Iron intake, supplement adherence, and perceived social support as predictors of anemia in rural Indonesia: A cross-sectional study

Yayuk Sri Rahayu* -  Midwifery Diploma Study Program, Faculty of Health Sciences, Sehati Indonesia University, Karawang, Indonesia
Marliana Rahma -  Midwifery Diploma Study Program, Faculty of Health Sciences, Sehati Indonesia University, Karawang, Indonesia
Nita Farida -  Midwifery Diploma Study Program, Faculty of Health Sciences, Horizon University Indonesia, Indonesia
DOI : 10.30867/action.v10i4.2617

Anemia among pregnant women remains a significant public health issue in Indonesia, particularly in Purwasari District, where 37.1% of women are anemic. Anemia may be directly influenced by social and supplementation factors, which also affect nutritional status, fetal health, and pregnancy outcomes through environmental support and the fulfillment of essential nutrient needs. This study aimed to analyze the association between social, supplementation, and nutritional factors and anemia among pregnant women in Purwasari District. A quantitative approach with a cross-sectional design was used. The sample consisted of 150 pregnant women who met the inclusion criteria of this study. Eligible participants were pregnant women aged 18–40 years in their second or third trimester. Data were analyzed using logistic regression analysis. The results showed that adequate vitamin C intake (p = 0.004; OR = 2.912), adherence to iron–folic acid (IFA) tablet consumption (p = 0.000; OR = 4.030), side effects of IFA intake (p = 0.003; OR = 3.027), and support from parents or in-laws (p = 0.026; OR = 2.563) were significantly associated with anemia in pregnancy. In conclusion, vitamin C adequacy, IFA adherence and side effects, and family support were significantly related to the occurrence of anemia among pregnant women in the Purwasari District.

