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Health education to prevent anemia among adolescents in Samarinda,

Indonesia

Article  in  Abdimas Jurnal Pengabdian Masyarakat Universitas Merdeka Malang · May 2023

DOI: 10.26905/abdimas.v8i2.9224

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 ABDIMAS: Jurnal Pengabdian Masyarakat Universitas Merdeka Malang LPPM
Vol.8(2) May 2023, 288-296 UNMER
p-ISSN: 2721-138X e-ISSN: 2548-7159
MALANG
http://jurnal.unmer.ac.id/index.php/jpkm

Health education to prevent anemia among adolescents in

Samarinda, Indonesia
Ratih Wirapuspita Wisnuwardani, Shelia Wulandari, Annisa Dwi Kartika
Faculty of Public Health, Universitas Mulawarman, Samarinda, Indonesia
Jl. Kuaro, Gn. Kelua, Samarinda, 75119, Indonesia

ARTICLE INFO: ABSTRACT

Received: 2022-12-23
Revised: 2023-02-25  Health cadres play a vital role as community educators and frontline workers in the stunting handling
Accepted: 2023-05-08 Iron deficiency anemia disrupts the concentration of adolescent girls; reduce their academic
achievement, productivity, and physical strength and increases the risk of infection. The nutrition
education program about anemia is needed to increase nutritional awareness among students.
This community service aim was to evaluate the effectiveness of nutrition education among female
students of High School in Samarinda, East Kalimantan, Indonesia. There were two interventions:
health education using video among 128 students in in high school and health education using
leaflet among 11 students in the boarding school. A pretest/posttest was conducted to evaluate the
knowledge about anemia. Independent sample t-test was used to compare difference between the
before and after interventions. Health educations of using video or leaflet increased students’ anemia
Keywords: knowledge. A school health program could improve student’ anemia knowledge. It is very important
Female students, Iron for school to have collaboration with primary health center, university and other instituions for the
deficiency, Peditrics, health education program. Including nutrition education program to the curriculum of high school is
Self-efficacy, School
important to prevent malnutrition among female adolescents.

©2023 Abdimas: Jurnal Pengabdian Masyarakat Universitas Merdeka Malang

This is an open access article distributed under the CC BY-SA 4.0 license
(https://creativecommons.org/licenses/by-sa/4.0/)

How to cite: Wisnuwardani, R. W., Wulandari, S., & Kartika, A. D. (2023). Health education to prevent anemia among adolescents
in Samarinda, Indonesia. Abdimas: Jurnal Pengabdian Masyarakat Universitas Merdeka Malang, 8(2), 288-296.
https://doi.org/10.26905/abdimas.v8i2.9224

1. INTRODUCTION
Adolescents (aged 10 to 19 years) is a critical age period since health during adolescence might
affect the risk of adult non-commuicable diseases. Therefore, health intervention among adolescents
can have a positive effect. Nutrition education is the essential program to prevent the malnutrition
(Schembri et al., 2016). The knowledge about proper nutrition and balanced diet during adolescence is
very important to prevent malnutrition as adolescence is a critical period that can affect adult’s chronic
disease (Biro & Wien, 2010). Therefore, dietary intake during adolescence may indicate adult lifestyle
and health (Wisnuwardani et al., 2018). Inadequate diet during adolescence can lead to malnutrition
such as anemia.

