p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol.
2 No. 6 June 2023
RELATIONSHIP OF ADHERENCE TO FE TABLET CONSUMPTION IN
YOUNG WOMEN
Catur Retno Lestar,
Siti Nurjanah
Faculty of
Health, Universitas Ivet, Semarang, Indonesia
Email: caturretno.lestari@gmail.com,
stnrjnhhh82@gmail.com
Abstract
The prevalence
of anemia in young women is still quite high. Young women have a ten times
greater risk of suffering from anemia than young men. This is because young
women experience menstruation every month and are still growing so they need
more iron intake. In addition, an imbalance in nutrient intake is also a cause
of anemia in adolescents. This study was to analyze the relationship between
adherence in consuming Fe tablets and the incidence of anemia in young women
aged 16-19 years. This research is an analytic correlation with cross-sectional
approach. The sampling technique used a random sampling technique. The sample
in this study was 35 respondents. Data were analyzed with univariate and
bivariate analysis tests with the chi-square test. The results of the study
showed that most of the respondents (57.9) were disobedient in taking iron
tablets. Respondents who experienced anemia were 68.4% and respondents who did
not have anemia were 23.7%. There is a relationship between compliance with
blood supplement consumption and the incidence of anemia in young women at SMKN
1 Kokap in 2020 with a p-value = 0.013 (<0.05).
Conclusion: There is a relationship between adherence to blood supplement
consumption and the incidence of anemia.
Keywords: Anemia of young
women; Compliance; Fe tablets
INTRODUCTION
Adolescence is a period when
individuals experience development by showing secondary sexual signs until
reaching sexual maturity in the age range of 10-19 years (World Health Organization, 2016). Adolescence is the transition
from childhood to adulthood. Adolescence
occurs rapid growth including reproductive function so that it affects changes
in development both physical, mental and social roles (Kusumawati et al. , 2018) . Anemia is currently a
nutritional problem in developing countries including Indonesia. The incidence
of adolescent anemia is currently 48.9% while the number of consumption of
blood-added tablets < 52 grains is 98.6% and those who consume ≥ 52 grains
are 1.4% (Ministry of Health RI, 2019). Thelack of compliance and increasing anemia
in adolescents is a problem that needs to be addressed immediately, considering
that adolescent girls are prospective mothers who will later become pregnant
and produce offspring from a generation, so that if left untreated it will
increase the risk of maternal death, premature birth and low birth weight
(BBLR) (Putrianingsih et al. , 2022) . The Ministry of Health through
the Director General of Public Health issued a circular No.
HK.03.03/V/0595/2016 concerning the administration of blood-added tablets to
adolescent girls and women of childbearing age.
The government makes preventive efforts
in cases of anemia by providing blood-added tablets for adolescent girls
and women of childbearing age, especially those who are pregnant. These tablets are given free of charge, while
for fertile women who are not in a pregnant condition are attempted to consume
blood-added tablets independently.
Nutritional knowledge is an understanding of food and nutritional
components, sources of nutrients, foodsthat are safe
for consumption, and the right record to process foodstuffs, as well as a
healthy lifestyle (Putri, Simanjuntak and Kusdalinah, 2017). The results of research conducted by (Runiari and Hartati, 2020), the level of knowledge of respondents is most in the fairly good category as
much as 44.3%. It was found that there
were still as many as 21.5% of respondents with poor knowledge. The compliance rate of respondents taking TTD
was 87 people (58.4%) with low compliance and as many as 62 people (41.6%)
moderate compliance. Low knowledge of
anemia nutrition in adolescent girls also has an impact on the high incidence
of anemia. Good nutritional knowledge
about anemia will affect the tendency of adolescent girls to choose food
sources of iron, avoid iron-blocking foods, and adherence to consuming
blood-added tablets (Putri, Simanjuntak and Kusdalinah,
2017). Adolescent girls who have a bad
diet are 1.2 times more likely to suffer from anemia than adolescent girls who
have a good diet (Suryani et al., 2017). The same results were stated by Yuniarti, et
al who said that there was a significant relationship between adherence to
taking Fe tablets and the incidence of anemia in adolescent girls in MA Darul Imad, Tatah Makmur District, Banjar Regency. Adherence to taking Fe
tablets is influenced by two main factors, namely factors from health workers
and factors from oneself such as awareness in consuming Fe tablets (Putra et al., 2020).
