How to cite:
Patimah,S., Megawati, M., (2022) The Effect Of Tempe Biscuit Consumption On Increasing Anemia
Youth Hb Levels, Syntax Idea, 4(4), https://doi.org/ 10.36418/syntax-idea.v4i4.1824
E-ISSN:
2684-883X
Published by:
Ridwan Institute
Syntax Idea: p–ISSN: 2684-6853 e-ISSN: 2684-883X
Vol.4, No.4, April 2022
THE EFFECT OF TEMPE BISCUIT CONSUMPTION ON INCREASING
ANEMIA YOUTH HB LEVELS
Siti Patimah, Meti Megawati
Department of Midwifery Poltekkes Ministry of Health Tasikmalaya Jawa Barat,
Indonesia
Email: [email protected], [email protected]
Abstract
Anemia occurs a lot in the community, especially in adolescents and pregnant
women.Ministry of Health research on anemia prevalence in Indonesia is 21.7% with
anemia sufferers aged 5-14 years 26.4% and 18.4% aged 15-24 years (Ministry of
Health, 2014). Young women have ten times greater risk of anemia compared to
young men. The most common cause of anemia is iron deficiency which includes
50% of all cases of anemia. One obstacle in giving TTD tablets to adolescents is that
they are not consumed by teenagers for various reasons. One of the alternative
efforts to treat anemia is Fe fortification. The research method used in this study is a
type of experimental research. The research design used at the clinical trial stage
was True Experimental and the product testing phase was quasi-experimental, with
the design of the Two Group Pretest Posttest Design. The population in this study
were students of the seventh grade of Tasikmalaya Middle School 9 with 178 people.
Based on the calculation of the sample obtained a sample size of 43 people. The
sampling technique uses purposive sampling technique. The results were analyzed
using univariate and bivariate analysis with analysis of non parametric Wilcoxon
test. The results of the study found that the organoleptic sample E test had a higher
value than the other samples so that sample E was selected. The statistical test
results of the treatment group pretest mean is 10.22 and the posttest mean is 10.35.
For the median pretest 10.35 while the median posttest was 10.60. There was a
significant increase from the results of the posttest pretest. Bivariate testing with the
Wilcoxon test obtained a value of ρ 0,000 <0,05 so that it can be concluded that
there was an effect of iron fortification and vitamin C on tempe biscuits on the levels
of juvenile Hb anemia.
Keywords: anemia; adolescent; tempe biscuit
Received: 2021-12-22; Accepted: 2022-01-05; Published: 2022-04-20
Introduction
Anemia in adolescent girls is still quite high. The World Health Organization
(WHO, 2001) reports that the prevalence of anemia ranges from 40-88%. Based on
research results from the Ministry of Health, the prevalence of anemia in Indonesia is
(21.7%) with anemia sufferers aged 5-14 years (26.4%) and (18.4%) aged 15-24 years
Siti Patimah, Meti Megawati
782 Syntax Idea, Vol. 4, No 4, April 2022
(Kemenkes, 2014). Women have the highest risk of developing anemia, especially
young women (RI, 2013).
Adolescent girls have a ten times greater risk of suffering from anemia compared
to young men. This is because young women experience menstruation every month and
are in a period of growth so they need more iron intake (Jakarta, 2010). Anemia in
school-age children and adolescents is a health problem that can lead to a decrease in
learning concentration, low ability to understand lessons, the risk of contracting
infectious diseases and emotional depression because anemia affects the process of
growth and development of brain cells (Agustian, 2010). The most common cause of
anemia is iron deficiency, which accounts for (50%) of all cases of anemia. Lack of
nutritional intake due to unhealthy lifestyles of adolescents can cause health problems,
one of which is anemia.
Research conducted by (Novitasari, Endang Nur, St, Herawati, & KJ, 2014) in
Surakarta stated that iron intake, protein intake, zinc intake and vitamin C intake greatly
affect the formation of Hb levels. So if the intake is less it can cause anemia in
adolescents. In West Java, adolescent girls aged 12-18 years who received blood
supplement tablets (8.2%), this figure is still small when compared to the puskesmas
that conducted health screening for class VII and X which amounted to (65.43%). One
of the obstacles in giving TTD tablets to adolescents is that the tablets are not consumed
by adolescents for various reasons, including feeling nauseous and bored. Efforts to
improve nutrition through foods containing iron are also difficult to do because of the
difficulty of changing eating habits and the high cost (Kemenkes, 2016).
The difficulty of changing eating habits, especially in adolescents, requires special
strategies, especially through foods that are easy, inexpensive, and contain Fe.