Keywords : Anemia, vitamin C intake, iron supplementation, family support

  1. Abdulsalam, M., Tessema, M., Mohsin, M., Malik, T., & Abdulsalam, F. I. (2025). Determining factors associated with anaemia in pregnant women visiting the antenatal care unit at St. Paul’s Hospital, Addis Ababa, Ethiopia: Unmatched case-control study. Women and Children Nursing, 3(1), 27–34.
  2. Al Rahmad, A. H. (2023). Scoping review: The role of micronutrients (Fe, Zn, iodine, retinol, folate) during pregnancy. Jurnal Kesehatan Manarang, 9(1), 1–13. https://doi.org/10.33490/jkm.v9i1.812
  3. Anne Marie, U., Murererehe, J., Rehman, M., Chittilla, M., Uwambaye, P., & Razzaque, M. S. (2023). Oral manifestations of iron imbalance. Frontiers in Nutrition, 10, 1272902. https://doi.org/10.3389/fnut.2023.1272902
  4. Anwar, S., Kumar, V., & Raut, R. (2024). A review on factors causing vitamin B12 deficiency in pregnant women and infants. [Nama Jurnal tidak tersedia], 12(1), 1450. https://doi.org/10.1016/S0140-6736(24)00185-5
  5. Azzam, A., Khaled, H., Alrefaey, A. K., Basil, A., Ibrahim, S., Elsayed, M. S., ... & Halim, H. W. A. (2025). Anemia in pregnancy: A systematic review and meta-analysis of prevalence, determinants, and health impacts in Egypt. BMC Pregnancy and Childbirth, 25(1), 29. https://doi.org/10.1186/s12884-024-07111-9
  6. Banerjee, A., Athalye, S., Shingade, P., Khargekar, V., Mahajan, N., Madkaikar, M., & Khargekar, N. (2024). Efficacy of daily versus intermittent oral iron supplementation for prevention of anaemia among pregnant women: A systematic review and meta-analysis. EClinicalMedicine, 74, 102742. https://doi.org/10.1016/j.eclinm.2024.102742
  7. Chung, G. K. K., Sharma, B., Vargas, D. C., Lee, W., Sun, K. S., Hung, H., ... & Yeoh, E. K. (2025). Prevalence and determinants of anemia in South Asian diaspora women residing in Hong Kong: An exploratory cross-sectional study. Journal of Migration and Health, 11, 100312. https://doi.org/10.1016/j.jmh.2025.100312
  8. Conrad, A., Burns, J., Sherburne, L., Kaled, M. D., Souley, H., & Nielsen, J. (2024). Understanding behavioral drivers of iron and folic acid supplementation and vitamin A- and iron-rich food consumption among women and adolescent girls in Niger. Public Health Nutrition, 27(e249), 1–8. https://doi.org/10.1017/S1368980024002192
  9. Darebo, T. D., Spigt, M., Teklewold, B., Badacho, A. S., Mayer, N., & Teklewold, M. (2024). The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low- and middle-income countries: A qualitative evidence synthesis. BMC Public Health, 24(1), 520. https://doi.org/10.1186/s12889-024-17916-0
  10. Elvira, E., Nurvinanda, R., & Sagita, A. (2022). Factors associated with anemia in pregnant women. Citra Delima Scientific Journal of Citra Internasional Institute, 6(2), 111–118. https://doi.org/10.33862/citradelima.v6i2.295
  11. Faghir-Ganji, M., Amanollahi, A., Nikbina, M., Ansari-Moghaddam, A., & Abdolmohammadi, N. (2023). Prevalence and risk factors of anemia in first, second, and third trimesters of pregnancy in Iran: A systematic review and meta-analysis. Heliyon, 9(3), e14197. https://doi.org/10.1016/j.heliyon.2023.e14197
  12. Ge, S., Ali, S., Haldane, V., Bekdache, C., Tang, G. H., & Sholzberg, M. (2025). An approach to hemequity: Identifying the barriers and facilitators of iron deficiency reduction strategies in low- to middle-income countries. British Journal of Haematology, 428–442. https://doi.org/10.1111/bjh.19984
  13. Gougoutsі, V., Pouliakis, A., Argyrios, T., Tolia, M., Nazos, N. A., Panagopoulos, P., & Kokoris, S. (2024). The critical role of the early evaluation of iron and vitamin B12 deficiency in pregnancy. Cureus, 16(8), 1–11. https://doi.org/10.7759/cureus.67592
  14. Hansen, R., Sejer, E. P., Holm, C., & Schroll, J. B. (2023). Iron supplements in pregnant women with normal iron status: A systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 102(9), 1147–1158. https://doi.org/10.1111/aogs.14607
  15. Jaisamrarn, U., Esteban-Habana, M. A., Padolina, C. S., Decena, D. C. D., Dee, M. T., Damodaran, P., ... & Hu, H. (2023). Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion. SAGE Open Medicine, 11, 20503121231173377. https://doi.org/10.1177/20503121231173377
  16. Kebede, S. S., Asmelash, D., Duguma, T., Wudineh, D., Alemayehu, E., Gedefie, A., & Mesfin, G. (2025). Global prevalence of iron deficiency anemia and its variation with different gestational age: Systematic review and meta-analysis. Clinical Nutrition Open Science, 59, 68–86. https://doi.org/10.1016/j.nutos.2024.12.002
  17. Lauer, J. M., Bhaise, S., Dhurde, V., Gugel, A., Shah, M., Hibberd, P. L., Patel, A., & Locks, L. M. (2024). Maternal anemia during pregnancy and infant birth outcomes: A prospective cohort study in Eastern Maharashtra, India. Current Developments in Nutrition, 8(11), 104476. https://doi.org/10.1016/j.cdnut.2024.104476
  18. Ministry of Health of the Republic of Indonesia. (2023). Indonesian Health Survey (SKI). Ministry of Health. [URL tidak tersedia]
  19. Ministry of Health of the Republic of Indonesia, & UNICEF Indonesia. (2023). Maternal nutrition in Indonesia: Landscape analysis and recommendations. UNICEF Indonesia. https://www.unicef.org/indonesia/media/21766/file/Gizi%20Ibu%20di%20Indonesia%20-%20Analisis%20Lanskap%20dan%20Rekomendasi.pdf
