Biopsychosocial Factors Affecting the Risk of Musculoskeletal Disorders in Surakarta, Central Java

Journal of Epidemiology and Public Health Vol 3, No 3 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Musculoskeletal Disorders (MSDs) are injuries and disorders that affect the hu­man body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.). The impacts of MSD include reduced activity, reduction of work abi­lity, and use of health care (seeing a health professional or taking prescription or non­prescription medication). Studies investigating risk factors of MSD are lacking in Indonesia. The purpose of this study was to investigate biopsychosocial factors affecting the risk of MSD in Sura­karta, Central Java.Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was carried out at Dr. Moewardi hospital, Surakarta, Central Java from April to May 2018. A sample of 116 patients was selected by fixed disease sampling. The dependent variable was MSD. The independent variable were gender, history of chronic disease, body mass index (BMI), stress, occupational type, environmental working, and working posture. Data on MSD status were taken from medical record. Working posture was measured by REBA questionnaire. Other data were collected by questionnaire. The data were analyzed by path analysis.Results: The risk of MSDs was directly increased with BMI ≥25 (OR= 1.22; 95% CI= 0.15 to 2.30; p= 0.026), history of chronic disease (OR= 2.02; 95% CI= 0.96 to 3.08; p<0.001), heavy occupational type (OR= 1.56; 95% CI= 0.43 to 2.68; p<0.007), and poor working posture (REBA score ≥4) (OR= 1.75; 95% CI= 0.65 to -2.86; p= 0.002). The risk of MSDs was indirectly affected by environmental working, stress, and gender.Conclusion: The risk of MSDs is directly increased with BMI ≥25, history of chronic disease, heavy occupational type, and poor working posture (REBA score ≥4), and is indirectly affected by environmental working, stress, and gender.Keywords: musculoskeletal disorders, biopsychosocial factorCorrespondence: Dea Linia Romadhoni. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36 A, Surakarta, Indonesia. Email: Mobile: +6282227862718.Journal of Epidemiology and Public Health (2018), 3(3): 361-368

Polimorfisme Gen Ferroportin (FPN1) Q248H dan Karakteristik Sosial Ekonomi Ibu Hamil dengan Anemia di Surakarta

Pena Medika Jurnal Kesehatan Vol 4, No 1 (2013): Pena Medika Jurnal Kesehatan, Vol.4 No.1 Desember 2013
Publisher : Fakultas Ilmu Kesehatan Universitas Pekalongan

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Background: Iron deficiency anemia in pregnancy remains an important health problem in Indonesia. Ferroportin (FPN1) is one of important gene in iron metabolism encodes ferroportin for iron absorption, release, and recycle inside the body. The polymorphism of FPN1 Q248H alters negative charge of the amino acid sequence positively, hence influenced its ubiquitination and degradation. Beside of that, the high prevalence of anemia not only caused by genetics, nutrition, physiology of each pregant women, but also demographic factor and sosio-economic burden of family. This research will study the polymorphism of ferroportin Q248H and demographic character in pregnant women in Surakarta. Methods: The study using descriptive analytic case-control approach. The data used were from questionaire and blood sampling whose counted for screening anemia in private laboratorium. Pregnant women who had intention and had 10-25 week in pregnant were selected to be research subject.  FPN1 Q248H polymorphism were determined using PCR-RFLP method. Analysis Chi-square dan Independent t-test used to conclude the relationship between each variable to anemic state of pregnant women in Surakarta. A p<0.05 was considered as significant. The study using decriptive analytic design method. Results: Prevalence of anemia in Surakarta is 25.7% with 80.7% have mild anemia. There was no varian in FPN1 Q248H. Majority of pregnant women in group of anaemia have demographic character like 20-25 old, multigravid, last education in High School, housewife, their income range from Rp 500.000,00 to Rp 1.000.000,00, and consume Fe tablet. The bivariat analysis show no statistical significancy of parity, maternal age, education, income, and comsumption of iron tablet to state of anaemia (p>0.05). Conclusions: The FPN1 Q248H polymorphism was not a risk factor for iron deficiency anemia in pregnant women, likewise socio-economic factors had no significant role to incidence of anemia in Surakarta. Keywords: Anemia in pregnancy, Ferroportin (FPN1) Q248H polymorphism, Socio-Economic

