Analisis Hubungan Pengetahuan Anemia, Daya Terima Menu dan PHBS dengan Kadar Hemoglobin Santri Putri

Abstract

Anemia merupakan permasalahan gizi dan kesehatan di berbagai negara termasuk di Indonesia, yang ditandai salah satunya dengan penurunan kadar hemoglobin dan berujung pada penurunan kapasitas darah dalam mengangkut oksigen. Akar permasalahan anemia pada remaja terletak pada kurangnya asupan zat besi dan zat lain yang dapat meningkatkan penyerapan zat besi seperti vitamin C dan protein. Santri berada pada usia remaja yang sedang mengalami masa pertumbuhan dan perubahan fisik, selain itu juga memiliki kepadatan aktivitas akademik dan keagamaan setiap harinya sehingga membutuhkan asupan gizi yang sesuai untuk menjaga status kesehatan santri. Siswa yang tinggal di asrama melaporkan bahwa makanan yang disediakan dari sekolah tidak enak, tidak memadai dan tidak seimbang. Permasalahan malnutrisi dan anemia antargenerasi dapat diputus dengan mengobati anemia pada masa remaja dengan konsumsi makan yang sehat, seimbang, dan bergizi sehingga dapat memenuhi kebutuhan dalam mencapai kesehatan optimal. Penelitian ini bertujuan untuk menganalisis keterkaitan hubungan pengetahuan anemia, daya terima menu dan Perilaku Hidup Bersih dan Sehat (PHBS) dengan kadar hemoglobin santri putri. Tujuan khusus penelitian ini adalah: 1) Mengidentifikasi karakteristik santri putri (kelas, usia, uang saku, siklus menstruasi dan status gizi antropometri) dan karakteristik keluarga (pendidikan, pekerjaan orang tua dan jumlah anggota keluarga), 2) Mendeskripsikan proses penyelenggaraan makanan di pesantren dan mengidentifikasi ketersediaan pangan sumber zat besi pada menu pesantren, 3) Mengidentifikasi pengetahuan anemia, daya terima menu, asupan gizi dan praktik PHBS individu, serta kadar hemoglobin santri putri, 4) Menganalisis hubungan pengetahuan anemia dengan konsumsi pangan dan sisa makanan, serta hubungan sisa makanan dengan tingkat kecukupan gizi santri putri, dan 5) Menganalisis hubungan konsumsi pangan, asupan gizi dan PHBS dengan kadar haemoglobin santri putri. Penelitian ini menggunakan desain studi cross-sectional yang dilakukan di Pesantren Dar El Hikmah Kota Pekanbaru pada bulan November sampai Desember 2024. Total subjek adalah 105 subjek yang dipilih secara purposive berdasarkan kriteria inklusi dan kriteria eksklusi. Data yang dikumpulkan pada penelitian ini meliputi data karakteristik subjek (kelas, usia, siklus menstruasi dan status gizi antropometri), pengetahuan anemia, daya terima menu, asupan gizi dan kadar hemoglobin. Analisis data diantaranya uji sebaran data, analisis deskriptif dan analisis bivariat dengan menggunakan korelasi Rank Spearman karena data tidak berdistribusi normal. Subjek pada penelitian berada pada kelas 10 dan 11 MA, yang sebagian besar berusia 16 tahun. Pola menstruasi subjek sebagian besar (61,9%) normal atau 21 35 hari dan 45,7% subjek memiliki durasi menstruasi sedang yaitu berkisar 4-6 hari. Berdasarkan status gizi (IMT/U) didapatkan sebagian besar subjek (72,3%) memiliki status gizi normal. Berdasarkan karakteristik keluarga, sebagian besar ayah (49,5%) dan ibu (35,2%) subjek memiliki pendidikan terakhir SMA/sederajat, dengan sebagian besar ayah (43,8%) subjek bekerja sebagai wiraswasta dan Ibu (51,4%) subjek sebagai Ibu rumah tangga dan hampir sebagian subjek (46,7%) memiliki jumlah anggota keluarga 5-6 orang. Secara umum menu yang disediakan masih kurang bervariasi yaitu terdiri dari 3 hari siklus menu sarapan, dan 5 hari siklus menu makan siang dan malam, selain itu ketersediaan menu juga belum sesuai dengan anjuran Pedoman Gizi Seimbang (PGS) dan zat gizi yang tersedia belum mencukupi kebutuhan gizi subjek. Tingkat pengetahuan anemia sebagian besar subjek (68,6%) memiliki pengetahuan yang cukup. Berdasarkan data daya terima yang dilihat dari sisa makanan, rata-rata 80% subjek memiliki daya terima yang baik pada menu sarapan, siang dan malam. Konsumsi pangan protein hewani, kacang-kacangan, sayuran dan buah masih belum memenuhi anjuran PGS, karena ketersediaan yang kurang sehingga didapatkan tingkat keucukupan gizi hampir seluruh subjek masih dalam kategori defisit, baik pada energi (61,9%), protein (85,7%), zat besi (92,4%), vitamin C (98,1%), vitamin B9 dan B12 (100%), selain itu estimasi tingkat bioavailabilitas zat besi subjek masih sangat rendah (94,3%). Praktik PHBS santri putri sebagian besar cukup (57,1%) dan kurang (41,9%). Hasil pemeriksaan kadar hemoglobin didapatkan sebagian besar subjek (53,3%) memiliki kadar hemoglobin dibawah normal atau kurang dari 12 g/dL. Hasil analisis bivariat menunjukkan bahwa pengetahuan anemia tidak berhubungan dengan konsumsi pangan (protein hewani, protein nabati/kacang kacangan, serealia, sayuran, buah dan teh) (p>0,05), selain itu pengetahuan anemia juga tidak berhubung dengan sisa makanan (p>0,05), selanjutnya sisa makanan berhubungan dengan tingkat kecukupan gizi (p<0,05). Berdasarkan penelitian ini konsumsi pangan sayuran, serealia dan kacang-kacangan; tingkat kecukupan gizi protein, vitamin C, vitamin B9 dan B12; estimasi bioavailabilitas zat besi; dan praktik PHBS memiliki hubungan dengan kadar hemoglobin subjek (p<0,05).

