The Efficacy of Nutrition Education on Anemia and Upper Arm Circumference among Pregnant Women in Aceh Besar District of Indonesia during the Covid-19 Pandemic

Aripin Ahmad, Silvia Wagustina, Cesilia Meti Dwiriani, Wiwit Estuti, Teuku Salfiyadi, Arnisam Arnisam, Eva Fitrianingsih


This study aimed to analyze the effects of nutrition education on anemia and upper arm circumference in pregnant women. It was a cluster-randomized control study involving 110 pregnant women. The nutrition education interventions, was a combination of offline and online sessions, conducted by trained Nutrition education staffs with a 1:5 ratio to pregnant women. Twelve education sessions were conducted for three months utilizing a nutrition booklet for pregnant women, food monitoring cards, and flyers shared on a social media WhatsApp group. The socio-demographic data were obtained through an interview method. The nutritional status collected, by measuring Mid Upper Arm Circumference (MUAC), and anemia was determined through a diagnosis by the family doctor. Data were analyzed using the chi-square test and the paired and independent t-tests, the confidence interval was set at 95%. Hemoglobin levels in the intervention group experienced a higher increase than in the control group. The MUAC in the intervention group increased by 0.8 cm while in the control group it was decreased by -2.7 cm. However, the Difference in Difference (DID) analysis did not show significant different for both parameters (p=0.198 and p=0.274). Chi square analysis showed that the prevalence of anemia at the end line point in the intervention group (3.6%) was significantly lower compared to the control group (14.5%) (p=0.047). The prevalence of the Chronic Energy Deficiency (CED) measured by MUAC decreased by 9% in the intervention group, and 1.8% in the control group. However, the difference in prevalence of CED was not statistically significant (p=0.696). The nutrition education within three months did not significantly increase the mean hemoglobin and MUAC. But considering the trend in decreasing anemia and CED prevalence in the intervention group, structured and routine nutrition education can be implemented as part of nutritional intervention in pregnant women to prevent anemia and CED to observe effects in a longer-term intervention.


