17377
Addition Of Sukkari Dates (Phoenix Dactylifera L) And Fe Supplementation In Increasing Ferritin Levels To Young Women With Anemia
1Ridni Husnah, 2Suryani As’ad, 3Wardihan Sinrang
4Nilawati Usman, 5Mardiana Ahmad, 6Healthy Hidayanty
1Midwifery Study Program, Postgraduate, Hasanuddin University, Makassar [email protected]
2Nutrition Study Program, Postgraduate, Hasanuddin University, Makassar [email protected]
3Midwifery Study Program, Postgraduate, Hasanuddin University, Makassar [email protected]
4Midwifery Study Program, Postgraduate, Hasanuddin University, Makassar
5Midwifery Study Program, Postgraduate, Hasanuddin University, Makassar
6Nutrition Study Program, Postgraduate, Hasanuddin University, Makassar Corresponding E-mail: [email protected]
ABSTRACT
Ridni Husnah, Addition of Sukkari Dates (Phoenix Dactylifera L) and Fe Supplementation in Increasing Ferritin Levels to Young Women with Anemia (guided by Suryani As'ad and A. Wardihan Sinrang) Sukkari dates contain a number of nutrients such as protein, iron and vitamin C that have the potential to prevent anemia that often occurs in young women. The purpose of this study was to find out the influence of the administration of Sukkari dates (Phoenix Dactylifera L) and Fe supplements to increase levels of Ferritin in young women with anemia. This research was conducted at SMPN 3 Lembang and SMAN 8 Pinrang for intervention and Microbiology Laboratory of Hasanuddin University Makassar Education Hospital for Ferritin Level Examination. This research was conducted for 1 month by pre and post-test with control group. The samples used in this study were 42 anemia girls divided into 3 groups (14 respondents each) with the division of 1 control group and 2 intervention groups. The control group was only monitored for nutrinya intake using a 24- hour food recall and intervention group 1 was given Fe 60 mg supplements twice in a week and every day during menstruation, intervention group 2 was given Sukkari dates 50 grams daily in combination with Fe 60 mg supplements twice in a week and every day during menstruation. Ferritin levels checking applied ELISA method. The data in the analysis used statistical analysis of chi square test, One-way Anova Test, Kruskal- Wallis posthoc mann-whitney test and Wilcoxon posthoc Friedman test. The characteristics of age, height, weight, menstruation, education, parents’ education and parents’ occupation from the three groups have been comparable before treatment with a value of p > 0.05, with most samples aged 13-15 years old, weighing 35- 60 kg, height 145 – 151 cm. within menstruation duration 3-7 days, there was a significant average increase in Ferritin levels from 8.38 +3.41 to 33.00 + 17.12 P=0.002 values in the group given Fe supplement , Ferritin levels from 5.00 +1.31 to 34.45 + 10.06 P value = 0.001 in the group given Sukkari dates combination of Fe supplements, in the control group there was a significant average increase in Ferritin levels from 13.55 + 4.56 to 16.60 + 2.21 p=0.001.
Conclusion: There is an influence of Sukkari dates (phoenix Dactylifera L) and Fe supplements on Ferritin levels in anemia young women.
Keywords: Sukkari Dates, Fe Supplements, Ferritin Levels, Young Women, Anemia
INTRODUCTION
Anemia is a condition where hemoglobin (Hb) levels in the blood are lower than normal values for the group of people according to age and gender, in adolescent women normal hemoglobin is 12 – 16 g/dl and adolescent men 13 – 17 g/dl (andriani,2017).
The World Health Organization (WHO) (2017) says anemia is a condition where the number of red blood cells is insufficient to meet the physiological needs of the body. A person's physiological needs vary based on age, gender, place of residence, smoking behavior and stage of pregnancy.
The cause of anemia is generally due to lack of knowledge about anemia, iron deficiency, folic acid, vitamin B12 and vitamin A. Acute and chronic inflammation, parasite infection, congenital failure that affects hemoglobin synthesis, deficiency, production of red blood cells can cause anemia (Siska, 2017).
Anemia is a continuation of the impact of macro nutrient deficiency, namely protein, carbohydrates, fats and micronutrient deficiencies, namely vitamins and minerals (Hasri, 2016).
The impact of anemia on young women is stunted growth and development of adolescents, resulting in reduced fitness or freshness of the body, learning spirit or decreased achievement (Damayanti, 2016). The impact of low iron status (Fe) can result in anemia with symptoms of paleness, lethargy or fatigue, shortness of breath and lack of appetite as well as growth disorders (Barasi, 2016).