Effects of Predisposing, Enabling, and Reinforcing Factors on the Uptake of Voluntary Counselling and Testing among Female Sex Workers in Grobogan, Central Java

Journal of Health Promotion and Behavior Vol 2, No 3 (2017)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Human Immunodeficiency Virus (HIV) infection is a global public health issue. Global AIDS Response Progress Reporting (GARP) reported that in 2015, about 36.7 million people worldwide suffered from HIV-AIDS in all age groups. The highest number of HIV/AIDS cases occured in East Africa and South Africa. This study aimed to examine the effects of predisposing, enabling, and reinforcing factors on the uptake of voluntary counselling and testing (VCT) among female  sex workers in Grobogan, Central Java.Subjects and Method: This was an analytical observational study with cross-sectional design. It was conducted in Grobogan, Central Java, in July 2017. A sample of 142 female sex workers  were selected for this study by exhaustive sampling. The dependent variable was uptake of VCT. The independent variables were attitude, perceived benefit, external motivation from others, and social support. The data were collected by a questionnaire and analyzed by multiple logistic regression.Results: Positive attitude towards HIV status (OR= 6.09; 95% CI= 0.968 to 38.38; p= 0.054), positive perceived benefit (OR= 10.58; 95% CI= 1.48 to 76.93; p= 0.019), external motivation (OR= 8.30; 95% CI= 1.21 to 56.82; p= 0.031), and social support (OR= 9.45; 95% CI= 1.46 to 60.83; p= 0.018), positively affected uptake of  VCT.Conclusion: Positive attitude towards HIV status, positive perceived benefit, external motivation, and social support, positively affect uptake of  VCT.Keywords: HIV, Voluntary Counselling Testing, female sex workersCorrespondence: Muhammad Vidi Perdana. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: Journal of Health Promotion and Behavior (2017), 2(3): 242-256

A Potential Candidate of Lactate Dehydrogenase Inhibitor Derived from Indonesia Herbal Compounds

Nexus Kedokteran Translasional Vol 6, No 1 (2017): Nexus Kedokteran Translasional
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

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Introduction: Lactate dehydrogenase A (LDHA) is an enzyme that catalyzes  pyruvate into lactate. LDHA plays an important role in promotion of cancer cells growth through increasing aerobic glycolysis. Because LDHA has a central role in energy metabolism, it become a molecular target for development of anticancer drug. This was a  biocomputational study that aimed to identify Indonesian herbal compounds which became a potential candidate of LDHA inhibitor via molecular docking analysis. Methods: Samples in this study were Indonesian herbal compounds that met the following criteria: (1) Registered on Database Herbal Indonesia, (2) had three-dimensional structure, and (3) met the criteria Lipinski rule of five. Oxamate used as a ligand standard and was validated using Autodock Vina software. Herbal compounds were also docked using the same program. Docking results were visualized using  PyMOL software. LDHA inhibitor candidate is determined by comparing herbal compounds and standard ligand in terms of binding energy, binding site and Lipinski criteria. Result: Oxamate interacting with LDHA had -4.26 ± 0.06 kcal / mol binding energy and bound to six amino acid residues at Gln 99, Arg 105, Asn 137, Arg 168, His 192, and Thr 247. A lower binding energy was observed in 23 herbal compounds and these compounds bound to LDHA at least five amino acid residues like Oxamate. Herbal compounds Phaseolic Acid, Sebacic Acid, D (-) - Fructose, Suberic Acid and Pimelic Acid interacted with amino acid residues of LDHA as same as Oxamate. The other herbal compounds interacted with less or more than six amino acid residues of LDHA. Based on characteristics of five herbal compounds, Phaseolic Acid, Sebacic Acid and Suberic Acid were probably the best candidates of LDHA inhibitor. Conclusion: Phaseolic Acid, Sebacic Acid and Suberic Acid become biocomputationally the best LDHA inhibitor. Enzymatic assays are needed to investigate whether or not all these compounds can inhibit LDHA enzyme activity. Keywords : Cancer, Inhibitor LDHA, Molecular Docking, Herbal Indonesia