Corresponding Author: Ratih Wirapuspita Wisnuwardani: Tel. +62 541 749343│ E-mail: ratih@fkm.unmul.ac.id
 Health education to prevent anemia among adolescents in Samarinda, Indonesia
Ratih Wirapuspita Wisnuwardani, Shelia Wulandari, Annisa Dwi Kartika
a diet with a low overall or bioavailable iron content); increased losses of iron due to chronic blood
loss (in women, due to menstruation and exacerbated in cases of heavier menstrual bleeding, and by
Iron deficiency is the most prevalent nutrition deficiency in the world that contribute to at least
intestinal hookworm infection in individuals living in endemic settings and increasing iron
half of global burden anemia. Iron deficiency is the most major couse of anemia (McLean et al., 2009).
requirements
The major (e;g; during
causes growth
of iron or pregnancy)
deficiency (Low et al.,
include inadequate 2016).
dietary iron intake (due to the consumption
Anemia decreases the concentration of female
of a diet with a low overall or bioavailable iron content); increased losses of adolescents, productivity,
iron due to chronictheir blood
educational
successloss
and(in increase
women, due the torisk of infection
menstruation (Abu-Baker
and exacerbatedetinal., 2021).
cases Approximately,
of heavier one out and
menstrual bleeding, of sixby people
intestinal hookworm infection in individuals living in endemic settings
affected anemia are adolescents (WHO, 2018). In Indonesia, anemia among adolescents is a moderate and increasing iron requirements
public (e;g; during
health growthas
problem or 23%
pregnancy)
female (Low et al., 2016).(13-18 years olds) are anemia (Indonesia Ministry of
adolescents
Health, 2013). Anemia Thedecreases
prevalence the concentration
of anemia of female adolescents,
among Indonesianproductivity,
adolescents theirincreases
educationalinsuccess
2018 (32%)
and increase the risk of infection (Abu-Baker et al., 2021). Approximately, one out of six people affected
(Indonesian Ministry of Health, 2018). Iron supplementations are a commonly used to prevent anemia.
anemia are adolescents (WHO, 2018). In Indonesia, anemia among adolescents is a moderate public
However,
health the lowest
problem province
as 23% female of iron suppelementation
adolescents (13-18 years olds) are coverage among Ministry
anemia (Indonesia female of adolescents
Health, in
Indonesia
2013).isThe East Kalimantan
prevalence (7.8%)
of anemia among(Indonesian
IndonesianMinistry
adolescentsof increases
Health, in 2018). Primary
2018 (32%) health centre
(Indonesian
(Puskesmas)
MinistryWonorejo is oneIron
of Health, 2018). of supplementations
primary health are centre in East used
a commonly Kalimantan
to prevent hasanemia.
20% anemia
However,among
the lowest province of iron suppelementation coverage among
female adolescents. Other primary health centre in East Kalimantan, Puskesmas Samarinda female adolescents in Indonesia is East
Kota also
Kalimantan (7.8%) (Indonesian Ministry of Health, 2018). Primary
has a problem about non-compliance in consuming iron supplement tables in female high school health centre (Puskesmas) Wonorejo
is one of primary health centre in East Kalimantan has 20% anemia among female adolescents. Other
students. Some of schools don’t have nutrition program to educate the students about balanced diet.
primary health centre in East Kalimantan, Puskesmas Samarinda Kota also has a problem about non-
Nutrition education
compliance in consuming reduces the prevalence
iron supplement tables in of anemia
female high in European,
school students.North
Some of American, Asian and
schools don’t
Autralian
havecountries (Sunuwar
nutrition program et al., 2019).
to educate In addition,
the students nutrition
about balanced program in schools was suggested as
diet.
an appropriate Nutritionintervention to increase
education reduces nutritional
the prevalence awareness
of anemia (Xu et
in European, Northal., American,
2020). Asian Therefore,
and this
community
Autralianservice used
countries a nutrition
(Sunuwar education
et al., 2019). program
In addition, nutritionasprogram
intervention
in schoolsto was
increase theasnutritional
suggested an
appropriate
knowledge among intervention
female high to increase
schoolnutritional
studentsawareness
in Puskesmas(Xu et al., 2020). Therefore,
Wonorejo this community
and Puskesmas Samarinda
service
Kota, East used a nutrition
Kalimantan, education program as intervention to increase the nutritional knowledge among
Indonesia.
female high school students in Puskesmas Wonorejo and Puskesmas Samarinda Kota, East Kalimantan,
Indonesia.
2. METHODS
2. METHODS
Location
Location
There were two locations of community services, Boaring School in the coverage of Puskesmas
There were two locations of community services, Boaring School in the coverage of Puskesmas
Wonorejo and and
Wonorejo highhigh
school in in
school thethecoverage
coverage of PuskesmasSamarinda
of Puskesmas Samarinda Kota.
Kota. BothBoth of cities
of cities were inwere in
Samarinda, East Kalimantan
Samarinda, (Figure
East Kalimantan (Figure1).1).

