Proportion and Characteristics of Anemia in Adolescents Girl
Zata Ismah, Wahidah, Bebby Alfiera R. H., Maduri Sakilla, Dwichy Augie, Windi Aulia, Lelya
Nosiayu
Public Health Faculty, Universitas Islam Negeri, Sumatera Utara, Indonesia
Keywords: Anemia, Adolescents Girl, Lifestyle, Nutrition.
Abstract: Anemia in Indonesian adolescent girl has been increased, this can be seen from the RISKESDAS 2013 result
where the prevalence of anemia in adolescent girl was 37.1% and 48.9% in 2018. This study aims to determine
the proportion and characteristics of anemia in adolescent girl. This study using a cross-sectional study design.
Data were collected by using a questionnaire as an interview instrument. Adolescents anemia status was
obtained from the recognition of adolescents who had consulted with doctors or other health workers. The
study location in Percut Sei Tuan, Deli Serdang, North Sumatra. Sampling selection by using C-Survey
software, namely 210 female high school respondents in 14-18 years old. Data analysis used frequency
distribution analysis with 95% CI range. The proportion of anemia incidence was 14.3%, anemic adolescents
never consumed blood-booster tablets was 73.3%, abnormal menstrual frequency and range was 6.7% and
23.3%, anemic adolescents consumed less milk was 60%, anemic adolescents ever dieted was 74,4% and
have a bad breakfast pattern was 40%. The anemia rate of adolescent girl in this study was high, most of the
respondents had never consumed blood-booster tablets and unhealthy lifestyles could have an impact on the
worsening of their anemia.
1 INTRODUCTION
According to WHO 2016, the prevalence of anemia
in adolescents in developing countries is 27%, while
in developed countries it is 6%. According to WHO
2016, if the prevalence of anemia is 40%, it is
categorized as severe, moderate 20-39%, mild 5-
19.9% and normal <5% (WHO, 2016).
While in Indonesia, anemia in adolescent girl has
increased, this can be seen from the results Riskesdas
in 2013 where the prevalence of anemia in adolescent
girl was 37.1% and in 2018 it was 48.9%, with the
proportion of anemia in the 15-24 years and 25-34
years age groups (KEMENKES RI, 2018).
Based on the health profile of North Sumatra in
2015, the incidence of anemia reached 57.1%, in 2016
it was 54.5%, and in 2017 it increased to 58.2%.
Anemia in adolescent girl in Medan City is still a
public health problem because its prevalence is more
than 25%, which is 26.5%. This is comparable to the
results of research conducted by Arianti (2016), that
the incidence of anemia in class XI adolescent girl at
SMA Negeri 17 Medan are 30 people (62.5%) (BPS,
2015).
Adolescents girl at puberty are prone to anemia
due to the large amount of iron lost during
menstruation, moreover there is a body image view
that women who have thin and small bodies are
considered beautiful, so that it becomes a challenge
for anemia in adolescents girl in Indonesia The
impact of the occurrence of anemia experienced by
adolescents girl, among others, is to reduce the body's
resistance so that people with anemia are susceptible
to infectious diseases, decrease fitness and thinking
dexterity due to lack of oxygen to muscle cells and
brain cells, and decreased learning achievement.
Moreover, adolescent girl are prospective mothers
who will become pregnant and give birth to a baby,
thereby increasing the risk of maternal mortality,
premature birth and low birth weight (LBW).
Several studies have shown that inadequate food
intake, sleep disturbance or duration is correlated
with iron metabolism which further increases the risk
of anemia (Xiaoxue, L., Qiaofeng, S., Wanning, H.,
Xiaochen, H., Jianhui, G., Xiang, Z., Xizhu, W., &
Shouling, W., 2018), (Hyungjo, K., Chol, S., & Good,
I, 2016), (Khan, ZA, Khan, T., Anu, B., Aziz, SJ, &
Sharma, S, 2018). Other studies suggest that dietary
Ismah, Z., Wahidah, ., R. H., B., Sakilla, M., Augie, D., Aulia, W. and Nosiayu, L.
Proportion and Characteristics of Anemia in Adolescents Girl.
