COMPARISON OF INTAKE OF MORINGA LEAF AND
GREEN BEANS AS AN ALTERNATIVE TO INCREASE HEMOGLOBIN LEVELS OF PREGNANT WOMEN
WITH ANEMIA
Aulia
Choirunnisa, Syarif Thaufik Hidayat, Supriyana
Semarang Health Polytechnic, Indonesia
Politeknik Kesehatan Kemenkes Semarang, Indonesia
Email: [email protected]
|
KEYWORDS Moringa Leaves, Green Beans, Hemoglobin, Pregnant Women, Systematic
Review |
ABSTRACT Anemia is a "potential danger of
mother and child". According to Riskedas
(2018) anemia prevalence of pregnant women increased within 5 years from
37.1% to 48.9%. The biggest cause of anemia in pregnancy is iron deficiency
anemia. One of the causes is lack of pregnant women get iron tablet (SF) less
than 90 tablets and have not consume iron tablets correctly and continuously.
Improving iron status can be done with non-pharmacological therapy, including
the consumption of moringa and green beans. To compare the effectiveness of
Moringa leaves and green beans on hemoglobin levels in pregnant women. Search
for articles through the databases of Google Schoolar, Science Direct,
PubMed, Elsevier (SCOPUS), Medline using Boolean operators (AND and OR). The research inclusion criteria were : Studies with randomized controlled trial (RCT) or
quasi experiment design from 2015 to 2020, research participants were
pregnant women, the intervention given was Moringa leaves or green beans. The
results of the measurement of hemoglobin levels. Eighteen studies met the
eligibility criteria and were analyzed. Moringa leaves were more effective in
increasing the hemoglobin level of pregnant women with Standardized Mean
Different (SMD) by 0.10 compared to green beans (SMD 0.10; CI 93% = -0.38 to
0.58; p<0.00001). Moringa leaves are more effective in increasing
hemoglobin levels of pregnant women than green beans. |
INTRODUCTION
The
highest percentage of causes of maternal death is bleeding (38%) both during
pregnancy and postpartum due to anemia (Statistik, 2014). Anemia
is a "potential danger of mother and child" during pregnancy which
means it is potentially dangerous for mother and child. This is due to the low
red blood cells that bind oxygen in the blood so that the work of the organs in
the body is not optimal. The result of low red blood cells is a lack of oxygen
intake (Banhidy et al., 2011). The fetus in pregnant women will also be
affected due to lack of oxygen that is channeled with blood through the
umbilical cord (Prawirohardjo, 2014). Therefore, serious attention is needed to
overcome anemia (Manuaba, 2010; Manuaba et al., 2010).
According
to Riskesdas (2018), the anemia rate in pregnant women in Indonesia has
increased from 37.1% to 48.9% in the last 5 years. One of the causes is the
lack of pregnant women who get blood added tablets (TTD) less than 90 grains
and pregnant women do not consume TTD appropriately and continuously (Dewantoro & Muniroh, 2017;
Wiradnyani et al., 2013).
Anemia in
pregnant women is physiological because during pregnancy there is an increase
in blood volume (hypervolemia). Hypervolemia is the result of an
increase in the volume of plasma and
erythrocytes (red blood cells) in the body, but this increase is unbalanced,
that is, the increase in plasma volume is much greater, giving the effect that
the hemoglobin concentration decreases from 12 g / 100 ml3. In addition, at 10-36 weeks gestation there
is blood thinning or hemodilution. which is useful to relieve heart performance (Wiknjosastro, 2015).
Improving
iron status can also be done with two kinds of approaches, namely
pharmacological and non-pharmacological. The provision of pharmacological
therapy includes the provision of blood enhancer supplementation or better
known as ferrossus sulfas (Fe) (Organization, 2011).
Non-pharmacological therapy can use food ingredients that refer to a healthy
diet with balanced nutrition in accordance with the needs of the body. Foods
that contain complex components such as iron, vitamin C, protein, vitamin B6,
and vitamin b12 to support Ferossus sulfas are Moringa leaves and green beans.