FigureFigure 1. activity
1. The The activity location
location was5-8
was 5-8km
km from
from Faculty
Facultyofof
Public Health,
Public Universitas
Health, Mulawarman
Universitas Mulawarman

Tools and Materials

Preparation stage
| 289 |
This activity was begun with problem identification. Discussion with the health officers in
Puskesmas Wonorejo and Puskesmas Samarinda Kota, East Kalimantan and using the secondary data
were the first step to do in this community service.
After that, we chose the priority issue, determining the cause of the problem and problem
 ABDIMAS: Jurnal Pengabdian Masyarakat Universitas Merdeka Malang
Volume 8, No 2, May 2023: 288-296

Tools and Materials

Preparation stage
This activity was begun with problem identification. Discussion with the health officers in
Puskesmas Wonorejo and Puskesmas Samarinda Kota, East Kalimantan and using the secondary data
were the first step to do in this community service.
After that, we chose the priority issue, determining the cause of the problem and problem solution
with the teachers, health officers, high school students and community. Detail of the preparation stage
was discussed below:

Problems identification
Based on observation and secondary data, there were 4 problems in Puskesmas Wonorejo and
Puskesmas Samarinda Kota: (1) The prevalence of anemia among adolescents was high, ex. 20% in
Puskesmas Wonorejo in 2022; (2) Low consumption of iron supplementation among adolescents; (3)
Inadequate
Inadequate knowledgeand
knowledge andskill
skillofofposyandu’s
posyandu’s cadres
cadres about
about antropometri
antropometrimeasurement
measurement(d)(d)
there were
there were
other malnutrition in children, such as underweight and wasting.
other malnutrition in children, such as underweight and wasting.

Figure
Figure2.2.Discussion
Discussion with
with health officer
officer and
andteachers
teachers

Priority issues
Priority issues
Using Urgency, Seriosness, Growth (USG) method, the high prevalence of anemia among
adolescents was choosen as the priority issues. The choosing the priority issues was disscused with
Using Urgency, Seriosness, Growth (USG) method, the high prevalence of anemia among
nutritionists of Puskesmas Wonorejo and Puskesmas Samarinda Kota.
adolescents was choosen as the priority issues. The choosing the priority issues was disscused with
nutritionists
Determining of Puskesmas Wonorejo
the cause of and Puskesmas Samarinda Kota.
the problem
Using the fishbone method, there are 5 main of the causes of high prevalence of anemia (Figure
2): (1) Few human resources in Puskesmas so lack of anemia socialization; (2) Uneven distribution of
Determining the cause duet
iron supplementation of theo problem
few human resouces; (3) Lack of media information about anemia; (4)
LackUsing
of heallthy life style programs
the fishbone method, there at schools; and (5)
are 5 main ofLow
the socio-economic characteristics
causes of high prevalence of of students.
anemia (Figure
2): (1) Few human resources in Puskesmas so lack of anemia socialization; (2) Uneven distribution of(1)
There were some of problem solution alternatives to solve low knowledge of anemia: iron
Nutrition education program to socialize the healthy lifestyle and balanced nutrients among high
supplementation duet o few human resouces; (3) Lack of media information about anemia; (4) Lack of
school students; (2) Coordination and advocasy to the head of schools for healthy lifestyle programs at
heallthy life style programs at schools; and (5) Low socio-economic characteristics of students.
schools; (3) Healthy menu at school restaurants. CARL (capability, accessibility, readness leverage)
Therewas
method were some
used to of problem
choose the solution
problem alternatives to solve
solving priority. Thelow knowledge
socialization of of anemia:
healthy (1) Nutrition
lifestyle and
education
balancedprogram
nutrientstoamong
socialize the
high healthy
school lifestyle
students wasand balanced
choosen nutrients
as the program. among high school students;
(2) Coordination and advocasy to the head of schools for healthy lifestyle programs at schools; (3)
Healthy menu at school restaurants. CARL (capability, accessibility, readness leverage) method was used
to choose the problem solving priority. The socialization of healthy lifestyle and balanced nutrients
among high school students was choosen as the program.