Based on Jayant's research (2017), it described that the world's adolescent population faces a series of nutritional challenges that affect not only their growth and development but also their livelihoods as adults. However, adolescents remain a largely neglected, hard-to-measure and hard- to-reach population, where the needs of young women in particular, are often overlooked. Anemia in young women contributes to maternal and fetal mortality and morbidity in later life.
The World Health Organization (WHO) in the worldwide prevalence of anemia in 2015 showed that the prevalence of anemia in the world ranged from 40–88%. In Southeast Asia, 25-40% of young women experience mild and severe anemia. The number of adolescents is 10 - 19 years old in Indonesia.
It is 26.2% consisting of 50.9% of men and 49.1% of women (Ministry of Health, 2018). Based on The Health Profile of South Sulawesi (2014), iron deficiency anemia is the most prevalent nutritional problem in the world and infects more than 600 million people. With a frequency, that is still quite high ranges between 10% and 20% (Health Profile of South Sulawesi, 2014).
Basic Health Research (Riskesdas) data report in 2013, prevalent anemia in Indonesia is 21.7%.
Based on the demographic and health survey of Indonesia 2017, the prevalence of anemia among children aged 5 - 12 in Indonesia is 26%. Prevalent anemia in women aged 13 - 18 is 23% while the prevalence of anemia in men is lower than women which is 17% with the age of 13 - 18 years (Ministry of Health, 2018). Prevalent anemia in south Sulawesi is 33.7%. Based on data from the
17379 Health Office of South Sulawesi Province, hawker food contributed to the fulfillment of energy needs by 31.1% of protein by 27.4%(Profile of South Sulawesi Health Office, 2015).
Based on a preliminary study conducted on July 4, 2020 by measuring Hb Levels using the Easytouch Hb meter tool, it was obtained from SMP 3 Lembang with a total of 83 students who performed Hb examination, and found that 53 people had anemia (63.86%). Afterwards, for those who did not experience anemia as many as 30 people (36.14%), in SMAN 8 Pinrang the number of students as many as 100 people who experienced anemia 42 people (42%) and those who did not experience anemia 58 people (58%).
Young women have a higher risk of developing anemia, especially iron deficiency anemia than in young men. The first reason is that every month young women have menstruation. The second reason is that young women often maintain the appearance, the desire to stay slim or thin so diet and reduce eating. A diet that is not balanced with the nutritional needs of the body will cause the body to lack important nutrients such as iron, and can be at risk of iron deficient anemia (Syatriyani
& Aryani, 2010).
The impact of anemia on school-age children, especially adolescents, can interfere with learning, decreased muscle function, and endurance in children. If the immune system decreases then the risk of infection will also increase. Because the main factor is nutrition, iron nutrition anemia should be treated immediately with the administration of iron (Fe) preparations or supplementation. Therefore, the treatment of anemia in the form of supplements should be given (M.Ridwan, 2018).
Fe supplement program on a large scale for the prevention of anemia has been conducted by the government to pregnant women, toddlers and school-age children who suffer from anemia.
However, in Indonesia itself fe supplementation is still not able to do the overall anemia prevention. In addition, this Fe supplement has side effects such as nausea, vomiting, bloating, constipation and diarrhea (Cicik, 2016)
Therefore, there needs to be other ways to prevent the occurrence of anemia, especially iron deficiency anemia in addition to taking blood-added tablets, young women can consume nutrients that contain many vitamins and minerals that can help increase hemoglobin levels in the blood.
One of them is by using treatment with herbal ingredients (Saifudin. et al., 2011).
Dates are one of the natural ingredients that have many benefits that are very remarkable because of the many content in the fruit as described in the Qur'an and hadith of the prophet that alludes to dates. One of these verses is QS Maryam verses 24-26. Dates are also believed to have benefits as a nutritious and highly nutritious food ingredients as phytopharmaceuticals. Dates that have a lot of dietary fiber, polyphenols, carotenoids, vitamins, minerals, glucosinolic, folic acid, selenium and zinc so that dates can be an anti-oxidant and a source of energy for our body (Istikomah, 2018).
Research using Fe and date supplements is a study conducted by (Nora, 2017) in midwifery students with the administration of Fe and date supplements, the result of Hb increase after the administration of dates and giver Fe supplements. Another study using date giving was conducted (M.Ridwan, 2018) on date giving in young women to increase the level of Hemoglobin and the results showed a significant increase in Hemoglobin levels. Based on the description above researchers are interested to conduct research on the administration of Sukkari dates and Fe supplements in increasing Ferritin levels in adolescent women with anemia.
