School of Health Sciences Jenderal Achmad Yani Page 341 Jenderal Sudirman Canal Road – Cimahi 40533 Phone: +62-22-6631622 - 6631624
THE EFFECT OF MUNG BEAN (Vigna radiata) ESSENCE ON SCHOOL-AGE CHILDERN HEMOGLOBIN LEVELS WITH IRON DEFICIENCY ANEMIA IN SDN
CIMAHI MANDIRI 1 2018
Rini Mulyati*, Budi Santoso, Avisya Fadilla [email protected]
Department of Nursing, School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia ABSTRACT
Iron deficiency anemia is one of the major nutritional problems in Indonesia. The prevalence of iron deficiency anemia in Indonesia by age characteristic for school-age (5-14 years) reached 26,4%, whereas in Cimahi, the prevalence of iron deficiency anemia in school-age childern reached 7%. School-age childern have an irregular dietary habit, uncertain appetite, and do not like to eat nutritious food. As a result, childern become very susceptible to iron deficiency anemia. This research used “Pre-experiment” design with “One group pretest postest”. The number of samples were 15 people taken using total sampling technique. The analysis used is univariate and bivariate analysis with Paired T-test (T-test Dependent). The result showed that the mean value Hemoglobin levels of school age childern before consumption mung beans essence is 11,4 gr/dl, and the mean value Hemoglobinlevels of school age childern after consumption mung beans essence is 13,3 gr/dl. Statistic test showed that obtained p value (0,001) < α (0,05), so it can be concluded mung beans essence is effective for increasing school age childern levels with iron deficiency anemia. Mung beans essence can be used as on of nursing intervention in raising Hemoglobin levels of school age childern. It is recommended that healht workers, especially nurses, can apply the result of this study as one of the intervention in nursing care anemic patients
Keywords: Iron deficiency anemia, school age childern, mung beans essence.
INTRODUCTION
School age children are a period where children begin to socialize with their peers, and begin to have the desire to choose whatever their likes. This has an impact on changes in attitudes and behavior in accordance with the period of its development, including changes in diet. Changes in eating patterns in school age children will affect the adequacy of children’s nutritional intake, because at this time the child is more active in choosing foods that he likes or dislikes according to his taste (active consumers) (Istiany & Rusilanti, 2013).
At this time, shildren prefer to eat snacks outside rather than having to eat at home, which result in irregular eating patterns and parents find it difficult to control the foods what they consume.
Tese things can be the cause of various nutritional poblem in school-age children.
Nutritional problems in school-age children are the impact of an imbalance between nutrient intake and output (nutritional imbalance) (Arisman, 2009).
School-age children are very vulnerable to experiencing nutritional problems, because children have eating patterns that tend to be irregular.
Nutrition problems that are often found in school-
age children, one of which is problem of iron deficiiency anemia.
Iron deficiency anemia is anemia caused by nutritional deficiencies, especially iron which result in the number of red blood cells or the oxygen transporting concentration (hemoglobin) insufficient for the physiological needs of the (Respati, 2012). The cause of iron deficiency anemia is due to low iron blood in the body.
According to Faridah and Indraswari (2017), parasites such as worms (hookworm) and others (skistosomiasis) are also a causes of iron deficiency anemia because it is estimated that worms suck blood from 2-100 cc every day.Some signs and symptoms that often arise in iron deficiency anemia such as looking pale, weak, tired, and less excited or look listless (Respati, 2012).The impact of iron deficiency anemia on school-age children is can reduce the ability to learn concentration, and can trigger a decrease in antibodies or the immune system so that children become susceptible to desease or infection (Susilowati, 2016).
The prevalence of iron deficiency anemia is still quite high and attacks almost all age groups including school-age children, this causes iron deficiency anemia still a public health problem
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(Ani, 2013). It is estimated that around 30% of the world’s population suffer from anemia, and more than half are iron deficiency anemia (Respati, 2012).
