Effectiveness of Moringa-Fortified Local Food Combined with Iron Supplementation for Anemia in Pregnant Women in Tidore Islands-Indonesia

Background: Anemia during pregnancy remains a critical global health challenge. While iron tablet supplementation is the standard intervention, its effectiveness is often limited by poor adherence due to side effects. However, evidence comparing Moringa-fortified local supplementary food combined with iron supplementation with iron supplementation alone among anemic second-trimester pregnant women remains limited; therefore, this study aimed to compare their effectiveness in increasing hemoglobin levels. Methods: This quasi-experimental pretest–posttest control-group study, reported in accordance with the TREND guideline for non-randomized designs, recruited 56 anemic second-trimester pregnant women in Tidore Islands, Indonesia, using consecutive sampling. Participants received either Moringa-fortified local supplementary food plus iron tablets (intervention/exposure variable) or iron tablets alone for six weeks; the outcome variable was change in hemoglobin level (ΔHb). Fifty-three participants (intervention, n = 28; control, n = 25) completed the six-week follow-up and were included in the per-protocol analysis. Between- and within-group changes in hemoglobin were analyzed using the Mann–Whitney U and Wilcoxon signed-rank tests. Results: After six weeks, hemoglobin increased significantly within both groups (Wilcoxon signed-rank, both p < 0.001). The median increase was greater in the Moringa-fortified food plus iron group (1.40 g/dL) than in the iron-only group (0.80 g/dL), and the between-group difference was statistically significant (Mann–Whitney U = 138.0, p < 0.001; rank-biserial correlation r ≈ 0.61, a large effect. Conclusion: Moringa-fortified local supplementary food combined with iron tablets produced a greater increase in hemoglobin than iron tablets alone among anemic second-trimester pregnant women in this quasi-experimental study. The intervention may serve as a culturally acceptable adjunct—not a replacement—to standard iron supplementation; larger randomized studies are needed to confirm generalizability before broader implementation.