DOI: 10.5220/0010760500003235
In Proceedings of the 3rd International Conference on Social Determinants of Health (ICSDH 2021), pages 111-119
ISBN: 978-989-758-542-5
Copyright
c
 2022 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
111

patterns are currently considered the newest
epidemiological approach to assess dietary factors
and risk of anemia (Fengqing, Z., Tinashe, MT, &
Jiangtao, G., 2018). Adolescent girls are a group that
is prone to anemia due to increased iron needs to
support growth and development and replace the iron
needs lost due to menstruation (Ranganath & Debata,
L, 2015). A study also found that skipping breakfast
will increase the risk of low body mass index and will
increase the risk of anemia (Li, L., Peipei, X., Titi, Y.,
Qian, G., Wei, C., Hui, P., Xu, J., Xiaoqi, H., & Qian,
Z., 2018). The more consumption of milk will reduce
the risk of anemia, and vice versa, adolescents who
do not consumed milk and consumed less milk will
be at risk of developing anemia (Zhonghai, Z.,
Sudfeld, C., Cheng, Y., Qi, Q., Shaoru, L., Elhoumed,
M., Yang, W., Chang, S., Dibley, M., Zeng, L., &
Fawzie, W., 2021)
Based on the description above, it can be seen that
the unhealthy lifestyle of adolescent girl can lead to
anemia. Therefore, this study is very important to
study considering the many effects of anemia that can
be caused.
2 METHODS
We hope you find the information in this template
useful in the preparation of your submission The
design of this study used a rapid survey method which
was carried out in senior high schools in Percut Sei
Tuan, Deli Serdang, North Sumatra in October to
November 2019. The population in this study were
210 girls in high school. Sampling was carried out
using the rapid survey method recommended by
WHO using the help of C-Survey software, namely
30 clusters consisting of 7 samples per cluster. Data
was collected by obtaining primary data through
interviews and the assistance of research instruments
in the form of questionnaires. Data processing is
carried out after the questionnaires are collected by
going through stage editing, coding, entry, cleaning,
and scoring. Data analysis used frequency
distribution analysis with 95% CI range.
3 RESULTS
Table 1: Characteristics of respondents (n=210)
Variable n % 95% CI
Age (in years)
14 5 5.1 0-17.9
15 69 15.4 5.1-25.6
16 51 48,7 33.3-69.2
17 73 28.2 15.4-41.0
18 12 2.6 0– 7.7
Diagnosed with Anemia by Health Workers
Yes 39 18.1 12.5-23.2
No 171 81.9 76.8- 87.5
Based on table 1, it can be seen that there are many
anemia sufferers at the age of 17 years (28.2%, 95%
CI: 15.4-41.0). However, it was also found at the age
of 14 years (5.1%, 95% CI: 0-7.7). Respondents
diagnosed with anemia (18.1%, 95% CI: 12.5-23.2).
Table 2: Description of Respondents with Anemia (n = 39)
Variable Min Max Mean CI 95%
Lower Upper
Milk
Consumption
(
da
y)
0 9.14 0.45 0.10 0.75
Menstrual
Frequency
(day)
3 10 5.69 5.15 6.43
Menstrual
Ran
g
e
(
da
y)
5 30 25.71 22.97 28.23
Breakfast
Pattern (day)
0 1 0.47 0.34 0.62
Sleep Duration
(hour)
3 18 0.45 6.85 8.74
Body Mass
Index
(
K
g
/m
2
)
24.32 45.39 32.047 30.55 33.43
Based on Table 2, it can be seen that the lifestyle
of anemia sufferers such as the average consumption
of milk (0.45/day, 95% CI: 0.10-0.75), menstrual
frequency (6 days, 95% CI: 5.15-6.43), menstrual
interval (26 days, 95% CI: 22.97-28.23), Breakfast
pattern (0.47 days, 95% CI: 0.34-0.62), sleep duration
(0.45/hour, 95% CI: 6.85-8.74) and BMI (32.04, 95%
CI: 5.15 -6.43).
