Determinants of Iron Supplementation Compliance Among Adolescent Girls in Kuningan Regency, Indonesia

Nur Laily  Ramdhani; Cesilia Meti  Dwiriani; Ali  Khomsan

doi:10.56303/jhnresearch.v4i3.685

Authors

Nur Laily Ramdhani Department of Community Nutrition, Faculty of Human Ecology, IPB University, Indonesia https://orcid.org/0009-0007-2778-2195
Cesilia Meti Dwiriani Department of Community Nutrition, Faculty of Human Ecology, IPB University, Indonesia https://orcid.org/0000-0003-2245-310X
Ali Khomsan Department of Community Nutrition, Faculty of Human Ecology, IPB University, Indonesia https://orcid.org/0000-0001-6101-3583

Keywords:

Adolescent Girls, Compliance, Iron Supplement Consumption

Abstract

The iron supplementation program is one of the efforts to overcome anemia based on WHO recommendations. The compliance of iron supplement consumption is an indicator of the success of anemia prevention programs. This cross-sectional study aims to analyze factors related to compliance with iron supplement consumption among adolescent girls in health center areas in Kuningan Regency. The study involved 105 respondents selected using a proportional random sampling technique. Data were collected using a questionnaire for each variable. The data were analyzed using Chi-Square statistical test. The results showed that only 21% of adolescent girls were found to be compliant in taking iron supplements. Approximately 62.9% of adolescent girls with good knowledge were compliant in taking iron supplements (p=0.041). 70.4% of adolescent girls with positive attitudes were compliant in taking iron supplements (p=0.018). Approximately 50.6% of adolescent girls lacked support from teachers (p=0.019), 71.1% lacked support from peers (p=0.010), and 62.7% lacked access to nutrition education or counseling at school (p=0.010). This study suggests the need of cross-sectoral support from both the health and education sectors to strengthen the implementation of the routine iron tablet consumption program as recommended.

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References

World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health Organization; 2024. 79 p.

Habtegiorgis SD, Petrucka P, Telayneh AT, Shitu Getahun D, Getacher L, Alemu S, et al. Prevalence and associated factors of anemia among adolescent girls in Ethiopia: A systematic review and meta-analysis. PLoS One [Internet]. 2022;17(3):1–11. Available from: http://dx.doi.org/10.1371/journal.pone.0264063

Roche ML, Bury L, Yusadiredjai IN, Asri EK, Purwanti TS, Kusyuniati S, et al. Adolescent girls’ nutrition and prevention of anaemia: A school based multisectoral collaboration in Indonesia. BMJ. 2018;363:1–6.

Badan Kebijakan Pembangunan Kesehatan Kemenkes RI. Survei Kesehatan (SKI) 2023 Dalam Angka. Jakarta: BKPK Kemenkes RI; 2023. 965 p.

World Health Organization. World Health Statistics 2015. Geneva: World Health Organization; 2015. 164 p.

Dinas Kesehatan Kabupaten Kuningan. Laporan Tahunan Anemia Remaja Putri Usia Sekolah Tahun 2023. Kuningan: Dinas Kesehatan Kabupaten Kuningan; 2023.

Kementerian Kesehatan RI. Pedoman Pencegahan dan Penanggulangan Anemia pada Remaja Putri dan Usia Subur (WUS) [Internet]. Kemenkes RI. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018. 92 p. Available from: https://promkes.kemkes.go.id/download/fpck/files51888Buku Tablet Tambah darah 100415.pdf

World Health Organization. Weekly Iron and Folic Acid Supplementation as an Anaemia-Prevention Strategy in Women and Adolescent Girls [Internet]. World Health Organization. Geneva: World Health Organization; 2018. 40 p. Available from: https://www.who.int/nutrition/publications/micronutrients/WIFS-anaemia-prevention-women-adolescent-girls/en/