METHOD
The research was conducted from October 2020 to November 2020. This research was conducted in 3 different places according to the stages of research conducted. Sampling and intervention were conducted at SMPN 3 Lembang and SMAN 8 Pinrang, The Ferritin level submission stage was conducted in unhas Hospital Laboratory. The research design used is Quasi Experiment Research with Pre And Post-Test With Control Group design.
The population in this study is all female students of SMPN 3 Lembang and Female Students of SMAN 8 Pinrang as many as 789 students. The samples in this study were young women with anemia who attended SMPN 3 lembang and SMAN 8 Pinrang. The sample was divided into three groups, namely intervention group 1 given Fe supplement, Intervention group 2 given fe supplement combination of Sukkari dates and control group that monitored nutrient intake using food recall 24 hours with a total sample of 42. Sampling Purposive techniques is sampling with inclusion criterion: young women who have anemia, willing to be studied and sign informed consent, young women aged 13-18 years, Have got menstruation, Not menstruating, Hb levels <
12 gr / dl, Not taking vitamins or additional supplement, Not undergoing a diet program and Not having diseases such as lumps under the stomach, diarrhea, inflammation of the intestines.
Data collection instruments are questionnaire sheets screening prospective respondents, approval sheets or informed consent, data sheets characteristics of respondents, food recall sheets 24 hours, sheets to monitor compliance consumption of dates Sukkari and supplements Fe. To analyze the characteristics of respondents using chi-square statistics analysis and to analyze the Ferritin levels of young women anemia using a single-way Anova statistical test analysis, the Kruskal-Wallis posthoc mann-whitney test and the Wilcoxon posthoc Friedman test.
17381 RESULTS
1. Univariat Analysis
TABLE 1
Respondent Characteristics
Respondent Characteristics
Intervention 1 (Having Fe Supplement)
Intervention 2
(Having Sukkari Dates Combined with Fe Supplement)
Control (Monitoring of Nutrient
Intake) P Value
n(%) n(%) n(%)
Education:
Middle School High School
5(11.90) 9(21.42)
6(14.29) 8(19.04)
10(23.81) 4(9.52)
0.747
Age:
13 – 15 years old 16 – 18 years old
10 (23.81) 4 (9.52)
8(19.04) 6(14.29)
13(30.95) 1(2.38)
0.100
Weight:
< 35 kg 35-60 kg
2 (4.76) 12 (28.57)
0(0) 14(33.33)
5(11.90) 9(21.43)
0.376
Height:
<145 cm 145 – 151 cm
3 (7.14) 11 (26.19)
2 (4.76) 12 (28.57)
6(14.29) 8(19,04)
0.213
Menstruation Period:
<3 days and >7 days 3 – 7 days
5(11.90) 9 (21.42)
5(11.90) 9(21.42)
8(19.04) 6(14.29)
0.910
Parent Education:
Elementary Middle School High School Bachelor-Master
3 (7.14) 4(9.52) 6(14.29) 1(2.38)
2(4.76) 2(4.76) 6(14.29)
4(9.52)
1(2.38) 3(7.14) 7(16.67)
3(7.14)
0.592
Parent Occupation:
Farmer Entrepreneur Civil Servant
11(26.19) 2(4.76) 1(2.38)
9(21.42) 4(9.52) 1(2.38)
10(23.80) 2(4.76) 2(4.76)
0.812
IMT:
Thin: < 17 Normal: 17 – 25 Fat: > 25
2 (4.76) 11(26.19)
1(2.38)
1(2.38) 13(30.95)
0(0)
7(16.67) 7(16.67) 0(0)
0.001
Chi Square
Table 1 data shows that junior and senior high school respondents have the same number of respondents as 21 respondents. The number of respondents in junior high school was 5 (11.90) in intervention group 1, 6 (14.29) in intervention group 2 and control as much as 10 (23.81%), while in high school respondent education was 9 (21.42%) respondents to interventions 1, 8(19.04%) 2 intervention and control of 4(9.52%). In age characteristics most of the respondents of the intervention and control group had ages 13-15 years with 10 students (23.81%) interventions 1, 8 (19.04%) students in intervention groups 2 and 13 (30.95%) students in the control group which means all three groups are in the adolescent age range of anemia. On the characteristics of Weight Loss Most respondents weigh 35-60 kg with 12 (28.57%) students in the intervention group 1, 14(33.33%) students in intervention groups 2 and 9 (21.43%) control group.