World Health Organization (2008), states that the total world population with anemia reaches 1,62 billion. The prevalance of school-age children is 25,4% or as many as 305 million school-age children around the world experience iron deficiency anemia. The prevalence of anemia among children in Asia reaches 58,4% which is higher than the average prevanlence in Africa (49,8%).
In Indonesia, the prevalence of anemia is 21,7%. The proportion of 20,6% in urban areas and 22,8% in rural areas, and 18,4% occurred in men and 23,9% occurred in women. Base on the age group, anemia patients aged 5-14 years were 26,4%, in the 15-24 years age group were 18,4%, and in the 25-34 years age group were 16,9% (Riskesdas, 2013). The prevalence of anemia in West Java Province is 13,4%
Cimahi City is one city that has a high prevalence of anemia. Based on the report in the selection of School Health Efforts (2017) of the Cimahi City Health Office conducted on new students for the 2017-2018 schoo year, it was found that the prevalence of anemia in the junior high school education level was 49%, high school education level 44%, and elementary school education level 7%.
Among other sub-districts, Cimahi Tengah has the highest prevalence of anemia for elementary school sducation level of 14%. Of the 9 elementary school/MI in the working area of Cimahi Tengah Public Health Center, SDN Cimahi Mandri 1 has the highest prevalence rate of 25%, then SDN Cimahi Mandiri 4 at 19,7%, and SDN Cimahi Mandiri 2 at 9,8%. Seeing this phenomenon, it is necessary to handle iron deficiency anemia in school-age children both pharmacologically and non- pharmacologically. One treatment that can be done as a nurse is to provide non-pharmacologically therapy or complementary therapy.
The intervention of iron deficiency anemia with non-Pharmacological therapy can be done by increassing consumption of foods that contain lots of iron, both from animal elements and from vegetable elements (Almatzier Sunita, 2011). The one type of food from the vegetable element (non- heme) which contains high iron levels is mung beans (Vigna radiata).
Mung beans contain nutrients that are needed in the process of the formation of red bloods cells, so they can overcome the decrease in hemoglobin levels in iron deficiency anemia. Mung beans contain minerals such as calcium, phosphor, iron, sodium, and potassium. The contens of vitamins C and A contained in Mung Beans can help the process of absorption of iron in the body. If you consume 2 cups of Mung Beans every day, then 50% of the need for vitamin C in one day has be fulfilled which is equal to 75 mg (Heltty, 2008).
Vitamin A is contained in half a cup of Mung Beans that is equal 7 mg (Maulina & Sitepu, 2015).
Mung beans have the highest iron content among other types of beans and are useful for supporting the growth period of children (Akbar, 2015). Studies of flatulent products in children who consume legumes show that among various legumes, mung beanss contain the least and most easily digested flatulent compounds (Ulum, 1997).
In a preliminary study conducted on 30 January 2018, researchers screened the 5th grade students of SDN Cimahi Mandiri 1 by examining the conjunctiva and interview, it was found that 41 out of 206 students had anemic conjunctiva. From the results of interviews with 10 grade 5 students of SDN Cimahi Mandiri 1, it was found that 5 out of 10 students complained often felt dizzy or weak, with 3 of them saying it was difficult to concentrate while studying in class, 2 students seemed to have difficulty remembering something (lessons), and 6 students said that they prefer snacks rather than eating at home (Ulum, 1997).
METHODS
The research design used in this study was a Experiment 8with one group pretest posttest research design. The design of this study aims to determine the differences before the intervention and after the intervention by measuring the pretest and posttest. The population is the whole of an object that will be examined in accordance with the criteria determined by the researcher (Pamungkas &
Usman, 2017). The population in this study were VA and VE class students who had iron deficiency anemia with mild anemia classification (Hemoglobin level 11.0-11.9 gr / dl) in SDN Cimahi Mandiri 1 as many as 17 students. In this study, the sample was taken using the Non-Probability Sampling method, which is a method where every subject in the population does not have the same opportunity to be selected or not selected as a sample (Supardi, 2013). The technique used is total
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sampling technique. The technique of data collection is done is to use an observation sheet to record the results of measurement of Hb levels.
