Effect of Moringa Oleifera Leaf Capsul on Hemoglobin Levels in Anemia: A Pilot Study
Phase: PHASE3
Conditions: Anemia of Pregnancy
Sponsor: Universitas Padjadjaran

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Effect of Moringa oleifera Leaf Capsul on Hemoglobin Levels 
in Anemia: A Pilot Study 
 
 
Date Upload : 06 February 2023 
 
 

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Effect of Moringa oleifera Leaf Capsul on Hemoglobin Levels 
in Anemia: A Pilot Study 
 
 
Yuni Vianingsih 1, Dewi Marhaeni Diah Herawati 2, Ginna Megawati 2 
1 Public Health Study Program, Faculty of Medicine, University Padjadjaran, Bandung, Indonesia 
2 Department of Public Health, Faculty of Medicine, University Padjadjaran, Bandung, Indonesia 
 
Correspondence author: Dewi Marhaeni Diah Herawati, Faculty of Medicine, University 
Padjadjaran, Jalan Eyckman No. 38 Bandung, Indonesia. Mobile: +62 82126033975 
Email: marhaeni@unpad.ac.id 
 
Abstract 
Backgrounds. With a prevalence of 36.5%, anemia in pregnancy is public health concern in developing 
nations. This study aims to analyze the effect of Moringa oleifera leaf capsules for enhanced hemoglobin 
levels in pregnant women. 
Methods. This study used a pretest–posttest design with a control group design. The study was conducted 
in Cibeureum Cimahi City, Province West Java, Indonesia. A total of 60 participants were recruited in the 
study. Thirty participants were divided into each groups. The treatment group received additional blood-
related pills and capsules of powdered moringa leaf, and the control group received additional related tablets 
only. Statistical test using the Wilcoxon test. 
Results. Based on analysis Wilcoxon test statistics obtained the result (p = 0.000). Hemoglobin levels in 
the moringa group were enhanced at 1.743 mg /dL while they increased by 0.81 mg/dL in the control group. 
Enhancement more moringa group tall compared to the control group. 
Conclusions. Giving mothers capsules made from moringa oleifera leaves capsules for a month raises their 
hemoglobin levels, making their babies taller than those who do not take the supplements. 
 
Keywords: Anemia, Capsules Leaf Moringa, Tablets, Blood 
 
 
 

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Introduction 
Anemia during pregnancy is a public health concern, specifically in developing countries. 1 Anemia during 
pregnancy is defined by the World Health Organization (WHO) as a hemoglobin (Hb) concentration below 
11 g/dL. 2 Causes of anemia include poor nutrition, infections and chronic diseases like malaria, TB, and 
HIV, as well as domestic violence, which are all factors that might arise during pregnancy in developing 
nations. 3,4 
Prevalence of anemia in women of child-brearing ag was 29.9% (15–49 years old) and in pregnant women 
was 36.5%, respectively, according to WHO in 2019. 5 Prevalence of anemia during pregnancy ranges from 
41.8% to 43.8% worldwide, with Africa (61.3%) and Southeast Asia (52.5%) having the highest prevalence. 
6,7 According to Riskesdas data 2018, the prevalence of anemia deficiency iron on mother pregnant 
experience enhancement from 37.1% in 2013 to 48.9% in 2017. 8 Prevalence anemia is present in pregnant 
women in West Java in 2020 at 7%, and in Cimahi in 2021at 6%. 9 
Anemia is one most frequent complications that occur during pregnancy. This is typically regarded as a 
risk factor for an unfavorable pregnancy and can lead to life-threatening issues for both the mother and the 
fetus, including early birth, low birth weight, miscarrage, and death. 10 When anemia no overcome so could 
cause a dead mother, fetus, and baby. Globally 1 in 5 deaths mother very related to anemia. 11 
The WHO advises pregnant women to consume iron and folic acid supplements (IFA) for at least 180 weeks 
of their pregnancy, at a dose of 30–60 mg of iron and 0.4 mg of folate. 12 The Indonesian government has 
to improve the nutrition intake via administration of iron and acid folate tablets during pregnancy. 
Intervention, however, is not yet able to reduce the prevalence of anemia in Indonesian pregnant mothers. 
Hemoglobin levels are affected by several factors factor including types of food source substance iron, the 
composition of food, disease infection, and menstrual periods. 13 Increasing hemoglobin levels require the 
proper dosage of extra tablets of blood alone character supplementation as well as their combination with 
other micronutrients. 14 because it is necessary existence intervention nutrition and possible alternative to 
lower the prevalence of anemia in mother pregnant. 
Moringa oleifera is native to Indonesia and has a high nutritional value. It can be used as a dietary 
supplement for expectant mothers to help reduce the prevalence of anemia. 15 Moringa oleifera extract has 
phytochemicals in the form of flavonoids, phytosterols, and steroids that are anti-inflammatory, anti-
carcinogenic, anti-proliferative, and anti-viral. 16 Moringa oleifera extract has more micronutrients than 