Adolescents generally like snacks, such as cakes/biscuits. Therefore, to facilitate the
handling of anemia in adolescents, an approach according to the characteristics of
adolescents is needed. One of the ingredients that can be used as processed food is
tempeh, because tempeh is a daily food that almost everyone consumes, it is easy to get
and cheap. Tempe is rich in dietary fiber, calcium, B vitamins and iron. Various kinds
of content in tempeh have medicinal value, namely antibiotics. Tempe is also believed
to prevent anemia and osteoporosis because it contains vitamin B12 and iron (uny.ac.id)
Research Methods
The type of research used in this study is a quasi-experimental research type. The
research design used was a quasi-experimental with control at the product-to-sample
trial stage with a two-group pretest posttest design. The tempe biscuits given to the
respondents have been through the results of organoleptic tests, and their nutritional
value has been tested in the laboratory.
The population in this study were all students of SMPN 9 Kota Tasikmlaya class
VIII, as many as 178 people. The sample size was calculated using the sample
calculation formula for numerical comparative analysis of 2 groups. Based on the
calculation results obtained a sample of 43 people. This study was conducted on two
The Effect Of Tempe Biscuit Consumption On Increasing Anemia Youth Hb Levels
Syntax Idea, Vol.4, No.4, April 2022 783
groups, namely the control and treatment groups, so the number of samples consisted of
43 people in the treatment group and 43 people in the control group. The sampling
technique in this research is using purposive sampling technique. Data analysis used
non-parametric statistical analysis with the Wilcoxon test (Arikunto, 2006). The
instrument used was a checklist and the instrument used to measure the Hb levels of the
samples before and after treatment was a digital Hb meter.
Results and Discussion
A. Result
In the implementation of the data used is primary data. The process of data
collection was carried out by examining Hb levels in class VIII students in the
control and treatment groups. In the treatment group, biscuits were given 3 times a
day for 30 days. After 30 days, the Hb level was measured again. In the control
group, pregnant women were given PMT biscuits from the health center once a day.
After giving the tempeh biscuits, the Hb level was checked.
Respondents were given tempeh biscuits that had passed the organoleptic test.
The ingredients for this tempeh biscuit are tempeh flour, banana kepok, green beans,
eggs, sugar, butter, cocoa powder, and skim milk, red guava jam. Based on
laboratory testing, the given tempeh biscuit contains the following nutritional values:
Table 1
nutritional content of tempeh biscuits
No
Parameter
Unit
Result
1
Calcium
Mg/100 g
104.04
2
Iron
Mg/100 g
4.88
3
Carbohydrate
%
52.76
4
Water content
%
7.92
5
Protein
%
16.26
1. Analisis Univariat
The following are the results of Hb levels before and after treatment in the
control and treatment groups. Hb levels were seen as mean, median and
minimum and maximum values. Shown in table 2 below:
Table 2
Pretest and posttest results for adolescent Hb levels
Pretest
Posttest
Mean
Median
Min
Maks
Mean
Median
Min
Maks
Control
10,29
10,50
8
12
10,22
10,40
8
12
Treatment
10,22
10,50
8
12
10,35
10,60
8
12
Based on table 1, it can be seen that in the treatment group the mean
pretest was 10.22 and the mean posttest was 10.35. The median for the pretest
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784 Syntax Idea, Vol. 4, No 4, April 2022
was 10.35 while the median for the posttest was 10.60. This means that there is
an increase in the mean and median values from pretest to posttest.
2. Analisis Bivariat
Bivariate analysis was carried out to measure the effect of giving tempeh
biscuits on Hb levels of anemic adolescents, which can be seen in tables 3 and 4
below: Table 3
Data on the effect of tempe biscuits on Hb . levels
N
Mean
Rank
Sum of
Ranks
control_post -
control_pre
Negative Ranks
10a
10,20
102,00
Positive Ranks
7b
7,29
51,00
Ties
28c
Total
45
interv_post - interv_pre
Negative Ranks
3d
5,00
15,00
Positive Ranks
30e
18,20
546,00
Ties
12f
Total
45
Table 4
Effect of tempe biscuits on Hb . levels
Control_post -
Control_pre
interv_post -
interv_pre
Z
-1,211b
-4,812c
Asymp. Sig. (2-tailed)
,226
,000
Based on the test results, the t-count value is 0.000, if the two-way test
results <0.05, it means that ho is rejected and ha is accepted. So it can be
concluded that there is a difference between Hb before and after treatment.
B. Discussion
Anemia is a medical condition in which the number of red blood cells or
hemoglobin is less than normal. Normal Hb level in adolescent girls is 12 g/dl.
Adolescent girls are said to be anemic if the Hb level is < 12 g/dl (Proverawati,
2011). Teenage girls every month experience menstruation which automatically
bleeds. That is why young women need iron to restore their body to its original state.