In the characteristics of height some respondents have a height of 145 - 151 cm, the number of respondents who have a height of 145- 151 cm in intervention 1 as much as 11 (26.19%), intervention 2 as much as 12 (28.57%) and control of 8(19.04%). Menstruation period most of the respondents are 3-7 days, the number of respondents on intervention 1 and intervention 2 is the same is 9 (21.42%) and control respondents were 6(14.29%). In the education characteristics of parents, the majority of parents' education is high school, the number of respondents in the intervention group 1 as much as 6 (14.29%), intervention 2 6 (14.29%) and control 7(16.67%). On the characteristics of respondents working parents as parents of respondents are farmers, the number of responders on intervention 1 as much as 11 (26.19%), in intervention 2 as much as 9 (21.42%) and control of 10(23.80%). In the homogeneity test all three characteristics of the group were already equivalent to the value p>0.05.
Table 2
Nutritional Adequacy of Macronutrients and Micronutrients before the distribution of Sukkari Dates and Fe Supplements
Nutrition AKG
MEAN + SD P-Value
Intervention 1 (Fe Distribution)
% AKG
Intervention 2
(Distributing Sukkari Dates with Fe)
% AKG
Control
(Monitoring Nutrient Intake) % AKG
Energy (kkal) 2125 450.76 + 577.52 21.21 657.48 + 946.67 30.94 224.96 + 172.37 10.58 0.110
Protein (g) 69 38.75 + 23.77 56.15 28.91 + 23.97 41.89 31.85 + 16.00 46.15 0.471
Fat (g) 71 49.20 + 33.39 69.29 40.48 + 15.58 57.01 47.51 + 27.65 66.9 0.930
Carbohydrate
(g) 292 161.92 + 32.38 55.45 151.62 + 42.13 51.92 138.74 + 41.68 47.51 0.068
Calcium (mg) 1200 367.64 + 149.29 30.63 341.35 + 171.07 28.44 307.14 + 75.89 25.59 0.467
Phosphorus
(mg) 1200 38.23 + 27.50 3.18 26.51 + 14.66 2.2 36.25 + 11.37 3.02 0.149
Iron (mg) 26 17.24 + 6.64 66.30 15.70 + 6.60 60.38 14.76 + 9.47 56.76 0.692
Vitamin C (mg) 65 27.23 + 17.07 41.89 38.24 + 24.73 58.83 34.41 + 24.40756 52.9 0.453
17383 Anova One-way Test, Kruskal-Wallis test posthoc mann-whitney
Based on the data in table 3.2 shows that all three groups have AKG of energy nutrients, proteins, fats, carbohydrates, calcium, phosphorus, iron, and vitamin C as a whole is still below the minimum 80% of AKG set, so it can be said that it is not sufficient nutritional needs per day. After being tested the analysis of energy nutrients, proteins, fats, carbohydrates, calcium, phosphorus, iron and vitamin C as a whole had a value of p = > 0.05 which means before being given the treatment of intervention group 1, intervention group 2 and the control group had a comparable or equivalent nutrient intake.
Table 3
Nutritional Adequacy of Macronutrients and Micronutrients after Administration of Sukkari Dates and Fe Supplements
Nutrition AKG
MEAN + SD P-Value
Intervention 1 (Fe Distribution)
% AKG
Intervention 2
(Distributing Sukkari Dates with Fe)
% AKG
Control
(Monitoring Nutrient Intake) % AKG
Energy (kkal) 2125 143.24 + 28.03 6.74 130.97 + 25.76 6.16 112.41 + 14.30 5.28 0.005
Protein (g) 69 63.65 + 14.45 92.24 55.06 + 21.27 79.79 50.62 + 46.60 73.36 0.144
Fat (g) 71 27.13 + 8.02 38.21 66.36 + 34.77 93.46 62.30 + 16.77 87.74 0.000
Carbohydrate
(g) 292 127.25 + 18.28 43.57 126.62 + 24.28 43.36 111.49 + 8.86 38.18 0.079
Calcium (mg) 1200 116.95 + 122.95 9.74 126.59 + 75.79 10.54 58.12 + 50.58 4.84 0.054
Phosphorus
(mg) 1200 95.59 + 77.99 7.96 89.61 + 58.98 7.46 39.60 + 14.99 3.3 0.025
Iron (mg) 26 19.82 + 8.32 76.23 13.91 + 5.56 53.5 16.77 + 9.72 64.5 0.165
Vitamin C (mg) 65 13.70 + 6.70 21.07 48.92 + 53.35 75.2 28.69 + 37.51 44.13 0.139
Anova One-way Test, Kruskal-Wallis test posthoc mann-whitney
Based on the data in table 3.3 shows from the overall nutrition only Fats and proteins that have AKG % which is more than the minimum requirement (80%) 93.46% and 92.24%. After the analysis test it was known that some nutrients namely energy, fat and phosphorus that have a level of significance namely P = < 0.05 which means that some of these nutrients have a significant average difference between the intervention group and the control group after being treated.