Badan Perencanaan Pembangunan Nasional RI. Pedoman Pelaksanaan Intervensi Penurunan Stunting Terintegrasi di Kabupaten/Kota [Internet]. Rencana Aksi Nasional dalam Rangka Penurunan Stunting: Rembuk Stunting. Jakarta: Bappenas RI; 2018. 59 p. Available from: https://www.bappenas.go.id

Joe W, Rinju, Patel N, Alambusha R, Kulkarni B, Yadav K, et al. Coverage of iron and folic acid supplementation in India: Progress under the Anemia Mukt Bharat strategy 2017-20. Health Policy Plan. 2022;37(5):597–606.

Gosdin L, Sharma AJ, Tripp K, Amoaful EF, Mahama AB, Selenje L, et al. A School-Based Weekly Iron and Folic Acid Supplementation Program Effectively Reduces Anemia in a Prospective Cohort of Ghanaian Adolescent Girls. J Nutr. 2021;151(6):1646–55.

World Health Organization. Accelerating anaemia reduction [Internet]. Geneva: World Health Organization; 2023. 46 p. Available from: https://www.who.int/publications/i/item/9789240074033

Alfiah E, Briawan D, Khomsan A, Dewi M, Ekayanti I, Mardewi, et al. Coverage and adherence of weekly iron folic acid supplementation among school going adolescent girls in Indonesia. J Nutr Sci Vitaminol (Tokyo). 2020;66:S118–21.

Apriningsih, Madanijah S, Dwiriani CM, Kolopaking R. Determinant of highschool girl adolescent’adherence to consume iron folic acid supplementation in Kota Depok. J Nutr Sci Vitaminol (Tokyo). 2020;66:S369–75.

Direktorat Gizi dan Kesehatan Ibu dan Anak Kemenkes RI. Panduan Indikator Program Gizi dan Kesehatan Ibu dan Anak. Jakarta: Kementerian Kesehatan RI; 2021. 1–99 p.

Silitonga HTH, Salim LA, Nurmala I, Wartiningsih M. Compliance of Iron Supplementation and Determinants among Adolescent Girls: A Systematic Review. Iran J Public Health. 2023;52(1):37–48.

Anjarwati A, Ruqoiyah S. Obedience of iron tablet consumption reduces risk of anemia among Indonesian female adolescents. J Heal Technol Assess Midwifery. 2020;3(1):24–8.

Dubik SD, Amegah KE, Alhassan A, Mornah LN, Fiagbe L. Compliance with Weekly Iron and Folic Acid Supplementation and Its Associated Factors among Adolescent Girls in Tamale Metropolis of Ghana. J Nutr Metab. 2019;2019:1–12.

Green LW, Kreuter. Fourth Edition. Health Program Planning: an educational and ecological approach. New York: The McGraw-Hill Companies. Boston: Mc-Graw-Hill; 2005.

Sudfeld CR, Rai RK, Barik A, Valadez JJ, Fawzi WW. Population-level effective coverage of adolescent weekly iron and folic acid supplementation is low in rural West Bengal, India. Public Health Nutr. 2020;23(15):2819–23.

Lemeshow S, David J. Besar Sampel dalam Penelitian Kesehatan. Yogyakarta: Gadjah Mada University Press; 1997.

Nasrul, Hafid F, Taqwin, Hikmah, Risma, Nuswantari A, et al. Iron Supplement Consumption, Dietary Intake, Nutritional Status, and Anemia Among Adolescent Girls in Banawa, Donggala Regency. J Heal Nutr Res. 2025;4(2):892–904.

Hindarta NA. Evaluasi Manajemen Program Tablet Tambah Darah Dan Konsentrasi Hemoglobin Remaja Putri Stunted Dan Non-Stunted Di Cianjur. IPB University; 2021.