Moringa
leaves contain important nutrients such as iron 28.2 mg / 100 g (25 times more
than spinach, 3 times more than almonds), protein 27.1 gr, vitamin C 220 mg,
and B6 3.32 mg (Arisman, 2004). Based
on research by Madukwe (2013), Moringa leaf powder per 100 mg has a composition
of iron 19.42 mg and vitamin C 18.72 mg (Madukwe et al., 2013). Estiyani
(2017) stated that supplements containing 250 mg Moringa leaf flour
significantly improved blood profiles (hemoglobin, hematocrit, erythrocytes,
and platelets) in postpartum mothers with consumption of 2x1 / day for 14 days (Estiyani et al., 2017).
RESEARCH
METHOD
Literature
Search Strategy
The search
for articles in this study was carried out by searching the Google Scholar,
Proquest, Science Direct, PubMed, Elsevier (SCOPUS), Medline databases from
2015 – 2020 using the PRISMA method. Article search results using
keywords: moringa oleifera and/or
hemoglobin of pregnant women, Vigna radiata and/or hemoglobin of pregnant
women, mungbean and /or hemoglobin of pregnant women, green bean and /or
haemoglobin of pregnant women, increase hemoglobin during pregnancy, moringa
and/or hemoglobin of pregnant women, moringa leaves and/or hemoglobin of
pregnant women, green beans and/or hemoglobin of pregnant women and synonyms of
keywords related to moringa oleifera and/or mungbean increase hemoglobin
Data Extraction
Researchers
extract articles using inclusion criteria and exclusion criteria and conduct
screening to prevent duplication of articles.
RESULTS AND DISCUSSION
Result
The
results of 18 studies that met the criteria for systematic literature review
obtained the results of 4 Randomized Control Trial (RCT) studies, 2
experimental studies, 12 quasi-experimental studies. Analysis of 18 articles
obtained 2 studies with insignificant results, namely with (pvalue <0.058)
and mutivariate analysis results R2: 0.231 in moringa leaf articles, while in
green bean articles obtained 1 study with insignificant results, namely with (p
value: 0.452).
The
research obtained in this literature study to be able to find out whether it
has an influence between variables is known by calculating the effect
size using the Revman 5.4
application. Effect size is used in
decision making in the comparison of moringa leaf and mung bean article groups. Effect size is divided into fixed
effect and standard mean different (SMD). Both effect sizes are used
depending on the heterogeneity of the article (I2). For the acquisition of effect size can be
seen in the following Forest Plot
image:
Figure 1. Forest
Plot
Based on
the results of analysis using RevMan 5.4 software, it is known that there is
high heterogeneity between experiments with one another (I2 = 93%;
P<0.00001) so that the Random Effect Model (REM) is used. Moringa leaf
intervention was able to increase hb levels with Standardized Mean Different
(SMD) by 0.10 compared to green beans (SMD 0.10; CI 95% = -0.38 to 0.58;
p<0.00001).
Article
distribution can be used to visually detect the possibility of publication
bias. Interpretation of funnel plot results shows no publication bias
characterized by: 1. Symmetrical plot shape on the right and left sides, 2.
Balanced distance between plots, 3. SE value< 0.5. The funnel plot image in
this study shows that there is no publication bias. It is characterized by
symmetry of the right and left sides of the plot. On the right side there are 4
circles and on the left side there are 4 circles.
The
description of the funnel plot in this study can be seen in the following
figure :
Figure 2 Funnel Plot
The
journals in this literature review are carried out in several regions in
Indonesia. Both from Sumatra, Java, Sulawesi to Maluku. Starting from 1 journal
from Banten Province (Tangerang), 1 journal from West Java Province (Bekasi), 4
journals from Central Java Province (Ungaran, Pekalongan, Semarang,
Temanggung), East Java (Pasuruan), 2 journals from Lampung Province (Bandar
Lampung Tanggamus), 1 journal from Bengkulu Province, 1 journal from Kepri
Province, 5 journals from South Sulawesi Province (Makassar, Gowa, Jeneponto, Luwu, Takalar), 1 journal
from Central Sulawesi Province (Donggala), and 1 journal from Maluku.
