EFFECT OF PIGEON PEAS ON HEMOGLOBIN LEVEL AND COGNITIVE ABILITY

OF ELEMENTARY SCHOOL CHILDREN

Saifuddin Sirajuddin1, Masni 2, and Resti Kusumarini3

1
Nutrition Department Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
2
Biostatistics Department Faculty of Public Health, Hasanuddin University, Makassar,
Indonesia
3
Post-Graduate of Health Nutrition, Hasanuddin University, Makassar, Indonesia

*Author to whom the correspondence should be addressed: saifuddin59@yahoo.com

1
Abstract
Background: Prevalence of anemia among school-age children in Indonesia is more
than 20% and is considered a moderate public health issue. The current study
assessed the effect of pigeon peas (Cajanus cajan) on hemoglobin levels and
cognitive ability in anemic elementary school children.
Materials and Methods: Our quasiexperimental study used a pretest-posttest control
group design to examine 60 elementary school students of Jeneponto District South
Sulawesi Indonesia who were divided into three groups. The first group was given
10 mL of pyrantel pamoate (wormer) at the start of the study, and then one week later
began eating 60 g of pigeon peas per day (6 d/week) for a total of 8 weeks. The
second group began the same 8-week pigeon peas diet but did not receive wormer,
while the third group received 10 mL of wormer but did not receive pigeon peas.
Measurement of hemoglobin levels and cognitive ability were completed one week
before and after the dietary intervention. Hemoglobin levels were measured using
HemoCue®, and cognitive ability was assessed using a standardized questionnaire
from the local education office.
Results: The results showed the mean percent change in hemoglobin levels and
cognitive ability of students in first group (wormer and pigeon peas) were
significantly higher than that of the other groups.
Conclusion: Eating a diet of pigeon peas shortly after receiving pyrantel pamoate
wormer increases hemoglobin levels and cognitive ability in elementary school
students.

Key words: pigeon peas, anemia, cognitive ability, elementary school children

INTRODUCTION (48%), and preschool children (39%).

