Objectives
To evaluate the impact of a 12‐month multi‐modal public health intervention programme for treating and preventing anaemia among children aged 6 months to 4 years in an underserved ...community in Peru.
Methods
The intervention included nutritional education, use of a Lucky Iron Fish® cooking tool, and dietary supplementation. The primary outcome measure was anaemia resolution. Secondary outcomes included absolute changes in haemoglobin, change in knowledge survey scores and adherence to interventions. Chi‐square test and Mann–Whitney U‐test were employed to identify associations between anaemia and intervention‐related measures. Variables found to be significantly associated in bivariate analysis or of clinical importance were included in a logistic regression model.
Results
Of the 406 children enrolled, 256 (63.1%) completed the programme. Of those, 34.0% had anaemia at baseline; this decreased to 13.0% over 12 months. The mean haemoglobin for all ages at baseline was 11.3 g/dL (SD 0.9). At 12 months, the mean was 11.9 g/dL (SD 0.8), with a mean increase of 0.5 g/dL (95% CI 0.4–0.6). Children with anaemia at baseline saw an increase of 1.19 g/dL at the 12‐month follow‐up (95% CI 1.12–1.37). Parents correctly answered 79.0% of knowledge assessment questions at baseline, which increased to 86.6% at 12 months.
Conclusions
We observed a reduction in the prevalence of mild to moderate anaemia among study participants in this vulnerable population and conclude that multi‐modal intervention programmes providing nutrition education in conjunction with low‐cost iron supplementation and easy‐to‐use Lucky Iron Fish® cooking tools may reduce and prevent anaemia in children.
Anemia affects 45% of women of childbearing age in Cambodia. Iron supplementation is recommended in populations in which anemia prevalence is high. However, there are issues of cost, distribution, ...and adherence. A potential alternative is a reusable fish-shaped iron ingot, which, when added to the cooking pot, leaches iron into the fluid in which it is prepared.
We sought to determine whether there was a difference in hemoglobin concentrations in rural Cambodian anemic women (aged 18–49 y) who cooked with the iron ingot or consumed a daily iron supplement compared with a control after 1 y.
In Preah Vihear, 340 women with mild or moderate anemia were randomly assigned to 1) an iron-ingot group, 2) an iron-supplement (18 mg/d) group, or 3) a nonplacebo control group. A venous blood sample was taken at baseline and at 6 and 12 mo. Blood was analyzed for hemoglobin, serum ferritin, and serum transferrin receptor. Hemoglobin electrophoresis was used to detect structural hemoglobin variants.
Anemia prevalence was 44% with the use of a portable hemoglobinometer during screening. At baseline, prevalence of iron deficiency was 9% on the basis of a low serum ferritin concentration. There was no significant difference in mean hemoglobin concentrations between the iron-ingot group (115 g/L; 95% CI: 113, 118 g/L; P = 0.850) or iron-supplement group (115 g/L; 95% CI: 113, 117 g/L; P = 0.998) compared with the control group (115 g/L; 95% CI: 113, 117 g/L) at 12 mo. Serum ferritin was significantly higher in the iron-supplement group (73 μg/L; 95% CI: 64, 82 μg/L; P = 0.002) than in the control group at 6 mo; however, this significance was not maintained at 12 mo (73 μg/L; 95% CI: 58, 91 μg/L; P = 0.176).
Neither the iron ingot nor iron supplements increased hemoglobin concentrations in this population at 6 or 12 mo. We do not recommend the use of the fish-shaped iron ingot in Cambodia or in countries where the prevalence of iron deficiency is low and genetic hemoglobin disorders are high. This trial was registered at clinicaltrials.gov as NCT02341586.
The principal objective was to explore in greater detail safety issues with regard to the use of the Lucky Iron Fish® (fish) as a treatment for iron deficiency and iron deficiency anaemia in women in ...rural Cambodia.
Experiments were done to determine: (1) purity of the iron in the fish by mass spectroscopy; (2) release of iron and contaminants released during boiling in water using inductive-ly-coupled plasma optical emission spectroscopy; (3) the impact of cooking time, acidity and number of fish in acidified water and two types of Khmer soups; and (4) drinkability of the water after boiling with different num-bers of fish.
The fish is composed primarily of ferrous iron with less than 12% non-ferrous iron. Contaminants were either not detectable or levels were below the acceptable standards set by the World Health Organization. The length of time boiling the fish and the acidity of the water increased iron release but even with 5 fish boiled for 60 minutes, iron levels only approached levels where side effects are observed. Boiling one fish in water did not affect the perception of colour, smell or taste of the water but boiling in water with two or more fish resulted in the water being unpalatable which further limits the potential for iron toxicity from using the fish.
The results suggest that the Lucky Iron Fish™ may be a safe treatment for iron deficiency.
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