Improvement of Knowledge on Iron Deficiency Anemia and Its

Prevention among Bustanul Athfal Teachers in Malang

Diah Hermayanti*, Meddy Setiawan and Hawin Nurdiana

Faculty of Medicine, University of Muhammadiyah Malang

Jalan Bendungan Sutami 188A Malang 65145 East Java, Indonesia

Keywords:

Iron deficiency anemia, knowledge, prevention

Abstract:

Iron deficiency anemia is still one of the national nutritional problems in Indonesia. This anemia mainly

affects women and children. In woman, increased of iron is due to pregnancy, childbirth, and breastfeeding.

In infants and children this due to their needs for growth. Iron deficiency anemia is also influenced by

socio-economic factors, mal absorption, and infection. In this study, a deficiency anemia prevention

training was conducted among Busthanul Athfal Teachers in Malang. This studiy is aimed to compare the

average knowledge about iron deficiency anemia and its prevention before and after training. The research

was conducted with training activities, pretest and posttest. Data was analyzed by comparative analytic

paired t-test. The questionnaire was filled by 46 respondents. The average value of the pretest knowledge

was 47.8, and the test post was 75.2. Result of data analysis on different test was 0,000 (p <0.05). There

was an increase in knowledge about iron deficiency anemia and its prevention. There was an increase in

knowledge about iron-deficiency anemia and its prevention after training among Busthanul Athfal Malang

teachers.

1 INTRODUCTION

The World Health Organization (WHO) reported that

in 2011, there were an estimated 800 million children

and women who developed anemia. The highest

prevalence occurred in children at 42.6% and

pregnant women at 38.2%. In Indonesia, the

prevalence of anemia occurs in 32% of children aged

6-59 months, 22% in non-pregnant women aged 15-

49 years, 30% in pregnant women aged 15-49 years

(WHO et al., 2011; World Health Organization,

2015).

In Indonesia, Riset Kesehatan Dasar (Riskesdas)

in 2013 reported that the prevalence of anemia at age>

1 year was 27.1%. Based on the age group, it was

found that anemia in children under five was quite

high at 28.1%, and pregnant women around 37.1%

(Kementrian Kesehatan Republik Indonesia, 2019).

Efforts should be made to reduce the prevalence

of iron deficiency anemia. The strategic activity is

training on Busthanul Atfal teachers in Malang,

because every day they interact with toddlers and

their parents. After this training, it is expected to be

able to transfer knowledge to parents of students, and

pay more attention to giving iron-rich nutrition to

their students. The obstacle is that the knowledge

about iron deficiency anemia and its prevention is not

good. This activity was carried out by increasing their

knowledge of iron deficiency anemia and its

prevention, and the introduction of a variety of iron-

rich foods.

Anemia occurs when hemoglobin (Hb) levels are

below 13.0 g / dl in adult men, below 12.0 g / dl in

non-pregnant women, and below 11.0 g / dl in

pregnant women (World Health Organization, 2015).

The erythrocytes morphology in iron deficiency

anemia appear microcytic hypo chrome characterized

by a decrease in the mean corpuscular hemoglobin

(MCH) index and mean corpuscular volume (MCV),

there is a decrease in transferrin saturation below 20%

and ferritin below 30 mg / ml (Jimenez, Kulnigg-

Dabsch and Gasche, 2015). On blood smear,

erythrocytes appear hypochromic microcytic,

anisocytosis-poicylocytosis, target cells and pencil

cells. Erythroblasts in the bone marrow show crude

irregular cytoplasm and the absence of iron reserves,

but bone marrow is usually not used for diagnosis

(World Health Organization, 2015; DeLoughery,

2017).

Hermayanti, D., Setiawan, M. and Nurdiana, H.

Improvement of Knowledge on Iron Deﬁciency Anemia and Its Prevention among Bustanul Athfal Teachers in Malang.

DOI: 10.5220/0009127302010204

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 201-204

ISBN: 978-989-758-462-6

201

Iron deficiency anemia will only occur when the

body's iron reserves are very low and not enough to

produce erythrocyte cells. The etiology of iron

deficiency anemia can occur due to low iron in diet,

blood loss (excessive menstrual blood, blood loss

after childbirth, diseases that cause chronic blood

loss) and low absorption of iron in the intestine

(Chron's disease, gastric bypass, worms, or the

presence of substances that inhibit iron absorption in

food (Harper et al., 2007; Jimenez, Kulnigg-Dabsch

and Gasche, 2015).

