Nutritional Knowledge, Social Support, and the Incidence of Anemia

in Adolescent Girls in Junior High School Alam Lampung

Anisa Nuraisa Jausal

, Giska Tri Putri, Maya Ganda Ratna and Faridi Pani

Medical Education, Faculty of Medicine, Lampung University, Bandar Lampung, Indonesia

Keywords: Adolescent Girls, Anemia, Nutritional Knowledge, Social Support.

Abstract: Anemia is a condition of hemoglobin levels less than normal, which is prone to occur in adolescent girls due

to the menstrual cycle that occurs every month. In addition, dietary habits also affect hemoglobin levels of

adolescent girls. Dietary habits are also influenced by nutritional knowledge and social support from their

peers. This study aims to determine the association between nutritional knowledge and social support on the

incidence of anemia in adolescent girls. This study is an observational analytical study using the cross-

sectional method, with 12 respondents (total sampling) grade 7, 8, and 9 at Junior High School Alam Lampung.

Data collection of nutrition knowledge and social support was carried out by filling out questionnaires by

respondents, while blood capillaries sampling for hemoglobin measurement were done by researchers using

hemoglobin meters. The results of the study found that the average Hb respondents were 13.5mg / dl, there

were 2 respondents (16.7%) who had anemia, as many as 6 respondents had good nutritional knowledge

(50%), and as many as 7 people (58.3%) had good social support. There was no significant association

between the incidence of anemia and nutritional knowledge (p value: 0.12) or social support (p value: 0.79).

1 INTRODUCTION

Anemia is a condition where the levels of red blood

cells or hemoglobin in the body are below normal

levels according to age and physiological state of the

body. Adolescent girls have high risk of anemia

because of their rapid growth and development,

menstruation, poor dietary habits, peer pressure and

dieting. Based on the PRECEDE behavioral theory by

Lawrence Green, there are 3 factors that influence

health behavior, including predisposing, enabling

and reinforcing. Health behavior will affect the

incidence of anemia, predisposing factors that affect

the incidence of anemia one of them is iron

consumption (Junengsih dan Yuliasari, 2017),

knowledge (Yunita et al., 2020) and attitude (Listiana,

2016). Meanwhile the enabling factors that influence

the incidence of anemia is the availability of family

iron sources, and the strengthening factors are

maternal nutrition knowledge, maternal nutritional

attitudes, maternal nutritional behavior (Zuraida,

2020) as well as social support (Sri Raharjo dan

Indrayanti, 2021). In this study, researchers will look

for a relationship between adolescent girls'

knowledge and social support on the incidence of

anemia in junior high school Alam Lampung.

2 METHODS

This research is an observational analytical research

with cross sectional method. The population in this

study is 12 adolescent girls in grades VII, VIII and IX

(age 12-14 years old) at Junior High School Alam

Lampung, all population are taken as research sample

(total sampling method). Data was collected by filling

out questionnaires by respondents [18 points

nutritional knowledge questionnaire modified from

Zuraida (2020) and 7 points social support

questionnaire Duke-UNC FSSQ].

Figure 1: Questionnaire filling by the respondent

234

Jausal, A. N., Putri, G. T., Ratna, M. G. and Pani, F.

Nutritional Knowledge, Social Support, and the Incidence of Anemia in Adolescent Girls in Junior High School Alam Lampung.

DOI: 10.5220/0013668500003873

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Medical Science and Health (ICOMESH 2023), pages 234-237

ISBN: 978-989-758-740-5

Blood sampling taken directly by researchers,

conducted from distal blood capillaries with digital

measurement. This research has received ethical

approval from the Health Research Ethics

Commission of the Faculty of Medicine, University

of Lampung No. 1754/UN26.18/PP.05.02.00/2023.