2. Bivariate Analysis
Bivariate analysis was used to test differences in nutritional adequacy between the intervention group and the control group after administration. Furthermore, to see the difference in Ferritin levels in the control group and intervention before and after administration while comparing the differences in Ferritin levels in all three groups. The obtained data is presented in the form of the following table:
Table 4
Differences in Ferritin Levels of Respondents Before and After Distribution of Sukkari Dates and Fe Supplements
Ferritin N Mean + SD
Mean P* P
Value
Pre Post
Control (Monitoring Nutrient Intake) 14 13.56 + 4.57 16.60 + 2.21 3.05 0.002 0.008
Intervention 2 (Distributing Sukkari Dates with Fe) 14 5.00 + 1.31 34.46 + 10.07 29.45 0.001 0.000
Intervention 1 (Fe Distribution) 14 8.39 + 3.41 33.00 + 17.12 24.62 0.001 0.000
P-Value 0.674 0.000
Friedman+ test post hoc Wilcoxon, Kruskal-wallis Test
Based on the data in table 3.4 showed post hoc results wilcoxon in intervention group 1 and intervention group 2 before and after administered fe supplements and dates sukari combination fe supplement obtained value P = 0.001 greater than the value of p < 0.05.
This suggests there was a difference in Ferritin levels in intervention group 1 and intervention group 2.
The data table above was also seen after the Friedman Test in intervention group 2 there was an increase in Ferritin levels between before and after the behavior with a difference of 29.45 man and statistically significant with nila p = 0.000, where p < 0.005 which means there is a significant difference between before and after treatment. In both intervention groups there was also an increase between before and after treatment with mean cells in intervention 1 24.62 and mean difference in control 3.05, where p < 0.005 which means there is a significant difference between before and after treatment.
The data in the table above was also seen after conducting a kruskal-walls test of pretest values between the control group, intervention 1 and intervention 2 obtained a value of P = 0.674, where p > 0.005 which means that the pretest value between the three groups there was no significant difference. In the posttest value between the three groups after the analysis test obtained a value of p = 0.000, where p < 0.005 which means there is a significant difference in the posttest results of the three groups.
17385 DISCUSSION
The number of samples that followed this study was as many as 42 female students divided from 3 groups, namely intervention group 1, intervention 2 and control group each consisting of 14 students with an age range of 13-18 years, the sample is student from SMPN 3 Lembang and SMAN 8 Pinrang, Pinrang district. This study discusses the Effect of Sukkari Dates (Phoenix Dactylifera L) and Fe Supplements in Increasing Ferritin Levels which aims to determine the effectiveness of dates and fe supplements in improving the value of Ferritin levels of young women with anemia.
Additional iron for adolescent women is necessary to replace iron loss during menstruation.
Haliberg (1996) mentioned that menstruation during adolescence is no different from other reproductive ages. The average menstrual blood loss is 84 ml. assuming a loss of HB 133 g/dl.Requires an additional 0.56 mg/day of iron. (Briawan, 2013).
Adolescents need high iron and need iron supplements and urgently require treatment. In this group, handling through fortification and diet alone is sometimes not enough. Therefore, supplements in the form of pills, syrups or sprinkles are required to be consumed to improve nutritional status, further to maintain nutritional status, can be continued through improved food consumption. Some stages of life that may require iron supplements include young women (micronutrient initiative, 2003), Briawan, 2013)
Blood-added tablets are a talet for nutritional anemia prevention supplementation which each tablet contains 200 mg of Sulphas Foreus (which is equivalent to 60 mg of elemental iron) and 0.25 mg of Folic Acid. The amount of iron content has been obtained by experts. (depkes.2003) Iron supplement has long been known as the primary strategy for achieving risky targets, most often being the main target for pregnant women. However, very little attention is paid to schoolchildren, teenagers and the elderly. In fact, this group is among the high risk in developing countries (Briawan, 2013).
