ANEMIA IN PREGNANT WOMEN AND ITS DETERMINANTS: A CROSS-SECTIONAL STUDY AT UMMU HANI MOTHER AND CHILDREN'S HOSPITAL, PURBALINGGA REGENCY

Anemia in pregnant women is still a global problem, almost half of all pregnant women throughout the world experience anemia. Ummi Hani Mother and Children Hospital is one of the referral hospitals for mothers and children in Purbalingga that provides the antenatal care service. This study aimed to identify the determinants of anemia in pregnant women at the hospital. This research was an analytical observational study with a cross-sectional design. A total sample of 100 pregnant women was taken using convenience sampling method from a population of 135 pregnant women. The dependent variable was anemia status in pregnant women, while the independent variables included age, education, employment, gestational age, level of knowledge, and level of compliance with taking Fe tablets. Data sources were obtained from medical records, parturition registers, and cohorts of pregnant women at Ummi Hani Mother and Children Hospital. Primary data collection used a structured questionnaire. Bivariate analysis used chi square and/or Fisher exact, and multivariate analysis used logistic regression. This study found that 51% of pregnant women suffered from anemia. Multivariate analysis results showed pregnant women who had a low level of education were 5.07 times more likely to suffer from anemia compared to pregnant women who had a high level of education (p-value=0.002; OR=5.07; 95%CI=1.79-14.37), unemployed pregnant women were 2.73 times more likely to suffer from anemia compared to employed pregnant women (p-value=0.045; OR=2.73; 95%CI=1.02-7.29). This research highlights importance of improving health promotion regarding risks of anemia and prevention measures such as consuming nutritious and varied foods at affordable prices which is focused on groups of low-educated and unemployed pregnant women.


INTRODUCTION
. Anemia is a condition when the hemoglobin concentration is lower than the normal limit value (Snook et al., 2021).Pregnant women are categorized as anemic if their hemoglobin level is <11 gr/dl (Ministry of Health of the Republic of Indonesia, 2020).Pregnant women are susceptible to anemia because physiologically during pregnancy, blood volume increases, resulting in a blood thinning process which results in a decrease in hemoglobin (Hb) concentration (Putri et al., 2023).
Anemia in pregnant women is characterized by weakness, pale eyelids, pale tongue and lips, dizziness, and dizzy eyes (Ministry of Health of the Republic of Indonesia, 2020).Iron and folic acid deficiencies are the causes of anemia in pregnant women.This is because the need for iron and folic acid is high during pregnancy, while food intake is insufficient and if you don't get supplementation, pregnant women are susceptible to anemia (Nasir et al., 2020).
The impact of anemia in pregnant women can occur on the fetus and mother, such as miscarriage, abnormal maternal immune-inflammatory status, premature birth, low birth weight, low Weight-for-age z-score, middupper arm circumference, and has a significant impact on the child's physical and neurological growth and development (Finkelstein et al., 2020a;Huang et al., 2015;Zhang et al., 2021).Moreover, pregnant women who suffer from severe anemia can be at risk of maternal death (Daru et al., 2018).

Respondent Characteristics
The respondents involved in this research were 100 pregnant women.Previously, Table 1 2 shows that 51% of pregnant women suffered from anemia, while 49% of pregnant women did not suffer from anemia.Tanzania, which stated that the prevalence of anemia was greater in pregnant women with low education (Edison, 2019;Stephen et al., 2018).

Determinants of Anemia in Pregnant Women
a high Level of education of pregnant women reduced the risk of developing anemia during pregnancy (Stephen et al., 2018).This is possibly because there are benefits when pregnant women are highly educated.Pregnant women who have a high level of education can have high productivity and higher income so they tend to obtain more information and make better decisions about their nutritional adequacy (Yadav et al., 2021).Thus, this can result in good dietary diversity practices, including during pregnancy (Gudeta et al., 2022;Yadav et al., 2021) with the consumption of Fe tablets (Balcha, Eteffa, Arega Tesfu, et al., 2023).This will prevent pregnant women's hemoglobin levels from below normal limits.This is important because anemia has bad effects such as premature birth, low birth weight babies (Finkelstein et al., 2020b;Huang et al., 2015), and anemia in pregnant women will have a negative impact on the child's physical development and cause nerve damage (Zhang et al., 2021).
Moreover, if a pregnant woman suffers from severe anemia, there is a risk of maternal death (Daru et al., 2018).
This study also found that unemployed pregnant women were more at risk of experiencing anemia 10 Novita Endang Fitriyani, Anemia In Pregnant Women And Its Determinants: A Cross-Sectional Study At Ummu Hani Mother And Children's Hospital, Purbalingga Regency than pregnant women who were employed.Pregnant women who did not have a job probably tended to have a lower socio-economic status (Rizkah and Mahmudiono, 2017).
Septiasari, 2019 stated that pregnant women who earned less than the district minimum wage were more at risk of anemia than pregnant women who earned more than the regency minimum wage (Septiasari, 2019).
Hospital-based research conducted by Khaskheli et al (2016) found that 83.27% of pregnant women who experienced anemia had low socioeconomic status (Khaskheli et al., 2016).Balcha et al (2023) also stated that pregnant women whose family's monthly income was low could affect their ability to purchase nutritious household food products so that pregnant women did not get enough nutrition and were at risk of developing anemia (Balcha, Eteffa, Tesfu, et al., 2023).
in 2013 to 48.9% in 2018 (Ministry of Health of the Republic of Indonesia The limitation of this research was that it could not explain cause and effect because the study design applied was cross-sectional.The sample in this study was not representative of the population so it was not appropriate to generalize the results.This was because the sample the risk of anemia and prevention of anemia in pregnant women, such as consuming nutritious food at affordable prices, is focused on groups of pregnant women who have a low level of education and do not work, which is important to be carried out by health workers in health service facilities.

Table 1 .
Characteristics of Respondents

Table 2 .
Prevalence of anemia in pregnant women

Table 3 .
Results of bivariate analysis of the determinants of anemia in pregnant women

Table 4 .
Final model of multivariate analysis of determinants of anemia in pregnant women