Figure 2. Blood sampling

3 RESULTS AND DISCUSSION

3.1 Anemic Status of Adolescent Girls

The results of hemoglobin (Hb) levels of adolescent

girls of JHS Alam Lampung students were obtained

on average 13.5 mg / dl with the lowest level of 9.3

mg / dl and the highest 20.4 mg / dl/. Hb levels that

exceed 20mg / dl can be caused by several things such

as dehydration, chronic hypoxia, or other conditions

that produce excess erythropoietin, so a physical

examination and further support are needed to

determine the cause of the excess Hb levels. Based on

the examination from the 12 respondents, 10

adolescent girls who did not have anemia and 2

adolescent girls who had anemia (Table 1).

Table 1. Adolescent Girls' Anemia Status

Status n %

Non Anemic 10 83,3

Anemic 2 16,7

Total 12 100,0

The results of this examination showed good things,

because adolescent girls who did not have anemia

reached 83.3%. Normal haemoglobin levels indicate

a good level of health, because it is assumed that

oxygen transport and tissue oxygenation occur

optimally, so that energy production and other body

functions occur optimally (Ahmed et al., 2020).

Normal haemoglobin levels can be maintained by

ensuring a diet that contains balanced nutrition in

accordance with the portion of "isi piringku" for

adolescents (Kemenkes, 2023) shown in Figure 3.

Figure 3. Balanced Nutrition in Adolescents (Kemenkes,

2023)

The fulfilments of iron needs during adolescence not

only improves the reproductive health of adolescent

girls but will also have an impact until the adolescent

is an adult, especially during pregnancy and

childbirth (UNICEF, 2020). Adequate iron reserves

will minimize the occurrence of anemia in pregnant

women, so that the growth of the fetus conceived will

occur optimally and reduce the risk of low birth

weight and the incidence of stunting in the child itself

(Das et al., 2018). At the time of labor, the risk of

bleeding will be more minimal and postpartum

recovery will occur more optimally (Camaschella,

2019).

In addition to a diet that is in accordance with

balanced nutrition, haemoglobin levels can also be

maintained with the addition of iron supplements.

Based on information provided by JHS Alam

Lampung, students of junior and senior high school

Alam Lampung and Senior High School are routinely

given the iron supplements by the local Healthcare

Facility (Puskesmas Karang Anyar, Lampung

Selatan). However, no further attention has been paid

to the compliance of female students in consuming

the iron supplements itself.

3.2 Nutritional Knowledge of

Adolescent Girls

The results of research on nutritional knowledge of

adolescent girls obtained through filling out

questionnaires with 18 questions found that

adolescent girls who had good and less nutritional

knowledge each amounted to 6 people per category

(Table 2). The question items answered correctly in

the modified questionnaire from the Zuraida (2020)

Nutritional Knowledge, Social Support, and the Incidence of Anemia in Adolescent Girls in Junior High School Alam Lampung

235

questionnaire that contained questions regarding

nutrition slogans, balanced nutrition messages,

menus with balanced nutrition according to the

contents of my plate, animal protein sources, energy

adequacy for young women, menus with high iron

content, and foods that help or inhibit iron absorption.

Table 2. Results of Adolescent Girls’ Nutritional

Knowledge

Nutritional Knowledge n %

Great 6 50

Less 6 50

Total 12 100,0

These results show that adolescent girls who

have good nutrition knowledge have reached 50%,

this achievement level is quite good, considering the

characteristics of respondents, namely the age of

adolescent girls as respondents to this study ranged

from 12-14 years. Great nutritional knowledge will

support adolescents to have a more nutritious diet and

food selection, know the daily energy needs of

adolescents in order to balance between food intake

and physical activity needed so that ideal body weight

is maintained, manage reproductive health and

mental (emotional) which will have an impact on

good health behaviour (Hamulka et al., 2018).

However, nutrition knowledge alone will not

have a significant impact if it is not done in

conjunction with good eating practices (Chung &

Fong, 2018). Adolescent Girls with this age range still

depend on caregivers (mothers) in the process of

preparing daily meals, but it is hoped that with good

nutritional knowledge, adolescent Girls can

independently choose healthier foods, for example

when buying food in the school cafeteria.

3.3 Social Support of Adolescent Girls

Based on the results of research on adolescent girls'

social support, it was found that as many as 7

adolescent girls had great social support and 5

adolescent girls had less social support (Table 3). The

results of this examination showed good things,

because adolescent girls who had great social support

reached 58.3%.

