Effect of Mother Knowledge and Household Food Security on Anemia of Pregnant Women (Study in North Buton Regency)

Background: Anemia in pregnancy can cause disruption of pregnancy continuity, disruption of the birth process, disorders during the puerperium, and disturbances to the fetus. World data shows the prevalence of anemia in pregnant women is 41.8% with a maternal mortality rate due to anemia of 303,000 people or around 216/100,000 live births. This study aims to analyze the determinants of anemia in pregnant women in North Buton Regency. Method: This study used a cross-sectional design. The population in this study were all pregnant women aged <21 years who came to check their pregnancies at all Health Centers in North Buton Regency in January 2023 as many as 97 people with a total sample of 77 people who were taken using the proportional sampling technique. Results: The research data was analyzed using using the chi-square test. The results showed body mass index (p-value = 0.002), food consumption level (p-value = 0.023), food security (p-value = 0.002), adherence to consumption of Fe tablets (p-value = 0.002), knowledge (p-value = 0.827), income (p-value = 0.015). Conclusion: It can be concluded that body mass index, level of food consumption, food security, consumption of Fe tablets, and income are related to the incidence of anemia in pregnant women, while knowledge is not related to the incidence of anemia in pregnant women.


INTRODUCTION
World Health Organization (WHO) in 2019, it is estimated that there will be 303,000 maternal deaths or around 216/100,000 live births worldwide. Globally the prevalence of anemia in pregnant women is 41.8%. About half of the incidence of anemia is caused by iron deficiency. The prevalence of anemia in pregnant women in Africa is 57.1%, Asia is 48.2%, Europe is 25.1% and America is 24.1%. A person is said to suffer from anemia if the hemoglobin (Hb) level is below 11g% in the first and third trimesters or the level is below 10.5g% in the second trimester [1] The prevalence of anemia in pregnancy in Indonesia in 2019 was 48.9% and this figure has increased quite high compared to the 2013 Basic Health Research results of 37.1%. Anemia in pregnancy which is most common in Indonesia is caused by iron deficiency as much as 62.3% which can cause miscarriage, premature parturition, uterine inertia, prolonged parturition, uterine atony and cause bleeding and shock. The impact that can be caused by iron deficiency anemia in pregnant women is 12% -28% fetal mortality, 30% perinatal mortality and 7% -10% neonatal mortality [2] The direct impact of anemia in pregnant women during childbirth is the occurrence of bleeding of 17.24%. This condition certainly requires special attention to be able to reduce maternal and child mortality. Even though the government has carried out a program to combat anemia in pregnant women by giving 90 tablets of Fe (iron) to pregnant women during the gestation period, the incidence of anemia is still high [3]. The incidence of anemia in Indonesia is still quite high. Based on the 2018 Basic Health Research data, the prevalence of anemia in adolescents is 32%, meaning that 3-4 out of 10 adolescents suffer from anemia. This is influenced by the habit of nutritional intake that is not optimal and lack of physical activity. In fact, the 2018 Basic Health Research found quite good results, because it succeeded in capturing a decrease in Lack of Energy Calories rates in women of childbearing age. The 2013 Basic Health Research recorded 24.2% of pregnant women with Lack of Energy Calories and 20.8% of women with non-pregnant lack of energy calories, Meanwhile, the 2018 Basic Health Research noted that 17.3% of Women of Reproductive Age Lack of Energy Calories were pregnant and 14.5% of women of reproductive age lack of energy calories were not pregnant. However, there is a wrong assumption among adolescents regarding the size of beauty which is identified with thin body, which is a big challenge in efforts to prevent stunting. Not to mention the challenge of anemia in young women from 37.1% in Riskedas 2013 which actually increased to 48.9% in Basic Health Research 2018, with the proportion of anemia in the age group 15-24 years and 25-34 years. Some of the effects of anemia on female adolescents (rematri) are quite concerning, such as declining health and school achievement. In adulthood, anemia is exacerbated during pregnancy which causes non-optimal growth and development of the fetus, complications of pregnancy and childbirth, and results in maternal and child mortality [4] Based on the results of the 2018 Indonesian Demographic Health Survey (IDHS), it was found that 0.7% of female adolescents aged 15-19 years had active sex before marriage, while 1.8% of female adolescents aged 20-24 years. The survey results from the Central Bureau of Statistics in 2012 revealed that the number of teenage pregnancies at the age of 15-19 reached 48 out of 1,000 pregnancies. Premarital active sex in adolescents is at risk of teenage pregnancy and transmission of sexually transmitted diseases. Unplanned pregnancies in teenage girls which lead to unsafe abortions and teenage marriages. Both will have an impact on the future of the teenager, the fetus he is carrying and his family [5] Data from the Southeast Sulawesi (Southeast Sulawesi) National Family Planning Coordinating Board stated that of the total marriage rate data in Southeast Sulawesi, around 20% of them were young marriages. Based on BPS data for 2021 the percentage of women aged 10 years and over who have ever been married by Regency/City and the age at first marriage in 2019 in North Buton Regency, namely age ≤ 16 years was 11.67%, aged 17-18 years was 24.43 %, ages 19-20 years of 23.95% [6]. From these data it is possible that teenage pregnancy is very high. Adolescence is a period of transition from childhood to adulthood marked by a number of biological, cognitive and emotional changes. Biological changes, namely height gain, hormonal changes, and sexual maturation. Cognitive changes that occur are increased abstract, idealistic, and logical thinking. Socio-emotional changes include demands to achieve independence, conflicts with parents and the desire to spend time with peers [7]. The characteristic of adolescence is curiosity in various ways, including aspects of sexual behavior. In adolescence, the reproductive organs experience development and will eventually experience maturity. During puberty, hormones that begin to function apart from causing physical/body changes also affect sex drive in adolescents. Adolescents begin to clearly feel an increase in their sex drive, for example, they appear attracted to other people and the desire for sexual satisfaction [8].
Rismawati and Rohmatin's research (2018) concerning the Analysis of Factors Affecting Anemia in Teenage Pregnancy is adherence to taking Fe tablets, diet, and regular pregnancy check-ups (Antenatal Care visits) [9] .In line with Dania's research, et al (2022) concerning Pregnancy in Adolescents with Anemia concluded that factors that influence anemia in teenage pregnancies are adherence to taking Fe tablets, diet and regular pregnancy checks [10]. As well as Sari et al's research (2021) concluded that there is a relationship between middle adolescent age and moderate anemia (61.11%). Suggestions are expected to carry out health promotion regarding the age of mothers at risk for pregnancy and conduct safe motherhood to reduce the incidence of 4 too (too young, too old, too close, and give birth too often). It is hoped that health workers can inform reproductive health to adolescents and parents. [11] Based on the results of Detty Afriyanti S's research on the risk factors associated with the incidence of anemia in pregnant women in the city of Bukittinggi, it was concluded that there was a significant relationship between the incidence of anemia and economic status, education, employment, age, parity and nutritional status. In line with Lilik Hartati and Sri Wahyuni's research on the Socio-Economic Relationship with the Incidence of Anemia in the 3rd Trimester Pregnant Women at the Jatinom Health Center concluded that there is a relationship between Socio-Economy and the Incidence of Anemia in the 3rd Trimester Pregnant Women [12] Based on data taken from the Kulisusu Health Center in the working area of the North Buton District Health Office, it was found that 10 pregnant women aged <21 years had their hemoglobin levels checked. There were 4 pregnant women who identified Hb <11 g/dL, namely 2 pregnant women in the second trimester and 2 pregnant women. third trimester. Data on pregnant women <21 years from January -October 2022 as many as 117 people 12 (North Buton District Health Office, 2022).