Ahmad A, Wagustina S, Estuti W. 2019. Pengembangan kartu monitoring konsumsi makanan ibu hamil (KMK-Bumil) dan buku saku gizi ibu hamil (BSG-Bumil) sebagai alat dan media edukasi gizi untuk meningkatkan praktik konsumsi makanan pada ibu hamil. Laporan riset pembinaan tenaga kesehatan (Risbinakes) tahun 2019. Politeknik Kesehatan kemenkes Aceh. [Accessed 20th March 2022].
Ahmad A, Madanijah S, Dwiriani CM, Kolopaking R. 2020a. Effect of nutrition education and multi-nutrient biscuit interventions on nutritional and iron status: A cluster randomized control trial on undernourished children aged 6‒23 months in Aceh, Indonesia. J Nutr Sci Vitaminol 66:S380‒S390.
Ahmad A, Wagustina S, Esturi W. 2020b. Nutritional practices, chronic energy deficiency and anemia in pregnant women; Aformative study in Aceh Besar district, Aceh Indonesia. [Accessed 24th March 2022].
Chau MM, Burgermaster M, Mamykina L. 2018. The use of social media in nutrion interventions for adolescents and young adults-A systematic review. Int J Med Inform 120:77‒91.
Churchill D, Nair M, Stanworth SJ, Knight M. 2019. The change in haemoglobin concentration between the first and third trimesters of pregnancy: A population study. BMC Pregnancy and Childbirth 19(1):1‒6.
[FAO/UNICEF/WFP/WHO] Food Agricultural Organization, United Nation Children's Fund, World Food Programme, World Health Organization. 2020. Joint statement on nutrition in the context of the COVID-19 pandemic in Asia and the Pacific. United Station. April, 1‒12. [Accessed 4th March 2021].
Girard AW, Olude O. 2012. Nutrition education and counselling provided during pregnancy: Effects on maternal, neonatal and child health outcomes. Paediatr Perinat Epidemiol 26:191‒204.
Goodyear VA, Wood G, Skinner B, Thompson JL. 2021. The effect of social media interventions on physical activity and dietary behaviours in young people and adults: a systematic review. Int J Behav Nutr Phys Act 18(1):1‒19.
Khani Jeihooni A, Hoshyar S, Afzali Harsini P, Rakhshani T. 2021. The effect of nutrition education based on PRECEDE model on iron deficiency anemia among female students. BMC Women's Health 21(1):1‒9.
Khotimah H. 2019. Pengaruh edukasi gizi melalui media facebook terhadap pengetahuan anemia dan konsumsi protein, zat besi, dan vitamin c pada remaja putri desa Tebas Kuala. Pontianak Nutrition Journal (PNJ) 2(1):1‒5.
Laroche E, Espérance SL, Mosconi E. 2020. Use of social media platforms for promoting healthy employee lifestyles and occupational health and safety prevention: A systematic review. Saf Sci 2020 131:104931.
Lemeshow S, Hosmer DW, Klar J, Lwanga SK. 1990. Adequacy of sample size in health studies. Chichester (UK): Wiley.
Lestari WOSW, Syarif S, Hidayanty H, Aminuddin A, Ramadany S. 2021. Nutrition education with android-based application media to increase knowledge, attitudes, and behaviors of pregnant women about chronic energy deficiency (KEK). Int J Health Med Sci 4(1):15‒22.
[MoH RI] Ministry of Health Reoublic of Indonesia. 2019. Laporan Nasional Riset Kesehatan Dasar Tahun 2018. In Badan Penelitian dan Pengembangan Kesehatan. Badan Penelitian dan Pengembangan. [Accessed 5th March 2021].
[MoH RI] Minisrty of Health Republic of Indonesia. 2020. Guidelines for nutrition service during the COVID-19 emergenacy respons period for health workers. [in Indonesia [Accessed 7th November 2021].
Mousa A, Naqash A, Lim S. 2019. Macronutrient and micronutrient intake during pregnancy: An overview of recent evidence. Nutrients 11(2):443
Nahrisah P, Somrongthong R, Viriyautsahakul N, Viwattanakulvanid P, Plianbangchang S. 2020. Integrated pictorial handbook education and counseling on improving anemia status, knowledge, food intake, and iron tablet compliance among anemic pregnant women in Indonesia: A quasi-experimental study. J Multidiscip Healthc 13:43‒52.
Permatasari TAE, Rizqiya F, Kusumaningati W, Suryaalamsah II, Hermiwahyoeni Z. 2021. The effect of nutrition and reproductive health education of pregnant women in Indonesia using quasi experimental study. BMC Pregnancy and Childbirth 21(1):1‒15.
Saputri NS, Anbarani MD, Toyamah N, Yumna A. 2020. Dampak pandemi Covid-19 pada layanan gizi dan kesehatan ibu dan anak (Kia): Studi kasus di lima wilayah di Indonesia. The SMERU Research Institute 5:1‒8.
Soylu M. 2019. Effects of nutrition education on general health and nutrition status of pregnant women. Eur J Sustain Dev Res 3(1):18‒23.
Sunuwar DR, Sangroula RK, Shakya NS, Yadav R, Chaudhary NK, Pradhan PMS. 2019. Effect of nutrition education on hemoglobin level in pregnant women: A quasi-experimental study. Plos One 14(3):p.e0213982.
Tang AM, Chung M, Dong K, Terrin N, Edmonds A, Assefa N, Maalouf-Manasseh Z. 2016. Determining a gobal mid-upper arm circumference cutoff to assess malnutrition in pregnant women. Food and Nutrition Technical Assistance 23(17): 3104‒3113.
Tanziha I, Damanik MRM, Utama LJ, Rosmiati R. 2016. Faktor Risiko Anemia Ibu Hamil Di Indonesia. J Gizi Pangan 11(2):143‒152.
[UNICEF] United Nations Children's Fund. 2020. Maternal and Child Nutrition: Unicef programming priorities to respond to the socio-economic impacts of the covid-19 pandemic-respond, recover, and reimagine. [Accessed 20th November 2021].
[WFP/UNICEF/Global Nutrition Cluster] World Food programme, United Nations Children's Fund, Global Nutrition Cluster G. 2020. Protecting maternal diets and nutrition services and practices in the context of COVID-19. 4:1‒5. [Accessed 10th Nivember 2021].
[WHO] World Health Organization. 2011. Haemogoblin concertations for the diagnosis of anemia and assessment of severity. Vitamin and mineral nutrition information system. [Accessed 3th March 2021]
Zaki I, Sari HP, Farida SA. 2019. Nutrition education based on multi-media can improve nutrition knowledge and unhealthy snacking habits in adolescents. Annals of Tropical Medicine and Public Health 22(11):S343.


Aripin Ahmad (Primary Contact)
Silvia Wagustina
Cesilia Meti Dwiriani
Wiwit Estuti
Teuku Salfiyadi
Arnisam Arnisam
Eva Fitrianingsih
AhmadA., WagustinaS., DwirianiC. M., EstutiW., SalfiyadiT., ArnisamA., & FitrianingsihE. (2022). The Efficacy of Nutrition Education on Anemia and Upper Arm Circumference among Pregnant Women in Aceh Besar District of Indonesia during the Covid-19 Pandemic. Jurnal Gizi Dan Pangan, 17(1), 27-36.

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