Factors Analysis of Anaemia in Adolescent Girl
Gita S. Prihanti*, Nurul Fadli, Galih H. S. P., Putri Sholih D. I. and Frida D. Hidayati
Faculty of Medicine, Muhammadiyah Malang University, Jalan Bendungan Sutami No 188A, Malang, Indonesia
Keywords: Anaemia, adolescent, HB, age, parent education, parent income, knowledge of student, age of menstruation,
eating habits.
Abstract: Early detection of anaemia in adolescent girls is important to optimize future maternal health. Prevention of
anaemia in junior and senior high school students is the target program of Community Health Center in
Indonesia. This study aimed to determine factors that affect the incidence of anaemia at adolescent girls of
Junior High School 3 Kediri. We used observational analytic study with cross sectional design through
questionnaires and blood sampling using HB Stick from 171 girls in Junior High School aged 10 - 19 years.
The result showed 78 respondents (45.6%) had anaemia and 93 respondents (54.4%) did not experience
anaemia. From the analysis, there was a correlation of Menarche age (p 0.036; OR 0,574; CI 0.342-0,964),
father education (p 0.027; OR 0.309; CI 0.109-0.877), parents income (p 0.026; OR 0.119; CI 0.018-0.776),
Menstruation cycle (p 0.000; OR 0.098; CI 0.031-0.318) and Duration of Menstruation (p 0.031; OR 0.348;
CI 0.129-0.904) with the incidence of anaemia. There was no correlation between eating habits (p 0.999;
OR 0.999; CI 0.000) with the incidence of anaemia. Iron supplementation and support from family, school
and community health center was necessary to prevent anaemia in adolescent girls.
1 INTRODUCTION
Anaemia is a major public health problem
worldwide and is often ignored in both developed
and developing countries. Preschool children,
pregnant women and adolescents constitute
vulnerable group of anaemia (Deshpande et al.,
2013). Adolescence, a period of transition between
childhood and adulthood, occupies a crucial position
in the life of human beings. This period is
characterized by an exceptionally rapid rate of
growth (Nelima, 2015)
The global youth population face a series of
serious nutritional challenges that not only affect
their growth and development but also their
livelihood as adults. However, adolescents remain
dormant, difficult to measure and difficult to reach
population, where the needs of adolescent girls in
particular, are often ignored. Anaemia in adolescent
girls contributes to maternal and fetal death and
future morbidity (Upadhye and Upadhye, 2017)
Fe deficiency anaemia is a common problem in
the world with a prevalence of 9% in infants, 9-11%
in girls, and less than 1% in young men (Marcdante
and Kliegman, 2015). Other study showed 25% of
adolescent students in the world are suffering from
iron deficiency anaemia (Whitfield, Bergmann and
Lazarchick, 2015). Fe deficiency occurs in both
developing and developed countries with nutritional
problems. In response, the World Health
Organization (WHO) aims to reduce anaemia in
women of childbearing age by up to 50% in addition
to children's initiatives targeted by 2025 (WHO et
al., 2011). The proportion of anaemia in non-
pregnant women in Indonesia resulted in Riskesdas.
A cut off point reference used for women of
reproductive age 15-49 years old with anaemia is
when Hb <12.0 g / dL. Data available on urban-rural
areas (Badan Pusat Statistik, 2016). This study aim
is to determine factors that affect the incidence of
anaemia in adolescent girls in Junior High School.
2 METHODS
2.1 Participant
The study was conducted in Junior High School 3
urban areas of the northern city of X aged 10 years -
19 years and has not married as many as 171 girls.
Adolescence is defined by WHO as period of life
spanning the ages between 10-19 years which is a
Prihanti, G., Fadli, N., H. S. P., G., D. I., P. and Hidayati, F.
Factors Analysis of Anaemia in Adolescent Girl.
DOI: 10.5220/0009124201130118
In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 113-118
ISBN: 978-989-758-462-6
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
113

period where both physical as well as psychological
changes occur (Jawarkar et al., 2015)
2.2 Research Procedure
This research was analytic observational with cross
sectional design to collect population data through
questionnaire and blood sampling using HB Stick.