Analysis of the data used is univariate analysis and
bivariate analysis with Paired T-test (t-test dependent) with a 95% confidence level.
RESULT
Table 1. The effect of giving Mung Beans Essence (Vigna radiata) On School-Age Childern Hemoglobin Levels With Iron Deficiency Anemia In SDN Cimahi Mandiri 1
Variabel Measurement N Mean SD Min-Max p Value
Hemoglobin levels
Before
15 11,4 0,357 11,0-11,9
0,001
After 13,3 1,390 11,4-16,0
Based on Table 1, it was found that the average value of Hemoglobin levels in 15
respondens before given the intervention of mung beans essence was 11,4 gr/dl with a standard deviation of 0,357 and entered into the
classification of mild anemia, while the average value of Hemoglobin levels in 15 respondens after given mung beans essence is 13,3 gr/dl with a standard deviation of 1,390 and entered into the classification of no anemia. The average difference in Hemoglobin levels is 1,9. Statistical test result show that the p value obtained is 0,001. This shows that the value of p value < 0,05, it can be concluced that is the effect of giving Mung Beans essence (Vigna radiata) on Hemoglobin levels of school-age children with iron deficiency anemia in SDN Cimahi Mandiri 1.
DISCUSSION
Based on the results of statistical tests using paired t-test (t-test dependent) p values obtained are 0.001 (α <0.05), then Ha is accepted and Ho is rejected. This shows there is an increase in hemoglobin levels in school-age children with iron deficiency anemia before and after given mung beans extract (Vigna radiata). It can be concluded that there is an effect of giving mung beans extract on hemoglobin levels of school-age children with iron deficiency anemia in SDN Cimahi Mandiri 1.This is in line with previous research conducted by Amalia (2016) with the results of statistical tests using paired t-test, the p value is 0,000. This shows the effect of giving mung beans drinks to the increase in hemoglobin levels of semester 4 D-III midwifery students of STIKES Muhammadiyah Lamongan.
Another study conducted by Retnorini (2017) showed the same results, namely that the results of
data analysis using the Independent T-test, obtained p value 0,000, concluded that there was an effect of giving mung beans extract and Fe tablets to increase hemoglobin levels in TM pregnant women III in the working area of the Pare Health Center, Temanggung Regency. This study also supports the research of Faridah and Indraswari (2017) which states that the administration of mung beans extract for 7 days is effective to increase the levels of hemoglobin in girls in class X SMK Al-Islam Kudus, as evidenced by p value 0.005.
Similar research has also been done by Maulina and Sitepu (2015) using white mouse objects which show that the results of data analysis using the Kruskal Wallis test, obtained p value 0.003 (α <0.05). It can be concluded that the administration of mung beanss with a dose of 18 gr / kgBB / day and a dose of 36 gr / kgBB / day affects the increase in hemoglobin levels in white rats.
Research conducted by Amalia (2016) states that mung beans drinks can increase hemoglobin levels in the blood significantly because they contain high iron, folic acid, zinc, vitamin C, vitamin A which are very instrumental in the formation of red blood cells, so can minimize the occurrence of lack of hemoglobin levels in the body. Theoretically, the content of nutrients in mung beanss will help the process of formation of red blood cells.
This is consistent with the theory previously expressed that the nutritional content of mung beanss can increase hemoglobin levels. The iron content in mung beanss is needed in the process of forming hemoglobin. Hemoglobin has an important role in the process of formation of red blood cells because it is able to bind oxygen which is one of the elements in red blood cells. Carbohydrates, protein, and fat contained in mung beans can support the process of hemoglobin synthesis. Carbohydrates
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and fats will form succinnyl-CoA, which together with glycine will form protoporphyrin through a series of porifirinogen processes. Protophirin is formed, then together with heme molecules and globin proteins to form Hemoglobin (Maulina &
Sitepu, 2015). This explains that mung beanss (Vigna radiata) are one of the legumes that can overcome the decrease in hemoglobin levels in iron deficiency anemia.