| 290 |

Figure 3. Presentation material in the health education

 Lack of heallthy life style programs at schools; and (5) Low socio-economic characteristics of students.
There were some of problem solution alternatives to solve low knowledge of anemia: (1)
Nutrition education program to socialize the healthy lifestyle and balanced nutrients among high
school students; (2) Coordination and advocasy to the head of schools for healthy lifestyle programs at
schools; (3) Healthy
Healthmenu at school
education restaurants.
to prevent anemia among CARL (capability,
adolescents accessibility,
in Samarinda, readness leverage)
Indonesia
method was used to choose the problem
Ratih Wirapuspita solving
Wisnuwardani, priority.
Shelia TheAnnisa
Wulandari, socialization
Dwi Kartika of healthy lifestyle and
balanced nutrients among high school students was choosen as the program.

The aim of program was to improve knowledge of healthy life style, balanced diet and anemia
among female high school students in the coverage area of Puskesmas Wonorejo and Puskesmas
Samarinda Kota. This program was held to prevent anemia among adolescents. Anemia education
programs was conducted in Islamic boading school in the coverage area of Puskesmas Wonorejo (14
Figure3.3.Presentation
Presentation material inin the
the health education
December 2022) and SMKN 7Figure in the coverage ofmaterial
Puskesmas health education
Samarinda Kota (1 December 2022).There
were several activity during anemia education programs in both Puskesmas: (1) Participants answered
3. 3. RESULTS
RESULTS AND DISCUSSION
AND DISCUSSION
pre test; (2) Anemia education programs were used video in high school and leaflet in islamic boarding
school; (3) The
Discussion
program
The program for answer
waswas
Anemia and
Anemia question
Education
Education sessions.
Program
Program among Participants
among female
female high asked
high wome
school
school questions
students
students (Figureto
(Figure speaker;
5).5).
The
material
and (4) The of program
material
Participants were: (1)
ofanswered
program the definition
were:
post (1)
test of anemia.
theMaterial.The
definition The material
of anemia.
speakers were the
Thedesigned
material difference
were
video theand anemia
difference
leaflet toand
anemia low in
present
bloodandpressure
low blood and the
pressure definition
and the of anemia;
definition of(2) Anemia
anemia; symptoms.
(2) Anemia The
symptoms.
anemia education programs. For video, LCD was used in the intervention. The presentation with ppt speaker
The discussed
speaker “Is weakness
discussed “Is
andweakness
fatique aandsymptom
fatiqueofa anemia?”
symptom in ofthe program;
anemia?” (3) Cause
in the program;of anemia.
(3) Cause Micronutrient deficiency and
of anemia. Micronutrient
(power point) was used also in both Puskesmas, to discuss about the isi piringku or eating behaviours,
deficiency
infections was and infections
discussed was discussed
by speaker as the main bycause
speaker as the(4)
of anemia; main cause of anemia; The
Iron supplementation. (4) speaker
Iron
and ironsupplementation.
supplementation. The The importance
speaker presented of consumption
the importance of protein,
iron iron, zink,
supplement asam folat
consumption, and vitamin
especially
presented the importance of iron supplement consumption, especially during menstruation among
C to female
prevent
during anemia
menstruation
adolescents; were explained
(5) among
Healthy femaleto the
eating high school
adolescents;
behaviors. students.
(5) Healthy
Balaced eatingInsufficient
nutrition behaviors.
was discussedconsumption
Balaced nutrition
by speaker ofwas
with nutrients
the
and picture
infection
discussedwere
of “ISIby the main
speaker
PIRINGKU”; cause
with
and the in anemia.
picture
(6) Prevention of “ISI Therefore,
PIRINGKU”;
of anemia. other
and
Healthy (6)healthy behaviors
Prevention
behaviors and of anemia.such
supplementation as were
Healthy physical
activity, behaviors
by and
and hygiene
discussed speakersupplementation
(washing hand)
to prevent were
were
anemia. discussed
explainedby speaker
in the to preventeducation
anemia anemia. programs.

