Evaluation of Salak Chips (a Complementary Food) as an Intervention to Increase Hemoglobin Levels in Pregnant Women for Anemia Prevention

Abstract

Anemia in pregnancy remains a critical public health issue in Indonesia, with dietary iron deficiency being the predominant etiology. Snake fruit (Salacca zalacca) is a local commodity rich in iron and vitamin C; processing it into salak chips offers a shelf-stable complementary food that may improve hemoglobin (Hb) levels.  To evaluate the effectiveness and acceptability of salak chips as a food-based intervention for anemia prevention among pregnant women. Methods: A convergent mixed-methods design was employed. Thirty anemic pregnant women (Hb 9.0–10.9 g/dL) in primary healthcare settings consumed 50 g of standardized salak chips daily for four weeks. Hb levels were measured pre- and post-intervention using a HemoCue® device. Simultaneously, in-depth interviews and two focus group discussions were conducted to explore acceptability, perceived benefits, and adherence. Quantitative data were analyzed with paired t-tests; qualitative data followed thematic analysis. Mean Hb increased significantly from 9.7 ± 0.6 g/dL to 11.1 ± 0.7 g/dL (p<0.001). Three overarching qualitative themes emerged: (1) restored vitality and reduced fatigue, (2) high acceptability due to familiar taste and convenience, and (3) family support as a key adherence facilitator. No adverse events were reported. Salak chips represent a locally available, culturally acceptable, and effective food-based strategy to elevate Hb in mildly anemic pregnant women. Integration into routine antenatal care could complement existing iron-folic acid programs. Future controlled trials are warranted.