For interpretation of anaemia, cut-off point for
hemoglobin level taken was < 12g/dl (Kaur,
Deshmukh and Garg, 2006). The questionnaire
consists of 26 questions to know the student
knowledge about anaemia (causes of anaemia,
anaemia sufferers, anaemia symptoms). It is said
good knowledge with scores above 12, and said less
knowledge with a total score of less than 12.
Feeding habits assessed by questionnaire contained
9 questions about the number of meals per day, diet,
iron supplements, vitamins, and coffee or tea habits.
Rating by category: less (<7), moderate (7-8), good
(> 8).
3 RESULTS AND DISCUSSION
Based on table 1 of 171 respondents found that most
respondents aged 10-12 years as many as 51
respondents (29.9%) and respondents aged 13-16
years as many as 120 respondents (70.1%)
Table 1: Adolescent girls age frequency distribution.
Age N %
10-12 years
51 29.9%
13-16 years
120 70.1%
16-19 years
0 0%
Total
171 100%
Table 2: Frequency distribution of haemoglobin level
characteristics.
HB levels N %
Anaemia 78 45.6
Non Anaemia 93 54.4
Total 171 100%
Based on table 2 of 171 respondents obtained 78
respondents (45.6%) had anaemia and 93
respondents (54.4%) did not experience anaemia.
Table 3: Frequency distribution of parental education
characteristics.
Parents
education
Father
%
Mother
%
>9 years 127
74.3
105
61.4
<9 years 44
25.7
66
38.6
Total 171
100%
171
100%
Based on table 3 of 171 respondents found that
education over 9 years in the father 127 respondents
(74.3%) and mother 105 respondents (61.4%) and
education less than 9 years in the father 44
respondents (25.7%) and mother 66 respondents
(38.6%).
Table 4: Frequency distribution characteristics of parent
income.
Parents income N %
≥ Rp 1.758.000,00 142 83.0
< Rp 1.758.000,00 29 17.0
Total 171 100,0
Based on table 4 of 171 respondents found that
the income of parents ≥ Rp 1.758.000,00 as many as
142 respondents (83.0%) and <Rp 1.758.000,00 of
29 respondents (17.0%).
Table 5: Frequency distribution of respondent knowledge
characteristics.
Respondents knowledge N %
Good 62 36.3
Low 109 63.7
Total 171 100,0
Based on table 5, of 171 respondents found that
most respondents have less knowledge about
anaemia as much as 109 persons (63.7%) and good
knowledge about anaemia that was as much as 62
persons (36.3%).
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Table 6: Frequency distribution of menstrual pattern
characteristics.
Menstruation pattern N %
Menarche Age
(<11 years)
14 8.2
(≥11 years) 157 91.8
Menstrual cycle
(Regular)
74 43.3
(Irregular) 97 56.7
Duration of menstruation
(≤ 8 days)
88 51.5
(>8 days) 83 48.5
Total 171 100,0
Based on table 6 of 171 respondents found that
the menarche age is less than 11 years as many as 14
respondents (8.2%) and more than the same as 11
years as many as 157 respondents (91.8%). Regular
Cycle of 74 respondents (43.3%) and irregular as
much as 97 (56.7%). The time of menstruation was
less than equal to eight days as many as 88 (51.5%)
and more than 8 days as many as 83 (48.5%)
Table 7: Frequency distributions of eating habits
characteristics.
Eating habits N %
Good 72 42.1
Moderate 91 53.2
Defisit 8 4.7
Total 171 100,0
Based on table 7, of 171 respondents found that
good eating habits as much as 72 respondents
(42.1%), while 91 respondent (53.2%) and deficit of
8 respondents (4.7%).
Table 8: Resumes of bivariate analysis.
