https://doi.org/10.4081/gh.2022.1118
Spatial distribution and identifying biochemical factors affecting haemoglobin levels among women of reproductive age for each province in Indonesia: A geospatial analysis
Submitted: 14 June 2022
Accepted: 10 October 2022
Published: 30 November 2022
Accepted: 10 October 2022
Abstract Views: 1580
PDF: 690
HTML: 50
HTML: 50
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Anaemia is still a public health problem in Indonesia. The iron supplement program, known as Tablet Tambah Darah (Blood Add Tablet) has not yet produced optimal results. This study aimed to identify the cause of anaemia and the factors that influence it. Biochemical indicator data are haemoglobin (Hb), C-reactive protein (CRP), ferritin and serum transferrin receptor (sTfR) from 9,463 women of reproduction age. Data from the Basic Health Research (Riskesdas) project of 2013 were used for the study. ANOVA as well as global and local regression approaches (classical regression and geo-weighted regression) were used to compare the mean Hb and CRP values between provinces and to determine the factors that influence Hb concentrations. The results showed that the distribution of anaemia in Indonesia is uneven and not always caused by iron deficiency. The lowest Hb mean coupled with the highest iron deficiency was found in Papua, where there are high rates of parasitic infections. In contrast, the highest mean Hb coupled with low iron deficiency, and also low infection rates, was found in North Sulawesi. The Hb concentrations were significantly associated by ferritin, CRP and sTfR and there were varying magnitudes between provinces. Although anaemia is mainly influenced by the iron concentration, CRP, ferritin and sTfR can also affect it through their association with inflammatory reactions. Identification of all causes of anaemia in each province needs to be done in the future, while blanket iron supplementation should be reviewed.
Alexopoulos E, 2010. Introduction to multivariate regression analysis. Hippokratia, 14:23–28.
DOI: https://doi.org/10.1201/b10289-6
Alper B, Kimber R and Reddy A, 2000. Using ferritin levels to determine iron-deficiency anaemia in pregnancy. J Fam Pract 49:829–832.
Ali PB,Solikha DA, Arifin, MD, Siahaan RGM, Firdaus MZ, 2022. Buku Putih Reformasi Sistem Kesehatan Nasional. Jakarta: Direktorat Kesehatan dan Gizi Masyarakat, Kementerian Perencanaan Pembangunan Nasional/Badan Perencanaan Pembangunan Nasional (Bappenas).
Andriastuti M, Ilmana G, Nawangwulan SV, Kartika Anastasia Kosasih KA, 2020. Prevalence of anemia and iron profile among children and adolescent with low socio-economic status. Int J Pediatr Adol Med 7,:88-92.
DOI: https://doi.org/10.1016/j.ijpam.2019.11.001
Breusch and Pagan, 1979. A simple test for heteroscedasticity and random coefficient variation. Econometrica 47:1287–1294.
DOI: https://doi.org/10.2307/1911963
Bullmann M, Fetzer T, Ebner F, Deinzer F, Grzegorzek M, 2018. Fast kernel density estimation using gaussian filter approximation’, 21st International Conference on Information Fusion. FUSION, pp. 1233–1240.
DOI: https://doi.org/10.23919/ICIF.2018.8455686
Byg KE, Milman N, Hansen S, Agger AO. 2000. Serum Ferritin is a Reliable, Non-invasive Test for Iron Status in Pregnancy: Comparison of Ferritin with Other Iron Status Markers in a Longitudinal Study on Healthy Pregnant Women; Erythropoiesis. Hematology 5:319-32.
DOI: https://doi.org/10.1080/10245332.2000.11746526
Byg KE, Milman N and Agger AO, 2000. Correlations between iron status markers during normal pregnancy in women with and without iron supplementation erythropoiesis correlations between iron status markers during normal pregnancy in women with and without iron supplementation. Hematology 4:529–539.
DOI: https://doi.org/10.1080/10245332.1999.11746481
Central Agency on Statistic, 2013. Papua in Figure 2013 [Papua dalam Angka 2013]. Jakarta: BPS - Statistics of Papua Province.
Central Agency on Statistic, 2019. Area and number of islands by province [Luas daerah dan jumlah pulau menurut provinsi]. Available at: https://www.bps.go.id/indikator/indikator/view_data_pub/0000/api_pub/UFpWMmJZOVZlZTJnc1pXaHhDV1hPQT09/da_01/1.