Anemia is also found in 45% of parents
he prevalence of anemia in

T
developing countries is three to
four times higher than in developed
countries. In developing countries,
anemia is mostly found in pregnant
women (52%), women aged 15-59
years (42%), school-age children
and 30% of adult men, among other
community groups, and is most
prevalent in subtropical regions of
southeast Asia and Africa where it is
associated with poverty1.
The proportion of Indonesians ≥1
year-old with anemia has reached
21.7% nationally. Based on age, the
proportion of anemic infants is quite
high (28.1%), decreases slightly in
school-age children (26.4%), but tends
to rise with age. Stratification by sex
showed that anemia is higher in women
than men in Indonesia. Furthermore,
statistics based on area of residence
showed that anemia is higher in rural
areas than urban areas2.
One of the main causes of anemia in
school-age children is parasitic worm
infestation. Researh result of Nahdiyati,
Nurpuji and Attamimi3 in Mamuju West
Sulawesi Indonesia showed that 13.7%
of students were infected with worms,
and there is a significant correlation
between parasitic worm infection and
anemia status in students in high
malaria endemic areas (P = 0.002) but
not low endemic areas (P = 1.000).
Anemia in elementary school students
can impact physical growth of the body
and brain characterized by symptoms of
fatigue, lethargy, a pale complexion,
and weakened immunity. These
symptoms lead to reduced fitness,
concentration, learning ability, and
academic performance4,5. Iron
deficiency in anemia causes a decrease
in hemoglobin and availability of
oxygen to the tissues, which ultimately
affects the heart. Iron deficiency also
affects the content and distribution of
iron in the brain, altering the function of
neurotransmitters, which affects
cognition. Hence, anemia may result in
decreased academic achievement and
behavioral disorders6.
Furthermore, anemia affects
physical work capacity and cognition,
especially in adolescent girls during
puberty. A study of four elementary
schools in India found 67% of children
with anemia have much lower physical
and cognitive ability than children
without anemia (p<0.001)6.
Interestingly, a study in Vietnam
revealed that helminth infections are a
significant cause of iron deficiency
worldwide, especially high-density
infections7.
Improving the nutritional status of
school-age children is best
accomplished by utilizing food stuffs
originating or readily available in the
local area. This food-based approach to
nutritional intervention has a high
acceptability, efficacy, and low cost,
making it sustainable8. For example,
nutrient content of pigeon peas cake
(Cajanus cajan) per 100 gram are
readily available throughout Indonesia
and contain more protein (22.07 g),
carbohydrates (0.16 g), and vitamin A
(150.0 SI) than soybeans and are a good
source of fat (1.13 g), iron (6.787 mg),
vitamin C (5.0 mg)9, crude fiber, iron,
sulfur, calcium, potassium, manganese,
and water-soluble vitamins, especially
thiamine, riboflavin, and niacin. Pigeon
peas also contain more minerals, ten
times more fat, five times more vitamin
A, and three times more vitamin C than
ordinary peas10. The present study
assessed the effect of a diet
supplemented with pigeon peas on the
form of traditional pastry on
hemoglobin levels and cognitive ability
of elementary school students with
anemia in Indonesia, by comparing
hemoglobin and cognitive ability
between before and after intervention.
MATERIAL AND METHODS
Pigeonpea beans (Cajanus cajan) is
a type of legume that is an annual
(perennial). The seeds can be eaten and
be as source of alternative food. Pigeon
peas contain protein,fat, carbohydrate.
Legume seed has a lower fat content
and cholesterol-free. In addition, it was
found as a source of minerals and
vitamins. Therapeutic value for human
clinical nuts are considered as drug
therapy for heart disease and diabetes.
This is because the pigeon pea was
significantly higher sulfur-containing
amino acids (cysteine and methionine).
Pigeonpea containing methionine,
cystine, tryptophan, and threonine
which is an essential amino acid. These
qualities will be very useful when made
cereal with a composition of 70:30. This
combination is a good source for crude
fiber, iron (Fe), sulfur, calcium,
potassium (K), manganese and water
soluble vitamins, especially thiamine,
riboflavin, niacin (Sharma, 2011).
Nutrient content of raw pigeon pea per
100 gram
Nutrient
Carbo Hydrat (g) 62
Protein (g) 20.7
Fat (g) 1.4
Calcium (mg) 125
Magnesium (mg) 113,7
Fosfor (mg) 275
Zink (mg) 2,5
Iron (mg) 6,7
Vitamin A ( IU) 150
Vitamin B1 (mg) 0,48
Vitamin C (mg) 5
Study Design: Our quasi experimental
study used a pretest-posttest control
group design. Subject were split equally
into three treatment groups: The first
group was given 10 mL pyrantel
pamoate (wormer), and then one week
later began eating a diet supplemented
with 60 g of C. cajan pigeon pea per
day (6 d/week) for a total of eight
weeks. The second group began the
same 8-week pigeon pea diet but did
not receive wormer, while the third
group received 10 mL of wormer but
did not receive diet supplemented with
pigeon peas. The independent variable
was pigeon pea consumption, and
dependent variables were changes in
hemoglobin levels and cognitive ability.
Controlled variables were student age,
hemoglobin levels before intervention,
and mode of pigeon pea administration.
Research Subjects: Subjects included
in the current study were elementary
school students (grades 4, 5, and 6)
from eight primary schools in the
Bontoramba District of Jeneponto
Regency in Indonesia. Anemia was
confirmed by measuring hemoglobin
levels before intervention began, and
subjects were excluded if they
experienced diarrhea, symptoms of
malaria, and/or developed other
infections throughout the study period.
A total of 60 students were ultimately
included in the current study (n = 20
students per group).

