. These findings are expected to form the basis for more comprehensive instructions for breastfeeding mothers to improve the success of exclusive breastfeeding with expressed breast milk.