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Abstract

Background: Anemia remains a major public health concern among adolescent girls in Indonesia. To address this, weekly iron-folic acid (IFA) supplementation has been implemented nationwide. This study examined factors associated with anemia and adherence to IFA supplementation among adolescent girls in three senior high schools within the Poka-Rumah Tiga Health Centers' catchment area in Ambon City, Indonesia.

Methods: A cross-sectional survey was conducted in August 2022 involving 522 female students from three senior high schools in Ambon City. Factors associated with anemia and adherence to weekly IFA supplementation were examined using logistic regression.

Results: A high prevalence of anemia (49.23%) was found among participants. Only 14.75% of participants complied with taking IFA supplements weekly. A reduced odd of anemia was associated with having no previous history of worm infections. The odds of adherence to weekly IFA supplementation increased in those who did not consume green vegetables and knew the rules of taking IFA tablets. The odds of adherence also increased among those who understood the benefits of IFA tablets. The highest odds of adherence were associated with those who knew at least two benefits of taking IFA tablets.

Conclusion: Worm infection was associated with anemia, while consumption of green vegetables, as well as awareness about the rules for taking IFA tablets and the benefits of IFA tablets were associated with compliance with weekly IFA supplementation. Worm control measures and health promotion activities benefit the anemia control efforts in Ambon City, Indonesia.

Keywords: Low Hb level, Senior high school students, Indonesia

References

[1] Killeen R, Tambe A. Acute anemia. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Apr 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537232

[2] Yusufu I, Cliffer IR, Yussuf MH, Anthony C, Mapendo F, Abdulla S, et al. Factors associated with anemia among school-going adolescents aged 10–17 years in Zanzibar, Tanzania: a cross sectional study. BMC Public Health. 2023 Sep 18;23(1):1814. doi: 10.1186/s12889-023-16611-w.

[3] World Health Organization [WHO]. Anaemia in women and children; 2021 [cited 2024 Jan 13]. Available from: https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children

[4] World Health Organization [WHO]. Prevalence of anemia in women of reproductive age [cited 2024 Jan 13]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-women-of-reproductive-age-(-)

[5] Widyanthini DN, Widyanthari DM. Analisis Kejadian Anemia pada Remaja Putri di Kabupaten Bangli, Provinsi Bali, Tahun 2019. Buletin Penelitian Kesehatan. 2021 Jul 27;49(2):87–94. [ in Indonesian]

[6] Deivita Y, Syafruddin S, Andi Nilawati U, Aminuddin A, Burhanuddin B, Zahir Z. Overview of Anemia; risk factors and solution offering. Gac Sanit. 2021;35 Suppl 2:S235-S241. doi: 10.1016/j.gaceta.2021.07.034.

[7] Mudjiati I, Mursalim, Julina, Ruslina E, Firna E, Samkani H, et al. Pedoman Pemberian Tablet Tambah Darah (TTD) Bagi Remaja Putri Pada Masa Pandemi Covid-19 Bagi Tenaga Kesehatan. Direktorat Gizi Masyarakat Kementerian Kesehatan Republik Indonesia. Jakarta; 2020. [in Indonesian].

[8] Annan RA, Gyimah LA, Apprey C, Edusei AK, Asamoah-Boakye O, Esi Aduku LN, et al. Factors associated with iron deficiency anaemia among pregnant teenagers in Ashanti Region, Ghana: A hospital-based prospective cohort study. Factors associated with iron deficiency anaemia among pregnant teenagers in Ashanti Region, Ghana: A hospital-based prospective cohort study. PLoS One. 2021 Apr 27;16(4):e0250246. doi: 10.1371/journal.pone.0250246.

[9] World Health Organization [WHO]. Programme Data Global database on the Implementation of Nutrition Action (GINA): Weekly Iron Folic Acid Supplementation-Nutrition International-Indonesia-Iron and folic acid supplementation-Adolescents, 2012 [cited 2024 Jan 13]. Available from: https://extranet.who.int/nutrition/gina/sites/default/files/whoLogoPdf.jpg

[10] Tim Riskesdas 2018. Laporan Nasional Riskesdas 2018. Jakarta; 2019 [cited 2024 Jan 13]. Available from: https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/Laporan%20Riskesdas%202018%20Nasional.pdf. [in Indonesian].

[11] Munira S. Hasil Survei Status Gizi Indonesia (SSGI) 2022. [cited 2024 Jan 13]; Available from: https://ayosehat.kemkes.go.id/pub/files/files46531._MATERI_KABKPK_SOS_SSGI.pdf [in Indonesian].