Procedure: All subjects were instructed
to recall their 24 hours food consumtion
history before intervention began, after
five weeks intervention, and after the
final week of dietary intervention using
a semiquantitative food frequency
questionnaire (FFQ). Groups 1 and 2
were given a traditional pastry (baruasa)
which made with pigeon peas whose
composition was adjusted to fit the
recommended daily allowance (RDA)
for school children who have been
through the integrated hedonic and
organoleptic testing laboratory. The
baruasa pastry mixture consisted of
75% pigeon pea flour, 25% rice flour,
brown sugar, eggs, and baking powder;
this blend was mixed by a manufacturer
of traditional baruasa in the local area.
One serving of baruasa (100 g) contains
387.11 kcal of energy, 69.76 g of
carbohydrates, 7.75 g of fat, and 7.83
mg of iron; thus, it is considered a good
quick snack for school children. After 8
weeks of dietary intervention,
hemoglobin levels and cognitive ability
were measured again. Compliance with
pigeon pea baruasa consumption was
monitored using a control card with the
help of teachers and parents. The
students given a control cards that have
to filled out after taking pigeon peas
before school finish under the
supervision of teachers and to control
the availability of products pigeon peas
on site and to see the level of
compliance of the students eating
pigeon pea .
Equipment and Forms: Hemoglobin
levels in student blood samples were
measured using a HemoCue®. Students
and parents initially filled out forms to
prescreen test subjects, collect identity
and other important information on
students and their families, and
determine the willingness of parent
respondents. FFQs were used to
measure student food intake, and other
questionnaires were administered to
assess cognitive abilities, appropriate
grade levels, and monitor compliance
with pigeon pea baruasa consumption.
Cognitive measurement is based on the
students' math test and Indonesian
Language as many as 20 items depend
on appropriate grade levels of students.
reasons for the selection of subjects
Indonesian and mathematics are due to
cognitive linguistics focuses on verbal
intelligence and mathematical on logic
intelligence regarded as academic
intelligence. Thus, Students' cognitive
abilities measured by comparing test
scores before and after intervention.
Statistical Analysis: Univariate and
bivariate analysis of data was
completed using SPSS 16.0 software.
Univariate testing was performed on
each variable to obtain an overview of
the distribution and frequency, while the
bivariate test was done by comparing
the results of hemoglobin and cognitive
ability testing before and after the
intervention period using a paired t-test
and analysis of variance or Wilcoxon
test to examine treatment effects
between groups.
RESULTS
Students in all groups remained under
observation throughout the study period
to assess dietary intake and behavior.
No students prematurely dropped out of
the study. The results showed that most
 students in the three groups were 7–9
years-old, female, and had a mean DISCUSSION
hemoglobin level before intervention
(pretest) of 11.19–11.29 g/dL, The results of the current study indicate
confirming all had mild anemia (Table that elementary school students with
1). The mean hemoglobin level after the anemia given pigeon pea baruasa and
intervention period (posttest) in the first worming medicine had significantly
Group showed a significance increase increased mean hemoglobin levels and
of 9.21% (p-value=0.00), while the cognitive ability. Pigeon peas have also
increases observed in Groups 2 and 3 been formulated as complementary
were not significant. foods for deficiencybreast milk with
the addition of starch, which makes it a
Table 1. Hemoglobin (Hb) levels before sufficient food supplement for
11
(pretest) and after (posttest) intervention. toddlers .
Groups
Pretest Posttest Change
P-value
Pigeon peas contain 20.70% protein,
Hb (g/dL) Hb (g/dL) in Hb
so they can be used as another source of
Baruasa 11.19 ± 12.22 ± 1.03 vegetable protein other than soybeans in
+ 0.00a
Wormer 0.95 1.31 (9.21%)
Baruasa 11.26 ± 12.13 ± 0.87
drier environments. Diversified
0.11a
only 0.63 1.16 (7.72%) products, such as baruasa cakes, made
Wormer 11.29 ± 11.68 ± 0.39
only 0.57 1.31 (3.45%)
0.2a with pigeon pea flour can improve
p-value 0.81c 0.36b 0.50b people's favorite to nuts so that nuts
Data presented as the mean ± standard deviation; n = 20
students per group
baruasa pigeon pea has the potential to
a
Wilcoxon test; bAnalysis of variance; CKruskal-Wallis test be developed11.
In the present study, the first group
Similar results were found for mean students (baruasa + wormer) showed a
cognitive ability (Table 2). While Group significant increase in hemoglobin
1 showed a significant increase after the levels and cognitive ability, while the
treatment period (p = 0.04 < 0.05), other two groups did not. This is
Groups 2 and 3 did not show a undoubtedly the result of giving
significant increase in cognitive ability pyrantel pamoate worming medicine
(p > 0.05). just before beginning the pigeon pea
baruasa diet. Considering helminth
infections, among others, have been
Table 2. Cognitive ability before (pretest)
and after (posttest) intervention. shown to cause significant iron
Pretest Posttest deficiency7, coadministration of wormer
Groups p-value
Median Median to vulnerable populations along with a
Baruasa
36.25 38.75 0.040a diet rich in iron and other nutrients can
+ Wormer
increase their absorptivity and reduce
Baruasa only 26.25 28.75 0.301a
the prevalence of anemia. Research
Wormer only 35.00 32.50 0.812a conducted by Haryati12 showed that the
p-value 0.497b 0.337b helminth drug delivery to elementary
n = 20 students per group; Student’s t-test; bWilcoxon
a
students in the complementary food for
test
elementary school children program in
the Mandai Maros district of Indonesia
increased mean hemoglobin levels by
0.37 ± 81 g/dL, reducing the prevalence
of anemia from 34% to 20%. The same
situation was found by Sudargo et al.13,
who showed that giving the placebo
group worming medicine increased
hemoglobin levels as much as 0.34
g/dL.
Anemia is a condition where
hemoglobin levels, hematocrit, and red
blood cell counts decrease below
normal values. The cause of anemia is