Figure 4. Anemia
Figure 4. Anemia Education
EducationPrograms withleaflet
Programs with leafletininIslamic
Islamic boarding
boarding school
school
(11(11
students)
students)and
and with
with video inSMK
video in SMK77Samarinda
Samarinda

The evaluation of nutrition education program used the active participation of female high
| 291 |
school students and also analyse the different knowledge before and after intervention. All participants
were active in the nutrition education programs. Based on the answer of participants, most of them
knew anemia (86%), although they never attend nutrition education programs or other sosialization
about anemia (60%).
 ABDIMAS: Jurnal Pengabdian Masyarakat Universitas Merdeka Malang
Volume 8, No 2, May 2023: 288-296

The aim of program was to improve knowledge of healthy life style, balanced diet and anemia
among female high school students in the coverage area of Puskesmas Wonorejo and Puskesmas
Samarinda Kota. This program was held to prevent anemia among adolescents. Anemia education
programs was conducted in Islamic boading school in the coverage area of Puskesmas Wonorejo (14
December 2022) and SMKN 7 in the coverage of Puskesmas Samarinda Kota (1 December 2022).There
were several activity during anemia education programs in both Puskesmas: (1) Participants answered
pre test; (2) Anemia education programs were used video in high school and leaflet in islamic boarding
school; (3) Discussion for answer and question sessions. Participants asked wome questions to speaker;
and (4) Participants answered post test Material.The speakers designed video and leaflet to present in
anemia education programs. For video, LCD was used in the intervention. The presentation with ppt
(power point) was used also in both Puskesmas, to discuss about the isi piringku or eating behaviours,
and iron supplementation. The importance of consumption protein, iron, zink, asam folat and vitamin C
to prevent anemia were explained to the high school students. Insufficient consumption of nutrients and
infection were the main cause in anemia. Therefore, other healthy behaviors such as physical activity, and
hygiene (washing hand) were explained in the anemia education programs.
The evaluation of nutrition education program used the active participation of female high school
students and also analyse the different knowledge before and after intervention. All participants were
active in the nutrition education programs. Based on the answer of participants, most of them knew
anemia (86%), although they never attend nutrition education programs or other sosialization about
anemia (60%).
Before and after nutrition education programs, there were pre test and post test. Data entry was
analyzed by software package IBM SPSS version 23 (IBM, New-York, USA) and the level of significance
was set at two-side р<0.05. Frequencies, percentage, mean (standard deviation) were calculated under
descpriptive statistics. No normal distribution was found, alhtought log transformation was applied
to fit normality. The difference between knowledge of before and after intervention was tested using
Wilcoxon test.
Increasing knowledge about anemia was found in both anemia education programs in both
schools (table 1). Using leaflet in small group and using video in big group participants increased the
knowledge of participants. After post test, all participants consumed iron supplementation together
(Figure 6).

Table 1. Increasing knowledge after nutrition education programs

Anemia Education Program Р-value*

Media Before intervention After intervention

Median Range (min, max) Median Range (min, max)

Using leaflet** 75 50 (35, 85) 80 20 (80, 100) 0.005

Using video*** 5 5 (3, 8) 6 4 (4, 8) <0.001

*Data was tested by wilcoxon test
**the highest score was 100
***the highest score was 8, and the lowest was 4

| 292 |
**the highest score was 100
Media Anemia Education Program Р-value*
***the highest score was 8, and the lowest was 4
Before intervention After intervention
Median Range (min, max) Median Range (min, max)
Using leaflet** 75 50 (35, 85) 80 20 (80, 100) 0.005
Using video*** 5 5 (3, 8) 6 4 (4, 8) <0.001
Health education to prevent anemia among adolescents in Samarinda, Indonesia
*Data was tested by wilcoxon test
Ratih Wirapuspita Wisnuwardani, Shelia Wulandari, Annisa Dwi Kartika
**the highest score was 100
***the highest score was 8, and the lowest was 4

