HEALTH ASPECTS OF DIETARY IRON ON STUDENTS IN PESANTREN TAPAK SUNAN
FLORENCE LOW 1 , SAPTAWATI BARDOSONO 2
1. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia 2. Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
E-mail: flo.low1690@gmail.com
Abstrak
Defisiensi zat besi pada anak dan remaja dapat mengakibatkan penuruanan fungsi kognitive dan psikomotor. Salah satu cara yang efektif untuk mencegah terjadinya defisiensi zat besi adalah dengan memberikan edukasi gizi terutama pada anak usia sekolah. Tujuan dari studi ini adalah mengevaluasi efek dari edukasi gizi terhadap peningkatan pengetahuan tentang zat besi pada siswa-siswi di Pesantren Tapak Sunan. Studi ini menggunakan desain pre-experimental dengan intervensi pre-post. Data dikumpulkan dari hasil penilaian kuesioner pre dan post-test. Analisis data dilakukan dengan menggunakan program SPSS 20.0. Hasil studi menunjukkan bahwa setelah pemberian edukasi, terdapat peningkatan bermakna pada pengetahuan siswa-siswa secara menyeluruh (uji t berpasangan, p<0.001). Akan tetapi, berdasarkan jenis kelamin, tidak ada perbedaan bermakna pada peningkata pengetahuan (uji t tidak berpasangan, p>0.05). Uji one-way ANOVA juga menunjukkan perbedaan tidak bermakna pada peningkatan pengetahuan berdasarkan jenjang sekolah. Berdasarkan hasil ini, dapat disimpulkan bahwa pemberian edukasi gizi bermanfaat meningkatkan pengetahuan tentang zat besi pada siswa- siswi di Pesantren Tapk Sunan.
Abstract
Iron deficiency in children and adolescent could cause deficit in cognitive performance and lower psychomotor function. Nutritional education about dietary iron targeted at school-age children is one of the effective approaches to prevent iron deficiency. The aim of this study is to evaluate the effect of nutritional education on the improvement of knowledge about dietary iron among students in Pesantren Tapak Sunan. This study used pre-experimental design with pre-post intervention. Data was collected from scoring result of pre and post-test questionnaire. Analysis of data was conducted using SPSS ver 20.0 programme. Result of the study showed that after receiving education, there was significant improvement of knowledge among all students by 21 points (paired sample t-test, p<0.001). Meanwhile, there was no significant difference in the improvement of knowledge between each gender (independent t-test, p> 0.05). One-way ANOVA analysis also showed insignificant difference in the improvement of knowledge among three different levels of grades (p> 0.05). In conclusion, nutritional education is effective in improving the knowledge about health aspects of dietary iron on students in Pesantren Tapak Sunan.
Keywords: dietary iron; nutritional education; improvement of knowledge; student; Pesantren Tapak Sunan
INTRODUCTION
Iron is one of the most important nutrients in human body. It plays role in many physiological and biochemical process in body system. Deficiency in iron can cause many health problems. Iron deficiency anaemia developed in the severe case of iron deficiency. In 2005, World Health Organization (WHO) reported that anaemia affect 1.62 billion people globally, contributing to 24.8% of world population. WHO estimated that Africa has the highest proportion of individuals affected by anaemia, which reached 47.5-67.6% of the population. South-East Asia by far has the greatest number of people affected, which are 315 million individuals. The prevalence for global anaemia in school age (around 5-15 years old) is 25.4% and the number of individual affected reached to 305 million people. In Indonesia, it is estimated that more than 9 million pre-school children and more than 1 million pregnant women in Indonesia suffer from severe anaemia. 1
Iron plays a major role involved in cognitive performance and psychomotor development. Iron deficiency in children and adolescent is associated with lower psychomotor development. and deficit in cognitive function. Cochrane review study conducted found out that children with severe iron deficiency tends to have lower psychomotor development and deficit it motor activity and behaviour. 2 A survey also showed that school children age 6-16 years old with iron-deficiency tends to have lower cognitive function than those with normal iron level. 3
In order to prevent iron-deficiency anaemia, WHO promotes several strategies targeted at reduction of poverty, improvement of health services and sanitation, and increased access to adequate diets. WHO also recommend development of support activities such as human resource development for information, education and communication, research, and provide facilities for these activities. 4
Educational intervention aimed at family and children has been proven useful to modify negative behaviour towards healthier behaviour. A study in Venezuela aimed to correlate nutritional educational intervention to reduction of iron deficiency was also conducted and have proven that educational intervention have an impact in nutritional health among school children. 6 In Indonesia, studies conducted in Semarang and Makassar showed positive improvement in behaviour modification and improvement of diet after receiving nutritional education. 7, 8 A research in Central Java also shown that there was an improvement of anaemia status in school-age children receiving nutritional education. 9
Based on information above, researcher conducted this study to evaluate the effect of nutritional education on the improvement of knowledge about health aspect of dietary iron. Increase in knowledge about health aspect of iron can also increase peoples awareness of iron deficiency and modification of health behaviour. These changes in turn can prevent the occurrence of iron deficiency. Researcher is hoping that data and information obtained from this study can also be used to for further research of medical studies in the future.