Application of Health Belief Model on Preventive Behaviors of Patients with Low Back Pain

Journal of Health Promotion and Behavior Vol 3, No 3 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Low back pain (LBP) has different negative impacts in some people around the world. There are many risk factors of LBP, either biology, psychology, or social economics. A psychological theory (Health Belief Model/HBM) can be applied for preventive behaviors of some human diseases. This study aimed to analyze the application of HBM on preventive behaviors of patients with LBP.Subjects and Method: This was a case-control study conducted at the medical rehabilitation policlinic, Dr. Moewardi Hospital, Surakarta, from October to November 2018. A sample of 50 LBP patients and 100 non-LBP patients was selected by fixed exposure sampling. The dependent variable was preventive behaviors. The independent variables were perceived severity, susceptibility, benefit, barrier, threat, cues to action, and self-efficacy. Data on LBP was obtained from medical record. The other data were collected by questionnaire and analyzed by path analysis.Results: LBP preventive behaviors were directly and positively associated with perceived threat (b= 0.46; 95% CI= 0.24 to 0.68; p<0.001), perceived benefit (b= 0.29; 95% CI= 0.18 to 0.40; p<0.001), and self-efficacy (b= 0.16; 95% CI= 0.08 to 0.23; p<0.001). It was indirectly associated with perceived susceptibility, perceived severity, perceived barrier, and cues to action.Conclusion: LBP preventive behaviors are directly and positively associated with perceived threat, perceived benefit, and self-efficacy. It is indirectly associated with perceived susceptibility, perceived severity, perceived barrier, and cues to action. This study supports the application of HBM to explain LBP preventive behaviors.Keywords: low back pain, Health Belief Model, path analysisCorrespondence: Septi Ayu Arum Yuspita Sari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Mobile: +6282338986991.Journal of Health Promotion and Behavior (2018), 3(3): 192-198

Theory of Planned Behavior Implementation on the Factors Affecting Self-Care Management in Type 2 Diabetes Mellitus Patients

Journal of Health Promotion and Behavior Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Diabetes mellitus (DM) is one of the largest global health emergencies in the 21st century. Diabetes self-management education (DSME) is a continuous process of knowledge transfer in order to improve skill and ability of diabetic patient to perform self-care management, which reduces blood glucose level and prevent diabetic complications. The success of DSME is determined by behavior changes of diabetic patients, which can be assessed using behavior theories including Theory of Planned Behavior (TPB). This study aimed to analyze the factors affecting self-care management in patients with type 2 DM using TPB.Subjects and Method: A randomized controlled trial study was carried out in 7 community health centers in Tarakan City, North Kalimantan, from March to May, 2018. A sample of 126 type 2 DM patients was selected by simple random sampling. The dependent variable was self-care management. The independent variables were intention, attitude, subjective norm, self-efficacy, and education level. The data was collected by questionnaire and analyzed by path analysis.Results: Self-care management was positively and directly affected by education ?senior high school (b= 7.10; SE= 3.22; p= 0.028) and strong intention (b= 2.40; SE= 0.75; p= 0.001). Self-care management was indirectly affected by self-efficacy, attitude, and subjective norm trough intention.Conclusion: Self-care management in type 2 DM is directly affected by education and strong intention. These findings support the TPB implementation in self-care management.Keywords: self- care management, type 2 DM, Theory of Planned BehaviorCorrespondence:Ana Damayanti. Faculty of Health Science, Universitas Borneo Tarakan, Jl. Amal Lama 1, Tarakan 77115, North Kalimantan. Email: Mobile: +6281347727774.Journal Health Promotion and Behavior (2018), 3(2): 139-145

