Factors Associated with the Occurrence of Anemia in Pregnant Women at the Anutapura Hospital in Palu

Anemia is considered a public health problem because its prevalence is still high. Anemia can give bad consequences to pregnant women such as susceptible to disease, Low Birth Weight (LBW), influence on workability, even on severe anemia can result in death. The formulation of the problem in this study is whether there is a relationship of parity, maternal age, consumption of Fe tablets, a distance of pregnancy and utilization of antenatal care with the incidence of anemia in pregnant women at Anutapura General Hospital, Palu. The purpose of this study was to determine the factors associated with the incidence of maternal mortality in Anutapura General Hospital, Palu. This type of research is an observational study with a cross-sectional study approach. The independent variables in this study are parity, age, pregnancy distance, and the use of antenatal care services, the dependent variable is anemia in pregnant women. Data analysis using univariate and bivariate analysis and chi-square and multivariate statistical tests. Sampling using the Purposive sampling method. Samples were 87 respondents. There was a relationship of ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
Anemia in pregnant women is associated with several factors, for example, knowledge, where there is a lack of knowledge of pregnant women regarding food containing iron essential, education level, parity, and antenatal use. The optimal use of antenatal care will improve the health status of pregnant women and will motivate them to consume foods that are rich in Fe.

MATERIALS AND METHODS
This research is an observational study with a cross-sectional study approach, where data on dependent and independent variables will be collected at the same time to obtain information about the relationship of several factors to the incidence of anemia in pregnant women at the Anutapura Hospital in Palu. The population in this study were all pregnant women who visited the Anutapura Hospital in Palu.
Primary data was obtained through the measurement of Hb levels using the Chyanmethimoglobin method and filling in questionnaires distributed to pregnant women.
Data analysis used was univariate using frequency distribution and single percentage, Bivariate used was chi-square test and multivariate using regression logistic analysis. Table 1 shows that based on the Hb levels of respondents, there were 57 (65.5%) pregnant women who were anemic, and 30 (34.5%) respondents did not experience anemia. Table 2 shows that according to the parity of respondents, pregnant women with highrisk parity were 40 (46.0%) respondents and pregnant women with low-risk parity were 47 (54.0%) respondents.         The results of relationship analysis using the Chi-Square test of 1 and α =0,05 were obtained p = 0,003 where p < α which means statistically the null hypothesis is rejected and the alternative hypothesis is accepted so that there is a significant relationship between parity and the incidence of anemia in pregnant women at the Anutapura Hospital in Palu.   Source: Primary Data, 2015 mother and the incidence of anemia in pregnant women at the Anutapura Hospital in Palu.  1 and α = 0,05were obtained p = 0,000 where p < α which means statistically the null hypothesis is rejected and the alternative hypothesis is accepted so that there is a significant relationship between Fe tablet consumption and the incidence of anemia in pregnant women at the Anutapura Hospital in Palu.  and α = 0,05 were obtained p = 0,001 where p < α which means statistically the null hypothesis is rejected and the alternative hypothesis is accepted so that there is a significant relationship between pregnancy distance and the incidence of anemia in pregnant women at the Anutapura Hospital in Palu.  1 and α = 0,05were obtainedp = 0,002where p < α which means statistically the null hypothesis is rejected and the alternative hypothesis is accepted so that there is a significant relationship betweenthe use of antenatal serviceand the incidence of anemia in pregnant women at the Anutapura Hospital in Palu.

Parity in Pregnant Women
Parity is the number of deliveries performed by a woman with live births or stillbirths. The number of births can affect the body's metabolic processes. In pregnant women, the need for hydrocytes will increase. So that the higher the level of parity, the more at risk of anemia in pregnant women (7).
Parity is the number of births experienced by a mother, both live and stillborn, but does not include abortion. Complications that can trigger postpartum hemorrhage are found in mothers with the first pregnancy and pregnancy more than the third time. This is because in the first pregnancy, the birth canal has not been tested and the psychological condition has not been stable. While in pregnancy more than the third time, the reproductive system has suffered a setback. Every pregnancy followed by labor will cause abnormalities in the uterus (27). This means that high-risk parity or more than three times of pregnancy are more likely to experience anemia compared to pregnant women with low-risk parity or less than three times pregnancy in pregnant women at the Anutapura General Hospital in Palu.
The high rate of parity in a mother can usually relate to a mother's lack of knowledge about the impact of a high number of pregnancies associated with the biological condition of the mother and iron intake. Anemia, in this case, is related to a previous pregnancy where if the iron reserves in the body are lacking or minimal, the pregnancy will drain the body's iron supply and will cause anemia in the next pregnancy.