The initial symptoms of iron deficiency, often in

the form of weakness and restless leg syndrome. The

anemia will occur if the iron deficiency continues and

a negative balance arises between iron input and its

use. (Jimenez, 2015). The symptoms of anemia may

not be specified in the form of paleness, fatigue,

dizziness, sensitivity to light, shortness of breath,

anorexia, and headache (DeLoughery, 2017; Wong,

2017). There are also symptoms such as brittle and

jagged nails (koilonikia), mouth sores (angular

ciliosis), red and swollen tongue (glossitis), abnormal

appetite (pica), thinning hair, pharyngeal looking like

a nest (Patrson-Kelly syndrome) (Reynolds et al.,

1968; Korman, 1990; Borgna-Pignatti and Zanella,

2016)

The management of iron deficiency anemia

depends on their etiology (Goddard et al., 2011;

Pavord et al., 2012). It is necessary to manage the

underlying primary disease, provide iron

supplements, a diet of rich iron-containing foods, and

avoid consuming food along with other foods that

contain other ingredients that inhibit iron absorption

(Harper et al., 2007; Jimenez, Kulnigg-Dabsch and

Gasche, 2015)

Iron is a mineral that is very important in the

synthesis of hemoglobin in erythrocytes. Iron in food

from animal sources (home iron) is two to three times

higher absorbed by the intestine than non-home iron

(Verena T, 2017; Kaufman C, 2016). Some of the best

sources of iron are lean beef, oysters, chicken, and

turkey. Although iron absorption from plant sources

is lower, consumption of iron-rich plants can be

combined with vitamin C to increase iron absorption.

Some plants that are rich in iron are: nuts, tofu, baked

potatoes, cashews, dark green vegetables like

spinach, fortified cereals, fortified wheat bread

(Zimmermann and Hurrell, 2007)

Some foods can inhibit iron absorption, so it is

recommended to eat it not at the same time or not

close to the time with food sources of iron. These

foods include: foods that contain phytate or phytic

acid are found in grains, cereals, soybeans, and nuts,

foods that are high in calcium, such as in dairy

products and calcium supplements, and foods that

contain polyphenols, such as tea and coffee (Hurrell,

2009).

The iron deficiency anemia caused by dietary

factors can be prevented by consuming food in a

balanced composition and consuming iron-based

foods. The combination of vegetable food sources of

iron with vitamin C also prevents iron deficiency by

increasing its absorption capacity. An example is a

combination of spinach with lemon juice, fortified

cereals with berries, etc. (Zimmermann and Hurrell,

2007; Hurrell, 2009). Another prevention is to avoid

consumption together or in the close time meal

between food sources of iron and those that inhibit

absorption such as food from dairy products, or coffee

(Zimmermann and Hurrell, 2007; Hurrell, 2009).

2 METHODS

The study was conducted at the Busthanul Athfal

Aisyiyah Malang Teachers Association, after being

given training in knowledge and prevention of iron

deficiency, followed by pretest and posttest. Data

were analyzed using a comparative pairing t-test.

3 RESULTS AND DISCUSSION

The training was held on February 26, 2019, at TK

Aisyiyah Busthanul Athfal X, Jl. Manyar 29 Malang.

Sixty-three respondents attended it, but 46

respondents only filled the questionnaire. The pre-test

average value was 47.8, and the test post was 75.2. T-

test results 0,000 (p <0.05). The pre-test value appears

low and increases after training. The results show a

significant increase in respondents’ knowledge.

From the study, respondents were mostly aware of

the causes of iron deficiency anemia. After training,

the respondents who answered incorrectly declined

from 6.5% to 2.2%. The respondents were not aware

of the most frequent age group affected by iron

deficiency anemia, but after training those who

answered incorrectly appeared to decline from 95.7%

to 87%. The respondents were less aware of

symptoms of iron-deficiency anemia. After training,

there was an increase from 69.6% to 91.3%. Most

respondents did not know about foods that contain a

lot of iron (91.3%). After training, those who did not

know were reduced (21.7%). Respondents who knew

the cause of iron deficiency anemia after training

78.3%.

HSIC 2019 - The Health Science International Conference

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Figure 1: Chart of average pretest and post-test value

Table 1: Pretest and posttest questionnaire answer.

Question

Answer (%)

Wrong

Right

What cause of iron deficiency anemia?

Pretest

6,5

93,5

Posttest

2,2

97,8

What is the common age group with iron deficiency anemia

Pretest

95,7

4,3

Posttest

What is the symptom of iron deficiency anemia?

Pretest

30,4

69,6

Posttest

8,7

91,3

What food is the most contain a lot of iron?

Pretest

91,3

8,7

Posttest

21,7

78,3

What food can inhibit iron absorption

Pretest

34,8

65,2

Posttest

2,2

97,8

Respondents who knew the food that could inhibit

iron absorption, only 65.2% increased to 97.8% after

training. After the training, it appeared that

respondents became more aware of the symptoms of

iron deficiency anemia, the types of foods that contain

a lot of iron, and foods that inhibit iron absorption.

However, respondents were still not aware of the

most frequent group affected by anemia, and possibly

the respondents were not in a state of full

concentration (Goddard et al., 2011; Jimenez,

Kulnigg-Dabsch and Gasche, 2015).

4 CONCLUSIONS

The early knowledge of Malang Aisyiyah Busthanul

Athfal Teacher about iron deficiency anemia and its

prevention is still low. After the training activities,

there was an increase in knowledge about iron

deficiency anemia and its prevention. It is necessary

to feedback to the respondents regarding the results

of the questionnaire about the most frequent groups

that have this disease, so that they know and are more

aware to prevent iron deficiency anemia in their

students.

Pre-test Post-test

Improvement of Knowledge on Iron Deﬁciency Anemia and Its Prevention among Bustanul Athfal Teachers in Malang

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