Discussion
Hematological changes in pregnant women occur due to
changes in maternal blood volume that begin to increase early in pregnancy as a
result of changes in osmoregulation and the renin-angiotensin system, leading
to sodium retention and an increase in body water. During pregnancy, blood
volume increases up to 45%, while the volume of red blood cells only increases
up to 30%. This difference in increase can lead to "physiological anemia" during pregnancy, with an average hemoglobin level of 11.6 g/dl and a hematocrit
of 35.5%. Additionally, from weeks 10 to 36 of pregnancy, there is blood
dilution or hemodilution, which is beneficial for
easing the workload on the heart. Hemodilution
results in a decrease in hemoglobin and ferritin
levels in the blood.
Antenatal care (ANC) is health services for
pregnant women provided by professionals from the first trimester until the
postpartum period. One of the minimum ANC service standards is "provide
iron tablets for routine consumption." However, a study by Wiradnyani (2015) reported that 73% of pregnant respondents
experienced nausea and vomiting after taking iron tablets, leading them to
discontinue their iron tablet consumption (Hamzah &
Yusuf, 2019).
There are two types of therapies to increase hemoglobin levels: pharmacological and non-pharmacological.
Commonly used pharmacological therapies in Indonesia include ferrous sulfate, iron tablets, or blood booster tablets (TTD).
Non-pharmacological therapy studied by the researcher includes moringa leaves
and green beans .
Moringa leaves, from the Moringaceae
family originating in India, can grow in tropical and subtropical climates due
to their robust adaptive abilities (Fiantis, n.d.). The nutritional content of moringa leaves
depends on soil conditions such as texture, moisture, nutrients, and pH. These leaves contain minerals and vitamins, with iron
at 60.5 mg, protein at 26.3 g, vitamin C at 200 mg, and vitamin B6 at 3.32 mg,
according to Estiyani (2017). Moringa leaves also
contain antioxidants, mainly in the form of tannins, steroids, triterpenoids,
flavonoids, saponins, anthraquinones, and alkaloids.
Various processing techniques were used in the
articles, including moringa leaf extract capsules (Iskandar et
al., 2015; Nurdin et al., 2018; Rahayu, 2016; Suriati & Abdullah, 2020;
Yulni et al., 2020), moringa leaf powder capsules (Rismawati et
al., 2021), moringa juice (Suheti et al.,
2020), and moringa biscuits (Astuti & Rochmaedah,
2020). The duration of moringa administration
ranged from 7 days to 90 days (Krisnadi,
2015).
Green beans (Vigna radiata L.). Green beans have the
characteristics of being relatively tolerant of water-deficient conditions, and
their growth cycle is short (70 days or more). Green bean plants can grow and
develop well depending on the elements of soil, moisture, water, and how to
plant in a country (Sitohang et
al., 2018). In line with the previous statement, soil type also affects
plant growth. Soil conditions in Indonesia are mostly fertile soil (Sari et al.,
2020). The content in 100 grams of green beans contains 6.7mg iron, 22.2g
protein, 6 mg vitamin C, 124 mg calcium and 326 mg phosphorus, which is useful
for strengthening the bone skeleton, as well as 19.7-24.2% protein and 5.9-7.8%
iron (Yuliana et
al., 2020). The highest content of green beans is
found in the epidermis so it is required to boil it first, besides that
green beans also contain phytate of 2.19%. Phytate which functions to inhibit
iron absorption so it is recommended to soak green beans before processing them (Novelia et
al., 2020). Green bean seeds that have been boiled or processed have high
digestibility and low flatulence (Astawan, 2009). In
addition, green beans also contain antinutrients in the form of hemagglutinin
which can clot red blood cells and are toxic (Asiyah et al., 2017; Mustakim, 2014). Technique of processing green beans into mung bean juice or juice, pudding (Aulia et al.,
2018; Choirunissa & Manurung, 2020; Jannah & Puspaningtyas, 2018;
Retnorini et al., 2017). The duration of giving to these articles is 7 days. 2 weeks, 20
days. There are dosage differences in each article, namely 1 cup/ day, 2 cups/day, 250cc/day, 2x500cc (Kurniasih et
al., 2017; Misra & Marliah, 2019, 2019; Soehartono et al., 2017).