Chaparro CM, Suchdev PS, 2019. Anaemia epidemiology, pathophysiology, and etiology in low- and middle-income countries’, Ann N Y Acad Sci 1450:15–31.
DOI: https://doi.org/10.1111/nyas.14092
Daoud J, 2017. Multicollinearity and regression analysis. J Physics: Conf Series, 949:012009.
DOI: https://doi.org/10.1088/1742-6596/949/1/012009
Directorate General of Population and Civil Registration, 2021. Distribution of Indonesia's population on June 2021: West Java the most, North Kalimantan the least [Distribusi penduduk Indonesia per Juni 2021: Jabar terbanyak, Kaltara paling sedikit]. Available at: https://dukcapil.kemendagri.go.id/berita/baca/809/distribusi-penduduk-indonesia-per-juni-2021-jabar-terbanyak-kaltara-paling-sedikit (Accessed: 7 August 2021).
Edayu Z, Syerinna Z, 2018. A statistical analysis for geographical weighted regression. IOP Conference Series: Earth and Environmental Science, 169.
DOI: https://doi.org/10.1088/1755-1315/169/1/012105
Engle-Stone R, Nankap M, Ndjebayi AO, Erhardt JG, Brown KH, 2013. Plasma ferritin and soluble transferrin receptor level and body iron stores identify similar risk factors for iron deficiency but result in different estimates of the national prevalence of iron deficiency and iron-deficiency anaemia among women and children in Cameroon. J Nutr 143:369–377.
DOI: https://doi.org/10.3945/jn.112.167775
Fotheringham A, Brunsdon C and Charlton M, 2002. Geographically weighted regression: the analysis of spatially varying relationships. Chichester: John Wiley & Sons Ltd.
Franchini M, Salvagno GL, Montagnana M, Lippi G, 2007. Serum ferritin levels correlate with Hb level: A report on 589 outpatients from a single centre. Blood Transf 5:244–245.
Hakizimana D, Nisingizwe MP, Logan J, Wong R, 2019. Identifying risk factors of anaemia among women of reproductive age in Rwanda - A cross-sectional study using secondary data from the Rwanda demographic and health survey 2014/2015. BMC Public Health 19:1–11.
DOI: https://doi.org/10.1186/s12889-019-8019-z
Halunga A, Orme C and Yamagata T, 2016. A heteroskedasticity robust Breusch–Pagan test for contemporaneous correlation in dynamic panel data models. J Econometr 198:209-230.
DOI: https://doi.org/10.1016/j.jeconom.2016.12.005
Jacobs A, Miller F, Worwood M, Beamish MR, Wardrop CA, 1972. Ferritin in the serum of normal subjects and patients with iron deficiency and iron overload. Br Med J 4:206–208.
DOI: https://doi.org/10.1136/bmj.4.5834.206
Jung Y, Hu J, 2015. A K-fold averaging cross-validation procedure. J Nonparam Stat 27:167–179.
DOI: https://doi.org/10.1080/10485252.2015.1010532
Kibret KT, Chojenta C, D’Arcy E, Loxton D, 2019. Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: A multilevel and spatial analysis. BMJ Open 9:1–14.
DOI: https://doi.org/10.1136/bmjopen-2018-027276
Klein AG, Gerhard C, Buchner RD, Diestel S, Engel KS, 2016. The detection of heteroscedasticity in regression models for psychological data. Psychol Test Assess Model 58:567–592.
Loy A, Follett L, Hofmann H, 2016. Variations of Q–Q Plots: The power of our eyes! Am Statist 70:202-214
DOI: https://doi.org/10.1080/00031305.2015.1077728
Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N. 1999. Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand 78:749–757.
DOI: https://doi.org/10.1080/j.1600-0412.1999.780902.x
Milman N, Byg KE, Agger AO, 2000. Hb and erythrocyte indices during normal pregnancy and postpartum in 206 women with and without iron supplementation. Acta Obstet Gynecol Scand 79:89–98.
DOI: https://doi.org/10.1034/j.1600-0412.2000.079002089.x
Ministry of Health, 2013. Basic Health Research for Biomedic 2013. Jakarta: Ministry of Health.