Age in Pregnant Women
Age is one of the non-modifiable factors.
The age intended in this study is related to the implementation of an appropriate pregnancy in every woman whose age is fast carrying out pregnancy tends to be more at risk of the emergence of various health problems compared to the normal gestational age.
A mother's age has a close influence on the development of reproductive organs. This is related to the physiological state of the mother's body in accepting presence and supporting fetal development. A woman entering the age of marriage will experience a certain phase in her life, namely the age of reproduction. In the age of healthy reproduction, it is known that the safe age for pregnancy and childbirth is between 20-35 years (23).
The pregnancy that occurs in the risky age category is an unhealthy pregnancy. This is because, in this age, the state of reproductive health and the state of the organs in a woman's body have experienced a decreased ability to deal with pregnancy, especially in the physiological function of the uterus as a reproductive organ.
The uterine elasticity has decreased so that it will increase the risk of LBW and complications during labor (14).
Age of pregnant women who are young (less than 20 years) is at high risk of fetal growth because they are in a period of growth that requires a lot of nutrients and then added by pregnancy which means that the calories received must be shared between the mother and the fetus. The development of reproductive instruments is also not entirely optimal. Besides, the psychological burden that must be borne is quite heavy to be pregnant and care for children with minimal knowledge.
The age factor of pregnant women influences the development of female reproductive organs where the age that is safe for pregnant women is aged 20-30 years.The age of pregnancy plays a high role in the occurrence of anemia in pregnant women. This is because with the higher pregnancy, the blood volume will increase which is usually called hydremia or hypervolemia of the blood, so that blood dilution occurs which can cause anemia.
The results of relationship analysis using the Chi-Square test of df (Degree of Freedom) 1 and α = 0,05 were obtained p = 0,005 where p < α which means statistically the null hypothesis is rejected and the alternative hypothesis is accepted so that there is a significant relationship between the age of the mother and the incidence of anemia in pregnant women at the Anutapura Hospital in Palu.

Fe Tablet Consumption in Pregnant Women
Iron enters the body through food. In body tissues, iron is a functional compound such as hemoglobin. Ferric iron from food will become ferrous if it is in an acidic state and is reduced so that it is easily absorbed by the intestinal mucosa.
In the body, iron is not free but binds to protein molecules to form ferritin namely apoferritin, while iron transport in the form of Ferro binds to proteins forming transfer called apo transferrin in blood plasma called set transfer in.
The results of relationship analysis using the Chi-Square test of df (Degree of Freedom) 1 and α = 0,05 were obtained p = 0,000 where p < α which means statistically the null hypothesis is rejected and the alternative hypothesis is accepted so that there is a significant relationship between Fe tablet consumption and the incidence of anemia in pregnant women at the Anutapura Hospital in Palu.
Iron from foods such as meat, liver, eggs, green vegetables and fruits are absorbed in the small intestine. The average of foods included contains 10-15 mg of iron but only 5 -10% which can be absorbed, so if the decrease in iron intake is the main element in the formation of hemoglobin, the level/production of hemoglobin will also decrease and causing anemia (10).

Pregnancy Distance in Pregnant Women
Pregnancy distance is the interval between two consecutive pregnancies from a woman.
Pregnancy spacing has an impact on the health of the mother and her baby. The distance of pregnancies that are too tight (<2 years) is riskier than a stretchy pregnancy (> 2 years). This is because anatomically women need time to restore their health and adequate nutritional intake. The results of relationship analysis using the Chi-Square test of df (Degree of Freedom) 1 and α = 0,05 were obtained p = 0,001 where p < α which means statistically the null hypothesis is rejected and the alternative hypothesis is accepted so that there is a significant relationship between pregnancy distanceand the incidence of anemia in pregnant women at the Anutapura Hospital in Palu. This is in line with the study conducted by Dewi (2010), that pregnancy distance is related to the incidence of anemia in pregnant women at Batua Raya Makassar Health Center with P-value 0.002.

Antenatal Service in Pregnant Women
DepartemenKesehatan RI (2011)