A Study of Anemia Prevalence and Dietary Habits among Adolescent

Girls in Rural and Urban Area in North Sumatera, Indonesia

Sri Lestari

, Isti Ilmiati Fujiati

, Sake Juli Martina

, Dina Keumala Sari

, Siti Ardianti Ahmad

Panjaitan

and Nur Hidayah Nasution

Departement of Public Health, Faculty of Medicine, Universitas Sumatera Utara, Jl. dr. Mansur No. 5 Kampus USU,

Medan 20155, Indonesia

Departement of Pharmacology, Faculty of Medicine, Universitas Sumatera Utara, Jl. dr. Mansur No. 5 Kampus USU

Medan 20155

Departement of Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Jl. dr. Mansur No. 5 Kampus USU, Medan

20155, Indonesia

Departement of Public Health Nutrition, Faculty of Public Health, Universitas Sumatera Utara, Jl. Universitas No. 21

Kampus USU, Medan 20155, Indonesia

Master Student in Departement of Administration and Health Policy, Faculty of Public Health, Universitas Sumatera

Utara, Jl. Universitas No. 21 Kampus USU, Medan 20155, Indonesia

Keywords: Anemia, Dietary Habit, Adolescence Girls.

Abstract: Anemia is one of the public health problems in developing countries. Adolescent is a part of the groups at

risk of anemia due to the increased need for iron during the age. Anemia in adolescent will lead to decreased

resistance to disease, impaired physical and mental development and decreased performance in schools.

This research aimed to determine the prevalence of anemia and associated with adolescent girls. This

research is an analytic study with cross sectional approach. Total sample 300 adolescent girls aged 12-19

years old from Mei-October 2018. Data collected by using Food Frequency questionnaire (FFQ),

anthropometric assessment and hemoglobinometer tool. Chi-square analysis was used to find the association

between dietary habits and anemia. The overall prevalence of anemia was found to be 30.0%, moderate

anemia (15.3%) was found to be more common than other forms of anemia. Anemia (23.0%) was found to

be more prevalent among girls with aged 13-15 years (mid adolescent). The dietary habits associated with

the anemia were consumption of heme sources, fruits, vegetables, tea (P <0.05). Anemia was more common

in rural adolescent girls. There was significant association between anemia and dietary habits of adolescent

girls.

1 INTRODUCTION

Anemia is still a global problem in the world

especially in Indonesia. It has been proven to be a

public health problem affected the low, the medium,

and the high income countries and has been a

significant adverse health consequences, detrimental

to social and economic development (WHO, 2015).

Anemia can occur for a number of causes; with the

most important contributor is iron deficiency.

Anemia affects half a million women at reproductive

age worldwide. In 2011, 29% of non-pregnant

women aged 15-49 years were anemia (WHO,

2015). More than 50% of girls aged 12-15 years old

are reported to have anemia.

The results of a study conducted by (Stevens,

2013), the prevalence of anemia in Asia's highest

continent in Uzbekistan was 51.7% and the lowest in

Vietnam was 14.1%. The prevalence of anemia in

Southeast Asian countries such as Malaysia,

Thailand, and Philippines was 20.7%, 23.8%, and

25.4%, and the highest was in Cambodia with a

prevalence of 43.8%. The prevalence of anemia in

Australia showed a smaller number of 17.5%. The

prevalence of anemia in Indonesia according to

Basic Health Research (Riskesdas, 2013) was

21.7%, with the second highest prevalence among

children and adolescents aged 5-14 years ie 26.4%

(Ministry of Health Republic of Indonesia, 2013)

Anemia in young women has serious

implications and almost all consequences of iron

652

Lestari, S., Fujiati, I., Martina, S., Sari, D., Panjaitan, S. and Nasution, N.

A Study of Anemia Prevalence and Dietary Habits among Adolescent Girls in Rural and Urban Area in North Sumatera, Indonesia.

