Tamarillo Juice (Solanum betaceum Cav) as An Alternative to Increase Hemoglobin Levels for Pregnant Women with Anemia

Article history: Received: 23 August 2021 Accepted: 16 November 202


INTRODUCTION
The fundamental right of humans is the right to live, but in the reality, there are around 830 mothers in the world and around 38 mothers in Indonesia (Data SUPAS 2015 Maternal Mortality Rate or MMR 305 / 100,000 live births) who lost their lives every day due to complications related to pregnancy and childbirth. Most of these passing mothers could have been largely prevented and they could have been saved with the right prevention. The estimation of high-risk pregnant women in Indonesia is 15%, the other 85% is normal, while in North Tapanuli the estimated high-risk is higher than the national rate, which is 20% [1]. Around 75% of this maternal death is due to bleeding, infection, and high blood pressure during pregnancy (preeclampsia/eclampsia), prolonged labor/congestion and unsafe abortion [2]. Anemia is the leading cause of maternal death due to postpartum hemorrhage.
The pregnant women group is a group with a high risk of experiencing Anemia. In Indonesia, almost half of the pregnant women (48.9%) suffer from Anemia [2]. This data has a higher number when compared to the result in 2013. In 2013, there are 37.1% of pregnant women suffer from Anemia, with a proportion of (37.8%) in rural areas. It is higher than urban with (36.4%) [3]. Anemia is defined as having less than 12 g/dL of hemoglobin concentration in nonpregnant women and less than 10 g/dL in pregnant women during their pregnancy or the puerperium. Anemia in pregnant women who receive blood supplement with hemoglobin concentrations of 5-11 g/dL in the first and third trimesters, Informed consent was obtained from the participants before the start of the interview sessions.

Respondent Characteristics
The results of this study showed that on average 1 of 2 pregnant women whose hemoglobin levels were measured had Anemia (96 respondents examined pregnant women) and 41 respondents (43%) had Anemia.
The characteristics of respondents consist of age, gestational age, parity, education, and occupation. The data was obtained through a questionnaire. Table 1 shows the results of the analysis of the   [15].

Parity
The result based on parity showed that Anemia increased in the Intervention group with multigravida parity of (64.7%) and the control group in primigravida of (82.4%). The risk factor for Anemia is parity (grande multiparity Anemia more than those with a parity of less than 2 (two) and the difference is statistically significant p ≤ 0.001 [16].

Education
The results of this study showed that pregnant women with secondary education levels are more likely to suffer from Anemia, namely the mothers in the intervention group (64.7%) and the Control group (82.4%).
Education has a significant effect on the occurrence of Anemia with p ≤ 0.001, the prevalence of Anemia is higher in mothers with low education, related to low levels of education [16].

Occupation
The  [17]. Work can lead to an increase in workload which affects pregnancy outcomes [18].

Changes in hemoglobin levels of anemic mothers due to Tamarillo juice and blood supplements administrations
The results of this study indicated that there Tamarillo is a plant with complete nutritional content. It is especially rich in iron.
This content is the main ingredient that increases hemoglobin levels because hemoglobin is a blood component that binds to iron (FE). In addition to the high iron content for the process of hemoglobin formation, Tamarillo is also rich in vitamin A [24] .

Tamarillo (Solanum Betacum Cav) has a high vitamin A content. Hemoglobin formation is strongly influenced by vitamin A.
Vitamin A is very good to maintain the health of epithelial tissue including the endothelium in blood vessels, so along with the increase and adequacy of vitamin A will increase the value of hemoglobin [25].

Changes in hemoglobin levels in mothers with FE tablets administration
The results of this study show that before the control group was given intervention (HB Level Test I) the average hemoglobin was up to 90% [26].

Levels compared to FE Tablets in Women with Anemia
The result of the study shows that Tamarillo administration. Blood supplements with iron enhancers should be given if there are anemic mothers with 9-10 g/dL HB levels. The iron supplement given will be an adequate iron reserve for the mother needed for the mothers with labor with surgery or experiences post-partum bleeding and the mother will start her next pregnancy with better iron stores [28]. with an optimal concentration of 60% (p <0.05) [24].

LIMITATIONS
The limitation in this study is that the researcher cannot fully control the external variables that can affect the results of the study, such as nutrition, knowledge, attitudes and behaviour, and dietary factors.

CONCLUSION
The intervention group was administered with Tamarillo juice (Solanum betacum cav) and iron tablets. An increase in hemoglobin levels in the Intervention group can be seen in the result. There was an increase in the average hemoglobin level of 0.91 g/dL in the first week and 1.75 g/dL in the second week.
It is higher than the Control group who was only administered with iron tablets, the average hemoglobin level increased to 0.43 g/dL in the first week and 0.89 g/dL in the second week, with a p-value ≥ of 0.011. These results show that Tamarillo has the potential as a companion product or diet (substitute for Vitamin C) to increase hemoglobin levels in mothers with Anemia.