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IFA because mothers who take Moringa oleifera can meet their demands for the micronutrient. 
Micronutrients like Fe in extract moringa oleifera delivers enhancement hemoglobin in mother pregnant 
and also prevents DNA damage due to oxidative stress. 17 
Moringa oleifera capsule was used to analyze the nutrient content in the Saraswati Bogor laboratory. Test 
results obtained content nutrition capsule leaf Mor & More brand moringa per 100 grams is energy 358.08 
Kcal, protein 24.52%, substances iron 13.09 mg, vitamin A 261.49 mg, calcium 2940.29 mg, zinc 2.57 mg, 
vitamin E 66.68 mg, vitamin C 8.90 mg, and vitamin D 3.73 mg. The results of the microbiological and 
contamination tests on the metal indicate that it is free of lead, mold, and yeast. The purpose of the study 
is to determine how taking IFA and moringa oleifera capsule affects a pregnant mother’s ability to increase 
hemoglobin levels. 
 
Materials and Methods 
Research Design 
Type Research used is a quasi-experiment design with pre and posttest. This study was conducted in the 
West Java, Indonesia, region at the Cibeureum public health center in Cimahi City. Studies were conducted 
for 3 months starting from May to July 2022. 
 
Participants 
Mothers only make up the study’s population, and there is anemia in the workplace. Cibeureum Cimahi 
City, a public health facility that later became a patient health center. Based on Puskesmas data the average 
number of mothers pregnant with anemia in one year final totaled 112 people. 18 All expectant mothers with 
anemia in the second and third trimesters are the study's subjects. Research this consist of two groups group 
treatment is given IFA tablets and Moringa oleifera capsules, while group control is only given IFA tablets. 
According to the calculation, a large sample of up to 60 respondents was acquired to assess the average 
difference between the two groups with 90% power. To prevent respondents drop out so added 10% to 
obtain a total of 66 respondents were divided into two group mother pregnant women with anemia. 
Moringa oleifera capsule supplementary 
The Moringa oleifera capsules contain 500 mg of powdered Moringa oleifera leaves and contain 13.09 mg 
of iron per100 gram. Mother pregnant given capsule leaf moringa as much as 2 × 2 capsules in a day. Giving 

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a pregnant mother a capsule of Moringa oleifera was done for 30 days. Capsule Moringa oleifera consumed 
together with added tablet blood taken 2 × 1 tablet. Each IFA tablet distributed contains 400 mcg of folic 
acid and180 mg of Ferrous Fumarate. 
 