Biswas B, Gautam A, Jahnavi G, Richa R, Gupta P, Varshney S. Barriers , Facilitators of Iron and Folic Acid Supplementation , and Deworming Program among School-Going Adolescents of Deoghar , Jharkhand , India : A Mixed-Methods Study. Korean J Fam Med [Internet]. 2023;1–9. Available from: Jurnal Faktor2/kjfm-23-01003.pdf

Nuradhiani A, Briawan D, Dwiriani CM. Dukungan guru meningkatkan kepatuhan konsumsi tablet tambah darah pada remaja putri di Kota Bogor. J Gizi dan Pangan. 2017;12(3):153–60.

Dhikale P, Suguna E, Thamizharasi A, Dongre A. Evaluation of Weekly Iron and Folic Acid Supplementation program for adolescents in rural Pondicherry, India. Int J Med Sci Public Heal. 2015;4(10):1360.

Ansari MR, Kandarina BJI, Kusmayanti N, Destriyani, Masfufah, Fikrinnisa R. The acceptability of weekly iron-folic acid supplementation and its influencing factors among adolescent school girls in Yogyakarta city : a mix- methods study The acceptability of weekly iron-folic acid supplementation and its influencing factors among a. Malays J Nutr. 2021;27(1):053–66.

Thifal F, Noviasty R, Ulfa UM, Farahita L, Utari A, Kurniawati ER, et al. Factors related to the compliance to consuming iron-folic acid in young women in East Kalimantan, Indonesia. AcTion Aceh Nutr J. 2023;8(2):260.

Mitra. Adolescent Knowledge of Anemia and Iron Supplement Consumption Before and After Health Education. Int J Sci Soc. 2020;2(4):10–8.

Harlisa N, Wahyurianto Y, Puspitadewi TR, Sumiatin T. Pengetahuan, Motivasi, dan Dukungan Keluarga dengan Kepatuhan Konsumsi TTD pada Remaja Putri di SMAN 5 Tuban. J Pendidik Tambusai. 2023;7:20427–35.

Yuliawati R, Ardi Bastian, Agustin Widyowati. Knowledge and Awareness Impact on Adherence to Iron Supplementation: Study in Baron sub-district, Nganjuk Regency. J Nurs Pract. 2023;7(1):121–6.

Wardani DSSJ. Tinjauan Literatur: Faktor-Faktor yang Berhubungan dengan Kepatuhan Konsumsi Tablet Tambah Darah pada Remaja Putri di Indonesia. Media Gizi Kesmas. 2024;13(2):878–97.

Khomsan A, Riyadi H, Ekawidyani KR, Dina RA, Nurhidayanti VA, Prasetya G. Empowering weekly iron-folic acid (WIFA) supplementation program for adolescent school girls in high stunting areas. Bogor: IPB University; 2023.

Setyaningtyas SW, Rochmah TN, Mahmudiono T, Hidayah S, D Adhela Y. Gambaran Pengetahuan, Sikap, dan Perilaku Kader Palang Merah Remaja (PMR) di SMAN 2 Lamongan Terhadap Program Suplementasi Tablet Tambah Darah. Amerta Nutr. 2020;4(3):213.

Agustina R, Wirawan F, Sadariskar AA, Setianingsing AA, Nadiya K, Prafiantini E, et al. Associations of Knowledge, Attitude, and Practices toward Anemia with Anemia Prevalence and Height-for-Age Z-Score among Indonesian Adolescent Girls. Food Nutr Bull. 2021;42(1_suppl):S92–108.

Priya SH, Datta S, Bahurupi Y, Narayan K, Nishanthini N, Ramya M. Factors influencing weekly iron folic acid supplementation programme among school children: Where to focus our attention? Saudi J Heal Sci. 2016;5(1):28.

Novia Fatmawati Putri, Winda Kurnia Astuti. Hubungan Pengetahuan dan Sikap Terhadap Kepatuhan Konsumsi Tablet Tambah Darah pada Mahasiswa Ekstensi FKM UI. SEHATMAS J Ilm Kesehat Masy. 2023;2(1):271–7.