DOI: 10.5220/0010082906520656

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

652-656

ISBN: 978-989-758-449-7

deficiency are closely related to the severity of

anemia. Anemia causes decreased resistance to

infection, impaired physical growth and mental

development, as well as reduced physical fitness,

work capacity, and school performance (Tesfaye,

2015). The most visible impact on adolescents,

especially those attending school, is the decline in

learning achievement.

Studies linking eating habits with the incidence

of anemia were among others done by (Thomas,

2015) who found that iron deficiency, folic acid,

vitamin B12, low-meat diets and menstruation were

associated with anemia in adolescents. Regular fruit

consumption, especially those containing iron and

vitamin C also decreases the risk of anemia in Indian

adolescents (Ahankari., 2017). The energy intake

influence the prevalence of anemia in pregnant

women (Lestari., 2018a), stunting in children

(Lestari, 2018), , and obesity in adult female

(Lestari, 2017).

Meanwhile, research on anemia in young

women in North Sumatera is still limited, so it is

necessary to do research to examine the relationship

of eating habits with anemia in young women in

North Sumatera.

2 MATERIAL AND METHOD

This type of research is an analytic survey with cross

sectional study design. Total samples of 300

adolescent girls aged 12-19 years coming from 4

areas : SMPIT Al USWAH, SMAIT AL USWAH

from Langkat Regency, and SMP Negeri 41 Medan

dan SMP Santo Yoseph from Medan City, of North

Sumatera Province. Data was taken in February-July

2018.

Types of data collected in this study were

primary data, using questionnaires and

anthropometry measurements and hemoglobin

examinations. Interviews with structured

questionnaires were to find socio-demographic data,

dietary habits and risk factors for anemia. While

anthropometric measurements include height, weight

and Body Mass Index (BMI). Food intake data

obtained by using a food recall 24 hours. The

measurement of anthropometry was included height

and weight. Height measurement using gauge height

"microtoice" with capacity measuring two meters

and the accuracy of 0.1 cm. Anemia was diagnosed

at haemoglobin level of less than 12g/dl (WHO,

2011). The level of hemoglobin (Hb) was measured

using the HemoCue blood photometer (Kisworini,

2005) and (Akhtar, 2008).

Data analysis was univariate and bivariate.

Univariate analysis used to describe the severity of

anemia, and age range in adolescent girls. The

bivariate analysis used was a chi-square test to see

the association of anemia with dietary habits. Data

was analyzed using SPSS Software.

3 RESULT

Total of 300 adolescent girls were invited to

participate in the present study. In this study found

as many as 30.0% of respondents suffer from

anemia. As many as 13% of adolescent girls were

suffer from mild anemia, 15.3% had moderate

anemia and 1.7% had severely anemia (table 1).

Table 1: Prevalence of anemia in adolescent girls

Anemia Frequency %

Severe (Hb <8,0

g/dL)

5 1.7

Moderate (Hb

8,0-10,9 g/dL)

46 15.3

Mild (Hb 11,0-

11,9 g/dL)

39 13.0

Normal (Hb >12

g/dL)

210 70.0

Total 300 100.0

Table 2 shows that in the age group of 13-15

years (mid) adolescent girls suffered more the mild

and moderate anemia. While in the age group 10-12

years (early) suffered more the moderate anemia and

age group 16-19 years (late) suffered the mild

anemia.

Table 2: Cross-distribution between age and severity of

anemia

Age Group

Normal

(

)

Mild

(

)

Moderate

(

)

Severe

(

)

10-12 years

(early)

10.7 1.3 3.3 0.0

13-15 years

(middle)

51.7 10.3 11.0 1.7

16-19 years

(late)

7.7 1.3 1.0 0.0

Total 70.0 13.0 15.3 1.7

In this study found that anemia of adolescent

girls more experienced by respondents who come

from rural (17.3%). Most girls in rural areas suffered

the moderate anemia. This is likely due to lower

socioeconomic status in rural areas. In addition, low

nutrition and anemia knowledge and nutritional

intake of young wom adolescent girls in rural areas

are inadequate (Table 3).