Data Collection and Measurement 
The whole respondent conducted measurement anthropometry including body weight (BW), body height, 
and MUAC mid-upper arm circumference. BW was measured using the Camry brand digital scale, and 
MUAC was measured using the proper measuring tape following Indonesian Ministry of Health guidelines. 
24 h food recall done as much as 1 time at a time beginning research. A food recall is carried out by 
nutritionists for knowing the intake eaten in 1 day Additionally, a meal journal is kept every week for a 
month, every time. This thing meant see intake eat every day to mom pregnant with anemia intake of energy, 
protein, carbohydrates, vitamin A, vitamin C, and substances iron. The program survey will directly record 
and process the daily food record data. Taking 1 ml of blood from the vein is carried out by personnel 
analyst at the laboratory public health center Cibeureum. Blood samples collected using the ferrocyanide 
method. 
Monitoring obedience with the use sheet checklist to see compliance and effect side conducted every day 
very in a month by a nutritionist and assisted midwife. However, every day respondents send reports via 
WA (WhatsApp) to the Cibeureum public health nutritionist on the effects on the side. During the study no 
there is complaint affect side from the mother’s pregnancy like diarrhea or allergy etc. 
 
Data Analysis 
Study This data is linked to compare the average hemoglobin count before and after receiving Moringa 
oleifera capsules. Statistical test using Wilcoxon, because the data is distributed not normal. 
 
Ethical Considerations 
This study is based on the Declaration of Helsinki and has received ethical approval from the UNPAD 
Health Committee Ethics Study under the designation 525/UN6.KEP/EC/2022. Informed consent was 
obtained from all subjects before participating in this study. 
 

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Results 
Age Mother moment pregnancy relate to risk consequence of pregnancy and childbirth. If the mother is 
between 20 and 35, she is considered to be at risk. Respondents studied this part big have age pregnancy 
no risk. According to amount parity, 46.67% of group controls are primiparous and 40% have multipara 
parity. On both groups part big complete education school middle and status no work. None of the 
respondents have ever had a chronic illness (table 1). 
Based on nutritional status respondents (table 2) are known in both group part big no malnutrition and no 
anemia. More anemic respondents were in the control group compared to the treatment group (40% versus 
10%) however a sizable portion (36.67%)of the anemic respondents were mildly anemic. 
On analysis intake food respondents (table 3), it is known that both groups have less intake of energy, 
carbohydrates, protein, consumption of Fe, and consumption of vitamin C. Only vitamin A is considered 
sufficient, although only 60% of respondents in the group treatment and 53.3% in the group control reported 
getting enough of it. 
There are different means (p = 0.000) on the average value of HB levels before and after intervention in 
both groups. When compared to the group receiving treatment, which has HB levels of 1,743 mg/dL, there 
are significant increases in HB alterations(table 4). 
 
Discussion 
According to research, taking IFA along with a capsule of Moringa oleifera leaves for a month could raise 
hemoglobin levels above those of the group receiving only IFA without a capsule of Moringa oleifera leaves 
(1.743 mg/dL vs. 0.81 md/dL), producing results that are statistically significant ( p = 0.000). Study this in 
line with the results study Manggul who uses a combination of biscuits flour leaf Moringa and Fe tablets 
(p = 0.001) and an increase in an average value of 1 g/dL. 19 Similar study findings indicate that 
supplementing with powdered leaf Moringa for 8 weeks in pregnant women who fall into the anemia 
category and are now in the third trimester can dramatically raise hemoglobin levels while also lowering 
perceived stress and cortisol. 20 
Giving supplementation extract leaf moringa during pregnancy is known could prevent stunting in children 
36-42 months old, so recommended for consumption while pregnant. 21 According to research, moringa 
leaves contain a variety of micronutrients, such substance iron (7 mg) per 100 g. Leaf Moringa is rich in 

