Association between Working Memory Deficits and Iron Deficiency Anemia Status among Elementary School Children in Jakarta, Indonesia: A Cross-Sectional Study using the Working Memory Rating Scale

Deficits in working memory and anemia in primary school children represent potential public health issues in terms of cognitive and educational development in Indonesia. This cross-sectional study investigates the relationship between working memory deficits and the presence of iron deficiency anemia in elementary school children in two schools in Jakarta, Indonesia, including the factors of nutritional intake and anthropometric status. The design of the study does not allow for causal inferences.

This cross-sectional study was conducted between May and August 2023 and included 335 elementary school students (grades 3-5) from two schools in Jakarta, Indonesia. A non-invasive hemoglobinometer was used to assess students' hemoglobin levels. The Working Memory Rating Scale (WMRS) was used to assess working memory. To evaluate nutritional status, anthropometric measurements (weight, height, age) and a 24-hour food recall exercise were performed.

The study reports that 19.7% of the students were anemic, and 22.1% of the students had working memory deficits. Students with working memory deficits had significantly lower mean hemoglobin levels (12.1±1.1 g/dL) than those with normal working memory (12.4±0.9 g/dL, p=0.035). Children who were short for their age had working memory scores that were low three times more often (OR = 3.04, 95% CI: 1.15-8.01). All students were found to have an inadequate intake of fat and protein, while anemic children had significantly poorer protein intake.

The findings show that even small changes in cognitive function can be linked to varying levels of hemoglobin and that iron plays an important role in the development of the neural system and the synthesis of crucial neurotransmitters. The relationship between chronic undernutrition (as evidenced by height deficit) and working memory limitations emphasizes the gradual, reciprocal relationship between cognitive development and nutritional status. The global deficiency in protein and fat intake is a serious nutritional problem that calls for urgent action through effective nutrition programs in the schools.

The associations between anemia, working memory, and malnutrition in elementary school children have been established. There is an urgent need for school-based nutrition programs.