Compliance is a change in
behavior from behavior that does not obey the rules. Compliance problems are an
obstacle to daily iron supply, therefore to maintain compliance with iron
supply consumption can be held by trying to consume iron supplements directly
in front of officers, by sending short messages to research samples (Fitriningtyas, Redjeki and Kurniawan,
2017). Some previous studies have shown that factors that influence anemia
include nutritional knowledge, diet and adherence to Fe tablet consumption. The
results of Yuniarti's research (2015) stated that if
nutritional knowledge is combined with iron supplementation for adolescent
girls will produce the most effective increase in hemoglobin levels compared to
nutritional knowledge alone or weekly supplementation for twelve weeks.
Adherence to taking Fe tablets is influenced by two main factors, namely
factors from health workers and factors from oneself such as awareness in
consuming Fe tablets. Adherence in consuming Fe tablets has a significant
relationship with increased hemoglobin levels in junior high school adolescents (Rusmilawaty and Tunggal, 2015). Based on the description above,
the author is interested in seeing whether there is a relationship between
adherence to taking Fe Tablets and the incidence of anemia in Young Women at
SMK Nurul Islami in 2022.
RESEARCH METHODS
The study used Cross Sectional design. The
population is grade III girls of SMK Nuruul Islami. The sample size in this study was 35 adolescent
girls. How to determine the sample by simple random sampling. The
inclusion criteria are
adolescent girls at SMK Nurul Islami, grade III female
students with ages1.6 years to 1.9 years, adolescent girls who consume Fe
tablets for 12 weeks and are willing to be respondents. Compliance data was obtained by looking at
tablet packs and interviewing respondents directly using compliance record forms.
Anemia status is obtained by measuring hemoglobin using a digital hemoglobinometer (Easy
Touch GCHb) with measuring results of 0 (anemia,
< 12 mg / dL ) and 1 (not anemia, 12
mg / dL). Data analysis includes univariate analysis, bivariate analysis using the
Chi-square test.
RESULT AND DISCUSSION
Characteristics of Respondents
Table 1. Frequency Distribution of Respondent Characteristics
|
Characteristics of Respondents |
f |
% |
|
Age |
||
|
16 Years |
1 |
2,9 |
|
17 Years |
23 |
65,7 |
|
18 Years |
9 |
25,7 |
|
19 Years |
2 |
5,7 |
|
Mentruation Cycle |
||
|
Orderly |
31 |
81,6 |
|
Disorganized |
4 |
10,5 |
Based on table 1, it can be seen that from 35 respondents, most
respondents aged 1, 7
years as many as 6.5.7% (23 respondents) and irregular menstrual cycles as much as
88.6% (3, 1 respondents). In this case,
what influences respondents' compliance is the knowledge factor that exists in
respondents. Knowledge is included in predisposing factors which can be an
influence on a person's behavior in consuming Fe tablets as blood-boosting
tablets. This is because knowledge is a factor that dominates a person in
decision making or action (Savitri et al. , 2021) .
