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THE EFFECT OF NUTRITIONAL EDUCATION ON

THE KNOWLEDGE IMPROVEMENT OF THE


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

Improvement ( Score)* Validity Test
Gender
Independent samples T-test
p= 0.878
Male (n= 34) 21.41 23.05
Female (n= 34) 20.59 20.79

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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