Knowledge and attitude on practice of iron deficiency anemia prevention among high school female students in Banjarmasin City, Indonesia: a mixed method study

Based on the Indonesia National Basic Health Survey in 2018, the prevalence of anemia in young women was 48.9%, along with the major proportions of anemia in the age group of 15-24 years. This study aimed to examine the influence of knowledge and attitude on iron deficiency anemia prevention practice and to find out the reasons for not practicing anemia prevention among female high school students in Banjarmasin, Indonesia. The mixed-method study with a quantitative study: cross-sectional survey study (April 2020) was conducted through an online survey among 359 female students (15-18 years old) and qualitative study: focus group discussion and in-depth interview (April-May 2020) were conducted through tele-interview via video call among teacher and health officers. Purposive sampling was used to select three high schools with a high prevalence of anemia in Banjarmasin, Indonesia. Data analysis for the quantitative study was used binary logistic regression and for qualitative study were used a combination of content analysis and thematic analysis. Results: A total of 359 female students participated in the study with the age range from 15 to 18 years old. The results showed 166 (46.2%) of female students had poor practice, along with 152 (42.3%) poor attitude level and 175 (48.7%) poor knowledge level towards iron deficiency anemia prevention.  The study also indicated that age group (17-18 years old) OR (95%CI): 1.60 (1.03, 2.50) p = 0.039, types of school l OR (95%CI): 0.55 (0.34, 0.90) p = 0.017, knowledge OR (95%CI): 1.07 (1.01, 1.13) p = 0.031 were significant predictors of practicing iron deficiency anemia prevention. Top 3 reasons for not practicing anemia prevention among students were 1) Feeling nausea after taking iron tablets (32%); 2) Don’t like the smell and color of iron tablets (21.4%); 3) Don’t know the benefit of practice anemia prevention (18.9%). From focus group discussion findings found that lack of information given and lack of the duration of information given linked to lack of knowledge among female students. Main reasons for not practicing anemia prevention among female students were related to the dislike of iron tablets and lack of knowledge due to ineffective anemia education program. Therefore, anemia prevention programs should be improved for increasing the knowledge of students towards the benefit of anemia prevention practice and iron tablets compliance.