"Sok Sa'bay Try": Amelioration of Iron Deficiency Anemia Using Lucky Iron Fish

Anemia is a severe public health problem with serious consequences for both human and socio-economic health. Previously, we reported on a pilot study of a uniquely-shaped iron ingot that can be used during cooking to provide additional iron to an otherwise deficient diet. Currently, we discuss a long-term investigation of the ingot in rural Cambodia to determine the effect of regular use of the iron ingot. A randomized controlled trial was conducted in Kandal Province, Cambodia. Participants were allocated to one of three groups: control, intervention, or intervention with follow-up nutrition education. The purpose of the follow-up sessions was to encourage integration of the intervention and to providing basic nutritional information. Distribution of a re-usable, fish-shaped iron ingot to both intervention groups occurred at baseline. Participants were instructed to use the ingot daily, while preparing soup or boiling drinking water. Data on compliance, hemoglobin and iron status was measured regularly throughout the 12-month trial period. Participants in the intervention groups had improved hemoglobin levels and indices of iron stores, and were also less likely to be anemic at endline. Decreased loss-to-follow-up and increased compliance to the treatment regime was observed in the intervention with follow-up group. The current study demonstrates the long-term acceptability and effectiveness of the iron ingot at ameliorating iron deficiency and anemia in rural Cambodia. A laboratory study confirms the bioavailability of the iron leached from the ingot, suggesting that approximately 75% of daily iron requirements can be met by using the ingot each daily. The iron fish represents an affordable and promising adventitious iron source for the amelioration of iron deficiency anemia. The development of a novel intervention that can be used throughout Asia, and beyond, will dramatically improve the quality of life for millions of women and children.