due to both nutritional and non-
nutritional factors. Nutritional factors
associated with anemia are a deficiency
of protein, vitamins, and minerals,
while non-nutritional factors related to
infectious diseases. Anemia in children
with poor nutrition, diets low in iron,
and/or conditions preventing sufficient
iron absorption can adversely affect
their health, growth, and immunity.
Protein also plays a key role in the
formation of hemoglobin; a long-term
lack of protein can disturb the
formation of red blood cells, causing
symptoms of anemia. Furthermore, lack
of vitamin C is associated with iron
deficiency; vitamin C helps speed up
the absorption of iron in the body, is
involved in transport of iron in the
blood, and mobilizes hemosiderin iron
stores in cells14,15.
Substances that can inhibit the
absorption of iron include caffeine,
manganese, tannins, oxalates, and
phytates which can be found in soy
bean products, teas, and coffee. Coffee
and tea which contain tannins and
oxalates are often consumed by people
worldwide. Food consumption logs
collected from students in the current
study showed a high consumption of tea
and bananas, with students in each
group drinking tea 2-4
times/week14.vThis is in line with a
study by Herta14, who showed
consumption of iron inhibitors was
significantly associated with anemia
status in school-age girls (P = 0.004).
He showed that most of the girls
included in that study consumed high
amounts of tea, bananas, and chocolate,
all foods containing compounds known
to inhibit the absorption of iron.
Furthermore, Ozasuwa et al.15 revealed
that children are more vulnerable to
parasitic infections, especially in
developing countries, because of a
lowered immune response consequent
to poor hygiene and sanitation, as well
as environmental conditions which
favor growth of the parasite.
Chauhan et al.16 showed that
children with anemia had a significantly
lower IQ (91.5 ± 2.3) than children
without anemia (97.5 ± 3.2).vOur
results show there was a significant
relationship between increased
cognitive ability and consumption of
pigeon pea baruasa with a dose of
wormer (Table 2). These results also
demonstrate that our anemic students
were deficient in a number of
micronutrients, such as vitamin A, iron,
iodine, and zinc, implicated in cognitive
development17. According to a study by
Raisita18, there was no difference in
hemoglobin levels before or after
ingestion of supplementary feeding for
elementary school students made from
green beans. Hemoglobin delivers
oxygen to the entire body. Lack of
oxygen in the blood causes widespread
disruption of cellular functions,
especially in the brain. As a result,
cognitive abilities are impaired and the
body becomes weak, fatigued, listless,
and inattentive. Futhermore, a study by
Sungthong et al.19 reported that children
receiving iron supplements every day
had a significantly lower IQ (3 ± 12
points) than those receiving the
supplement weekly (6 ± 12 points).
Research conducted by Seshadiri20
found that the impact of iron
supplementation in 163 anemic girls
aged 8-15 years-old for 4 and 8 months
increased their cognitive function. A
study by Ann et al.21 showed that
women who received iron nutrients
were have verbal ability and memory
better than the control group (p=0.01).
Lambert et al.22 showed that increased
iron status in women could improve
verbal working memory performance.
Michael et al23 found that iron
supplementation in women can provide
a significant increase in serum ferritin
associated with a 5- to 7-fold increase
in cognitive performance, whereas a
significant increase in hemoglobin was
associated with increased speed in
completing cognitive tasks.
According to Glazer and Bilenko24,
iron supplementation in infants with
IDA (Iron Deficiency Anemia) resulted
in an increase in language and mental
development test scores. However,
neither micronutrient interventions nor
administration of zinc and iron
combined or alone improved
performance on mental tests. Anemia
can also inhibit protein synthesis in the
brain which, in turn, disrupts
neurotransmission11.
There are some limitations to the
current study. First, the FFQ was only
administered once before and after the
intervention period and does not
necessarily reflect the daily dietary
intake of students throughout the
treatment period. Since multiple factors
can affect hemoglobin levels, such as
naturally occurring compounds in foods
which inhibit or enhance absorption of
nutrients, student diets should be more
consistently monitored and controlled in
future. Second, our methods for
assessing cognitive ability largely only
measured knowledge acquisition,
whereas cognitive ability includes
aspects of perception, concentration,
verbal ability/language, motor skills,
visual and spatial processing, and
executive functions. Thus, future
studies should also consider the
frequency with which supplementation
is administered.
Significance Statement:
This study discover the possible
synergistic effect of iron, vitamin C and
protein in pigeon peas with elevated
levels of hemoglobin and cognitive of
primary school students who are
anemic. Vitamin C can increase iron
absorption and futher collaborate with
globin protein to form hemoglobin in
the bone marrow. The hemoglobin
carries oxygen to the brain cells as a
fuel for energy synthesis, thus the brain
energy are expected to be fulfilled so that it
can improve cognitive abilities of the
students.
CONCLUSIONS AND
RECOMENDATIONS
 Based on the present results, we
concluded that consumption of pigeon
peas can improve hemoglobin levels
and cognitive ability of elementary
school children that have been
dewormed. Further research should be
conducted to develop an appropriate
sustainable and palatable food
supplement program for school-age
children to enhance nutritional health in
developing countries.
ACKNOWLEDGEMENTS
We would like to extend our sincere
gratitude to all of the school children
and their familes who participated in
our study, and to those who assisted
with its execution. Also, the directors
and teachers of the participating
primary schools in the Bontoramba
district of Jeneponto regency in
Indonesia are gratefully acknowledged
for their assistance and support during
data collection.
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