Figure 6. The consumption of iron supplementation in anemia education program

The distribution of knowledge

Figure
Figure 6.6.The participants
Theconsumption
consumption ofiron
of (before and
iron supplementation
supplementation aftereducation
ininanemia
anemia nutrition
education education programs) was
program
program
described in Table 2.
TheThe distributionofofknowledge
distribution knowledge participants
participants (before
(before and
andafter
afternutrition
nutritioneducation
educationprograms) waswas
programs)
described in Table
described in Table 2. 2.
Table 2. The distribution of knowledge among high school students.
Knowledge of Anemia Table 2. The distribution of knowledge amongTrue Answer (%)
Table 2. The distribution of knowledge amonghigh
highschool
schoolstudents.
students.
Knowledge of Anemia Before Intervention True Answer (%) After Intervention
Before Intervention True Answer (%) After Intervention
The definition ofKnowledge
anemia of Anemia 6.3 46.1
The definition of anemia Before Intervention 6.3 After Intervention46.1
Anemia symptoms
Anemia symptoms 50.9
50.9 59.4
59.4
The definition of anemia 6.3 46.1
Cause of anemia
Cause of anemia 90.690.6 89.8 89.8
Anemia symptoms 50.9 59.4
Iron supplementation
Iron supplementation 77 77 94.5 94.5
Cause of anemia
Healthy eating behaviors 90.6 75 89.8 81.3
Healthy eating behaviors 75 81.3
Prevention of anemia
Iron supplementation 77 85.9 94.5 96.1
Prevention of anemia 85.9 96.1
Healthy eating behaviors 75 81.3
All knowledge increased after nutrition education program, except the cause of anemia. The
Prevention of anemia 85.9 96.1
cause of anemia
All knowledge questionsafter
increased had several questions,
nutrition such as inadequate
education program,dietaryexceptiron the
intake (due toofthe
cause anemia. The
consumption of a diet with a low overall or bioavailable iron content); increased losses of iron due to
cause of anemia
chronic
questions
All knowledge had
increased
blood loss (in
several
women, after
questions,
nutrition
due to
such
education
menstruation
as inadequate
program,
and exacerbated except dietary
theofcause
in cases
iron intake The
of menstrual
heavier anemia. (due to the
consumption
cause of a diet
of anemia
bleeding, and bywith a low
questions
intestinal hadoverall or bioavailable
severalinfection
hookworm questions, such asiron content);
inadequate
in individuals living increased
dietary
in endemic iron intake
settings andlosses
(due of iron due to
to the
increasing
consumption
chronic blood loss (inof awomen,
iron requirements.diet with due
a lowtooverall or bioavailable
menstruation andiron content); increased
exacerbated in cases lossesof of iron due
heavier menstrual
bleeding,toand
chronic blood loss (in women, due to menstruation and exacerbated in cases of heavier menstrual
by intestinal hookworm infection in individuals living in endemic settings and increasing
bleeding, and by intestinal hookworm infection in individuals living in endemic settings and increasing
iron requirements.
iron requirements.

Figure 7. Discussion the evaluation program with students

Discussion
This community service program activities by conducting anemia education program have
relevance with the urgency of anemia in female adolescents. The routine anemia education programs
with leaflet, video and ppt is very importance to increase the knowledge of anemia prevention.
Figure 7. Discussion
Figure 7. Discussionthe
theevaluation program
evaluation program withwith students
students

Discussion
This community service program activities| 293by
| conducting anemia education program have
relevance with the urgency of anemia in female adolescents. The routine anemia education programs
with leaflet, video and ppt is very importance to increase the knowledge of anemia prevention.
 ABDIMAS: Jurnal Pengabdian Masyarakat Universitas Merdeka Malang
Volume 8, No 2, May 2023: 288-296