Listiana A. Analisis faktor-faktor yang berhubungan dengan kejadian anemia gizi besi pada remaja putri di smkn 1 terbanggi besar lampung tengah. J Kesehat. 2016;VII(3):455–69.

Pou R, Azhari ES, Virzanisda R. Dukungan Guru Terhadap Kepatuhan Konsumsi Tablet Tambah Darah Rutin Remaja Putri Sekolah. J Penelit dan Karya Ilm Lemb Penelit Univ Trisakti. 2024;9(1):97–105.

Dhikale PT, Suguna E, Thamizharasi A, Dongre AR. Evaluation of Weekly Iron and Folic Acid Supplementation program for adolescents in rural Pondicherry, India. Int J Med Sci Public Heal. 2015;4(10):1–6.

Utomo ETR, Rohmawati N, Sulistiyani S. Pengetahuan, dukungan keluarga, dan teman sebaya berhubungan dengan konsumsi tablet tambah darah pada remaja putri. Ilmu Gizi Indones. 2020;04(01):01–10.

Salsabila P, Ib BA, Arlianti N. Determinan Konsumsi Tablet Tambah Darah ( Ttd ) Pada Remaja Putri Di Tingkat Sma / Ma Kecamatan Pidie. J Kesehat Tambusai. 2024;5(3):8879–89.

Amir N, Djokosujono K. Faktor-Faktor yang Berhubungan dengan Konsumsi Tablet Tambah Darah (TTD) pada Remaja Putri di Indonesia: Literatur Review. J Kedokt dan Kesehat. 2019;15(2):119.

Jafari A, Hosseini Z, Tehrani H, Alami A. Evaluation of the barriers and facilitators of iron supplementation program among adolescent females. Clin Nutr ESPEN [Internet]. 2023;56:36–42. Available from: https://doi.org/10.1016/j.clnesp.2023.04.024

Nuradhiani A. Pengaruh perbedaan kartu monitoring terhadap kepatuhan pada program pemberian tablet tambah darah (TTD) di sekolah. IPB University; 2018.

Feriyanti A, Deviatin NS, Nurmala I, Widati S, Atmaka DR. Determinan Kepatuhan Suplementasi Zat Besi Pada Remaja Putri Dalam Upaya Intervensi Spesifik Pencegahan Stunting : A Systematic Review. Media Gizi Indones. 2022;(1):90–6.

Jikamo B, Samuel M. Non-Adherence to Iron/Folate Supplementation and Associated Factors among Pregnant Women who Attending Antenatal Care Visit in Selected Public Health Institutions at Hosanna Town, Southern Ethiopia, 2016. J Nutr Disord Ther. 2018;08(02).

Rahayuningtyas D, Indraswari R, Musthofa SB. Faktor-Faktor Yang Berhubungan Dengan Praktik Konsumsi Tablet Tambah Darah (TTD) Remaja Putri Di Wilayah Kerja Puskesmas Gilingan Kota Surakarta. J Kesehat Masy. 2021;9(3):310–8.

Raihani AD, Utami RP, Sari RA. The Effectiveness of Educational Media on Knowledge, Dietary Patterns and Compliance with Iron Supplement Consumption in Anemic Adolescent Girls. J Heal Nutr Res. 2024;3(1):53–61.

Revika E, Retno Heru S, Mediastuti F. Efektivitas Penyuluhan terhadap Pengetahuan, Sikap dan Niat Remaja Putri untuk Mengonsumsi Tablet Tambah Darah. J Ilmu Kebidanan. 2025;13(1):1–8.

Manjilala M, Idris NH, Rauf S, Sirajuddin S. Effectiveness of Interpersonal Communication in Nutrition Education on Iron Supplement Knowledge in Adolescent Girls at SMP Muhammadiyah Maros. J Heal Nutr Res. 2025;4(1):358–64.