Anemia is a nutritional and health problem in various countries, including Indonesia. It is characterized by decreased hemoglobin level, which ultimately decreases the blood's capacity to transport oxygen. In adolescents, the root cause of anemia lies in insufficient iron intake and insufficient intake of substances that increase iron absorption, such as vitamin C and protein. Students in boarding school are in a period of growth and physical changes, and they have demanding academic and religious schedules, necessitating adequate nutrition to maintain health. Students living in dormitories report that the school-provided food is unappetizing, insufficient, and unbalanced. Addressing intergenerational malnutrition and anemia issues requires treating anemia during adolescence by consuming healthy, balanced, nutritious meals that support optimal health. This study aims to analyze the correlation between knowledge of anemia, menu acceptance, and clean and healthy living behaviors (PHBS) with hemoglobin level in female Islamic boarding school students. The specific objectives of this study are: 1) To identify the characteristics of female students (class, age, pocket money, menstrual cycle, anthropometric nutritional status) and family characteristics (education, parents' occupation, and number of family members), 2) To describe the food preparation process in the boarding school and identifying the availability of iron-rich foods in the boarding school menu, 3) To identify knowledge of anemia, menu acceptance, nutrient intake, and individual PHBS practices, as well as hemoglobin levels among female students, 4) To analyze the correlation between knowledge of anemia and food consumption and food waste, as well as the correlation between food waste and nutrient adequacy level of female students, and 5) To analyze the correlation between food consumption, nutrient intake, and PHBS practices on hemoglobin level of female students . This study used a cross-sectional study design conducted at the Dar El Hikmah Islamic Boarding School in Pekanbaru City from November to December 2024. A total of 105 subjects were selected purposively based on inclusion and exclusion criteria. The data collected in this study included subject characteristics (class, age, menstrual cycle, and anthropometric nutritional status), knowledge of anemia, menu acceptance, nutrients intake, and hemoglobin level. Data analysis included data distribution tests, descriptive analysis, and bivariate analysis using the Spearman's rank correlation coefficient, as the data were not normally distributed. The subjects of the study were in grades 10 and 11 of MA, most of whom were 16 years old. The menstrual patterns of the subjects were mostly normal (61.9%) or 21-35 days, and 45.7% of the subjects had a moderate menstrual duration of 4-6 days. Based on nutritional status (BMI for age), most of the subjects (72.3%) had normal nutritional status. Based on family characteristics, most fathers (49.5%) and mothers (35.2%) of the subjects had a high school education or equivalent, with the fathers (43.8%) of the subjects working as entrepreneurs and the mothers (51.4%) as housewives, and nearly all (46.7%) of the subjects had 5-6 family members. In general, the menu provided was still insufficiently varied, consisting of a 3-day cycle for breakfast and a 5-day cycle for lunch and dinner menu. In addition, the availability of the menu is not yet in accordance with the recommendations of the balanced nutrition guidelines (PGS), and the nutrients available are not sufficient to provide the nutritional needs of the subjects. The level of knowledge about anemia was adequate for most subjects (68.6%). Based on data on food acceptance, as seen from the average food waste of 80%, subjects had good acceptance of the breakfast, lunch, and dinner menus. Consumption of animal protein, nuts, vegetables, and fruits still does not fulfil the recommendations of a balanced diet, due to insufficient availability, so that the nutrient adequacy level of almost all subjects is still in the deficit category, including energy (61.9%), protein (85.7%), iron (92.4%), vitamin C (98.1%), vitamin B9, and B12 (100%). Additionally, the estimated level of iron bioavailability of the subjects was very low (94,3%). PHBS practices among female students were mostly good (57.1%) and poor (41.9%). Hemoglobin level examinations revealed that some subjects (53.3%) had hemoglobin level below normal or less than 12 g/dL. The results of the bivariate analysis showed that knowledge of anemia is not related to food consumption (animal protein, vegetable protein/legumes, cereals, vegetables, fruits, and tea) (p>0.05). Furthermore, knowledge of anemia was also not correlated with food waste (p>0.05), while food waste was correlated with low nutrient adequacy levels (p<0.05). Based on this study, consumption of vegetables, cereals, and legumes; level of protein, vitamin C, vitamin B9, and B12 nutritional adequacy; estimated iron bioavailability; and PHBS practices are correlated with subjects' hemoglobin level (p<0.05).