[12] Profil Kemiskinan di Indonesia Maret 2023. Jakarta; 2023 [cited 2024 Jan 13]. Available from: https://www.bps.go.id/id/pressrelease/2023/07/17/2016/profil-kemiskinan-di-indonesia-maret-2023.html [in Indonesian].

[13] Penetapan Desa Negeri Kelurahan Lokasi Fokus Prioritas Penanggulangan Stunting Kota Ambon Tahun 2021. Ambon: Walikota Ambon; 2020. [In Indonesian].

[14] Assefa H, Abebe SM, Sisay M. Magnitude and factors associated with adherence to Iron and folic acid supplementation among pregnant women in Aykel town, Northwest Ethiopia. BMC Pregnancy Childbirth. 2019 Aug 14;19(1):296. doi: 10.1186/s12884-019-2422-4.

[15] Nasir BB, Fentie AM, Adisu MK. Adherence to iron and folic acid supplementation and prevalence of anemia among pregnant women attending antenatal care clinic at Tikur Anbessa Specialized Hospital, Ethiopia. PLoS One. 2020 May 4;15(5):e0232625. doi: 10.1371/journal.pone.0232625.

[16] Profil Puskesmas Poka-Rumah Tiga. Ambon: Puskesmas Poka-Rumah Tiga; 2023. [in Indonesian].

[17] Jan A, Weir C. BMI Classification percentile and cut off points. Treasure Island (FL) : StatPearls Publishing; 2023.

[18] Abadi E, Putri LAR. Nutrition Assistance Increases the Size of Middle-Upper Arm Circumference of Pregnant Women With Chronic Energy Deficiency. Public Health of Indonesia. 2020 Dec 14;6(4):157–62.

[19] Kassahun CW, Mekonen AG. Knowledge, attitude, practices and their associated factors towards diabetes mellitus among non-diabetes community members of Bale Zone administrative towns, South East Ethiopia. A cross-sectional study. PLoS One. 2017 Feb 2;12(2):e0170040. doi: 10.1371/journal.pone.0170040.

[20] Rokhmawati I, Rahmawati T, Soviana E. The Effect of Nutrition Counseling with Leaflet Media on the Level of Knowledge about Anaemia in Adolescent Girls at Christian Junior High School 1 Surakarta. [Surakarta]: Faculty of Health Sciences, University of Muhammadiyah Surakarta; 2015.

[21] Fadelina A. Overview of Adolescent Girls’ Knowledge about the Benefits of Taking Iron-Folic Acid Supplementation During Menstruation in Lawatan Village RW.04. [Tegal]: Politeknik Harapan Bangsa; 2021 [cited 2024 Apr 12]. Available from: http://eprints.poltektegal.ac.id/110/2/GAMBARAN%20PENGETAHUAN%20REMAJA%20PUTRI%20TENTANG%20MANFAAT%20KONSUMSI%20TABLET%20TAMBAH%20DARAH%20PADA%20SAAT%20MENSTRUASI%20DI%20DESA%20LAWATAN%20RW%2004_Annisa%20Nur%20Fadelina.pdf [in Indonesian].

[22] Sirichand, Bashir A, Saeed F, Laghari TM, Lail A, Nahal N. Relationship Between Intestinal Parasitic Infection and Anemia in School-Going Girls: A Cross-Sectional Study. Pakistan Journal of Medical and Health Sciences. 2022 Sep 30;16(9):905–8.

[23] Penanggulangan Cacingan. 15 Indonesia: Peraturan Menteri Kesehatan Republik Indonesia; 2017 [cited 2022 Jan 13]. Available from: http://hukor.kemkes.go.id/uploads/produk_hukum/PMK_No._15_ttg_Penanggulangan_Cacingan_.pdf [ in Indonesian]

[24] Pical F. Kegiatan Survei Penilaian Prevalensi Cacingan Pasca POPM Pada murid SD/MI di Kabupaten Magetan Provinsi Jawa Timur Tahun 2021. 2022 May 3 [cited 2024 Jan 15]; Available from: https://p2pm.kemkes.go.id/publikasi/artikel/kegiatan-survei-penilaian-prevalensi-cacingan-pasca-popm-pada-murid-sdmi-di-kabupaten-magetan-provinsi-jawa-timur-tahun-2021 [ in Indonesian].

[25] Khanal A, Paudel R, Wagle CN, Subedee S, Pradhan PMS. Prevalence of anemia and its associated factors among adolescent girls on Weekly Iron Folic Acid supplementation (WIFAS) implemented and non-implemented schools at Tokha municipality, Kathmandu. PLOS Glob Public Health. 2024 Jan 26;4(1):e0002515. doi: 10.1371/journal.pgph.0002515.