From the results of the study, it was obtained that the administration of Sukkari dates and Fe supplements for 1 month was able to affect the value of Ferritin levels. Indeed, the three groups either given Fe supplements, Fe supplements Sukkari date combination or not, both experienced an increase but only in the group given Fe supplements Sukkari date combination that experienced a significant increase in Ferritin value.
Dates are palm plants (palm) or in latinya more familiar with Phoenix Dectylifera L that bear fruit and can be eaten, both cooking and still raw (subagja, 2013).
Dates can be used as one of the daily food especially in the morning before doing activity because it is able to provide good efficacy and according to the needs. Dates are also able to strengthen body temperature naturally. In addition, it will not cause reduction of metabolic pulp deposits that
can damage the body as caused by most types of food and other fruits. Dates have a lot of vitamins and minerals, such as C, vitamin B1, Vitamin B2, Vitamins, Niacin, calcium, iron, magnesium, potassium, sodium, zinc and others (Khasnah, 2011).
From the results of the study showed that there is an average difference in Ferritin levels before and after treatment. In the treatment group there was an increase in the average level of Ferritin.
This increase is likely due to the effect of the content contained in Sukkari dates that serve to form in terms of iron absorption, namely vitamin C. Vitamin C plays a role in helping the absorption of iron reserves in the body by converting them from ferri to ferro form to be easily absorbed by the body again (Nurlely, 2014).
The content of Sukkari dates one of which iron is transported to the mitochondria from joining Heme proteins or bonding with Ferritin in Sidersosum for the development of erythroplasts. The iron is then bound by mitochondria for the synthesis of Heme proteins. In iron, mitochondria enter into the protoporfirin and join the globin protein to form hemoglobin. In addition, the content in dates Sukkari one of which vitamin C plays a role to help in the process of absorption of iron reserves in the body ( Ferritin).
While Ferritin itself is an important protein in iron metabolism. Under normal conditions. Ferritin stores re-extractable iron for use as a necessity. In the state of iron excess, the body's iron deposits greatly increase and much more Ferritin is present in the tissues. For example the liver and spleen.
Ferritin is also a preparation for the synthesis of iron containing proteins, including hemoglobin (Hb) and myoglobin (Ani, 2015).
Ferritin is a protein that can be found in cells where it is used to store Fe so that it can one day be used by the body. The amount of blood Ferritin is directly linked to the amount of Fe stored in the body.51 Examination of serum Ferritin levels can be used to determine the body's Fe reserves.
Serum Ferritin is usually examined using ELISA method (Mustiadji, 2001).
In intervention group 1 who get Fe tablets there is an increase in Ferritin levels this is caused by Fe tablets consumed will be processed in the stomach and will join in the blood plasma then bind to globulin. Excess Fe in the blood will be buried in the liver and will bind to the apoferritin so that Ferritin is formed. (Dewi, 2019)
In the study obtained Ferritin levels before being given dates are still relatively normal, but haemoglobin levels decreased. After being given dates, hemoglobin levels and Ferritin levels increase. Basically people with iron deficiency anemia are characterized by decreased serum Ferritin levels and followed by decreased hemoglobin levels. This is supported by the results of Pagdya (2018) which states that there are differences in hemoglobin levels and Ferritin levels in young women with anemia who get dates with a group that gets iron supplementation with a value of p < 0.05.
17387 Based on the results of UJi Friedman found that there were meaningful differences before and after treatment in the group given fe supplements judging from the average value of mean 8.38 pg to 33.00 pg with a mean difference of 24.62 and a value of p = 0.002 and the group given fe supplement combination of Sukkari dates has average value - mean 5.00 pg to 34.45 pg with a mean difference of 29.45 and value p = 0.001, p < 0.05 indicates that there is a difference in Ferritin value between before and after the intervention of fed supplements and fe supplements Sukkari date combination. The increase in Ferritin levels in the intervention group made the average value fall into the normal category than the previous one less than normal. In the control group there was also a change in the average value of Ferritin from 13.55 to 16.60 with a difference of mean of 3.05 and the value P = 0.001, P < 0.05 which means there is a significant difference before and after treatment.
This phenomenon resembles the results of research conducted by Dewi Triloka Wulandari (2019) about the potential of dates (phoenix dactylifera to hemoglobin levels and Ferritin levels in young women with mild anemia (study in MAN 3 Jombang east java) showed the result of increased levels of Ferritin in the group given Fe supplements and the group given dates plus Fe supplements, had a significant influence (p<0.05).