Variable p Explanation
Father education 0.000
Significant
(p< 0,05)
Maternity education 0.000
Significant
(p< 0,05)
Parents income 0.000
Significant
(p< 0,05)
Respondents
knowledge
0.000
Significant
(p< 0,05)
Menarche Age 0.201
Not Significant
(p>0,05)
Menstruation cycle 0.000
Significant
(p< 0,05)
Duration of
menstruation
0.000
Significant
(p< 0,05)
Eating habits 0.000
Significant
(p< 0,05)
Based on Table 8, the result of chi-square test in
bivariate analysis shows that there are seven
variables which have significant influence on the
incidence of anaemia in adolescent girls, include
education of father and mother (p = 0,000), parent
income (p = 0,000), Respondent's knowledge (p =
0.000), menstrual cycle (p = 0.000), duration of
menstruation (p = 0.000), and eating habits (p =
0.000) while those who have no effect on the
occurrence of anaemia are menarche age (p =
0,201).
Adolescence is a transition phase of life from
childhood to adulthood. This phase of life is
vulnerable to nutritional deficiency due to the
increased nutritional demands for growth and
development (Limbu et al., 2017). Iron requirement
is higher among girls because of the increased need
for blood volume expansion associated with
accelerated adolescent growth and menstrual onset.
Anaemia in this age group is a major concern
because it has direct and immediate effects on
productivity, cognitive function, decreases school
performance and decreases physical work capacity.
Table 9: Multivariate analysis binary logistic regression test.
Variable Β Wald Sig OR CI 95%
Menarche Age -0.554 4.397 0.036 0.574 0.342:0.964
Father education 1.173 4.873 0.027 0.309 0.109-0.877
Parents income -2.128 4.951 0.026 0.119 0.018-0.776
Mentruation cycle -2.318 15.027 0.000 0.098 0.031-0.318
Duration of Menstruation -1.074 4.677 0.031 0.348 0.129-0.904
Eating habits (1) -19.383 0.000 0.999 0.999 0.000
Eating habits (2) -20.903 0.000 0.999 0.999 0.000
Constant 30.899
Factors Analysis of Anaemia in Adolescent Girl
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This condition also has an indirect effect on the
future economy of the individual then the nation.
(Nelima, 2015). Iron deficiency anaemia (IDA)
constitutes the major anaemia during adolescent
period. Accelerated development, hormonal
changes, malnutrition and starting of menstrual
periods in girls are major causes in this period (Balci
et al., 2012).
Published risk factors for Iron deficiency
anaemia (IDA), including race, poverty, education,
low iron intake, heavy menses, parity, and a
previous diagnosis of IDA, are based on all women
of reproductive age, variably defined between 12
and 49 years. Adolescent women differ in many
ways from older reproductive-age women, including
nutritional requirements, duration of menses, and
contraceptive use (Sekhar et al., 2016)
Parents education in this research was divided
into two categories: low education if formal
education was taken <9 years (not finished primary
school or not finished Junior High School) and
higher education if formal education was taken ≥ 9
years (Graduated from Junior High School or
graduate high school or college finish) . According
to research conducted by (Gedefaw et al., 2015)
father education status had a significant correlation
to the prevalence of the incidence of anaemia in
school-age adolescents have a 9.03 times greater
chance of anaemia than teenagers who have a father
with upper secondary education. This was because
the father played an important role for good family
decisions that related to with adolescent health. On
the other hand, an educated father will also get a job
with the appropriate salary and can apply a healthy
lifestyle.
Maternal education played a role in building
family health, well-educated mothers would find it
easier to receive health information, both in food and
in childcare. Maternal inquiry was the main capital
in supporting the family economy also play a role in
preparing family food, as well as the care and care of
children (Udgiri et al., 2010). The result of this
study in accordance with (Srivastava, Kumar and
Sharma, 2016)which showed statistically significant
association with mother’s educational status and
father’s educational status.
Parent income in this research was the amount of
income of father and mother based on UMR
(Regency Minimum Wage) of 1.7 million rupiah.
Result of study by (Farida, Widajanti and Pradigdo,
2013) about parent income where value (p = 0,001),
which mean parent income was one of factor that
determine the quality and quantity of food. The
study results from (Sachan et al., 2012) suggest that
the socioeconomic status of the family and
traditional eating habits are of great importance in
the development of anaemia.