Analysis of the demographic picture of various regions in the article
there are differences in race/ethnicity/ethnicity/tradition. Mongoloid and
Melanesoid races are races living in Indonesia. Genetic polymorphism in each
race is different, including as a determinant of iron absorption. Genetic
polymorphisms for anemia can be seen through blood specimens to see the HFE
alleles p.C282Y and p.H63D. The p.C282Y allele is not found in Asians and
Hispanics/Melanesians/Negroids so iron deficiency anemia is common in Asian and
Hispanic/Melanesian/Negroid women (Barton et al.,
2020). According to research from Diddana (2019), one of the factors that
affect the diet and nutritional status of pregnant women is ethnicity. Along
with various tribes there are also various kinds of traditions (Diddana, 2019).
All journals with Moringa leaf and green bean interventions in pregnant
women analyzed can be concluded that when viewed from the significance, mean
and standard deviation values as well as the effect size of Moringa leaves are
more effective in increasing hemoglobin levels in pregnant women compared to
green bean interventions with SMD values of 0.10; CI 93% = -0.38 to 0.58;
p<0.00001). This is influenced by the nutritional content, growing area,
soil type, climate / season / weather, environment, race / ethnicity / tribe /
tradition in each journal, differences in the length of intervention,
differences in doses given, processing techniques, consumption of certain drugs
/ foods / drinks so that they have the potential to increase hemoglobin levels
in pregnant women.
CONCLUSION
All the
existing articles, there are 18 articles that are in accordance with the
research. Moringa leaf in take is
more effective than green beans to increase hemoglobin levels in anemic
pregnant women.
REFERENCES
Asiyah, S., Rahayu, D. E., & Isnaeni, W. D. N. (2017). Perbandingan
Efek Suplementasi Tablet Tambah Darah Dengan Dan Tanpa Vitamin C Terhadap Kadar
Hemoglobin Pada Ibu Hamil Dengan Usiakehamilan 16-32 Minggu Di Desa Keniten
Kecamatan Mojo Kabupaten Kediri. Jurnal Ilmu Kesehatan, 3(1), 76–81.
Astawan, I. M. (2009). Sehat Dengan Hidangan Kacang Dan
Biji-Bijian. Niaga Swadaya.
Astuti, A. D., & Rochmaedah, S. (2020). The Effect Of
Consumption Of Moringa Leaves To Pregnant Women’s Hemoglobin Levels In The
Village Of Waimital, Kairatu District, West Seram Region, Maluku In 2019.
Proceeding International Conference Syedza Saintika, 1(1).
Aulia, V., Sunarto, S., & Rahayuni, A. (2018). Pengaruh
Pemberian Sari Kacang Hijau (Vigna Radiata) Terhadap Kadar Hemoglobin Ibu Hamil
Anemia. Jurnal Riset Gizi, 6(1), 53–60.
Banhidy, F., Acs, N., Puho, E. H., & Czeizel, A. E.
(2011). Iron Deficiency Anemia: Pregnancy Outcomes With Or Without Iron
Supplementation. Nutrition, 27(1), 65–72.
Barton, J. C., Wiener, H. H., Acton, R. T., Adams, P. C.,
Eckfeldt, J. H., Gordeuk, V. R., Harris, E. L., Mclaren, C. E., Harrison, H.,
& Mclaren, G. D. (2020). Prevalence Of Iron Deficiency In 62,685 Women Of
Seven Race/Ethnicity Groups: The Heirs Study. Plos One, 15(4), E0232125.
Choirunissa, R., & Manurung, D. R. (2020). Pengaruh
Pemberian Sari Kacang Hijau Terhadap Kadar Hemoglobin Pada Ibu Hamil Di
Puskesmas Sirnajaya Kecamatan Serang Baru Bekasi Tahun 2019. Journal For
Quality In Women’s Health, 3(2), 171–176.
Dewantoro, N. K. P., & Muniroh, L. (2017). Studi
Deskriptif Program Suplementasi Tablet Besi Pada Ibu Hamil Di Puskesmas
Kalijudan Kota Surabaya. Amerta Nutrition.
