GHIC 2018: Global Health & Innovation Conference
April 14-15, 2018
Yale University, New Haven, CT

Unite For Sight's 2011 Global Health & Innovation Conference

Blog Report by Chung-Sang Tse, Unite For Sight Global Health Leadership Intern

"Soksabay try – Iron Fish for the Amelioration  of Iron-Deficiency Anemia in Rural Cambodia," Christopher Charles, PhD Candidate, University of Guelph

Social Enterprise Pitches are ideas in the brainstorming or early implementation stage. Selected participants presented their new idea in the format of a 5-minute social enterprise pitch. Following the pitch, there was a 5-minute period for questions and answers, as well as feedback from the audience. The presenters were directed to focus their presentations on the problem that they are working to solve, the evidence basis for their idea, the expected impact, as well as plans for measuring outcomes, and not just outputs.

Iron-deficiency anemia (IDA) is a severe public health problem in Cambodia – over 63% of the population suffers from this ailment. (1)  Anemia is the condition in which there is a lack of red blood cells in the body; in the case of IDA, this is due to a lack of dietary iron. As iron acts as the “vehicle” to carry oxygen around the body, iron-deficiency symptoms are manifested as persistent fatigue, muscle weakness, impaired concentration, and malaise/depression amongst other symptoms. Anemia affects all aspects of life, including one’s ability to go to school or work.

Malnutrition, a combination of the lack of quantity of food and poor quality of diet, is a leading cause of iron-deficiency anemia. In most cases, it is a reversible condition that can be treated with adequate intake of iron (e.g., iron supplements). The usage of iron pots can lead to the leaching of iron into food, which can then be eaten as a source of iron supplementation. But in Cambodia, where aluminum pots are much more prevalent, there is no adventitious source of iron. Is there a low-cost, sustainable solution to this public health program? 

Christopher Charles, a PhD Candidate in Biomedical Science/Population Medicine at the University of Guelph, proposes one solution: the “sok sabay try”, an iron ingot in the shape of a “lucky” fish in Cambodian culture. Resembling an iron paper weight no larger than the size of a child’s fist, it can be placed in a boiling pot of liquid, such as in soup or water, while a meal is being cooked. The ingot releases iron into the liquid (without altering the taste) and can be readily consumed. Moreover, vitamin C and iron ingestion has a mutually-enhancing absorption effect into the body. Cambodians often consume soup soured with ascorbic acid (a form of vitamin C), such as tamarind or lime juice, on a daily basis. So when this soup is prepared with the iron ingot in the pot, the consumers will benefit from better absorption of both iron and vitamin C.
Further information was gained through the Q&A session: “How much does this cost?” About $1.50 per iron fish ingot – half the cost of iron supplements. “How effective is this intervention?” More than 75% of required daily iron requirements are met when the sok sabay try was used in the preparation of boiling drinking water. “How receptive are the Cambodians?” The design of the iron ingot was in the form of the culturally ‘lucky’ fish which made it highly recognizable to the locals. It was more readily adopted as a result. “Is this a sustainable solution?” The sok sabay try is made of scrap metal assembled by a local manufacturer; this uses the country’s internal resources (material and labor) and generates local income. “Could this solution be transferred to other communities?” Perhaps, but is it critical to assess the situation at the household level to enhance uptake (maybe use another design instead of the ‘lucky’ fish).

Currently, a randomized community trial is being conducted in three rural Cambodian villages involving more than 300 women. Hopefully, these women will demonstrate improved blood iron levels (as measured with blood samples) and a lower prevalence of iron-deficient anemia. Perhaps then we will be one step closer to eradicating IDA in Cambodia.

Footnotes

(1) World Health Organization (WHO). “Worldwide prevalence of anemia 1993-2005.” 2008