A person's eating behaviour in this case was
influenced by many things, including family income.
What foods teenagers consume is highly dependent
on what food is served by the family in this case the
mother. This type of food was also highly dependent
on how much money is available for the purchase of
family food (Notoatmodjo, 2007).
From this study, the correlation between student
knowledge and anaemia in accordance with the
research (Martini, 2015) that there is a relationship
between knowledge with the incidence of anaemia
(p = 0.048 <α = 0.05). Adolescents with knowledge
who are less at risk 2.3 times more likely to develop
anaemia than well-informed teenagers. In addition,
the high proportion of anaemia is also due to
adolescent ignorance while drinking tea after or
along with eating can cause anaemia. For that, it is
necessary efforts of health workers to prevent the
incidence of anaemia by providing counselling about
anaemia and consumption of the right tea drink to
reduce the incidence of anaemia (Martini, 2015)
This study showed different result compared
with (Gupta et al., 2012). In this study, menarche
age had significantly affect the prevalence of
anaemia. Gupta study showed the result that onset of
menarche had no significant effect on the prevalence
of anaemia.
Menstrual cycle and duration of menstruation
affect the incidence of anaemia. According to (WHO
et al., 2011), the high blood loss in women was an
important risk factor that can cause iron deficiency
anaemia in women. Iron out as much as ± 42 mg
every menstrual cycle. While in men or women who
are not menstruating will lose iron by 1 mg per day.
Women with menstrual abnormalities over 8 days
with a history of bleeding and clots during
menstruation have a greater risk (WHO et al., 2011).
From table 9 there is a correlation between eating
habits and the occurrence of anaemia. This research
was in line with (Kaimudin, Lestari and Dkk,
2017)showing that there was a meaningful
relationship between eating habits and the incidence
of anaemia in adolescent girls with the value of p
value = 0.041 (Kaimudin, Lestari and dkk, 2017).
A diet was how a food was obtained, the type of
food consumed, or the frequency of eating from a
person. Diet was often irregular, rarely eat breakfast
or lunch, consequently teenage girls were often limp
and not enthusiastic in the learning process. This is
because at the age of adolescence was often wrong
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diet or limitation of high food contain Fe, mother's
knowledge as a provider of food in the household,
knowledge of young women, environmental
influences, and nutritional status of the teen
(Suryani, Hafiani and Junita, 2017).
A study also found that knowledge of low
anaemia also occurs in Junior High School, this may
be a factor in the lack of nutrient intake with low
iron content. In many studies it was found that the
anaemia is a common problem in adolescent age
group due to intake of low diet and lack of
awareness of nutrition is also main cause of anaemia
(Hafeez et al., 2016)
In many developing countries, one half all
children and adolescents fail to achieve their full
genetic growth potential due to the combined effects
of inadequate nutrition and frequent illness.
Moreover, due to faulty dietary habits, ignorance,
and in a country like India, with a multitude of social
customs and beliefs cited against women, the
prevalence of malnutrition amongst girls remains
quite high (Deshpande et al., 2013).
It is important to give iron therapy for young
girls who have anaemia. Iron therapy can lead to
gastrointestinal discomfort, constipation, and
bloating which, oftentimes, make patients self-
discontinue (Whitfield, Bergmann and Lazarchick,
2015). This could affect the compliance of the iron
therapy for young girls who have anaemia. Study
from (Joshi and Gumashta, 2013)strongly
recommends the ‘Weekly Iron Folic Acid
Supplementation’ regime mainly through school
health programme, and other similar adolescent
health care service providers (Joshi and Gumashta,
2013)
4 CONCLUSIONS
There exists a need to prevent and cure anaemia
incidence especially in young girls. Health education
especially about anaemia is important for improving
student knowledge about anaemia and eating habits.
Support from community health center, school and
parents are needed. Strengthening and empowerment
young girls are the key to prevent anaemia so could
reach better maternal health in the future.
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