Researchers assume that, the age of adolescents 10-19 years is an age of
growth and development that requires more energy, so additional supplements in
the form of Fe tablets are needed to prevent anemia. Normal menstrual patterns last every 21-35
days, while the length of menstrual days can last for 3-7 days. Menstrual cycle
disorders consist of 2 types, namely polymenorrhoea
and oligomenorrhoea. Polymenorrhoea is a menstrual
cycle with a number of days less than 21 days and or blood volume equal to or
more than the usual menstrual blood volume. This disorder indicates a
disturbance in the ovulation process, which is a short luteal phase. Polymenorrhoea causes unovulation
in women because the egg cannot mature so fertilization is difficult. This disorder indicates a disturbance in the
ovulation process, which is a short luteal phase. Polymenorrhoea
causes unovulation in women because the egg cannot
mature so fertilization is difficult. The irregularity of the menstrual cycle
must be treated immediately so that it does not occur prolonged. In someone who
experiences stress, it is recommended to reduce factors that can cause stress
by controlling emotions. By controlling emotions can affect the production of
the hormone cortisol to normal. That way a person will not experience stress
and will affect his menstrual cycle to be regular (Islamy and
Farida, 2019).
Fe Tablet Consumption Adherence
Table 2. Frequency distribution
of respondents based on Fe tablet consumption compliance
|
Fe Tablet Consumption Adherence |
f |
% |
|
Obedient |
13 |
34,2 |
|
Disobedient |
22 |
57,9 |
|
Total |
35 |
100 |
Based on table 2, it can be seen that from3.5 respondents, most respondents are non-compliant in consuming Fe tablets as much
as 57.9% (2, 2 respondents). Adherence
in consuming Blood Added Tablets (TTD) was highest in the group of respondents who were given a
monitoring card in the form of a leaflet, in which the teacher's signature was
found and there was information related to anemia and TTD (Savitri et al. ,
2021) . In addition, it is also influenced by health
workers and the support provided by teachers and parents. The school schedules
for TTD consumption together, this is intended to facilitate the process of
monitoring the progress of students who consume TTD. In line with research conducted by (Widiastuti &
Rusmini, 2019) where the school determines the day for TTD
consumption simultaneously in order to monitor the progress of students
according to TTD consumption. In line
with research (Nuradhiani,
Briawan and Dwiriani, 2017) on the
consumption of blood added tablets (TTD) weekly and during menstruation shows
that consumption is more at weekly times (15%) than during menstruation (5.8%).
The high adherence of weekly TTD consumption compared to during menstruation is
in accordance with several studies that show that taking TTD 1 tablet / week is
more acceptable for women and can improve compliance compared to taking TTD 1
tablet / day. The low compliance of subjects in taking TTD during menstruation
is that the supplement is supplied to the home so that its consumption cannot
be reviewed effectively.
Hemoglobin Value
Table 3. Distribution of respondents' frequency
based on hemoglobin value
|
Hb value (gr/dl) |
f |
% |
|
No Anemia |
26 |
68,4 |
|
Anemia |
9 |
23,7 |
|
Total |
35 |
100 |
Based on table 3, it can be seen that of the 26 respondents , most respondents had a normal Hb of
74.3% (2, 6 respondents). In addition,
the lack of iron absorption is due to lack of knowledge of foods rich in iron
and foods that can inhibit iron absorption. Iron absorption is influenced by 2
factors. Enhancers and inhibitors
are of important concern in assessing iron intake. There are several
micronutrients that are used together with iron to increase the absorption of
nutrients called driving factors including vitamin A, vitamin C, vitamin B2,
and vitamin B6. However, there are also some substances in food that can be
iron absorption inhibitors or inhibitors. Tannins in tea and coffee are
powerful inhibitors of
iron. In addition, foods containing calcium, phosphate, and phytate consumed in
large quantities will interfere with the absorption of iron (Dhito Dwi
Pramardika and Fitriana, 2019). Iron
has several essential roles in the body including as a means of transporting
oxygen from lung organs to body tissues, electron transporters in cells as well
as an integrated part of various enzyme reactions in human body tissues (Rahmad, 2017). In addition, this substance is especially
necessary in hemopobesis (blood formation), that is,
in the synthesis of hemoglobin (Hb). The total amount of iron in the body
averages 4-5 grams, about 65 percent of which is found in the form of
hemoglobin. About 4 percent is found in the form of 5 myoglobin and 1 percent
is found in the form of various heme compounds that can increase intracellular
oxidation while 0.1 percent combines with transferrin proteins present in blood
plasma, 15-30 percent is mainly stored in the reticuloendothelial system and
liver parenchyma cells, especially in the form of ferritin (Masthalina,
2015) . Iron deficiency in the body can result in
disruption or inhibition of growth, both body cells and brain cells, even
individuals suffering from iron deficiency will experience a decrease in body
immunity, besides iron deficiency can also reduce hemoglobin levels (Rahmad, 2017).