Metformin Enhances Anti-proliferative Effect of Cisplatin in Cervical Cancer Cell Line

Indonesian Journal of Clinical Pharmacy Vol 5, No 2 (2016)
Publisher : Indonesian Journal of Clinical Pharmacy

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Cervival cancer is one of the top rank of gynecological malignancy in the world, leading to high morbidity and mortality rates. Cisplatin is a chemotherapeutic agent that is generally used to treat cervical cancer but the use of this drug is limited because of serious side effects. Metformin, a diabetic drug, decreases not only blood glucose levels but also cell viability of some cancer cells. The aim of this study was to investigate the anti-proliferative effect of combination metformin and cisplatin in HeLa cells (cervical cancer cell line). Anti-proliferative effect of these combined drugs was analized using MTT assay, combination index assay and HeLa cell morphology. Inhibitory concentration (IC50) of cisplatin and metformin was determined before performing combination index assay. Administration of 10 mM metformin showed inhibition of HeLa cell proliferation and it reached 50% inhibition of cell proliferation at 60 mM. Whilst, cisplatin showed a stronger anti-proliferative effect with initial inhibition dose at 12 μM and IC50 dose at 44 μM. Combination of 30 mM metformin and 5 μM cisplatin indicated the strongest anti-proliferative effect on HeLa cell. In conclusion, metformin may become a promising drug for treatment of cervical cancer in future which enhances anti-proliferative effect of cisplatin.Key words: Anti-proliferative effect, combination index, cervical cancer, cisplatin, metformin Peningkatan Efek Anti-poliferatif Cisplatin oleh Metformin pada Cell Line Kanker Serviks Kanker serviks merupakan salah satu keganasan ginekologi tertinggi di dunia, dengan tingkat morbiditas dan mortalitas yang tinggi. Cisplatin merupakan obat kemoterapi yang umum digunakan untuk terapi kanker serviks, namun penggunaannya relatif terbatas karena menyebabkan beberapa efek samping yang serius. Metformin merupakan obat anti diabetik yang mampu menurunkan kadar glukosa darah dan juga mampu menurunkan viabilitas beberapa jenis sel kanker. Penelitian ini bertujuan untuk mengetahui efek anti-proliferasi kombinasi metformin dan cisplatin pada sel HeLa (cell line kanker serviks). Efek anti-proliferasi kombinasi kedua senyawa tersebut dianalisis melalui MTT assay, combination index assay dan morfologi sel HeLa. Nilai inhibitory concentration (IC50) metformin dan cisplatin pada sel HeLa ditentukan lebih dahulu sebelum melakukan combination index assay. Pemberian metformin 10 mM mulai menunjukkan penghambatan proliferasi sel HeLa dan penghambatan proliferasi sel mencapai 50% pada dosis 60 mM. Cisplatin menunjukkan efek anti-proliferasi yang lebih kuat dengan dosis awal penghambatan sebesar 12 μM dan IC50 sebesar 44 μM. Kombinasi antara metformin 30 mM dan cisplatin 5 μM memperlihatkan efek anti-proliferatif terkuat pada sel HeLa. Sebagai kesimpulan, metformin kemungkinan menjadi obat yang menjanjikan untuk terapi kanker serviks di masa mendatang dengan cara meningkatkan efek anti-proliferasi cisplatin.Kata kunci: Cisplatin, combination index, efek anti-proliferatif, kanker serviks, metformin

Ekspresi CD3 dan CD26 pada Limfosit T sebagai Biomarker Potensial Penyakit Systemic Lupus Erythematosus