Table 3. Results of Adolescent Girls’ Social Support

Social Support n %

Great 7

58,3

Less 5

41, 7

Total 12 100,0

Social support can be interpreted as verbal or

actional assistance and attention. Some forms of

social support are emotional support (listening to

complaints, providing encouragement and moral

support), instrumental support (can be in the form of

services, financial assistance or transportation), or

information support (explanation of a matter or

giving advice). Social support can be provided by

family, peers, or teachers at school.

Adolescence is the age of transition from child to

adult, adolescents are easily influenced by something

or someone who is considered to play an important

role in adolescent profit. The role of support from

family, peers and teachers is very influential on the

behaviour of a teenager, including health behaviour.

Adolescents tend to worry about physical changes

along with the puberty phase they experience, with

sufficient support for adolescents will have better

health behaviours, such as peer support to take iron

supplementation tablets (Raharjo & Indrayanti, 2021).

3.4 The Relation of Nutritional

Knowledge, Social Support, and

Anemia Status of Adolescent Girls

Bivariate analysis in this study was conducted to see

the relationship between anemia status and nutritional

knowledge as well as anemia status and social support.

The statistical analysis test used is chi square and

obtained the results as listed in Table 4. The results of

bivariate analysis between anemia status and

nutritional knowledge showed that all adolescent girls

who had great knowledge did not have anemia or had

normal hemoglobin levels, while there were 4

adolescent girls who had less nutritional knowledge

and did not have anemia (66.7%), with a p value

obtained of 0.12, which means that nutritional

knowledge did not have a significant relationship

with anemia status.

Table 4. Results of Bivariate Analysis

Anemic Status

value

Non-

Anemic

n % n %

Nutritional

Knowledge

Grea

6 100 0 0

0,12

Less 4 66,7 2 33,3

Total 10 2

Social

Support

Grea

6 85,7 1 14,3

0,79

Less 4 80 1 20

Total 10 2

ICOMESH 2023 - INTERNATIONAL CONFERENCE ON MEDICAL SCIENCE AND HEALTH

236

These results show that although adolescent girls

have less nutritional knowledge, not necessarily these

adolescents have low haemoglobin levels, because

haemoglobin levels not only depend on good

nutritional knowledge, but are also influenced by

daily food intake containing balanced nutrition

(Kemenkes, 2014), iron supplements consumption

(Rahmiati, 2019), as well as the illness experienced

by a teenager (Camaschella, 2019).

The results of bivariate analysis between anemia

status and social support showed that of 7 adolescent

girls who had great social support, there were 6

(85.7%) adolescent girls who did not have anemia or

had normal haemoglobin levels and 1 person (14.3%)

who had anemia, while of 5 adolescent girls who had

less social support there were 4 people (80%) who did

not have anemia or had normal haemoglobin levels,

and 1 person (20%) who had anemia, with a p value

of 0.79 which means there was no significant

relationship between social support and anemia status.

4 CONCLUSION

Based on research that has been conducted on

adolescent girls of Junior High School Alam

Lampung, the following conclusions were obtained:

1. The results of anemia status found that as many

as 10 people (83.3%) are non anemic and 2

people (16.7%) are anemic.

2. The results of nutritional knowledge found that

as many as 6 people (50%) had great nutritional

knowledge and 6 people (50%) had less

nutritional knowledge.

3. The results of social support found that as many

as 7 people (58.3%) had great social support and

5 people (41.7%) had less social support.

4. There was no significant association between

anemia and nutritional knowledge with p value:

0.12.

5 There was no significant association between

the incidence of anemia and social support with

p value: 0.79.

REFERENCES

Ahmed, M. H., Ghatge, M. S., & Safo, M. K. 2020.

Hemoglobin: Structure, Function and Allostery (Vol.

