The Relationship of Pregnant Women Knowledge about Iron Defi ciency Anemia and the Role of Family in Compliance in Consuming Fe Tablets in Health Center "

Pregnancy leads to increased energy metabolism, hence the need for energy and other nutrients increases during pregnancy. If levels of iron in the body of pregnant women is less, then there will be a condition called anemia. Most of the anemia in pregnancy is caused by iron defi ciency. The coverage of Fe tablet administration in Indonesia is 69.14%, where 17% of pregnant women did not comply with Fe Tablets. One of the reason causing the low consumptions of Fe was the role of family and knowledge. The purpose of this study is to determine the knowledge of pregnant women about iron defi ciency anemia and family role with compliance in consuming iron tablet in Health Center. This study is an analytic study with cross sectional study. In this study, the subjects were all pregnant women without look at the semester of pregnant and get a tablet Fe in Tanjungpinang Health Center based on data consist of 40 respondents. The result of this study shows that there is signifi cant relationship between knowledge of pregnant women to iron defi ciency anemia with compliance of consuming Tablet iron. The p-value of 0.814 shows that there is no correlation between knowledge of pregnant women about iron defi ciency anemia and compliance of consuming Iron Tablets. Family role in monitoring the consumption of iron tablet with compliance consuming Iron was relationship between family roles in 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
Maternal Mortality Rate (MMR) is one of the indicators that is estimated to be diffi cult to achieve.This diffi culty is felt not only in Indonesia but also in many developing countries in the While indirect causes of maternal deaths resulting from the disease that existed before the pregnancy and affect it e.g.malaria, anemia, HIV/AIDS, and cardiovascular disease.Globally 80% of maternal deaths are categorized as direct maternal death.The direct cause of this pattern is bleeding (2).
According to World Health Organization (WHO), maternal mortality is the death during pregnancy or the period of 42 days after the monitoring drinking iron tablet with compliance consuming iron tablet.This study was recommended that further research on the role of the family as the keeper of consuming Fe tablets mothers.
end of pregnancy, due to all causes associated with or burdened by pregnancy or handling, but not caused by accident or injury(3).One of the causes of death in pregnant women is anemia, which can cause bleeding in pregnancy (4).
Then one of the efforts to suppress the maternal mortality is to press the number of anemia gen in pregnant women.
According to WHO, 40% of maternal deaths in developing countries are associated with anemia in pregnancy.Most of the anemia in pregnancy is caused by iron defi ciency and of acute bleeding even both are interacting (2).
Anemia can worsen the condition of the woman during pregnancy, childbirth, and in the next period.This can cause abortion (miscarriage), premature birth (birth before its time), prolonged labor because the uterus does not contract, postpartum bleeding, shock, and infection during childbirth or immediately (5).this can be caused due to ignorance of the importance of Fe tablet for their pregnancy.

Medikoputra based on the theory of
The resulting impact is poor absorption or body response to Fe, so there is no increase in Hb levels.
Anemia often occurs due to iron defi ciency in pregnant women because of that there is a doubling of iron demand, as a result of increased blood volume without plasma volume expansion to meet the needs of the mother (to prevent blood loss at the time of giving birth) and fetal growth(10) .Based on the data table above it can be concluded that the average age of respondents is between 20-35 years for 32 people of total 40 people (80%).For the educational level from 40 respondents, most of them are in elementary level of education as many as 16 people (40%), the majority of the respondent's pregnancy is pregnancy for the second child.From 40 respondents, 15 (37.5%) mothers are pregnant for the second child.Seen from a mother's gestational age including the pregnancy are not at risk although there are still 8 (12.5%) of respondents who are experiencing pregnancy for 4th up to 6th child of which are the 3 people (7.5%) pregnant for 4th child, 1 (2.5%) pregnant for 5th child and 1 people (2.5%) pregnant for 6th child.For the majority of the respondents of the gestational age at the age of 6-9 months as many as 21 people (52.5 %).Hb levels for a large part of the respondents as many as 26 respondents (65%) with Hb ≥ 11 gr% and 14 respondents with Hb ≤ 11 gr%.

RESULTS AND DISCUSSION
For the compliance of mothers in consuming Iron Tablets can be seen in the following table.Based on table 4.5 above for the relationship between knowledge of pregnant women about iron/Fe defi ciency anemia and the compliance of consuming iron tablets showed that p-value 0.814 is greater than the value of α p-value of 0.05 indicates that there is no relationship between knowledge of pregnant women about iron/Fe defi ciency anemia and the compliance of consuming iron tablets.The role of family in monitoring the consumption of iron tablets towards the compliance of consuming iron tablets indicates the p-value of 0.00 whic is smaller than the α value 0.05.This indicates that there is a connection between the roles of the family in monitoring the consumption of iron tablets with the compliance of consuming iron tablets.