Diddana, T. Z. (2019). Factors Associated With Dietary
Practice And Nutritional Status Of Pregnant Women In Dessie Town, Northeastern
Ethiopia: A Community-Based Cross-Sectional Study. Bmc Pregnancy And
Childbirth, 19(1), 1–10.
Estiyani, A., Suwondo, A., Rahayu, S., Hadisaputro, S.,
Widyawati, M. N., & Susiloretni, K. A. (2017). The Effect Of Moringa
Oleifera Leaves On Change In Blood Profile In Postpartum Mothers. Belitung
Nursing Journal, 3(3), 191–197.
Fiantis, D. (N.D.). Klasifikasi Tanah.
Hamzah, H., & Yusuf, N. R. (2019). Analisis Kandungan Zat
Besi (Fe) Pada Daun Kelor (Moringa Oleifera Lam.) Yang Tumbuh Dengan Ketinggian
Berbeda Di Daerah Kota Baubau. Indonesian Journal Of Chemical Research, 6(2),
88–93.
Iskandar, I., Hadju, V., As’ad, S., & Natsir, R. (2015). Effect
Of Moringa Oleifera Leaf Extracts Supplementation In Preventing Maternal Anemia
And Low-Birth-Weight. International Journal Of Scientific And Research
Publications, 5(2), 1–3.
Jannah, M., & Puspaningtyas, M. (2018). Peningkatan Kadar
Hb Ibu Hamil Dengan Jus Kurma Dan Sari Kacang Hijau Di Kota Pekalongan.
Placentum: Jurnal Ilmiah Kesehatan Dan Aplikasinya, 6(2), 1.
Krisnadi, A. D. (2015). Kelor Super Nutrisi. Blora: Pusat
Informasi Dan Pengembangan Tanaman Kelor Indonesia.
Kurniasih, D., Atrie, U. Y., & Kurniawati, D. (2017).
Pengaruh Puding Kacang Hijau Terhadap Kadar Hemoglobin Ibu Hamil Dengan Anemia.
Jurnal Keperawatan, 7(1), 20–28.
Madukwe, E. U., Ugwuoke, A. L., & Ezeugwu, J. O. (2013).
Effectiveness Of Dry Moringa Oleifera Leaf Powder In Treatment Of Anaemia.
Manuaba, I. A. C. (2010). Ilmu Penyakit Kandungan Dan Kb
Untuk Pendidikan Bidan. Jakarta: Egc.
Manuaba, I. A. C., Manuaba, I., & Manuaba, I. B. G.
(2010). Anemia Pada Kehamilan, Bayi Dengan Berat Lahir Rendah Dalam Ilmu
Kebidanan Penyakit Kandungan Dan Keluarga Berencana Untuk Pendidikan Bidan.
Edisi Kedua. Jakarta: Egc, 240, 436–438.
Misra, M., & Marliah, M. (2019). Pengaruh Sari Kacang Ijo
Dan Tablet Fe Terhadap Peningkatan Kadar Hb Ibu Hamil Dengan Anemia. Jurnal
Ilmiah Kesehatan Sandi Husada, 8(2), 69–73.
Mustakim, M. (2014). Budidaya Kacang Hijau. Yogyakarta:
Pustaka Baru Press.
Novelia, S., Dewi, A., Melinasari, S., Widowati, R., &
Carolin, B. T. (2020). Iron And Orange Extract On Hemoglobin Among Anemic
Pregnant Women In Nusa Tenggara Barat In 2018. Asian Community Health Nursing
Research, 8.
Nurdin, M. S., Hadju, V., Zulkifli, A., & Arundhana, A.
I. (2018). The Effect Of Moringa Leaf Extract And Powder To Haemoglobin
Concentration Among Pregnant Women In Jeneponto Regency. Indian Journal Of
Public Health Research & Development, 9(2).
Organization, W. H. (2011). Haemoglobin Concentrations For
The Diagnosis Of Anaemia And Assessment Of Severity. World Health Organization.