Majalah Kedokteran Bandung Vol 48, No 3 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Systemic lupus erythematosus (SLE) merupakan penyakit autoimun yang sering dijumpai pada wanita. Penyakit ini ditandai oleh hiperautoreaktivitas limfosit T dan B. Di dalam sistem imun, CD3 dibantu CD26 sebagai molekul kostimulator berkaitan erat dengan aktivasi dan migrasi limfosit T. Pada penyakit SLE, ekspresi CD3 dan CD26 serta aktivitas enzim CD26 belum diketahui. Tujuan penelitian ini adalah mengetahui ekspresi CD3 dan CD26 dalam darah serta kultur limfosit T pasien SLE. Rancangan penelitian ini bersifat eksperimen laboratorium dengan pendekatan studi retrospektif. Penelitian dilakukan di Laboratorium Biomedik, Fakultas Kedokteran Universitas Sebelas Maret Surakarta selama lima bulan (Mei–September 2012). Diagnosis SLE ditentukan menurut kriteria dari American College of Rheumatology (ACR). Darah vena diambil dari tiga pasien SLE dan dua orang sehat. Satu µg/mL phytohaemmaglutinin (PHA) digunakan untuk stimulasi kultur limfosit T. Ekspresi CD3 dan CD26 ditentukan dengan flows sytometry. Substrat H-Gly-Pro pNA digunakan untuk menguji aktivitas enzim CD26. Data yang terkumpul dianalisis dengan uji t. Ekspresi CD3 dan CD26 menurun dalam darah dan kultur limfosit T pada pasien SLE dibanding dengan kontrol, sedangkan aktivitas enzim CD26 pada kultur limfosit T pasien SLE lebih tinggi daripada kontrol (0.042 vs 0.030 U/mL), tetapi perbedaan tersebut tidak bermakna secara statistik (p>0.05). Simpulan, terdapat penurunan ekspresi CD3 dan CD26 baik disirkulasi darah maupun di kultur limfosit T subtipe CD4+. CD3 dan CD26 berpotensi sebagai biomarker penting untuk SLE. Namun, riset lanjutan masih perlu dilakukan untuk menjelaskan peran keduanya dalam patogenesis penyakit SLE. [MKB. 2016;48(3):140–7]Kata kunci: CD3, CD26, systemic lupus erythematosus (SLE)CD3 and CD26 Expression on T Lymphocytes as a Potential Biomarker of Systemic Lupus ErithematosusSystemic lupus erythematosus (SLE) is an autoimmune disease that is frequently found in women and characterized by hyperautoreactivity of T and B cells. In the immune system, expressions of CD 3 and CD26 (as co-stimulatory molecule) are related to T cells activation and migration. Co-expression of CD3 and CD26 in SLE patients has not been determined. The aim of this study was to investigate the co-expression of CD3 and CD26 in blood and T cell culture of SLE patients. This was an analytical descriptive study with a retrospective approach. This study was performed at the Biomedical laboratory, Faculty of Medicine, Sebelas Maret University, for five months (May–September 2012). SLE diagnosis was determined by using the criteria from the American College of Rheumatology (ACR). Vein blood was collected from three female patients with SLE and two healthy female controls. T cells isolated from the blood were cultured and stimulated with 1 µg/mL phytohaemmaglutinin (PHA). Flow cytometry was used to determine the coexpression of CD3 and CD26. CD26 enzyme activities in T cell culture were spectrophotometrically measured using H-Gly-Pro pNA substrate. Collected data were then analyzed using Student’s t test. Decreased coexpression of CD3 and CD26 was lower in blood samples and T cell cultures of SLE female patients than in control. Meanwhile, CD26 enzyme activities in SLE T cell cultures were higher than control (0.042 vs 0.030 U/mL) but no statistical difference was found (p>0.05). In conclusion, there is a decreased coexpression of CD3 and CD26 in blood circulation and T cell cultures subtype CD4+. CD3 and CD26 in SLE patients could be a prospective biomarker. Further research is required to unravel the roles of CD3 and CD26 in SLE pathogenesis. [MKB. 2016;48(3):140–7]Key words: CD3, CD26, systemic lupus erythematosus (SLE) 