METHOD This study used pre-experimental design with pre-test and post-test intervention design. Data collection was conducted in Pesantren Tapak Sunan which was located in Condet, East Jakarta. Data collection was conducted on January 22 nd , 2011. Targeted and accessible population for this research were all senior high school students (madrasah aliyah) of Pesantren Tapak Sunan who were present at the location and time of research, which is on Pesantren Tapak Sunan on January 22 nd 2011. Participants included in this study are boys and girls age 5-20 years, currently studying Pesantren Tapak Sunan and who are willing to participate in the study by signing informed consent. Exclusion criteria for participants are student(s) who were not present during the education session. The dropout criteria is student(s) who follow the test, but does not do it correctly or does not submit it. The technique of selecting sample is by using consecutive sampling. On the day of data collection, students participated in the test was asked to do the pre- test. The pre-test question consisted of 5 questions about health aspect of iron. The questions were in form of multiple choices questions. Pre-test questionnaire was collected immediately before seminar is started. After seminar has finished, post-test was conducted. Post-test questions were the same as pre-test question. Post-test papers were collected after the students finished filling the answer. Subject of this research the senior high school students (madrasah Aliyah) in Pesantren Tapak sunan. Grade is level of school grade of the senior high school students. The classification of the grade was first grade, second grade, and third grade. Gender is the sex classification of the students. Nutritional education is the education given to students in form of public seminar. Education contains about information about nutrition which. The topic used in this study is about dietary iron. Data observed in this study is the improvement of knowledge about dietary iron after nutritional education. The data acquired was the score of the questionnaire which had been answered and marked. The data was classified to 3 types of score. Pre-test score was defined as level of knowledge of the subjects before receiving nutritional education. Post-test score was level of knowledge of the subjects after receiving nutritional education Delta score was improvement of level of knowledge of the subjects after receiving nutritional education, shown by score difference between pre and post test score The data was verified after questionnaires were collected, counted and grouped according to gender and school grade. Data was obtained from scoring results of the pre-test and post-test. The data was organized using Microsoft Excel 2010. Analysis of data was calculated with statistical test using SPSS 20.0. Kolmogorov-Smirnoff test of normality was used to assess the distribution of sample. All data acquired was normally distributed. Statistical test used to compare the difference in knowledge level about dietary iron among students before and after education was paired sample T-test. Improvement of knowledge about dietary iron was compared between each grade (grade 1, 2, 3) using the one-way ANOVA test while comparison based on gender (male and female) was calculated using independent sample t-test Independent variable in this study is nutritional education. The dependent variable is the improvement of level of knowledge about dietary iron before and after education. The cofounding variables in this study are gender and grade. Subjects that participate in this research were given detailed information about the purpose of this study and how it is conducted. Subjects were asked for informed consent before the data gathered is used. All private information gathered from subject was kept confidential.
RESULTS
General data of students in Pesantren Tapak Sunan There were 77 senior high school students (madrasah aliyah / MA) participated in this study as subjects. However, 9 students did not collect their pre-test or post-test questionnaire sheets hence they were counted as dropout criteria. The data of the participants were then categorized based on their respective variables. Table 1 showed the distribution of subjects based on the variables. It can be seen that the numbers of male and female participants are same. Most of the subjects are grade 1 MA students, followed by grade 3MA and grade 1 MA.
Table 1 Distribution of subjects based on gender and grade
Variables Category n % Gender Male 34 50.0 Female 34 50.0
Grade Grade 1 MA 24 35.3 Grade 2 MA 21 30.9 Grade 3 MA 23 33.8
Basic Knowledge about dietary iron Table 2 showed the comparison of basic knowledge of dietary iron among students based on gender and grade. Independent t-test showed insignificant difference of basic knowledge between male and female. There was also no significant difference of basic knowledge between different levels of grades
Table 2 Distribution of Basic Knowledge of Dietary iron by gender and grade
Pre-test* Validity Test Gender Independent samples T-test p= 0.194 Male (n= 34) 48.35 19.53 Female (n= 34) 61.45 19.67
Grade Level One-way ANOVA p= 0.087 Grade 1 MA (n= 24) 54.67 19.41 Grade 2 MA (n= 21) 48.00 18.02 Grade 3 MA (n= 23) 51.30 21.69 *Mean Standard Deviation
Improvement of knowledge after Nutritional Education From table 3, it can be seen that there is a difference between mean score before and after education. After education, the mean score of the test result increased significantly by 21.00 (SD 21.79) (p<0.001). Table 4 showed higher improvement in male students than female students however the independent t-test showed that the result is insignificant (p= 0.878). One-way ANOVA test showed insignificant higher improvement of knowledge can also be observed among the second grade students (p= 0.971).