A Study of Anemia Prevalence and Dietary Habits among Adolescent Girls in Rural and Urban Area in North Sumatera, Indonesia

653

Table 3: Prevalence of anemia in adolescent girls in rural

and urban.

Region

Normal

(

)

Mild

(

)

Moderate

(

)

Severe

(

)

Rural

32.7 6.3 10.3 0.7

Urban

37.3 6.7 5.0 1.0

Total

70.0 13.0 15.3 1.7

The association between nutritional status and

anemia is shown in Table 4. It was found that young

women with mild anemia were found in

Underweight group (BMI 16-18.4 and normal),

whereas in an overweight group there was only 2%

of adolescent anemia (Table 4).

Table 4: Cross distribution between Nutritional Status and

anemia.

Nutritional Status

Normal

(%)

Mild

(%)

Moderate

(%)

Severe

(%)

CED grade III

(BMI<16)

6.3 0.3 0.7 0.0

Underweight (BMI

16-18.4

)

17.7 5.7 3.0 0.7

Normal (BMI 18.5-

22.9

)

34.0 6.0 9.3 1.0

Overweight (BMI

23.0-24.9)

6.3 0.3 1.7 0.0

Obese (BMI >25.0) 5.7 0.7 0.7 0.0

Total 70.0 13.0 15.3 1.7

Table 5 shows women's eating habits in

consuming sources of heme, green vegetables, tea

and breakfast in a week. It was found that adolescent

girls with anemia sometimes consume food sources

of heme (21.0%), sometimes consume green

vegetables (21.7%) and often drink tea after-meal

(20.0%).

4 DISCUSSION

In adolescence there is a significant increase in the

need for iron. Deficiency of iron intake in this period

will lead to anemia. Anemia in young women will

decrease learning ability and physical capacity.

Generally, the prevalence of anemia in this study

was 30%. This figure is higher than the prevalence

of anemia in adolescents nationwide results

Riskesdas 2013 of 22.7%. Another study conducted

on junior high school students in Semarang found

26.7% of respondents suffered from anemia

(Indartanti and Kartini, 2014). Another study

conducted on high school students in Jogjakarta

found 17.0% suffered from anemia (Triwinarni,

2018). Greater prevalence was found by (Hapzah

and R. Yulita, 2011) in Polewali Mandar district of

South Sulawesi, 67% of adolescent girls were

anemic. A study by (Shaka and Wondimagegne,

2018) in South Ethiopia involving 443 adolescents

found anemia of 22.0%. While research conducted

by Jalambo (2013) in Gaza Palestine found the

prevalence of anemia in female adolescents by

33.5%. The results of this study indicate that the

majority of young women (15.3%) had Moderate

anemia and mild anemia (13.0%). Research by

(Chaturvedi, 2017) on 300 adolescent girls in Ranchi

India showed an 82% prevalence of anemia, that was

mild anemia (34.0%), moderate (30.3%) and severe

anemia (17.6%). The high prevalence of anemia also

found by (Gupta, 2012) found 77.3% adolescent

girls had mild anemia. While anemia studies in the

developed world showed a low prevalence of

anemia, (Kim, 2014) in Korea's study involved 1312

the 10-18-year-old girls found only 5.4% with

anemia.

Table 5: Association between dietary habits and anemia in

adolescent girls.

Dietary

habits

Categories

Anemic

(

)

Normal

(

)

P-value

Sources of

heme

Daily-weekl

9.0 31.0 0.021

sometimes 21.0 39.0

Green

etables

Daily-weekl

8.3 32.0 0.004

sometimes 21.7 38.0

Fruit

Dail

-weekl

7.4 25.9 0.039

sometimes 22.6 44.1

Tea post

meal

Daily-weekl

20.0 26.7 0.001

sometimes 10.0 43.3

Breakfast

Daily-weekl

17.3 45.0 0.286

sometimes

12.7 25.0

When viewed in terms of age, the results of this

study showed anemia more experienced by young

women in the age group 13-15 years (mid) that is

equal to 23%. This study is in line with the

(Amarnath and Lakshmanrao, 2013) in Andhra

Prades involved 270 adolescent girls, 88.9% anemia

and adolescents in the 12-15 year age group

experienced the most anemia (54.8%). In this study

found the prevalence of anemia in adolescent girls in

rural (17.3%), higher than in urban areas (13.7%).