Indeks massa tubuh, asupan vitamin D, dan serum 25-hydroxyvitamin D pada pasien kanker payudara

Jurnal Gizi Klinik Indonesia Vol 14, No 2 (2017): Oktober
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, Fakultas Kedokteran UGM

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Background: Breast cancer is the most common malignancy in women in the world. Vitamin D helps control the majority of gene expression in female reproductive tissues. Body mass index (BMI) influences the bioavailability of vitamin D. Diet is one of the main sources of vitamin D and it is directly converted into 25-hydroxyvitamin D [25 (OH) D] in the liver.Objective: This study aimed to analyze the relationship between BMI and vitamin D intake and 25 (OH)D serum in patients with breast cancer.Method: Analytic observational with cross sectional design was used in this study. A total of 37 breast cancer patient visited Dr. Moewardi Hospital in Surakarta was selected as research subjects using a purposive sampling technique. BMI data was obtained by measuring body weight and height. Vitamin D intake was determined using 1 x 24-hour food recall and semi-quantitative food frequency questionnaire. While, 25(OH)D serum was measured using enzyme-linked immunoabsorbent assay. Data analysis used Spearman correlation test.Results: The averages of BMI, vitamin D intake and 25(OH)D serum of breast cancer patients were 21.96±3.63 kg/m², 3.50±3.30 µg/day and 16.01±14.67 ng/mL respectively. Most breast cancer patients had less vitamin D intake and 25(OH)D serum deficiency. There was a weak relationship between BMI (r=0.188, p=0.266) and vitamin D (r=0.113, p=0.507) and 25 (OH)D serum in breast cancer patients.Conclusion: There were no significant correlations between BMI and vitamin D intake with 25(OH)D serum in breast cancer patients. Further study is required on the effect of chemotherapy regimens on vitamin D metabolism.


Jurnal Penelitian Gizi dan Makanan Vol 39, No 2 (2016)
Publisher : Pusat Penelitian dan Pengembangan Upaya Kesehatan Masyarakat

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Pregnant women with past history of CED have a higher risk 2,76 times to suffer anemia than normal pregnant women. Fe and folic acid supplementation is one program to overcome iron deficiency anemia in the pregnant women in Boyolali but the incidence rate of anemia remains high (42,9%). This study was to analyze the relationship of food intake, Fe and folic acid supplementation on hemoglobin level in pregnant women with history of CED and anemia of breastfeeding women. This research study used analytic observation with cross sectional approach. The subject of 42 breastfeeding women with past history of CED and anemia in the third trimester of pregnancy in five public health centers in Boyolali. Data of supplementation and nutrient intake was obtained by interview. Nutritional status was determined using upper arm circumference and BMI. Hemoglobin level was measured by using cyanmethemoglobin method. Statiscally analyzed using correlation and multiple regression tests. The breastfeeding women had low food intake (<70% RDA) including macro and micro nutrients. Food intake and nutritional status in breastfeeding women negatively affected hemoglobin level in breastfeeding women (B=-0,005; p=0,040 and B=-0,134; p=0,016 respectively). Fe and folic acid supplementation in pregnant women  with CED and anemia significantly influenced hemoglobin level during breastfeeding (B=0,720; p=0,016). Completed supplementation of iron-folic acid in pregnant women with CED and anemia could increase 0,720 g/dL hemoglobin levels during breastfeeding.Ibu hamil dengan kurang energi kronis (KEK) berpeluang menderita anemia 2,76 kali dari pada ibu hamil normal. Suplementasi Fe dan asam folat merupakan salah satu cara mengatasi anemia defisiensi besi tetapi angka kejadian ibu hamil di Kabupaten Boyolali dengan anemia masih tinggi (42,9%). Penelitian ini bertujuan menganalisis hubungan asupan makanan, suplementasi Fe dan asam folat dengan kadar hemoglobin pada ibu hamil riwayat KEK dan anemia saat menyusui. Jenis penelitian observasional analitik dengan pendekatan cross sectional. Subjek penelitian 42 ibu menyusui dengan riwayat KEK dan anemia pada trimester III dari lima Puskesmas di Boyolali. Data suplementasi Fe dan asam folat serta asupan zat gizi diperoleh dengan wawancara. Status gizi ditentukan dengan LILA dan IMT. Kadar hemoglobin ditentukan dengan metode cyanmethemoglobin. Analisis statistik menggunakan uji korelasi dan multivariat regresi ganda. Hasil menunjukkan bahwa asupan energi, lemak, karbohidrat, zat besi dan asam folat pada ibu menyusui termasuk kategori defisit (<70% AKG). Asupan makanan dan status gizi ibu menyusui berhubungan negatif terhadap kadar hemoglobin saat menyusui (B=-0,005, p=0,040 dan B=-0,134, p=0,016). Suplementasi Fe dan asam folat pada ibu hamil riwayat KEK dan anemia berhubungan secara signifikan terhadap kadar hemoglobin saat menyusui (B=0,720, p=0,016). Dapat disimpulkan bahwa suplementasi Fe dan asam folat pada ibu hamil KEK dan anemia berpeluang menaikkan 0,720 g/dL kadar hemoglobin ibu saat menyusui.