ICSDH 2021 - International Conference on Social Determinants of Health
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Table 3. Description of Respondents with Anemia (n = 39)
Variable N % CI 95%
Milk Consumption
Often (2 times/day) 5 12.8 2.6-23.1
Rarely (<2 times/day) 12 30.8 15.4-48.7
Never 22 56.4 41.0-66.7
Menstrual Frequency (every menstrual cycle)
Normal (3-8 days) 38 97.4 87.2 – 100
Abnormal (<3 days or >8 days) 1 2.6 0 – 12.8
Menstrual Range
Normal (21-35 days) 32 82.1 69.2-94.9
Abnormal (< 21 days or >35
days)
7 17.9 5.1-30.8
Sleep Duration
Good (8-9 hours) 18 46,2 33.3-66.7
Bad (<8 hours or >9 hours) 21 53,3 33.3-66.7
Type of Diet
Mayo 1 2.6 0 – 10.3
Keto 2 5.1 0 – 12.8
Karbo 3 7.7 0 – 17.9
Food Combining 2 5.1 0 – 12.8
Other 21 53.8 35.9-69.2
Never 10 25.6 12.8-43.6
Body Mass Index Status
Obesity 34 87.2 76.9- 100
Fat 5 12.8 0 – 23.1
Breakfast Pattern
Good 16 41.0 28.2 – 53.8
Bad 17 43.6 25.6– 59.0
Very Bad 6 15.4 5.1-30.8
Blood-booster Tablets Consumption
Ever 14 35.9 48.7-79.5
Never 25 64.1 20.5-51.3
Based on Table 3, it is known that the respondent
never consumed milk (56.4%, 95% CI: 41.0-66.7),
abnormal menstrual frequency (97.4%, 95% CI: 87.2-
100), abnormal menstrual range (17.9%, CI 95%:
69.2-94.9), bad sleep duration (53.3 %, 95% CI: 33.3-
66.7), never dieted (25.6%, 95% CI: 12.8-43.6),
obesity (87.2%, 95% CI: 76.9 -100) but found to be
fat (12.8%, 95% CI: 0-23.1), breakfast pattern was
very bad (15.4%, 95% CI: 5.1-30.8), never consumed
blood-booster tablets (64.1%, 95% CI: 20.5-51.3),
but those who had consumed tablets were still anemic
(35.9%, 95% CI: 48.7-79.5).
4 DISCUSION
This finding found that adolescents suffering from
anemia never consumed milk (60%, 95% CI: 46.7-
76.7). It was found that the average consumption of
milk (0.45/day, 95% CI: 0.10-0.75), berdasarkan
penelitian Atma (2019) remaja anemia yang
menderita anemia lebih sering mengkonsumsi susu
yakni sebesar 68,8% dengan rata-rata kebiasaan
onsumsi susu 1,42/hari (Atma, 2019). Based on the
findings in the field showed that adolescent girl who
never consumed milk because they do not like it, even
though milk is very important for nutritional intake
for adolescent girl such as a good source of calcium.
High in milk also contains vitamin B12 which is good
and useful for improving blood function. This is in
line with research conducted by Damayanti that there
is a relationship between vitamin B12 intake which
has an influence on the incidence of anemia
(Siallagan D, Swamilaksita PD, Angkasa D, 2016).
Milk is a source of protein that has high
bioavailability and contains iron, phosphorus, and
several vitamins such as vitamin A and vitamin D,
meanwhile milk also contains calcium where calcium
can inhibit iron absorption (Lynch SR, 2000) (El
Menchawy, I., El Hamdouchi, A., El Kari, K., Saeid,
N., Zahrou, FE, Benajiba, N., El Harchaoui, I., El
Mzibri, M., El Haloui, N., & Aguenaou, H, 2015).
Atma’s study in 2019 states that 40 mg of Calcium
will not inhibit iron absorption (Atma W AF &
Hidayati, IL, 2019). Lack of protein intake can result
in inhibited iron absorption, besides that iron is also
widely found in foods that are high in protein
(Tejasari, 2016).
El Menchawary’s study in 2015 also states that
consuming milk should be given a break after
mealtime so as not to interfere with iron absorption
optimally (El Menchawy, I., El Hamdouchi, A., El
Kari, K., Saeid, N., Zahrou, FE, Benajiba, N., El
Harchaoui, I., El Mzibri, M., El Haloui, N., &
Aguenaou, H, 2015).
Research evidence shows that milk consumption
can reduce the incidence of anemia in adolescents
with statistical analysis results obtained by OR = 0.68,
which means that consuming milk can reduce the risk
of anemia by 0.68 times compared to not consuming
it (Zhu, Z., Sudfeld, CR, Cheng, Y., Qi, Q., Li, S.,
Elhoumed, M., Yang, W., Chang, S., Dibley, MJ,
Zeng, L., & Fawzi , WW, 2021). This is in line with
Akbar's research (2014) with statistical test results
showing p-value = 0.044 (p <0.05) so that there is a
relationship between milk consumption and the
incidence of anemia (Akbar EH, 2014).