Ministry of Health, 2014a. Indonesia Health Profile 2013 [Profil Kesehatan Indonesia Tahun 2013]. Jakarta: Kementerian Kesehatan Republik Indonesia.
Ministry of Health, 2014b. Total Diet Study Book: Indonesian Individual Food Consumption Survey 2014 [Buku Studi Diet Total: Survei Konsumsi Makanan Individu Indonesia 2014]. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian.
Ministry of Health, 2018a. National Report of Basic Health Research Indonesia 2018. Jakarta.
Ministry of Health, 2018b. Guidelines for the prevention and control of anaemia in adolescent girls and women of childbearing age [Pedoman pencegahan dan penanggulangan anaemia pada remaja putri dan wanita usia subur (WUS)]. Jakarta: Ministry of Health.
Ministry of Health, 2020. Guidelines for giving blood-added tablets for pregnant women [Pedoman pemberian tablet tambah darah (BAT) bagi ibu hamil]. Jakarta: Ministry of Health.
Ministry of Health, 2021. Indonesian Health Profile 2020 [Profil Kesehatan Indonesia Tahun 2020]. Jakarta: Indonesian Ministry of Health.
Mockenhaupt FP, May J, Stark K, Falusi AG, Meyer CG, Bienzle U, 1999. Serum transferrin receptor levels are increased in asymptomatic and mild Plasmodium falciparum-infection. Haematologica 84:869–873.
Mohammadinia A, Alimohammadi A, Saeidian B, 2017. Efficiency of geographically weighted regression in modeling human leptospirosis based on environmental factors in Gilan province, Iran. Geosciences 7,1–12.
DOI: https://doi.org/10.3390/geosciences7040136
Nagata JM, Gatti LR, Barg FK, 2012. Social determinants of iron supplementation among women of reproductive age: A systematic review of qualitative data. Maternal Child Nutr 8:1–18.
DOI: https://doi.org/10.1111/j.1740-8709.2011.00338.x
Nakishbandy BMN, Barawi SAM, 2014. Level of C - reactive protein as an indicator for prognosis of premature uterine contractions. J Pren Med 8:25–30
DOI: https://doi.org/10.11138/jpm/2014.8.1.025
Nair KM, Bhaskaram P, Balakrishna N, Ravinder P, Sesikeran B, 2004. Response of Hb, serum ferritin, and serum transferrin receptor during iron supplementation in pregnancy: A prospective study. Nutrition 20:896–899.
DOI: https://doi.org/10.1016/j.nut.2004.06.011
Nugroho N, Slamet I, 2018. Geographically weighted regression model with kernel bisquare and tricube weighted function on poverty percentage data in central Java Province. J Physics Conf Series 1025:012099.
DOI: https://doi.org/10.1088/1742-6596/1025/1/012099
Owais A,Merritt C, Lee C, Bhutta ZA, 2021. Anaemia among Women of Reproductive Age : An Overview of in Low- and Middle-Income Countries. Nutrients 13:2745.
DOI: https://doi.org/10.3390/nu13082745
Pattola P,Nur A, Atmadja TFA, Yunianto AE, Rasminar R, Marzuki I, Unsunnidhal L, Siregar D, Puspita R, Pakpahan M, Purba AMV, 2020. Health Nutrition and Disease [Gizi Kesehatan dan Penyakit]. Jakarta: Yayasan Kita Menulis.
Pena-Rosas JP, Viteri FE, 2006. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy ( Review ). Cochrane Database Syst Rev. Edited by C. P. and C. G. Publication, 3(CD004736).
DOI: https://doi.org/10.1002/14651858.CD004736.pub2
Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, Ota E, Gilmour S, Shibuya K, 2016. Maternal anaemia and risk of adverse birth and health outcomes in low- and middle-income countries: Systematic review and meta-analysis. Am J Clin Nutr 103:495–504.
DOI: https://doi.org/10.3945/ajcn.115.107896
Rawlings J, Pantula S, Dickey D, 1998. Applied regression analysis: a research tool. Second. Verlag New York: Springer.
DOI: https://doi.org/10.1007/b98890
Ruzgas T, Drulytė I, 2013. Kernel density estimators for gaussian mixture models. Lithuanian J Stat 52:14–21.
DOI: https://doi.org/10.15388/LJS.2013.13919
Shrestha N, 2020. Detecting multicollinearity in regression analysis. Am J Appl Math Statist 8:39–42.