The results of this study are in line with studies

conducted by Shaka [14] in South Ethiopia, anemia

in the countryside found at 67.5%, urbanized 32.5%

anemia. Similarly, a study by (Sulakshana, 2014)

which found an prevalence of anemia among girls in

rural India by 75%. Lifestyle and socio-economic

level in rural areas are relatively lower than in urban

areas, which have an effect on anemia on young

women. Cross-distribution between nutritional status

and anemia in this study showed that adolescent

girls with underweight nutritional status were more

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

654

anemic (10.7%) than those with overweight (2.4%).

A similar study was conducted by (Kurniawan,

2006) in Tangerang Banten who found that the

majority of adolescent girls suffered from anemia

had underweight nutritional status (44.2%). A

similar study was conducted by (Kanodia, 2016), in

Nepal involve 433 adolescent girls and found no

significant relationship between nutritional status

and anemia, 75.4% of malnourished young women

suffered from anemia.

The results of this study indicated that young

women who rarely consume food sources of iron

heme such as meat, chicken and fish suffered more

anemia (21.0%). There was a significant correlation

between meat consumption and anemia in

adolescent girls. This result was in line with

previous research conducted by (Lestari., 2018) in

North Sumatera Province which found the influence

of food consumption of heme and non heme sources

with the incidence of anemia. Iron absorption is

influenced by two factors, namely the absorption of

heme iron and nonheme which indicate the existence

of two different types of iron in the food. The

sources of heme in human food are meat, fish, and

poultry, whereas nonheme sources are cereals, nuts,

vegetables and fruits (Briawan, 2012). Studies

conducted by Mikki in adolescent girls in Palestine

also showed a clear relationship between meat

consumption and anemia. Other studies that

supported the results of this study were conducted

by (Bhargava, 2001) in Bangladesh that found an

association of meat, fish and egg consumption with

haemoglobin concentrations in women. (Zuffo,

2017) study in Brazil found a strong influence

between the consumption of food sources of heme

(meat) with anemia in school children.

The results of this study also showed that the

consumption of green fruits and vegetables affect the

anemia of young women. This result was in line

with the (Jalambo, 2015) study in Gaza which

concludes that there is a significant association of

fruit and vegetable consumption with anemia in

young women. A study by (Alquaiz, 2015) in Saudi

Arabia with 495 adolescents concluded that

adolescents who ate less fruit were at anemia three

times more likely than adolescents who daily

consumed fruit. In this study found there is a

relationship to drinking tea after eating with anemia.

Tannin in tea can inhibit the absorption of iron.

Another similar study conducted by Tayel DI [29] in

Egypt involving 405 adolescents, it was found that

drinking habits had a significant effect on

adolescence anemia. The previous study in North

Sumatra also found a significant association of tea

drinking habits with anemia (Lestari, 2018)

Similarly, (Panat, 2013) study on 273 female

students in India found anemia prevalence (74.85)

more experienced by respondents with daily tea

habits.

5 CONCLUSIONS

The results of this study indicated that the

prevalence of anemia in adolescent girls in North

Sumatera was 30.0%. This prevalence number is

above the national rate. Dietary habits associated

with anemia incidence in adolescent girls (p <0.05)

were consumption of heme sources and non heme,

fruit, vegetable and tea post meal. So it is necessary

to immediately do nutritional intervention in

adolescent girls to reduce the incidence of anemia

and improve the quality of life of adolescent girls in

the future

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research is supported by Ministry of Research and

Technology and Higher Education Republic of

Indonesia. The support is under the research grant

PDUPT of Year 2018 Contract Number

1140A/UN5.I.R/PPM/2018.

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