Univariat Analysis
Respondents age between 20-35 years old as many as 32 respondents (80.5%) include those who have no risk in pregnancy or gestational age.
The risks associated to pregnancy and childbirth process are very low which only around 15%.
On the stage of this age, a woman already has maturity in terms of emotional, social aspects and the reproductive system.The ideal age to get pregnant and give birth.Health experts argue that even at the age of 24 years old is the culmination of a woman's fertility.On the data still there mother's  For the Hb levels of respondents, overall include normal i.e. ≥ 11 gr % as many as 26 people (65%), but there are still 14 respondents with Hb level is under 11 gr %.According to WHO, if the Hb levels of expectant mothers between 8 gr % up to 11 gr %, it is incuded in mild anemia.While if Hb levels of ≤ 8 gr %, it is classifi ed as Anemic.
In term of controlling the consumption of iron tablets, most of the respondents as many as 22 people (55%) consume it by their own consciousness.This probably because the mother realized the importance of consuming iron tablets during pregnancy.While 18 of those respondents (45%) need help from nearby people such husband or parents-in-law in consuming iron tablets, this probably because they yet feel it is important to consume iron tablets during the pregnancy process to prevent iron/Fe defi ciency anemia during pregnancy.The role of the close people is urgently needed in the process of consuming iron tablets on pregnant women so that iron/Fe defi ciency anemia does not occur during the process of pregnancy Bivariat Analysis Table 4.5 shows results of statistical tests for the relationship between knowledge of pregnant women about iron/Fe defi ciency anemia and the compliance of consuming iron tablets showed the value of p, the p-value 0814 shows that there is no relationship between knowledge of pregnant women about iron/Fe defi ciency anemia and the compliance of consuming iron tablets.
The level of knowledge about iron/Fe defi ciency anemia does not infl uence the behavior in consuming iron tablets.This also in line with a study conducted by Sri (2006) world.Maternal mortality in Indonesia is still quite high compared to countries in Asia.The decline in maternal mortality and infant mortality in Indonesia is the target of health services that could not be delayed any longer.Indonesian Health Demographic Survey in 2007 mentioned that MMR i.e. 228/100,000 live births and Infant Mortality Rate (IMR) i.e. 34/1000 live births, while the target by the Minister of Health in the year of 2014 MMR as much as 118/100,000 live births and IMR as much as 24/1000 live births (1).Maternal mortalities are caused by direct and indirect causes, a direct causes of maternal death such us complications of pregnancy, childbirth or the time of parturition, and any form of improper handling of these complications.