(Merryana Adriani, 2016) said the factors driving anemia in adolescent girls are:
Chronic infectious disease, excessive menstruation in adolescent girls, sudden
The Effect Of Tempe Biscuit Consumption On Increasing Anemia Youth Hb Levels
Syntax Idea, Vol.4, No.4, April 2022 785
bleeding such as an accident, the amount of food or poor dietary absorption. Based
on (Prastika, 2011), it was found that there was a relationship between the menstrual
cycle (22-35 days) and menstrual duration > 6 days with the incidence of anemia.
Anemia has a negative impact on health, including decreased reproductive
health, stunted motor, mental and intelligence development, decreased learning
ability and concentration, interfered with growth, decreased physical and fitness
levels, and pale faces. Given these consequences, anemia in adolescents needs to be
addressed immediately.
One of the efforts to overcome anemia in young women is the provision of
blood-added tablets (TTD). In its implementation, the provision of TTD has not met
expectations so that there are still many young women who suffer from anemia.
According to (Almatsier, 2004) how to prevent and treat anemia is to increase the
consumption of nutritious food, increase the intake of nutrients by taking blood-
added tablets, health education, surveillance of infectious diseases, and fortification
of staple foods with iron. Based on the Recommended Daily Allowance (RDA),
normal adult men (19 years and over) need iron as much as 8 mg/day, while women
at reproductive age (19-50 years) need iron around 18 mg/day. Vitamin C intake set
by the Recommended Daily Allowance (RDA) for adolescents aged 11-14 years is
50 mg/day and ages 15-18 years 60 mg/day.
Menurut (Poedyasmoro, 2015) shows that giving iron and vitamin C fortified
biscuits increases hemoglobin levels and can reduce the prevalence of anemia in
school-age children. Likewise, research by (Khuzaini & Santosa, 2016) found that
baby porridge with the addition of fortifications resulted in higher iron levels so that
iron adequacy in infants could be met. Iron is the most abundant micro mineral in the
human and animal bodies, which is as much as 3-5 grams in the adult human body.
Iron has several essential functions in the body; as a means of transporting oxygen
from the lungs to body tissues as a means of transporting electrons in cells and as an
integrated part of various enzyme reactions in body tissues (Almatsier, 2004). There
are two types of iron in food, namely iron that comes from heme and non-heme.
Animal foods such as meat, fish and chicken are major sources of heme iron. The
iron that comes from haem is Hb. Non-heme iron is found in plant foods, such as
vegetables, seeds, nuts and fruits (Wirakusumah & Bacharudin, 1999). Mung bean is
a food that has a fairly high iron content, namely 7.5 mg, and soybeans contain iron
15.7 mg. Because of the high iron content, green beans and soybean-based foods
(tempe) can used to treat anemia.
Guava is a fruit that contains high levels of Vitamin C, which is 302 mg/100
gr. Likewise with kapok bananas which contain Vitamin C of 17.1 mg/100 g.
Ascorbic acid (vitamin C) is the main factor that promotes the absorption of iron
known as Meat, Fish, Poultry Factory (MFP). Vitamin C has many functions in the
body, namely: As a collagen synthesis, absorption and metabolism of iron. Prevent
infection. because vitamin C is a reducing agent, iron (FE) in the intestine will be
maintained in ferrous form so that it is more easily absorbed. Vitamin C also helps
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786 Syntax Idea, Vol. 4, No 4, April 2022
transfer FE from the blood to the liver and activates FE-containing enzymes
(Muchtadi, 2009). The main study et al found that the combination of iron and
vitamin C was shown to increase hemoglobin levels significantly compared to iron
alone.
Based on this, the iron fortification in this tempeh biscuit was chosen as green
beans, and as a source of vitamin C it came from bananas and red guava. In this
tempeh biscuit, there is a decrease in the nutritional content caused by the heating
and cooking process. This is in accordance with research by (Astuti & Aryani, 2016)
that there are differences in iron levels in tempeh after cooking with raw tempeh.
Based on the calculation of the univariate statistical test, the results obtained in
the treatment group the mean pretest was 10.22 and the mean posttest was 10.35. The
median for the pretest was 10.35 while the median for the posttest was 10.60. This
means that there is an increase in the mean and median values from pretest to
posttest. In bivariate testing, the value of 0.000 <0.05 means that there is a difference
between Hb levels before and after treatment. Based on this, it can be concluded that
there is an effect of consuming tempeh biscuits on the hemoglobin levels of anemic
adolescents.
Conclusion
In general, the implementation of the research can go according to plan and run
well, so it can be concluded as follows: a.) The treatment group the mean pretest was
10.22 and the mean posttest was 10.35. The median for the pretest was 10.35 while the
median for the posttest was 10.60. This means that there is an increase in the mean and
median values from pretest to posttest. b.) The results of the pretest and posttest Hb
levels in the treatment group there are differences. c.) Bivariate testing obtained a value
of 0.000 which means that there is a difference between Hb levels before and after
treatment. So it can be concluded that there is an effect of consuming tempeh biscuits on
increasing the hemoglobin levels of anemic adolescents.
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