Good nutritional knowledge is related to the
consumption of healthier food as a whole, in this case
the role of the family is needed in the formation of
adolescent knowledge from an early age to meet
adequate nutritional needs.
Proportion and Characteristics of Anemia in Adolescents Girl
113

Anemic adolescents had abnormal menstrual
frequency (97.4%, 95% CI: 87.2-100). Average
menstrual frequency (6 days, 95% CI: 5.15-6.43),
Menstrual frequency is seen from how long the
female adolescent cycle is in menstruation. This fact
in the field occurs because it is a hereditary factor
from the family. Adolescent girls are very susceptible
to anemia because every month they experience
menstruation and the iron is lost along with the cycle.
Genetic factors accounted for 39% of menstrual
characteristic problems such as menstrual frequency
and 55% for menstrual pain problems (Jahanfar, S,
2012). The normal menstrual cycle is the result of a
complex and integrated process and requires
coordination between hormonal secretions and
signals in the hypothalamic-pituitary-ovarian axis,
the disruption of these signals related to the final
outcome of the menstrual cycle (Abusag, M,
Ehrmann, DA & Hoffman, L, 2016).
Kumalasari's study in 2019 found that there was a
relationship between the menstrual pattern and the
incidence of anemia where the results of the analysis
found an OR value = 8.886 (95% CI = 2.410 - 32.765)
which means that adolescents with abnormal
menstrual patterns have an 8.886 times chance of
experiencing anemia compared with adolescent girl
with normal menstrual patterns (Kumalasari, D.,
Kameliawati, F., Mukhlis, H., & Kristanti, DA, 2019).
In line with this, Khairani's study in 2019 also found
that there was a relationship between menstrual
frequency and the incidence of anemia in adolescent
girl at SMK Negeri 1 Yogyakarta with statistical test
results showing p-value = 0.000 (Khairani, Fitri, DA,
2019). This is in line with Listiana's study which
states that there is a significant relationship between
menstruation and the incidence of anemia in
adolescent girl at SMK Negeri 1 Terbanggi Besar,
Central Lampung Regency with the results of the
analysis that the value of OR = 2.349, meaning that
menstruating girls have a risk of 2.349 times for
suffer from anemia compared to adolescent girl who
do not menstruate (Listiana, 2016).
The same result was shown by Permatasari's study
with statistical test results showing the p-value of 0.06
(p < 0.05) so that there was a relationship between the
length of menstruation and the incidence of anemia in
adolescent girl and had correlation coefficient, which
means that the longer the menstruation period, the
lower the hemoglobin level and the higher the
incidence of anemia (Permatasari, Mahar W, 2016).
Irregular menstruation is influenced by several
modifiable factors (Bae, Park, & Kwon, 2018).
Studies have shown that changes in female hormones
are related to stress (Sang Su Lee1, Kim, Lee, Han, &
Park, 2016). It is necessary to provide short courses
on stress management techniques as an addition to the
educational curriculum, as well as the provision of
psychological counseling in schools to prevent higher
stress levels.
This finding showed that those suffering from
anemia had abnormal menstrual intervals (17.9%,
95% CI: 69.2-94.9). The average menstrual distance
was found (26 days, 95% CI: 22.97-28.23).
Ditemukan rata-rata jarak menstruasi (26 hari,CI
95%: 22.97-28.23). Penelitian ini sejalan dengan
penelitian yang dilakukan oleh dian yang menyatakan
bahwa terdapat 95% remaja dengan jaraka menstruasi
normal mengalami anemia dan artinya hanya 15%
yang memiliki jarak menstruasi tidak normal dengan
rata-rata jarak menstruasi 26.01 hari dan paling lama
29 hari (Irnayanti, Dian Kartika, Bantas, 2020). In the
body, iron functions to support growth and sexual
maturation and replace iron that is wasted along with
menstrual blood (Syabani, Sumarmi S, 2016).
Changes in the distance between short and long
periods of menstruation in adolescents are caused by
hormonal changes during puberty, so it is hoped that
adolescents can maintain balanced nutrition, not
stress and maintain a healthy lifestyle to trigger
significant hormonal changes that cause abnormal
menstrual range (Fadila, Kurniawati H, 2018).