[26] MITRA Youth: Weekly Iron Folic Acid Supplementation for prevention and reduction of anaemia among school-going adolescent girls in select districts of two provinces-East Java & East Nusa Tenggara, Indonesia Nutrition International; 2021 [cited 2024 Jan 13]. Available from: https://www.dfat.gov.au/sites/default/files/indonesia-mitra-youth-final-report-june-2021.pdf

[27] Siekmans K, Roche M, Kung’u JK, Desrochers RE, De-Regil LM. Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women. Matern Child Nutr. 2018 Dec;14 Suppl 5(Suppl 5):e12532. doi: 10.1111/mcn.12532.

[28] Lavanya P, Jayalakshmy R, Rajaa S, Mahalakshmy T. Adherence to iron and folic acid supplementation among antenatal mothers attending a tertiary care center, Puducherry: A mixed-methods study. J Family Med Prim Care. 2020 Oct 30;9(10):5205-5211. doi: 10.4103/jfmpc.jfmpc_721_20.

[29] Gosdin L, Sharma AJ, Tripp K, Amoaful EF, Mahama AB, Selenje L, et al. A School-Based Weekly Iron and Folic Acid Supplementation Program Effectively Reduces Anemia in a Prospective Cohort of Ghanaian Adolescent Girls. J Nutr. 2021 Jun 1;151(6):1646-1655. doi: 10.1093/jn/nxab024.

[30] Utami A, Margawati A, Pramono D, Julianti HP, Adespin DA, Wulandari DR. The Effectiveness of Iron-folic Acid Supplementation and Education Intervention to Hemoglobin Level, Knowledge, and Compliance among Adolescent Girls in Islamic Boarding School. Open Access Maced J Med Sci. 2022 May 6;10(E):1141–6.

[31] Humayrah W, Putri I. Pengaruh Program CANTIK Terhadap Pengetahuan, Sikap dan Perilaku Remaja Putri dalam Mengkonsumsi Tablet Tambah Darah di Kabupaten Bogor. Pro Health Jurnal Ilmiah Kesehatan. 2022 Jan;5(1):306–13. [ in Indonesian]

[32] Rosmanely S, Rahmadani S, Arista E, Rombedatu A, Pasudi C, Putri A, et al. Pembagian Buku Saku dan Tablet Tambah Darah Pada Remaja Putri di Desa Parenreng. Batara Wisnu Journal : Indonesian Journal of Community Services. 2023;3(1):181–7. [ in Indonesian]

[33] Moe-Byrne T, Evans E, Benhebil N, Knapp P. The effectiveness of video animations as information tools for patients and the general public: A systematic review. Front Digit Health. 2022 Oct 31;4:1010779. doi: 10.3389/fdgth.2022.1010779.

[34] Febria M, Kurniasari R. Penggunaan Media Kreatif Sebagai Sarana Edukasi Anemia Remaja Putri Selama Pembelajaran Jarak Jauh: Literature Review. The Indonesian Journal of Health Promotion. 2022 Aug;5(8):882–9. [ in Indonesian]

[35] Styaningrum S, Metty M. Games Kartu Milenial Sehat sebagai media edukasi pencegahan anemia pada remaja putri di sekolah berbasis asrama. Ilmu Gizi Indonesia. 2021 Feb;4(2):171–8. [ in Indonesian]

[36] Baroroh, Alimia A. Pengaruh Edukasi Pencegahan Anemia Melalui Instagram Terhadap Pengetahuan dan Sikap Santri Putri Terkait Konsumsi Tablet Tambah Darah, 2023 [cited 2024 Jan 13]. Available from: https://eprints2.undip.ac.id/id/eprint/13233 [ in Indonesian]

[37] Aisah S, Ismail S, Margawati A. Animated educational video using health belief model on the knowledge of anemia prevention among female adolescents: An intervention study. Malays Fam Physician. 2022 Oct 18;17(3):97-104. doi: 10.51866/oa.136.

[38] Bhardwaj A, Murage L, Sharma S, Dipo D, Makena C, Roche M, et al. Weekly iron and folic acid supplementation and nutrition education for adolescent girls in Africa and Asia. Filed Exchange Issue. 2021 Nov 1;40–3. [ cited 2024 Jan 13]. Available from: https://www.ennonline.net/fex/66/ironfolicacidnutritioneducation

[39] Yudina MK, Fayasari A. Evaluation of Iron Tablet Supplementation Program of Female Adolescent in East Jakarta. Jurnal Ilmiah Kesehatan (JIKA). 2020 Dec 31;2(3):147–58. [ in Indonesian]

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