DOI: https://doi.org/10.12691/ajams-8-2-1
Su H, Berenson M, 2017. Comparing tests of homoscedasticity in simple linear regression. JSM Mathematics Stat 4:10–17.
Tigani S, Chaibi H, Saadane R, 2019. Gaussian mixture and kernel density-based hybrid model for volatility behavior extraction from public financial data. Data 4:4010019.
DOI: https://doi.org/10.3390/data4010019
Tomkins A, 2003. Assessing micronutrient status in the presence of inflammation. J Nutr 133:1649–1655.
DOI: https://doi.org/10.1093/jn/133.5.1649S
Uyanik GK, Guler N, 2013. A study on multiple linear regression analysis. Procedia-Social Behav Sci 106:234–240.
DOI: https://doi.org/10.1016/j.sbspro.2013.12.027
Verhoef H,West CE, Ndeto P, Burema J, Beguin Y, Kok FJ, 2001. Serum transferrin receptor level indicates increased erythropoiesis in Kenyan children with asymptomatic malaria1-5. Am J Clin Nutr 74:767–775.
DOI: https://doi.org/10.1093/ajcn/74.6.767
Walpole RE, Myers RH, Myers SL, Ye K, 2012. Probability & statistics for engineers & scientist. 9th Ed. Prentice Hall.
Weatherall DJ,Miller HD, Baruch DI, Marsh K, Doumbo OK, Pascual CC, Roberts DJ, 2002. Malaria and the red cell.Hematology / the Education Program of the American Society of Hematology. Am Soc Hematol Educ Program 2022:35–57.
DOI: https://doi.org/10.1182/asheducation-2002.1.35
WHO/UNICEF/UNU, 2001. Iron deficiency anaemia assessment, prevention, and control: a guide for programme managers. Geneva: World Health Organization. Available at: http://www.who.int/nutrition/publications
WHO, 2011. Hb level for the diagnosis of anaemia and assessment of severity (WHO/NMH/NHD/MNM/11.1). Vitamin and Mineral Nutrition Information System.
WHO, 2012. Sixty-Fifth World Health Assembly (Wha65/2012/Rec/1), (May), pp. 1–3. Available at: http://www.who.int/nutrition/topics/WHA65.6_resolution_en.pdf?ua=1.
WHO, 2014a. C-reactive protein level as a marker of inflammation or infection for interpreting biomarkers of micronutrient status (WHO/NMH/NHD/EPG/14.7). Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization, pp. 1–4. Available at: http://apps.who.int/iris/bitstream/10665/133708/1/WHO_ NMH_NHD_EPG_14.7_eng.pdf?ua=1.
WHO, 2014b. Serum transferrin receptor levels for the assessment of iron status and iron deficiency in populations (WHO/NMH/NHD/EPG/14.6). Vitamin and Mineral Nutrition Information System, pp. 1–4. Available at: http://apps.who.int/iris/bitstream/10665/133707/1/WHO_NMH_NHD_EPG_14.6_eng.pdf?ua=1.
WHO, 2017. Nutritional Anaemias : Tools for Effective Prevention, World Health Organization.
WHO, 2020. Serum ferritin level for the assessment of iron status in individuals and populations: technical brief. World Health Organization, 10, pp. 1–6. Available at: https://apps.who.int/iris/handle/10665/331505.
Yap B, Sim C, 2011. Comparisons of various types of normality tests. J Statist Comput Simul 81:2141–2155.
DOI: https://doi.org/10.1080/00949655.2010.520163
Zhou Q, Song P, Thompson M, 2015. Profiling heteroscedasticity in linear regression models. Canadian J Stat 43:358–377.
DOI: https://doi.org/10.1002/cjs.11252
How to Cite
Aidi, M. N., Ernawati, F., Efriwati, E., Nurjanah, N., Rachmawati, R., Julianti, E. D., Sundari, D., Retiaty, F., Fitrianto, A., Nurfadilah, K., & Arifin, A. Y. (2022). Spatial distribution and identifying biochemical factors affecting haemoglobin levels among women of reproductive age for each province in Indonesia: A geospatial analysis. Geospatial Health, 17(2). https://doi.org/10.4081/gh.2022.1118
Copyright (c) 2022 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