This is in line with Nofianti's study which states
that there is a significant relationship between the
distance of menstruation and the incidence of anemia
in adolescents girl at SMP Negeri 2 Kerambitan,
Tabanan Regency with the results of the analysis that
the OR value = 36.08, meaning that adolescents girl
who experience menstruation with a cycle that is
abnormal will have a 36.08 times greater chance of
experiencing anemia compared to adolescents girl
who have a normal menstrual cycle (Nofianti, Juliasih,
& Wahyudi, 2021).
This finding showed that the anemic patients had
poor sleep duration (53.3%, 95% CI: 33.3-66.7) with
an average sleep duration (0.45/hour, 95% CI: 6.85-
8.74). Facts in the field show that adolescent girl often
do not take the time to rest but instead use it to play.
Penelitian ini didukung oleh penelitian Astuti tahun
2017 menyatakan bahwa durasi remaja yang
menderita anemia rata-rata kurang dari 1 jam dan
paling rendah ditemukan 0.45/hour (Astuti, 2017).
According to Musrah that sleep patterns are
strongly influenced by lifestyle such as stress which
leads to insomnia so that it will be difficult to sleep
and worsen sleep problems. Sleep duration will
determine the quality of sleep in a person. So that
when a person's sleep quality is very good, it will
stimulate the repair and renewal of cells including
ICSDH 2021 - International Conference on Social Determinants of Health
114

blood cells and reduce the risk of anemia (Musrah AS
& Putri, R, 2019).
Bad sleep duration can cause individuals to feel
tired, this can be prevented by regulating good sleep
patterns such as taking short naps and maintaining a
healthy diet such as avoiding high-caffeinated drinks.
These findings indicate that those who have never
done a diet program suffer from anemia (25.6%, 95%
CI: 12.8-43.6). Based on the observation that
adolescent girls do not pay attention to the food they
eat which makes people who have never done a diet
program suffer from anemia. Adolescent girl
consumed more plant foods that contain little iron
compared to animal foods so that the fulfillment of
iron in the body is not fulfilled (Sartika & Anggreni,
2021).
Based on study conducted by Esti and
Cahyaningtyas in 2021, adolescent girl prefers fast
food and drinks such as noodles, meatballs, batagor,
dumplings, tea and coffee and others. The choice of
food is only based on fun, besides that, the density of
activities at school and activities outside of school
such as taking lessons (Estri, BA, & Cahyaningtyas,
DK, 2021).
Diet programs can inhibit individuals from eating
healthy foods, especially those who are on an
unhealthy diet, therefore it is important to choose
healthy and nutritious foods when doing a diet
program and avoid fast food that is low in nutrients.
This finding showed that the anemic patients had
a very poor breakfast pattern (15.4%, 95% CI: 5.1-
30.8). The average breakfast pattern was found (0.47
days 95% CI: 0.34-0.62). However, it was also found
in the good breakfast patterns there were still anemia
(41.0%, 95% CI: 28.2-53.8). Facts in the field show
that adolescent girl mostly do breakfast but do not pay
attention to the type of food consumed. This research
is in line with Ummi's 2016 research stating that
breakfast is very important because it serves to
maintain body condition and increase learning
concentration. Breakfast also serves as a source of
energy to carry out activities (Kalsum U & Halim R,
2016).
The results of this study are in line with the
research by Permaesih and Herman in 2013 which
found a significant relationship between breakfast
habits and the incidence of anemia in adolescents in
Indonesia (P-value = 0.0057), where the relative risk
was 1.6 times. This means that adolescents who do
not eat breakfast have a risk of anemia that is almost
twice as large as adolescents who have breakfast
habits (Permaesih D, Herman S, 2013).
Wijiastuti's study in Tsanawiyah Cipondoh in
2015 also which found a significant relationship
between breakfast and incidence anemia in
adolescent girl (Wijiastuti H, 2015). Lack of nutrient
intake can cause disturbances in neurotransmitters
which will directly affect learning concentration due
to lack of energy and precursors needed (Astuti, Ari I,
2017).
According to an observational study in
Yogyakarta on 196 grade 5 and grade 6 students, it
was shown that children who children who do not
regularly have breakfast have a risk of low
hemoglobin levels 1.7 times compared to children
who regularly eat breakfast.
