A Randomized Control Trial Using a Fish-Shaped Iron Ingot for the Amelioration of Iron Deficiency Anemia in Rural Cambodian Women

Abstract

Objective: The objectives were to determine whether cooking food with an iron ingot increases the hemoglobin and serum ferritin of women and whether women would use an iron ingot shaped like a fish considered lucky in Cambodian culture. Methods: A randomized controlled trial was conducted in three villages in rural Kandal Province, Cambodia. Participants were randomly assigned to the iron ingot, the iron ingot plus nutrition education, or untreated control group. Participants were instructed to use the iron ingot daily by adding it to the cooking pot when preparing soup or boiling drinking water and boiling for at least 10 minutes. Blood samples were taken at baseline and every three months thereafter, over a 12-month trial period. Results: Overall, a 46% reduction in the prevalence of anemia within the intervention group was noted at the end of the study. Hemoglobin concentrations were greater by 11.8 g/L (95% CI: 9.1, 14.6; P<0.0001) in women in the iron ingot group when compared to controls. Serum ferritin concentrations were 31.0 ng/mL (95% CI: 17.1, 45.0; P<0.0001) greater after 12 months of using the iron ingot when compared to controls. Over 94% of women used the iron ingot at least 3 times per week. Conclusion: The iron ingot shaped as a lucky fish is a very effective, innovative form of homestead food fortification in a country lacking affordable and accessible means of improving iron intake.