94). https://doi.org/10.1007/978-3-030-41769-7

Camaschella, C. 2019. Iron deficiency. Blood, 133(1), 30–

39. https://doi.org/10.1182/blood-2018-05-815944

Chung, L. M. Y., Fong, S. S. M. 2018. Role of behavioural

feedback in nutrition education for enhancing nutrition

knowledge and improving nutritional behaviour among

adolescents. Asia Pacific Journal of Clinical Nutrition,

27(2),466–472.

https://doi.org/10.6133/apjcn.042017.03

Das, J. K., Lassi, Z. S., Hoodbhoy, Z., & Salam, R. A. 2018.

Nutrition for the Next Generation: Older Children and

Adolescents. Annals of Nutrition and Metabolism,

72(suppl 3), 56–64. https://doi.org/10.1159/000487385

Hamulka, J., Wadolowska, L., Hoffmann, M.,

Kowalkowska, J., & Gutkowska, K. 2018. Effect of an

education program on nutrition knowledge, attitudes

toward nutrition, diet quality, lifestyle, and body

composition in polish teenagers. The ABC of healthy

eating project: Design, protocol, and methodology.

Nutrients, 10(10). https://doi.org/10.3390/nu10101439

Junengsih, & Yuliasari. 2017. Hubungan Asupan Zat Besi

Dengan Kejadian Anemia Pada Remaja Putri SMU 98

di Jakarta Timur. Jurnal Ilmu Dan Teknologi Kesehatan,

5(1), 55–65. https://doi.org/10.32668/jitek.v5i1.68

Kementrian Kesehatan (Kemenkes) Republik Indonesia.

2014. Pedoman Gizi Seimbang. Pedoman Gizi

Seimbang, 1–99.

Kementrian Kesehatan (Kemenkes) Republik Indonesia.

2023. Gizi Seimbang Pada Remaja. Retrieved

September 28, 2023 via

https://yankes.kemkes.go.id/view_artikel/2487/gizi-

seimbang-pada-remaja

Listiana, A. 2016. Analisis Faktor-Faktor yang

Berhubungan dengan Kejadian Anemia Gizi Besi Pada

Remaja Putri di SMKN 1 Terbanggi Besar Lampung

Tengah. Jurnal Kesehatan, 7(3), 455-469.

Raharjo, D. S., Indrayanti. 2021. Dukungan Peer Group

Terhadap Kepatuhan Konsumsi Minum Obat Tablet

Tambah Darah Pada Remaja Putri Di Sma N 1

Banguntapan Tahun 2020. Journal of Health (JoH),

8(1), 36–41. https://doi.org/10.30590/joh.v8i1.226

Rahmiati, B. F. Naktiany, W. C. Ardian, J. 2019.

Effectiveness of Nutritional Education Intervention in

Iron Suplementation Programs on Knowledge Attitude

And Behavior. Jurnal Gizi Dan Kesehatan, 3(2), 47–51

Sri Raharjo, D., Indrayanti. 2021. Dukungan Peer Group

Terhadap Kepatuhan Konsumsi Minum Obat Tablet

Tambah Darah Pada Remaja Putri Di Sma N 1

Banguntapan Tahun 2020. Journal of Health (JoH),

8(1), 36–41.

United Nations Foundation (UNICEF). 2023. Retrieved

September 28, 2023 via

https://www.unicef.org/indonesia/nutrition/coronaviru

s/stories/keeping-anaemia-at-bay

Yunita, F. A., Parwatiningsih, S. A., Hardiningsih, M.,

Nurma Yuneta, A. E., Kartikasari, M. N. D., &

Ropitasari, M. 2020. Hubungan Pengetahuan Remaja

Putri Tentang Konsumsi Zat Besi Dengan Kejadian

Anemia di SMP 18 Surakarta. Placentum: Jurnal Ilmiah

Kesehatan Dan Aplikasinya, 8(1), 36.

Zuraida, R. 2020. Model Promosi Kesehatan CBA (Club

Bebas Anemia) Sebagai Model Intervensi

Penanggulangan Anemia Gizi Besi Berbasis Sekolah

Pada Remaja Putri.

Nutritional Knowledge, Social Support, and the Incidence of Anemia in Adolescent Girls in Junior High School Alam Lampung

237