Consumption of breakfast is very important to
regulate energy intake in the body, thus causing a
higher intake requirement if breakfast is skipped (Sila,
et al., 2019), there are many bad effects that will occur
if you skip breakfast, especially increasing the risk of
obesity (Gibney, et al., 2018) (Monzani, et al., 2018)
(Blondin, Anzman-Frasca, Djang, & Economos,
2016), which further increases the risk of anemia. It
needs cooperation between children, parents and
teachers in schools to promote the importance of
breakfast, build knowledge about breakfast
consumption and promote and provide healthy
breakfasts in schools so that they can help children
who skip breakfast at home.
This finding showed that the anemic patients were
obese (87.2%, 95% CI: 76.9-100.0) but also obese
female adolescents were anemic (12.8%, 95% CI: 0-
23.1) with an average BMI (32.04, 95% CI: 5.15-
6.43). This happens because they consumed foods
that are not balanced with the body's needs such as
more frequent consumption of foods that contain fat,
high calories and lack of iron intake. Another
assumption also shows that this is related to canteens
in schools for adolescent girl who suffer from anemia
who do not provide food that does not have high
nutritional value.
School children have almost half a day at school,
therefore the food sold at school contributes greatly
to the growth and development of adolescents who
are in the process of development. Things like this
really need to be given an intervention in the form of
a healthy canteen program that must be implemented
in every high school (SMA). A healthy canteen is a
place where the food needs of all school residents are
available, where the available food and drinks are
guaranteed safety, cleanliness and nutritional content
and have safe facilities (Utama & Demu, 2021).
The cleanliness of the canteen must be maintained
from the beginning of food processing to
environmental conditions, apply the habit of washing
hands before eating and provide closed and divided
trash bins according to the type of waste. Meanwhile,
Proportion and Characteristics of Anemia in Adolescents Girl
115

a nutritionally balanced diet is a combination of rice
and the like, meat and beans, vegetables and fruits,
and milk (Damayanti, D, 2013). Some of the menus
include Hainanese chicken rice, sandwiches with
various fillings, croquettes, risoles filled with
vegetables, fruit pudding, mineral water, juice, and
tea (Damayanti, D, 2011). If food is not fulfilled with
sufficient nutrition, especially for school children, it
is a risk of disease, one of which is obesity (Yuliatin,
2012).
Obesity has a negative effect on women's
reproductive health and obesity is a factor causing
menstrual disorders such as oligomenorrhea which is
often experienced by women with obesity (Sudargo,
LM, Rosiyani, & Kusmayanti, 2014).
Oligomenorrhea is a menstrual cycle that exceeds 35
days per cycle and is usually ovulatory with a
proliferative phase that is longer than the proliferative
phase of the classical menstrual cycle (Hendrik,
2006). This is in line with the research conducted by
Nead in 2004 where the opportunity to experience
anemia occurs in children and adolescents who are at
risk of obesity with OR = 2.0 (95% CI = 1.2-3.5), and
OR = 2.3 (95% CI = 1.4-3.9) in obese children and
adolescents (Nead KG, Haterman JS, Kaczorowski M,
2004).
This study is in line with Indah's research on
adolescent girl at SMA Batik 1 Surakarta, showing
that the percentage of overweight and obese
nutritional status that occurred in the case group
(31.4%) was higher than the control group (8.6%)
(Noviandari, 2016). Showed that there was a
relationship between nutritional status and menstrual
cycle in adolescent girl at SMA Batik 1 Surakarta (p-
value = 0.036).
Adequate nutrition is very important, because
nutritional deficiencies can cause a decrease in the
formation of red blood cells which can lead to
reduced red blood cells in the body and cause anemia.
From the results of this study, it can be seen that the
better the nutritional status of the respondents, the less
the risk of anemia. This is in line with the research
conducted by Yu Qin in China which stated that
hemoglobin levels tend to increase along with the
increase in BMI (Yu Q, Alida MB, Xiaoqun P,
Baojun Y, Yue D, Jinkou Z, 2013).
Body Mass Index is a simple measuring tool to
monitor nutritional status. In the case of obesity, it is
associated with anemia due to the accumulation of fat
in adipose tissue, thereby inhibiting iron absorption.
Therefore, it is important to maintain a normal BMI
status through nutritional intake and physical activity
to avoid anemia.
Adolescent girls need to take iron tablets in order
to replace the blood lost during the menstrual process.