Co-Authors -, Isfaizah Adi Prayitno Ahmad Hamim Sadewa AR, Risya Cilmiaty Argyo Demartoto, Argyo Arta Farmawati Ayu Sari, Amelya Augusthina Balgis Balgis Bhisma Murti Brian Wasita Damayanti, Amilia Yuni Damayanti, Ana Didik Gunawan Tamtomo Didik Tamtomo, Didik Diffah Hanim Endang Sutisna Sulaeman Ernawati Ernawati Gilang Akbar Shobirin, Gilang Akbar Hanim, Diffah Hastuti, Nunik Maya Hermanu Joebagio Kusnandar, K Kusumadewi Eka Damayanti Kusumawati, Indah Laksana, Budi Mahendra Wijaya Maryati, Warsi Muhammad Akhyar Nasrullah, Adam Haviyan Ningrum, Sri Setiyo Nor Istiqomah Nunuk Suryani Nurfitria, Fadhila Balqis Nurochim, Erna Paramanindita, Asti Swari Perdana, Muhammad Vidi Pesik, Riza N. Prabandari, Yunilla Prahesti, Ratna Prasetyaningsih, Roh Hastuti Pratiwi, Ayudhia Purwaningsih, Yustina Puspita, Rumeyda Chitra Putri, Anak Agung Alit Kirti Estuti Narendra Putri, Risma Aliviani Putri, Widya Kaharani Rahardjo, Setyo Sri Retiyansa, Yesi Riza Novierta Pesik Romadhoni, Dea Linia RUBEN DHARMAWAN Sari, Septi Ayu Arum Yuspita Setyaningrum, Th. Catur Wulan SUDARYANTO SUDARYANTO Sugiarto Sugiarto Suminah Suminah, Suminah Susanti, Rahmah Purwaningsih Febri Suselo, Yuliana Heri Suselo, Yuliana Heri Tiyas, Dwi Wahyuning Tonang Dwi Ardyanto, Tonang Dwi Tri Agustina, Tri Ulfia, Mila Umarghanies, Sarah Safira Utami, Agustina Dwi Vitria Sari Dewi Wulandari, R. AJ. Sri Wulandari, RAJ Sri Yatty Destani Sandy, Yatty Destani Yudhani, Ratih D. yulia lanti retno dewi Yuliana Heri Soesilo Yusrizal, Mirza