The results of this study are in line with research conducted by Cicik Mujianti (2016) obtained a meaningful change in Ferritin levels after treatment in the intervention group and no significant changes in Ferritin levels after treatment in the group was not given date juice. In Pravitasari research (2014) stated that the administration of dates 60 and 120 mg / kg BB per day can increase hemoglobin levels on the 60th day of research, while according to Onuh, 2012 stated the results of his research that raw methanol and dates have properties able to support the increase of synthesis of erythropoietin by the liver to stimulate the bone marrow to produce more red blood cells and Ferritin iron reserves in the body (Eny Sendra,2016).
This study proves that by consuming dates with a dose of 500 gram along with Fe tablets can routinely increase Ferritin levels in young women and taking Fe supplements twice a week can increase Ferritin levels in anemia young women. This is because dates in addition to containing flavonoid compounds also contain many nutrients that can help the absorption of iron in food.
CONCLUSIONS AND SUGGESTIONS
Regarding the results of research and analysis of data that has been conducted on the influence of administration of dates Sukkari and Fe supplements in increasing levels of Ferritin young women anemia obtained conclusions: There are differences in Ferritin levels before and after administration of dates Sukkari and Fe supplements in the intervention group and control group that significantly increased
Young women who experience anemia can use Sukkari dates to overcome nutrient intake to be fulfilled and not easily feel tired, lethargic and fail to focus in prison. Researchers can further develop this study and can review important cases for further investigation.
BIBLIOGRAPHY
1. Adriani.(2017). Faktor-Faktor Anemia pada Remaja Putri. Surakarta. Accessed on 22 May 2019
2. Achmad H, Putri AP. Contents of Banana Peel Extract as Hemostasis in Wound Healing. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 1, 2021, Pages. 4800 - 4810.
3. Achmad H, Faizah N. Effect of Orthodontic Facemask as a Treatment for Children in Growth and Development Period: A Systematic Review. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 1, 2021, Pages. 4620 - 4631.
4. Achmad H, Armedina RN, Timokhina T, Goncharov VV, Sitanaya R, Riyanti E. Literature Review:
Problems of Dental and Oral Health Primary School Children. Indian Journal of Forensic Medicine
& Toxicology, April-June 2021, 15(2): 4146-4153.
5. Achmad H, Safitri N, Paromova Y, Goncharov VV, Primarti RS, Riyanti E.
Functional Generating Bite Therapy in Children During Growth and Development Period. Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2. p. 4154-4162.
6. Achmad H, Gani A, Djais AI, Hatta LI, Rieuwpassa IE, Monry A. Effectiveness of Edible Film Chitosan from Waste White Shrimp (Litopenaeus vannamei) in Reducingcolonization of Porphyromonas Gingivalis Bacteria: In Vitro Research. Annals of R.S.C.B., ISSN:1583-6258, Vol.
25, Issue 2, 2021, Pages. 1673 - 1681.
7. Ani L (2015).Anemia defisiensi besi. Jakarta: EGC
8. Barasi.(2016). Dampak Anemia pada Remaja Putri. Jayapura: In Media
9. Briawan,Dodik. (2013) Anemia Masalah Gizi Pada Remaja Wanita. Jakarta: EGC
10. Calpin-Davies, P. (1999). Investing in the future. In Nursing management (Harrow, London, England: 1994) (Vol. 5).
11. Cicik Mujianti. (2016). Pengaruh pemberian sari kurma terhadap peningkatan Kadar Hemoglobin dan dan Kadar Feritin pada remaja putri di Pondok Pesantren Darul Arqam Muhammadiyah Gombara Makassar. Sekolah Pascasarjana Universitas Hasanuddin Makassar
12. Damayanti, Siallagan, et al. 2016. Pengaruh Asupan Zat besi, Vitamin A, Vitamin B12 dan Vitamin C dengan Kadar Hemoglobin pada Remaja Vegan di Pusdiklat Buddhis Maitreyawira. Journal 13. Dewi TW. (2019). Potensi buah kurma (phoenix Dactylifera L) terhadap kadar hemoglobin dan
kadar Ferritin pada remaja putri dengan anemia ringan di MAN 3 Jombang Jawa Timur. Poltekes Kemenkes Semarang
14. Eny Sendra. Pengaruh Konsumsi Kurma (Phoenix Dactylifera) Terhadap Kenaikan Kadar Hemoglobin pada Ibu Hamil Trimester II di Wilayah Puskesmas Kediri Jurnal Ilmu Kesehatan.