According to Nuradhiani's study (2017), teacher
support is related to the consumption of TTD in
adolescents, because teachers are considered to be
able to provide information about the TTD. Therefore,
good cooperation between teachers and parents is
needed to monitor TTD consumption in adolescent
girl (Nuradhiani, Briawan, & Dwiriani, 2017).
These findings indicate that anemic patients with
the status of never consumed blood-booster tablets
(64.1%, 95% ci: 20.5-51.3), then it was also found
that those who had consumed blood-booster tablets
were still anemic (35.9%, 95% CI: 48.7-79.5). Facts
in the field show that the provision of TTD has been
carried out by health workers in every high school but
only a small portion of the TTD is consumed. This is
because there are still many adolescent girls who do
not understand or have less knowledge about anemia
and consumed blood-booster tablets. This is in line
with Irianto's research which explains that the
awareness of consuming FE tablets in adolescent girl
cannot be separated from the information and
knowledge they get, this is because knowledge is a
factor that affects many problems including one's
consumption behavior. Compliance in consuming
blood-booster tablets or giving Fe tablets greatly
affects changes in hemoglobin levels, where
hemoglobin levels are normal, the anemia status will
also be normal, so as to prevent and overcome iron
deficiency anemia (Yuniarti, 2015).
Based on Putri's research in 2017 the most
dominant variable relationship multivariate results
obtained that adherence to Fe-added tablet
consumption is the most dominant variable that
affects the incidence of anemia in adolescent girl is
that female adolescents who do not comply with
consumed blood-booster tablets have a 61.55 times
risk of suffering from anemia compared to
adolescents. obedient daughter took the tablets. This
means that the more female adolescents are obedient
in consuming Fe tablets, the lower the chance of
anemia. On the other hand, if the non-compliance
with the consumption of Fe tablets is low, the chances
of anemia will continue to increase among adolescent
girl (Putri, Simanjuntak, & Kusdalinah, 2017)
This is in line with Putri’s study in 2017 which
states that consuming Fe tablets is very influential on
the occurrence of anemia with the results of the
analysis of OR = 61.55 which means that adolescent
girl who do not consumed Fe tablets will have a 61.55
times greater risk of developing anemia compared to
adolescent girls who do not consume Fe tablets.
ICSDH 2021 - International Conference on Social Determinants of Health
116

routinely consuming Fe tablets (Putri, Simanjuntak,
& Kusdalinah, 2017).
Several studies have explained that there are
factors that cause the ineffectiveness of the
consumption of blood-booster tablets even though
they are consumed regularly, such as the quality of
blood-booster tablets and the intake of nutrients given
to adolescent girl (Permatasari, Briawan, &
Madanijah, 2018).
5 CONCLUSIONS
Patients with high anemia at the age of 17 years
(28.2%, 95% CI: 15.4-41.0). Anemic adolescent girl
(18.1%, 95% CI: 12.5-23.2). Average milk
consumption (0.45/day, 95% CI: 0.10-0.75), average
menstrual frequency (6 days, 95% CI: 5.15-6.43),
average menstrual interval (28 days, 95% CI: 22.97-
28.23), average breakfast pattern (0.47 days 95% CI:
0.34-0.62), average sleep duration (0.45/hour, 95%
CI: 6.85-8.74) and average BMI (32.04, CI 95%:
5.15-6.43). Respondents never consumed milk
(56.4%, 95% CI: 41.0-66.7), Abnormal menstrual
frequency (97.4%, 95% CI: 87.2-100), Abnormal
menstrual distance (82.1 %, 95% CI: 69.2-94.9 ), poor
sleep duration (53.3%, 95% CI: 33.3-66.7), never
went on a diet (25.6%, 95% CI: 12.8-43.6), obese
(87.2%, 95% CI: 76.9-100) but found obese (12.8%,
95% CI: 0-23.1), very poor breakfast pattern (15.4%,
95% CI: 5.1-30.8), never consumed blood-booster
tablets (64.1%, 95% CI: 20.5-51.3), have ever
consumed blood-booster tablets and still suffer from
anemia (35.9%, 95% CI: 48.7-79.5).
ACKNOWLEDGEMENTS
The researchers are very grateful to Headmasters of
Senior High Schools in Percut Sei Tuan, Deli Serdang,
North Sumatra who has given study’s permission,
Academic Community in Faculty of Public Health
State Islamic University of North Sumatra and Ms.
Wan Rizky Chairatunnisa who has given study’s
direction.
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