METHOD
This type of research is quantitative with a cross-sectional study approach, namely research that seeks to find relationships between one variable and another by collecting data (measurements) on independent (independent) and dependent (bound) variables at one time at the same time. In this case the researcher measured household food security variables and the dependent variable anemia of pregnant women simultaneously. This research was carried out in North Buton Regency from December 2022 to January 2023. The table above shows that the highest age of the respondent is ≥19 years, namely 60 respondents (77.9%), and the lowest age is ≤18 years, namely 17 respondents (22.1%), the highest is Senior High School with 40 respondents (51.9%) ) and the lowest was elementary school with 3 respondents (3.9%), the most respondents with the first (first) pregnant status were 64 respondents (83.1%), while the second pregnancy was only 13 respondents (16.9%), with an income 50 respondents (64.9%) have low incomes, while those with high incomes are 27 respondents (35.1%). The highest gestational age at first visit was during trimester 1, namely as many as 60 respondents (77.9%), while for trimester 3 no one visited. The ethnicity of the respondents was dominated by the Kulisusu ethnic group with 71 respondents (91.2%), while other ethnicities only 6 respondents (6.8%) and all respondents were Muslim as many as 77 respondents (100%), with married status of 77 respondents (100 %). Respondents generally work as IRT with 76 respondents (98.7%), and 1 respondent is a trader (1.3%), with the highest respondent's husband's occupation being selfemployed with 46 respondents (59.7%) while the lowest is civil servant with 1 respondent (1.3%). The number of family members who are dependents of >5 people is 5 respondents (6.5) while <5 people are 72 respondents (93.5%), with non-anemia status as many as 63 respondents (81.8%) while those with anemia are 14 respondents (18.2%), with the most history of infectious diseases were intestinal worms with 11 respondents (14.3%) while the lowest was malaria with 6 respondents (7.8%).  Table 2 shows that of the 12 respondents with low food security, 6 respondents (50.0%) had anemia and 6 respondents (50.0%) were not anemic. Meanwhile, out of 65 respondents with high food security, 8 respondents (12.3%) had anemia and 57 respondents (87.7%) were not anemic. The results of statistical tests using Chi-Square at the 95% level of confidence show a ρvalue = 0.002 (ρ-value <0.05), so that H0 is rejected and H1 is accepted, which means that there is a significant relationship between food security and the incidence of anemia in pregnant women in North Buton Regency in 2023

Relationship between Knowledge and Anemia in Pregnant Women
In Graph 1. It shows that the highest correct answer is question no.6 as many as 75 respondents (97.4%), while the lowest is question no. 7, 10, and 11 respectively 1 respondent (1.3%) who answered correctly.  Table 3 shows that of the 46 respondents with poor knowledge, 8 respondents (17.4%) had anemia and 38 respondents (82.6%) were not anemic. Meanwhile, from 31 respondents with good knowledge, 6 respondents (19.4%) experienced anemia and 25 respondents (80.6%) were not anemic.
The results of statistical tests using Chi-Square at the 95% level of confidence show a ρ-value = 0.827 (ρ-value > 0.05), so that H0 is accepted and H1 is rejected, which means that there is no relationship between knowledge and the incidence of anemia in pregnant women. North Buton Regency in 2023.