2016; Vol 5 No 1
15. Hoffbrand,A.V. (2005). Kapita Selecta Hematologi.Jakarta:EGC
16. Isa, N., Novadela, T., & Imron, R. (2015).PENGARUH PEMBERIAN TABLET Fe DAN BUAH KURMA.XI(2), 305–309.
17. Kesehatan, J., Sai, M., Lestariningsih, S., Lestari, G. I., Kebidanan, J., Kesehatan, P., & Karang, T.
(2018).Konsumsi Buah Kurma Meningkatkan Kadar Hemoglobin pada Remaja Putri.11(2), 57–
64.
18. Kemenkes RI. 2013. Prevalensi Anemia pada Remaja Di Indonesia.Jakarta: Badan Litbangkes Kemenkes RI
19. Kemenkes, 2018.Survei Demografi dan Kesehatan Indonesia 2017: Kesehatan Reproduksi Remaja. Badan Kependudukan Dan Keluarga Berencana Nasional, Badan Pusat Statistik, Kementerian Kesehatan. Accessed on
https://ekoren.bkkbn.go.id/wpcontent/uploads/2018/10/laporansdki-2017-remaja.pdf
17389 20. Khasanah N. (2011). Kandungan buah-buahan dalam Al-Qur’an: buah tin (ficus caracal), zaitun (Olea europea), delima( Punice granatum), anggur ( Vitis Vinivera), dan kurma ( Phoenix dactylifera) untuk kesehatan. Walisongo Medical Journal, 1(1): 23-27
21. Kunci, K. (2019). Page 18.3(2), 3–6.
22. Mustiadji. Hubungan Kadar Hemoglobin, Hematokrit, Jumlah Eritrosit dengan Kadar Ferritin pada Kehamilan Trimester II dan III Semarang: Diponegoro; 2001.
23. Nadeem, M., Qureshi, T. M., Ugulu, I., Riaz, M. N., Ain, Q. U., Khan, Z. I. Dogan, Y. (2019).
Mineral, vitamin and phenolic contents and sugar profiles of some prominent date palm (Phoenix dactylifera) varieties of Pakistan. Pakistan Journal of Botany, 51(1), 171–
178.https://doi.org/10.30848/PJB2019-1(14)
24. Nurlely.(2014). Pengaruh honey bee pollen terhadap hemoglobin dan serum Ferritin anak sekolah dasar yang menderita anemia di SD Inpres Pannampu Tallo Makassar. Fakultas Kedokteran Universitas Hasanuddin Makassar, 1-14.
25. Onuh SN, Ukaejiofo E.O., Achukwu P.U. d. Haemopoietic Activity and Effect of Crude Fruit Extract of Phoenix dactylilfera on Peripheral Blood Parameters. BioMedSciDierect Publication. 2012;3:1720-3
26. Profil Kesehatan Sulawesi Selatan Tahun 2014. Makassar: Dinas Kesehatan 2014.
27. R1 K. Hasil Utama Rskesdas 2018. Jakarta: Kemenkes Badan Penelitian Dan Pemgembangan Kesehatan; 2018
28. Sarifudin Azis, dkk. (2011). Standar Bahan obat Alami, Yogyakarta: Graha Ilmu
29. Siska.(2017) .Faktor yang Berhubungan dengan Anemia Pada Remaja Putri. Jakarta. Accessed on 26 April 2019
30. Subagja, Prasetya. H. (2013).Ajaibnya Madu, Sari Kurma, Gingseng, Susu Unta dan Jintan Hitam.
Yogyakarta: Divapress
31. Suplementasi, E., & Kurma, S. (2018). Teh Hijau Terhadap Penurunan Kadar Malondialdehyde ( Mda ) Lasma Pada Anak. (October 2014).
32. Syatriani S. & Aryani A. (2010) Konsumsi makanan dan kejadian anemia pada siswi salah satu SMP di Makassar. Jurnal Kesehatan Masyarakat Nasional, 46(6): 163
33. Upadhye, J. V., & Upadhye, J. J. (2017).Assessment of anaemia in adolescent girls.International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(7), 3113.https://doi.org/10.18203/2320-1770.ijrcog20172944
34. Yulianti, Hasri. 2016. Pengaruh Ekstrak Daun Kelor terhadap Peningkatan Kadar Hemoglobin pada Remaja Putri Di SMU Muhammadiyah Kupang.ISSN Jurnal Kesehatan.
35. World Health Organization (WHO) in Worldwide prevalence of anemia 2015