For
the level of knowledge about iron defi ciency Anemia, from 40 respondents, there are 37 (92.5%) have good level of knowledge, but there are still 3 respondents (7.5%) who have low level of knowledge about iron defi ciency Anemia.The variables of this research are knowledge of pregnant women about iron/Fe deficiency anemia, Directly Observed Treatment (DOT) and compliance in consuming iron tablets in Kampung Bugis Health Centers.Those variables were tested using the Chi Square Test.Table 4.5 below explains about the correlation between knowledge of pregnant women about iron/Fe defi ciency anemia, Directly Observed Treatment (DOT) and compliance in consuming iron tablets.
than 20 years old as much as 3 people (7.5%) and above 35 years old as many as 5 people (12.5%)where the gestational age under 20 and above 35 are at risk of having problems during pregnancy.Teenage pregnancy at or under the age of 20 years old has higher health risks.This because the reproductive organs are not ready so that harm to pregnancy.The condition of the ovum at the age of adolescence is also rudimentary, so can interfere with fetal development.Teenage pregnancy also lead to high risk of experiencing high blood pressure on pregnant women, premature birth, low weight babies and feared women experiencing excess anxiety depression after childbirth.What should be feared is the risk of maternal death during childbirth due to bleeding and infection.Likewise, the opposite in pregnancies of women over 35 have several risks, including increasing the possibility of miscarriages, premature babies, babies with disabilities and chromosomal abnormalities, maternal health problems, diabetes pregnancies etc.The education level of the respondents mostly elementary school as many as 16 people (40%) followed by 15 People (37.5%) in Junior High School level.The Respondents in Elementary And Junior High School are included in low levels of education that allows them do not understand the phenomenon of anemia when they are pregnant.Education levels also determine whether a person is easy to understand the knowledge specifi cally about the incidence of anemia in pregnant women due to the lack of intake of tablet Fe.The interests of the family sorely needed someone of his own education to make it more responsive and sensitive to the problems that could interfere with health and could take a decision as soon as possible.Mulyati researches (2007) mentioned that the knowledge possessed by the expectant mothers about health in pregnancy can help in caring for the health of the pregnant women themselves including in terms of the selection of the type of food consumed during pregnancy so that the inevitable risks that can result harm to the mother and baby.As many as 5 respondents (12.5%) with ≥ 5 times of pregnancy (Grande multipara) are usually at risk of experiencing diffi culity in pregnancy and childbirth.If the mother has iron defi ciency anemic will be at risk of experiencing abnormalities of the fetus, rips the uterine wall due to slack on the uterine wall, prolonged labor, postpartum bleeding which increases the risk of death in the mother and fetus.Viewed from the age of pregnancy most respondents are included in 3rd trimester, whereby if the mother experienced iron/Fe defi ciency anemia will be at risk of causing a hindrance to the growth of the fetus either body cells or brain cells, miscarriage, the length of time since the delivery less thrust, uterine postpartum bleeding, vulnerable to infection, prone to cord decomposition in sufferers with Hb less than 4 gr %.Hypoxia due to iron/Fe deficiency anemia can cause shock even maternal death during childbirth, although not accompanied by bleeding, infant death in the womb, infant mortality at a very young age and disability, and anemia in babies born.
Knowledge about nutrition can prevent someone from wrong food consumption.With a good level of knowledge, pregnant women can fi gure out food that could endanger their pregnancy and can choose things that support the quality of their pregnancy, including iron tablets distributed by clinics devoted to health during pregnancy.13.From the statistical tests using the chisquare test for the role of family in monitoring the consumption of iron tablets and the compliance of consuming iron tablets retrieved the p-value 0.00 which is smaller than the α value 0.05.Then there is the relationship between knowledge of pregnant women and the compliance of consuming Fe tablets.Efforts are being made with the role of family is to make it as an important factor that exists around the expectant mother by empowering family members especially parents, in-laws or husbands to help expectant mothers in the compliance of consuming iron tablets.The result of this research is in line with the research by Maisa (2010), that there is relationship between family support and the consumption of Fe tablets in pregnant women at the Clinic Nanggalo Padang city (p < 0.05).This is a very important efforts that should be done for pregnant women, because they are individuals who do not standalone.They joined in a bond of marriage and living in a household where the factor of the closest person will infl uence the mindset and behavior including in treating her pregnancy.The husband is the one who is closest to pregnant woman who can create a physical and emotional environment that supports health and nutrition of pregnant woman.Family support can be an infl uential factor in determining the beliefs and values of individuals' health as well as determine the treatment program they will received.The family also give support and make decisions in caring the sick members of family.The degree in which someone insulated from the mentoring of others, social isolation, negatively associated with compliance (Baekeland and Lundawall) Besides the knowledge factor, the low number of pregnant women compliance in consuming iron tablets also infl uenced by other factors, such as forget, feared to have a heavy weight, less awareness regarding the importance of iron tablets, dizziness incurred after taking iron tablets.Some factors that influence the compliance of consuming iron tablet by expectant mothers are knowledge about anemia health care delivery, health, resistance to the use of iron tablets (tablet resistance), iron tablets side effects, and the health officer's behavior in disseminating the importance of iron tablets.One of factors that cause the number of anemia iron deficiency still high in pregnant women is the lack of compliance of pregnant women in consuming iron tablets.As much as 74.16% of pregnant women were declared compliant in consuming iron tablets. 13Research by Khatijah, et al. (2010) shows that pregnant women who consume fewer iron tablets or a tablet in a week have 12 times more risky of anemic during pregnancy compared with pregnant women who consuming iron tablets per day.Pregnant women who do not consume iron tablets during pregnancy are 1.9 times more at risk of having a baby with a low birth weight compared to pregnant women who consume iron tablets as much as 90 tablets or more.CONCLUSION 1.The average age of respondents is between 20-35 years for 32 people of total 40 people (80%) 2. The educational level from 40 respondents, most of them are in elementary level of education as many as 16 people (40%) 3. The majority of the respondent's pregnancy is pregnancy for the second child.From 40 respondents, 15 (37.5%) mothers are pregnant for the second child.Seen from a mother's gestational age including the pregnancy are not at risk although there are still 8 (12.5%) of respondents who are experiencing pregnancy for 4th up to 6th child of which are the 3 people (7.5%) pregnant for 4th child, 1 (2.5%) pregnant for 5th child and 1 people (2.5%) pregnant for 6th child.4. The majority of the respondents of the gestational age at the age of 6-9 months as many as 21 people (52.5 %) 5. Hb levels for a large part of the respondents as many as 26 respondents (65%) with Hb ≥ 11 gr % and 14 respondents with Hb ≤ 11 gr %. 6.There is no relationship between knowledge of pregnant women about iron/Fe defi ciency anemia and the compliance of consuming iron tablets in Tanjungpinang Health Center 7.There is a signifi cant relationship between the Directly Observed Treatment (DOT) and the compliance in consuming iron tablets in the working area of Tanjungpinang Health Center SUGGESTIONS 1. Pregnant women are expected to consume Fe tablets regularly because consuming Fe 58 Haryadi, Asmarita Jasda, 2017.JNKI, Vol. 6, No. 1, Tahun 2017, 49-58 tablets can increase hemoglobin levels so that they do not suffer from anemia during pregnancy because it can endanger the fetus, causing low birth weight, birth defects etc. 2. Health officers should be able to give motivation to expectant mothers to regularly consume Fe tablet to reduce anemia.3. Health offi cers can involve family members to supervise the consumption of medicines so that mothers can take Fe tablets regularly.4. The need for further research on the role of the family as supervisor of pregnant women who take Fe tablets.