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vitamin A, vitamin B, vitamin C, and calcium. 22 While capsule leaf moringa has been shown to have 
component iron 13.09 mg/100 grams, flour leaf Moringa is reported to have a higher Fe content tall, which 
is 28.2 mg/100 grams. 
Giving extract of Moringa oleifera to a woman pregnant could supply Abundant micronutrients including 
Fe, vitamin A, vitamin C, and selenium during pregnancy. Plant Moringa oleifera is known as the miracle 
tree because it contains numerous nutrients, both macronutrients, and micronutrients. 23 Giving intervention 
leaf moringa this could. Becomes supporting Fe tablets taken by a mother pregnant so the increase in 
maternal hemoglobin pregnant more significant. Iron absorption and metabolism are impacted by the 
combination of minerals, vitamins, and bioactive substances in moringa leaf. Animal studies rat show that 
the bioavailability substance iron leaf Moringa oleifera is more good than the bioavailability supplement 
substance iron, so that leaf Moringa oleifera could. serves as the foundation for efficient treatment of anemia 
in pregnant women. 24 
Moringa leaves are a good source of amino acids, vitamins, minerals, and various phytochemical agents. 
Compared to other plants, Moringa oleifera also contains a lot of iron. The high content of vitamins A and 
C could increase the bioavailability substance iron. 25 It has been demonstrated that vitamin C can boost 
iron absorption from non-heme sources by up to 4 times. Vitamin C and substances iron join to shape an 
easy ferro-ascorbate complex soluble and easily absorbed, vegetables and fruit very fresh and high in 
vitamin C are effective in increasing hemoglobin levels. Numerous studies have shown that Moringa 
oleifera absorption of non-heme iron from the diet that is consumed. 26 
Analysis of the food intake data reveals that both groups consume less in the way of calories, carbohydrates, 
protein, iron, and vitamin C and that there is no difference in the pace at which hemoglobin changes between 
the two groups. Besides that, upgrading sufficient Hb levels high in the group that received add tablet 
combination of blood and capsule leaf moringa could be considered as the effect produced by the capsule 
leaf moringa. Giving capsules of Moringa leaf to respondents may even help them meet their needs for a 
shortage of macro and micronutrients. 
Supplementing with Moringa oleifera offers positive health effects, particularly for pregnant women and 
those with anemia-related conditions. The scientific name moringa is Moringa oleifera or Moringa 
pterygosperma Gaertn. In Indonesia, the consumption of leaf moringa is one alternative for fighting 

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deficiency nutrition. Because nearly every part of the plant is plant-based, moringa is a versatile vegetable 
that may be utilized as a source of food and an ingredient in locally sourced, nutritious cuisine. 17 
In additional research, Herawati et al. used IFA and eel biscuits and they found that the rate of hemoglobin 
improvement in mothers with pregnancy anemia who receive eel biscuit supplementation is also higher 
than in those who only receive IFA. 27 Enhancement rate hemoglobin more tall using IFA and eel biscuit 
compared with IFA and Moringa oleifera capsules. The reason for this is that whereas Moringa oleifera is 
a herb, eels are animals. The advantages of Moringa oleifera are used ingredients very raw and cheap and 
can be planted in every house resident. 
There are certain restrictions on this research, specifically that the confounding variable for consumption 
of coffee and tea with tannins is neither measured nor quantified. Data only describe ingredient food source 
of tannin consumed by respondents. 
 
Conclusion 
IFA and Moringa oleifera leaves capsules are consumed together, and hemoglobin levels in expectant 
mothers who were previously anemic improve. This is in contrast to IFA consumption alone without 
Moringa Oliveira. As a suggestion, Service health can think about supplementing IFAs with a capsule of 
Moringa oleifera leaves. 
 
Conflicts of Interest 
All writer no have interest finance or conflict interest in study this . 
 
Acknowledgment 
Writer say many thanks to Service Cimahi City Health, Health Center Cibeureum and all participating 
respondents in study this. The author also says thanks to University Padjadjaran. 
Funding:  
- 
 
Disclosure 
All authors have no financial or non-financial conflicts of interest in this study. 