Table 3 Effect of Nutritional Education to Improvement of Knowledge about Dietary Iron
* Validity Test Knowledge of Dietary Iron Paired sample T-test p< 0.001 Before education 51.47 19.70 After education 72.47 14.73
Improvement ( Score) 21.00 21.79 *Mean Standard Deviation
Table 4 Distribution of Knowledge Improvement based on gender and grade
Grade Level One-way ANOVA p= 0.971 Grade 1 MA (n= 24) 17.00 21.31 Grade 2 MA (n= 21) 29.71 20.26 Grade 3 MA (n= 23) 17.22 22.22 * Score was presented with: Mean Standard Deviation
DISCUSSION
Although treatment and prevention of iron deficiency in society is quite effective by iron supplementation and diet modification, these approaches requires active participation. Knowledge about these programmes is needed to support and motivate healthier behaviour. WHO mentioned that educational intervention is important to increase publics awareness and knowledge. The result of this study indicates that after receiving education, mean score of test increase significantly which suggest that there is an improvement in knowledge about dietary iron. This result is comparable with 2 studies conducted about effectiveness of nutritional education in improving health knowledge. 26, 27 The previous study stated that nutritional education improve awareness towards iron deficiency compared with those only receive iron supplement without any educational intervention 27 while the latter showed that higher nutritional knowledge and dietary iron intake was assessed in groups receiving nutritional education. 26 These studies also showed that public seminar as media for nutritional education is quite effective in improving knowledge. When compared based on gender, male students has higher improvement score than female but independent sample t-test has shown that this result is insignificant. Thus, there is no relationship between improvement of knowledge and gender. Other comparison also showed no association of the improvement of knowledge to grade. These results indicate that there is education by means of public seminar is effective for both genders or grades hence there is no need for different educational approach for different gender or grade. Educator could give the same approach for different grades or gender in order to achieve equal positive improvement. In terms of basic knowledge, students overall had low level of knowledge about iron. Improvement can be achieve might be due to the fact that students are eager to learn about the subjects because they did not have the knowledge before. Although not significant, second grade students shows high improvement score compared with the other two grades. This can be contributed by the fact that second grade students might be more eager and more focused during seminar. Third grade student are less eager and less focused to the seminar because they have spent their effort to study for their final examination. On the other hand, first grade students have just entered their senior high-school level. They are still on the phase of making new relationship with other student and tend to have relaxed attitude in studying. This attitude resulted in students not paying enough attention during seminar. While second grade students had settled down in their second year of study, they adopt more serious attitude towards studying, therefor paying more attention during seminary which resulted in higher improvement compared with others. Two similar studies in two different countries was conducted in which both studies aimed to assess effect of nutritional education programme in school along with diet modification program to treat iron-deficiency. 21, 22 Both studies show similar results. They showed that educational program increase students and family motivation in improving diet while dietary intervention increase iron status in students. However both this study did not relate directly the effect of education to reducing iron deficiency. Different study addressed the issue directly by conducting nutritional education programme at several schools. 6 This study has proven an important result; nutritional educational intervention is indeed effective in improving health status. Habit modification, which is the aim of this intervention, is successfully achieved. Overall, this study has shown that there is an improvement in knowledge about dietary iron after nutritional education. This improvement is due to eagerness of the students in learning about dietary iron. Education material given was also interesting enough while educator plays important role in delivering and explaining material in simple and language which is easy to understand. Last factor that might affect the study is the students attitude. Honesty among the student during pre-test and post-test affect the accuracy regarding the level of knowledge before receiving education and how much it actually improved after education. Thus, effectivity of nutritional education in improving knowledge can be measured in more precise.
CONCLUSION AND SUGGESTION
Overall, female and male students have the same level of basic knowledge about dietary iron. There is also no difference of basic knowledge between students of different grades. There is a significant improvement of knowledge about dietary iron among students after receiving nutritional education about iron. There is no relationship between improvement of knowledge with gender or level of grade. Public seminar as media for nutritional education is effective in improving students the knowledge about health aspect of dietary iron Researcher suggests that nutritional education programme should be aimed at school- age and incorporated in school programme family to increase awareness and improve healthy behaviour. Nutritional education can be given in the same approach despite the gender or level of grade. Further research should be conducted to evaluate the effectiveness of nutrition education intervention in modifying health behaviour and reducing iron deficiency status.
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