  20. Nasution, A. S., Arifianto, N., Qurniyawati, E., Desmawati, E., Setiarsih, D., Andari, S., ... & Puspita, D. (2023). Introduction to health methodology. Sada Kurnia Pustaka.
  21. Nasution, A. S., & Nasution, A. (2020). Nutrition puzzles as an effort to promote balanced nutrition behavior in students. Indonesian Public Health Media, 16(1), 89–99. https://doi.org/10.30597/mkmi.v16i1.8606
  22. Olusesan, O. O., Nkanga, E. A., Oyerinde, I. E., Akintoye, O., Asekun-Olarinmoye, I., & Alabi, Q. K. (2023). Factors affecting anemia in pregnant women in Ibeju-Lekki, Lagos State, Nigeria. INQUIRY: The Journal of Health Care, 60, 1–8. https://doi.org/10.1177/00469580231159961
  23. Pratiwi, S., Makiyah, S. N. N., & Kartini, F. (2022). The effect of health promotion with video media on knowledge and behavior about anemia in pregnant mothers. Jurnal Health Sains, 3(9), 1403–1408. https://doi.org/10.46799/jhs.v3i9.594
  24. Putra, E. S., Irfan, A., Nopindra, A., Al Rahmad, A. H., & Dahliansyah, D. (2025). Nutrition education based on the “My T Plate” model enhances adolescents’ knowledge in preventing central obesity. Proceeding International Conference Health Polytechnic of Jambi, 5, 213–217. [DOI tidak tersedia]
  25. Qiu, C., Tao, T., Xia, Z., & Fang, J. (2024). Clinical efficacy of polysaccharide iron complex plus vitamin C in the treatment of iron deficiency anemia in pregnancy and their effect on iron metabolism. Tropical Journal of Pharmaceutical Research, 23(1), 109–115. https://doi.org/10.4314/tjpr.v23i1.14
  26. Rammohan, A., Chu, H., Awofeso, N., & Goli, S. (2025). Adolescent pregnancy, maternal and child anaemia: Empirical analysis from India, Bangladesh, and Nigeria. Maternal & Child Nutrition, 21(1), e13723. https://doi.org/10.1111/mcn.13723
  27. Rammutla, M. C., & Sundani, N. D. (2024). Social media’s influence on the attitudes of younger daughters-in-law towards their mothers-in-law: A South African context. Innovation Journal of Social Sciences and Economic Review, 6(1), 34–42. https://doi.org/10.36923/ijsser.v6i1.247
  28. Saeed, M. S., Adam, G. K., Hussein, S. M., Alhabardi, N., & Adam, I. (2024). Prevalence and factors associated with adherence to iron-folic acid supplementation among pregnant women in Eastern Sudan: A cross-sectional study. Patient Preference and Adherence, 18(8), 1665–1674. https://doi.org/10.2147/PPA.S476738
  29. Sharief, S. A. (2024). Normocytic anemia in pregnant women: A scoping review. Medical Journal of Malaysia, 79(5), 646–657. https://e-mjm.org/2024/v79n5/normocytic-anemia.pdf
  30. Simonenko, S. Y., Bogdanova, D. A., & Kuldyushev, N. A. (2024). Emerging roles of vitamin B12 in aging and inflammation. International Journal of Molecular Sciences, 25(9). https://doi.org/10.3390/ijms25095044
  31. Ssewankambo, U., & Nakaziba, R. (2023). Adherence to iron and folic acid supplementation and associated factors among mothers receiving antenatal care in Lira District, Uganda. Nursing Communications, 7(1), e2023021. https://doi.org/10.53388/in2023021
  32. Tateishi, Y., Toyoda, S., Murakami, H., Uchida, R., Ichikawa, R., Kikuchi, T., ... & Suzuki, K. (2023). A short-term intervention of ingesting iron along with methionine and threonine leads to a higher hemoglobin level than that with iron alone in young healthy women: A randomized, double-blind, parallel-group, comparative study. European Journal of Nutrition, 62(7), 3009–3019. https://doi.org/10.1007/s00394-023-03213-w
  33. Tsamantioti, E., Alfvén, T., Hossin, M. Z., & Razaz, N. (2025). Maternal anaemia and risk of neonatal and infant mortality in low- and middle-income countries: A secondary analysis of 45 national datasets. BMJ Global Health, 10(3). https://doi.org/10.1136/bmjgh-2023-014654
  34. WHO. (2025). Anaemia. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/anaemia
  35. Yani, M., Azhari, A., Al Rahmad, A. H., Bastian, F., Ilzana, T. M., Rahmi, C. R., ... & Salsabila, S. (2023). The relationship between menarche and nutritional status in junior high school students in Aceh Besar: A study from 30 years of armed conflict area, Aceh, Indonesia. AcTion: Aceh Nutrition Journal, 8(4), 635–641. https://doi.org/10.30867/action.v8i4.1310
  36. Yanuaringsih, G. P., Wigati, P. W., & Sutrisni. (2024). Control behaviors of fathers and pregnant women on adherence of pregnant women to take blood supplement tablets. Contagion: Scientific Periodical Journal of Public Health and Coastal Health, 6(1), 764–775. [DOI tidak tersedia]
  37. Yao, B., Xu, M., Cheng, F., Peng, M., & Mao, X. (2024). Knowledge, attitudes, and practices among patients with anemia towards disease management. Frontiers in Public Health, 12, 1380710. https://doi.org/10.3389/fpubh.2024.1380710

Open Access Copyright (c) 2025 Yayuk Sri Rahayu, Marliana Rahma, Nita Farida
Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

AcTion: Aceh Nutrition Journal
Published by: Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health.
Soekarno-Hatta Street, No. 168. Health Polytechnic of Aceh, Aceh Besar, 23352. Telp/Fax: 0651 46126 / 0651 46121.
Website: https://gizipoltekkesaceh.ac.id/
E-mail: jurnal6121@gmail.com

e-issn: 2548-5741, p-issn: 2527-3310

All content is licensed under a: Creative Commons Attribution ShareAlike 4.0 International License

View My Stats

Get a feed by atom here, RRS2 here and OAI Links here