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A 12 month randomized control trial assessing the efficacy of an iron ingot to improve hemoglobin concentration in rural Cambodian women Rappaport, Aviva


Background: Anemia affects 45% of women of reproductive age in Cambodia. Globally, iron deficiency is thought to be the most common cause of anemia. Iron supplementation is recommended in populations where anemia prevalence is high. However, there are issues of cost, distribution and compliance with iron supplementation. A potential alternative is The Lucky Iron Fish® (LIF®), a reusable fish-shaped iron ingot which, when added to the cooking pot, leaches iron into the boiling water or soup in which it is prepared. Objective: The primary objective of this study was to determine if there was a difference in hemoglobin concentration among rural Cambodian anemic women (18-49 y) cooking with the LIF or a daily iron supplement compared to control after one year. Methods: In Preah Vihear, 340 women (18-49 y) with mild or moderate anemia (hemoglobin< 80-119 g/L) were randomized to: 1) a LIF group, 2) a daily 18 mg iron supplement group, or 3) a control group. A venous blood sample was taken at baseline, 6 and 12 months. Blood was analyzed for hemoglobin, serum ferritin and serum transferrin receptor (sTfR). Hemoglobin electrophoresis was used to detect structural hemoglobin variants. Results: During recruitment, anemia prevalence (hemoglobin<120 g/L) was 45% with the HemoCue 301. At baseline, prevalence of iron deficiency anemia differed by biomarker: 9% with serum ferritin (<15μg/L), and 30% with sTfR (>8.3 mg/L). At endline, the prevalence of anemia was 61%, 67%, and 62% in the LIF, supplement, and control groups, respectively. There was no significant difference in hemoglobin (mean; 95% CI) between the LIF group (116; 113, 118 g/L), iron supplement group (115; 112, 117 g/L), and control group (115; 113, 118 g/L; p=0.897). Serum ferritin was significantly higher in the iron supplement group (97; 88, 105 μg/L; p=0.002) compared to the LIF (78; 69, 83 μg/L) and control groups (76; 71, 85 μg/L). Conclusions: Our findings show that in this population with a low rate of iron deficiency, the LIF is ineffective at reducing anemia. Our findings suggest that factors other than iron deficiency are likely responsible for the high rate of anemia in Preah Vihear, Cambodia.

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