Prawirohardjo, S. (2014). Ilmu Kebidanan Edisi Keempat. Pt
Bina Pustaka Sarwono Prawirohardjo, Jakarta, 4(8).
Rahayu, S. (2016). The Effectivity Of Moringa Leaf Extract
(Moringa Oleifera) Supplementation On Hemoglobin Level In Pregnant Women With
Anemia In Purwodadi Community Health Center Working Area In Pasuruan. Education,
15(93), 75.
Retnorini, D. L., Widatiningsih, S., & Masini, M. (2017).
Pengaruh Pemberian Tablet Fe Dan Sari Kacang Hijau Terhadap Kadar Hemoglobin
Pada Ibu Hamil. Jurnal Kebidanan, 6(12), 8–16.
Rismawati, R., Jana, V. A., Latifah, N. S., & Sunarsih,
S. (2021). Manfaat Kapsul Daun Kelor Dalam Meningkatkan Kadar Hemoglobin Ibu
Hamil. Jurnal Kebidanan Malahayati, 7(2), 229–233.
Sari, W. I. P. E., Almaini, A., & Dahlia, D. (2020).
Pengaruh Pemberian Tablet Fe Dengan Penambahan Sari Kacang Hijau Dalam Peningkatan
Kadar Hb Ibu Hamil. Jurnal Medikes (Media Informasi Kesehatan), 7(2), 347–356.
Sitohang, P. C., Candriasih, P., & Amdani, S. (2018).
Effect Of Moringa (Moringa Oleifera) Biscuit Administration On Hemoglobin
Levels Of Pregnant Women. International Journal Of Sciences: Basic And Applied
Research, 37(1), 243–252.
Soehartono, S., Ngadiyono, N., Muchlis, M., & Dyah, D.
(2017). Effect Of Consuming Green Bean (Phaseolus Radiatus) Juice On Maternal
Blood Profile During Pregnancy. Belitung Nursing Journal, 3(5), 515–524.
Statistik, B. P. (2014). Kajian Indikator Sustainable
Development Goals (Sdgs). Jakarta: Badan Pusat Statistik.
Suheti, E., Indrayani, T., & Carolin, B. T. (2020).
Perbedaan Pemberian Jus Daun Kelor (Moringa Oleifera) Dan Kacang Hijau (Vigna
Radiata) Terhadap Ibu Hamil Anemia. Jurnal Akademi Keperawatan Husada Karya
Jaya, 6(2).
Suriati, I., & Abdullah, N. (2020). The Importance Of
Moringa Oleifera Leaf Flour For Pregnant Women Hemoglobin. Iop Conference
Series: Earth And Environmental Science, 575(1), 12098.
Wiknjosastro, H. (2015). Ilmu Kebidanan (Edisi Ke-4).
Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo.
Wiradnyani, L. A. A., Khusun, H., & Achadi, E. L. (2013).
Faktor-Faktor Yang Berhubungan Dengan Kepatuhan Ibu Mengonsumsi Tablet Besi-Folat
Selama Kehamilan. Jurnal Gizi Dan Pangan, 8(1), 63–70.
Yuliana, B., Fitrianingsih, J., & Talli, R. (2020).
Formulasi Kapsul Kombinasi Kacang Hijau (Vigna Radiata) Dan Daun Kelor (Moringa
Aloefera) Dan Pengaruhnya Terhadap Kadar Hemoglobin Ibu Hamil. Prosiding
Seminar Nasional Kesehatan Masyarakat 2022, 1(1), 190–197.
Yulni, Y., Hadju, V., Bahar, B., Citrakesumasari, C.,
Indriasari, R., & Zainal, Z. (2020). The Effect Of Extract Supplements Of
Moringa Oleifera Leaves Plus Royal Jelly On Hemoglobin (Hb) Levels Of Anemia
Pregnant Mother In Takalar Regency. International Journal Papier Advance And
Scientific Review, 1(2), 22–29.
Copyright holders:
Aulia Choirunnisa, Syarif Thaufik Hidayat, Supriyana (2023)
First publication right:
Devotion - Journal of Research and Community
Service
This
article is licensed under a Creative
Commons Attribution-ShareAlike 4.0 International