Discussion
This community service program activities by conducting anemia education program have
relevance with the urgency of anemia in female adolescents. The routine anemia education programs
with leaflet, video and ppt is very importance to increase the knowledge of anemia prevention. Adherence
to consumption of iron supplementation among female adolescents will increase as in the of the anemia
education program, the female students should consumpt iron supplementation.
Increasing knowledge was found in both anemia education programs in both media (video and
leaflet). Anemia education programs in Islamic boarding school and high school were not significant
difference, as both of anemia education programs increased the knowledge among female students.
In line with community service among adolescent females in Islamic boarding school Purwokerto that
increasing reproductive health literacy was found after peer education (Nafisah et al., 2023).
This is also in line with a randomized control study in India that a significant improvement of
knowledge was found after intervention (Sharma & Rani, 2016). One of review study also found that
nutrition education programs that are delivered face to face and use active learning strategies are
positively associated with improvements in nutrition knowledge (Mitchell et al., 2018). Integaration of
a nutrition curriculum in the school should be mandatory as it can improve the knowledge of students
(Cuerda et al., 2020).
All knowledge increased in this community service except the knowledge of the cause of anemia.
There were several questions about the cause of anemia, and the presentation duration was too short
to discuss all about anemia. Therefore, the nutrition education program should be the routine agenda
in every school, so the speaker can present detail about anemia. The cause of anemia can be discussed
in several nutrition education program, so the students will be understand about this. If the students
know the causes of anemia, then they will be able to prevent anemia.
The program of Weekly Iron Folic Acid supplementation/WIFAS to adolescent girls is an effective
strategy in preventing anemia. However, in Indonesia it is known that only 1.4% adhere to taking WIFAS.
Therefore, after nutrition education program, all participants consumed iron supplementation. Similarly
with the community health service in Pondok Pesantren Salafiyah Syafi’iyah Sukorejo, Situbondo, that
the education of adherence to iron supplementation was given among female high school students as
only a half of female students consumed WIFAS (Nurhasanah et al., 2022).
The increasing of iron demand during adolescence is needed priority attention, as young women
are a target for the best intervention (Deivita et al., 2021). Early detection of anemia is better to prevent
anemia. Although anemia nutrition program can improve the knowledge, daily iron supplementation
is needed also. Daily iron supplementation may increase Hb levels and reduce the risk of anemia and
iron deficiency anemia (da Silva Lopes et al., 2021). Therefore, anemia nutrition educations, such as
socialization of anemia and daily iron supplementation are important in high schools to prevent anemia.
Anemia is a major health problem, especially among females in less developed countries (Safiri et al.,
2021). However, anemia education programs in Indonesia should focus more on the pathogenetic
complexity arising from personal behavior, sociocultural factors, dietary and health patterns, local
community and ecology (Nadiyah et al., 2020).

4. CONCLUSION AND RECOMMEDATIONS

This community service program is carried out in partnership with Puskesmas Wonorejo,
Puskesmas Samarinda Kota and Faculty of Public Health, Universitas Mulawarman. The implementation
of program is divided into 3 stages: preparation (problems identification, priority issues, determining

| 294 |
 Health education to prevent anemia among adolescents in Samarinda, Indonesia
Ratih Wirapuspita Wisnuwardani, Shelia Wulandari, Annisa Dwi Kartika

the cause of the problem, and problem solution), implementation and evaluation. The anemia education
program was choosen in this community service program. Increasing knowledge was found after the
intervention. The nutrition education programs in high schools, such as sosialization of anemia can
improve the knowledge among female high school students.
Regularly anemia education programs at high schools are important to prevent anemia among
female students. Therefore, the nutrition education programs should be schedule regularly at high
schools. This program can support also the Indonesia government that female adolescents should
consume WIFAS, as after the intervention, students will consume WIFAS together. The nutrition
education programs can be held with the collaboration between health officers, university and other
institutions. Including the anemia education programs to curriculum in high school is important also,
so the programs are sustainable. However, teachers should follow some workshops about anemia. The
nutrition workshops might have collaboration with education ministry, health ministry and university.
The knowledge of cause of anemis was not increasing in this community health service. Therefore, the
next community service program should focus to the cause of anemia. The long socialization will be
bored for students, so the short and routine nutrition education program will be suitable.

ACKNOWLEDGEMENTS
The community service team would like to thank the head of Puskesmas Samarinda Kota and
Puskesmas Wonoreja, Samarinda, and the team of Nutrition department in both Puskesmas. We
acknowledgement also to the headmaster of SMK 7, the headmaster of Islamic boarding school (Pondok
Pesantren Solusi) for assisting us in gathering participants and supplying the equipment needed
to perform out this activity. Additionally, we wish express out gratitude to Faculty of Public Health,
Universitas Mulawarman for giving funding of article submittion fee.

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