Association of Fe Tablet Adherence with the Incidence of Anemia
Table 4. Spearman Rho Statistical
Test Results Association of Fe Tablet Adherence with Anemia Incidence
|
Variable |
Hb value |
P value |
|
|
Fe tablet ingestion compliance |
Anemia |
No Anemia |
|
|
Obedient |
0 |
9 |
0,013 |
|
Disobedient |
13 |
13 |
|
Table 4 shows that the results of statistical analysis with the Chi Square
test obtained a
p-value of 0.0 13 (p<0.05), meaning that there is a significant relationship
between adherence to taking Fe tablets and the incidence of anemia. Compliance is a change in previous behavior
from non-rule-abiding behavior. The problem of compliance is a matter of daily
iron supplementation, which makes there is a safeguard related to compliance in
consuming iron supplements in front of health workers directly (Putri,
Simanjuntak and Kusdalinah, 2017). From various studies that have existed before,
it was found that factors that influence the incidence of anemia are knowledge
related to nutrition, diet and adherence in consuming Fe tablets. The results
of research (Rusmilawaty and
Tunggal, 2015) have found knowledge related to nutrition along
with giving iron supplements to adolescent girls will increase haemoglobin levels effectively when compared to nutritional
knowledge alone or only iron supplements. Young women are included in the
classification of groups that have a great vulnerability to anemia. Therefore,
the target of countermeasures has expanded to include adolescent girls at the
same junior and senior high school levels and women outside of school as an
effort is made to break the chain of weekly nutrition-related problem cycles
for 12 weeks. In the consumption of Fe tablets is influenced by several things,
namely the factors of health workers and themselves, namely about the level of
awareness in consuming Fe tablets. Where by consuming Fe tablets regularly has
a significant effect on increasing haemoglobin levels
in junior high school adolescents (Fatmawati and
Subagja, 2020). The effect of giving Fe tablets that can
increase haemoglobin levels can be concluded that Fe
tablets can effectively be an alternative in preventing anemia in female
students. Anemia iron can be done prevention by diligently consuming Fe tablets
which are through food. Where this will also increase haemoglobin
levels where normal haemoglobin levels can be an
alternative prevention and as a countermeasure to iron deficiency anemia (Runiari and
Hartati, 2020). Researchers have an assumption that the relationship
is influenced by adolescent compliance in consuming Fe tablets. If Fe tablets are consumed regularly, there
will also be an increase in haemoglobin. In this
study, a positive relationship was found, namely the level of adherence in
consuming Fe tablets is directly proportional to haemoglobin
levels, which in increasing adherence to Fe tablet consumption requires
encouragement from various parties (parents, teachers and health workers) as an
effort to increase knowledge about the urgency of Fe tablet consumption in
adolescent girls
CONCLUSION
The
results of the study found a relationship between Fe tablet consumption
compliance with Hb levels in young women of SMK Nurul Islami.
The level of adherence in taking iron supplements can increase haemoglobin levels, which in increasing the level of
compliance needs to be accompanied by support from around such as parents,
teachers and health workers and increasing respondents' knowledge about the
urgency of consuming Fe tablets in adolescents as prevention or control of the
occurrence of anemia in adolescent girls.
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Copyright holders:
Catur Retno Lestar,
Siti Nurjanah (2023)
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AJHS - Asian Journal of
Healthy and Science
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