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Table 1 Characteristics of Respondents 
 
 
Characteristics  
Treatment 
% 
Control 
% 
Age 
Risk 
Not Risk 
Amount 
 
 
9 
21 
30 
 
30.00 
70.00 
100.00 
 
6 
24 
30 
 
20.00 
80.00 
100.00 
parity 
nullipara 
Primipara 
Multipara 
Amount 
 
Education 
SD 
JUNIOR HIGH SCHOOL 
SENIOR HIGH SCHOOL 
College 
Amount 
 
Work 
Working 
Doesn't work 
Amount 
 
 
11 
7 
12 
30 
 
 
0 
7 
20 
3 
30 
 
 
8 
22 
30 
 
36.67 
23.33 
40.00 
100.00 
 
 
0.00 
23.33 
66.67 
10.00 
100.00 
 
 
26.67 
73.33 
100.00 
 
8 
14 
8 
30 
 
 
2 
7 
19 
2 
30 
 
 
3 
27 
30 
 
26.67 
46.67 
26.66 
100.00 
 
 
6.67 
23.33 
63.33 
6.67 
100.00 
 
 
10.00 
90.00 
100.00 
History Disease 
 
 
 
 
There is 
None _ 
Amount  
0 
30 
30 
0.00 
100.00 
100.00 
0 
30 
30 
0.00 
100.00 
100.00 

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Table 2 Respondents Nutritional Status 
 
 
Table 3 Results of Respondents' Food Intake 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Nutritional Status 
Treatment 
% 
Control 
% 
SEZ status 
KEK 
No KEK 
Amount 
 
 
2 
2 8 
30 
 
6.67 
93.33 
100.00 
 
3 
27 
30 
 
10.00 
90.00 
100.00 
Anemia Status 
No Anemia 
Anemia 
Amount 
 
Anemia Rate 
Anemia Light 
Anemia Currently 
Not anemia 
Amount 
 
27 
3 
30 
 
 
3 
0 
27 
30 
 
90.00 
10.00 
100.00 
 
 
10.00 
0.00 
90.00 
100.00 
 
18 
12 
30 
 
 
11 
1 
18 
30 
 
60.00 
40.00 
100.00 
 
 
36.67 
3.33 
60.00 
100.00 
Food Records 
Group 
 
Treatment 
% 
Control 
% 
Energy  
 
 
 
 
       Not enough 
22 
73.33 
25 
83.33 
       Enough 
8 
26.67 
5 
16.67 
Total 
30 
100.00 
30 
100.00 
Carbohydrate  
 
 
 
 
       Not enough 
24 
80.00 
24 
80.00 
       Enough 
6 
20.00 
6 
20.00 
Total 
30 
100.00 
30 
100.00 
Protein 
 
 
 
 
       Not enough 
16 
53.33 
21 
70.00 
       Enough 
14 
46.67 
9 
30.00 
Total 
30 
100.00 
30 
100.00 
Fe consumption 
 
 
 
 
       Not enough 
28 
93.33 
29 
96.67 
       Enough  
2 
6.67 
1 
3.33 
Total 
30 
100.00 
30 
100.00 
Consumption of 
Vitamin A 
 
 
 
 
       Not enough 
12 
40.00 
14 
46.67 
       Enough 
18 
60.00 
16 
53.33 
Total 
30 
100.00 
30 
100.00 
Consumption of 
Vitamin C 
 
 
 
 
       Not enough 
21 
70.00 
22 
73.33 
 Enough 
9 
30.00 
8 
26.67 
Total 
30 
100.00 
30 
100.00 

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Table 4 Changes in Hemoglobin Level Values Before and After Group Intervention _ 
Treatment and Group Control 
 
 
 
 
 
 
 
 
Variable 
Score 
mean 
SD 
Difference 
P value 
Hemoglobin levels 
Ex . Treatment 
Pre-test 
10,190 
0.7053 
1,743 
0.000 
Post-test 
11,933 
0.8864 
Hemoglobin levels 
Ex . Control 
Pre-test 
10.353 
0.4981 
0.81 
0.000 
Post-test 
11,163 
0.907