Mung beanss also contain vitamin C which helps in the absorption of Fe in the body because it can change the form of ferries to ferro. Vitamin A will interact with iron, so it can improve the utilization of iron in the body, and can reduce the prevalence of anemia (Maulina & Sitepu, 2015 ).
The content of glycine 0.9% of 22% of the total amino acids present in mung beanss, can help the formation of antioxidant glutathione which can maintain dietary iron in ferrous form, so that iron absorption can be increased. So that the content of these nutrients can be easily absorbed by the body, it should be noted that the form of presentation of the mung beanss itself. One of the most effective forms of serving mung beanss is by processing them into mung beans juice, which is the water and pulp filtered and separated so that the drink is nutrient- dense (Retnorini, 2017).
This explanation assumes that mung beans extract can significantly increase hemoglobin levels in the blood because it contains iron, vitamin C, vitamin A, amino acids, carbohydrates, proteins, and fats which are very instrumental in the process of iron absorption and red blood cell formation.
Mung beans not only work when there is interference or reduced iron in the body, but also can maintain stability or iron balance. Mung beanss are also very useful for the growth of school-age children. For that, it is recommended for parents to make mung beans extract as one of the children's breakfast menus before starting their daily activities.
Although statistically there was a difference in the mean before and after the administration of mung beans extract, there was 1 respondent who did not experience an increase in hemoglobin levels due to excessive sleep at night This causes the process of cell regeneration including red blood cells to be disrupted, resulting in a decrease in hemoglobin levels of 0.3 gr / dl. Mung beanss cannot increase the respondent's hemoglobin level, so the respondent is still classified as mild anemia.
Hemoglobin levels below normal cause the child to be less active, look weak, and not excited in
carrying out daily activities. Another impact is that children have difficulty concentrating in the learning process at school, and are susceptible to illness due to reduced body immunity against infection. This causes the growth and development of children to be hampered. This situation will not occur if the child has good hemoglobin levels.
Mung beanss have a positive impact on children's growth and development, being able to meet daily iron needs that can prevent children from iron deficiency anemia.
CONCLUSION
1. The mean hemoglobin level of school-aged children with iron deficiency anemia in SDN Cimahi Mandiri 1 before being given mung beans extract is 11.4 gr / dL.
2. The mean hemoglobin level of school-aged children with iron deficiency anemia in SDN Cimahi Mandiri 1 after given mung bean extract is 13.3 gr / dL.
3. There is an effect of giving mung beans extract (Vigna radiata) to the hemoglobin level of school-age children with iron deficiency anemia in SDN Cimahi Mandiri 1 in 2018 (p value = 0.001).
SUGGESTION
1. Respondents should consume mung beans extract regularly to meet their daily iron needs, especially female students who are going through menstrual periods.
2. Parents need to be more selective and creative in choosing nutrient-dense foods and liked by children, so that children like to eat at home rather than snacks. Parents can also make mung beans extract or a variety of processed mung beanss as one of the breakfast menus that are rich in sources of nutrition, to prevent iron deficiency anemia.
3. The school should consider counseling children and parents about anemia and the importance of consuming foods that contain iron nutrients.
Counseling can be done by school health cadres in accordance with UKS activities, namely Little Doctor, PHBS Ambassador, and Canteen Ambassador.
4. Researchers suggest to the school to collaborate with health services such as health centers to conduct screening in the form of examining hemoglobin levels in capturing students who have iron deficiency anemia to then be given an intervention in the form of giving mung beans
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extract periodically to students who have iron deficiency anemia.
5. Health workers, especially community nurses are expected to be able to apply the results of this study as one of the interventions in nursing care for anemic patients in the community. A standardized canteen of healthy canteen program needs to be held, in collaboration with the government and schools.
6. Researchers suggest to conduct further research on the effect of mung beans extract on hemoglobin levels in school-age children by considering the influence of other confounding factors that can affect hemoglobin levels. Further research can also be carried out by involving control groups and intervention groups, as well as increasing the number of samples. It is expected that there is research on how long mung beans extract can affect the levels of hemoglobin in school-age children and research on the relationship of hemoglobin levels to the level of achievement of children in school.
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