Overview of Anemia in Indonesia
Anemia is a widespread health problem globally, characterized by a deficiency of red blood cells or hemoglobin. In Indonesia, the challenge is particularly pronounced among vulnerable populations, posing a significant burden on the nation's public health system. While nutritional deficiencies, primarily iron deficiency, are a major cause, Indonesia's position within the thalassemia belt also means genetic disorders play a role in the complex etiology of anemia. The issue affects productivity and leads to long-term health complications, underscoring the need for comprehensive intervention strategies.
Anemia Prevalence by Demographic Group
Anemia disproportionately affects certain populations in Indonesia, with prevalence varying significantly by age and sex. Data from national health surveys and specific studies highlight the gravity of the issue.
Pregnant and Reproductive-Age Women
- Pregnant women: National data from 2018 revealed a substantial prevalence of 48.9%, up from 37.1% in 2013, meeting the WHO's criteria for a severe public health problem. This places both mothers and their unborn children at considerable risk for adverse health outcomes.
- Reproductive-age women: A study analyzing 2018 Basic Health Research data reported a prevalence of 22.3% among non-pregnant women aged 19-49 years. Another source indicated that the prevalence among women of childbearing age was 31.2% in 2019. These high rates are often linked to nutritional intake and menstrual iron loss.
- Women workers: Research conducted among female palm plantation workers from 2022 to 2023 found an alarmingly high anemia prevalence of 45.7%.
Children and Adolescents
- Children 6-59 months: WHO data from 2019 estimated the prevalence at 38.4%. Specific studies have revealed even higher rates in certain areas. For example, a 2025 study in West Java found 40.7% of children aged 6-24 months were anemic, mostly due to iron deficiency.
- Adolescents: A 2024 study in North Lombok discovered a very high anemia prevalence of 76% among adolescent girls. National statistics from a 2021 news report also cited that 32% of adolescents in the country suffer from anemia. This is a critical period, as anemia can disrupt growth and development.
Key Contributing Factors to Anemia
The multifactorial nature of anemia in Indonesia stems from a combination of nutritional, socioeconomic, and health-related issues.
Nutritional Deficiencies
- Iron Deficiency: Insufficient intake or poor absorption of iron is the most common cause of anemia. Inadequate intake of iron-rich foods, especially among those with low socioeconomic status, is a major contributor.
- Poor Dietary Diversity: A lack of varied nutrient-rich foods, including animal-source foods, fruits, and vegetables, is strongly linked to anemia.
- Micronutrient Deficiencies: Besides iron, inadequate intake of vitamins (A, B6, B12, C, D, folate) and zinc are also significant dietary determinants.
- Dietary Inhibitors: High calcium intake, often from fortified sources or supplements, can inhibit iron absorption. Poor knowledge about how certain foods and drinks affect iron absorption exacerbates the problem.
Socioeconomic and Environmental Issues
- Poverty and Food Insecurity: Lower household income and food insecurity limit the ability to purchase nutritious, diverse foods, especially for pregnant women.
- Low Parental Education: Studies indicate that low paternal education levels correlate with higher iron deficiency anemia prevalence in children. Low maternal education can also affect health knowledge and dietary practices.
- Poor Working Conditions: Female laborers in sectors like palm plantations often face poor working conditions, limited health access, and inadequate nutrition, contributing to high anemia rates.
- Infections: High rates of intestinal parasite infections, such as helminths, are a significant risk factor, particularly in rural or low-resource settings.
Genetic and Infectious Conditions
- Genetic Disorders: Indonesia is located in the thalassemia belt, and a significant portion of the population carries thalassemia traits, which can cause or complicate anemia. This needs to be considered in diagnosis and treatment, as iron supplementation may not be appropriate in all cases.
- Inflammation: Chronic inflammation, a factor associated with overweight and obesity, can lead to functional iron deficiency by elevating hepcidin levels, which interferes with iron absorption.
Comparison of Anemia Prevalence in Vulnerable Groups
| Demographic Group | Reference Year(s) | Reported Prevalence | Severity Level (WHO) | Primary Associated Factors |
|---|---|---|---|---|
| Pregnant Women | 2013, 2018 | 37.1% (2013), 48.9% (2018) | Severe Public Health Problem | Inadequate nutrition, chronic energy deficiency, iron loss, high calcium intake |
| Children (6-59 months) | 2019 | 38.4% | Moderate to Severe Public Health Problem | Nutritional deficiencies, low paternal education, wasting, infections |
| Women of Reproductive Age | 2018, 2019 | 22.3% (non-pregnant 19-49), 31.2% (WRA) | Moderate Public Health Problem | Nutritional status, physical activity, diet, chronic conditions |
| Adolescent Girls | 2021 (national), 2024 (regional) | 32% (national), 76% (regional) | Severe Public Health Problem (regional) | Iron deficiency, chronic energy deficiency, diet |
Public Health Impact and Intervention Challenges
Anemia's high prevalence in Indonesia poses several public health challenges, impacting individual well-being and national development. For children, it can lead to impaired growth, poor cognitive and motor development, and increased morbidity. In women, especially during pregnancy, it increases the risk of complications such as low birth weight and perinatal mortality. At a national level, it reduces labor productivity and overall economic output.
The Indonesian government has implemented various programs to combat anemia, including providing iron-folic acid tablets to pregnant women and adolescents and promoting nutritional education. However, these interventions face significant challenges, such as low compliance with supplementation guidelines, inadequate public knowledge about anemia, and issues related to program implementation and reach. Addressing these gaps requires a multi-pronged, life-course approach that combines nutrition-specific interventions with sensitive social safety nets. There is also a recognized need to consider genetic factors like thalassemia in screening and treatment strategies, as a one-size-fits-all approach is ineffective.
Commonly used prevention strategies include:
- Supplementation Programs: Providing iron-folic acid supplements to at-risk groups like pregnant women and adolescents.
- Nutrition Education: Enhancing public understanding of balanced and diverse diets rich in essential nutrients like iron, vitamin C, and zinc.
- Food Fortification: Enriching staple foods with micronutrients, though effectiveness varies and requires consistent implementation.
- Infection Control: Managing and preventing parasitic infections, such as helminths, which contribute to nutrient loss.
- Behavioral Interventions: Encouraging physical activity, especially among overweight or obese individuals, to improve iron homeostasis.
Conclusion
Anemia continues to be a major public health issue in Indonesia, with alarmingly high prevalence rates in pregnant women, children, and adolescents. The problem is driven by a complex interplay of inadequate nutrition, socioeconomic vulnerabilities, infections, and genetic factors like thalassemia. While government programs are in place, their effectiveness is limited by challenges in implementation and public compliance. A sustained and comprehensive national strategy is essential, one that not only addresses nutritional gaps but also accounts for broader socioeconomic and health-system factors to protect the health and future productivity of the Indonesian population. A life course approach to the prevention of iron deficiency anemia in Indonesia
