- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02341586
Lucky Iron Fish Home Fortification of Iron
A Randomized Control Trial of the Lucky Iron Fish to Improve Hemoglobin Concentration in Women in Preah Vihear, Cambodia
Study Overview
Status
Conditions
Detailed Description
Background: Anemia is prevalent in Cambodia, affecting ~44% of women. The causes of anemia are multifactorial. Globally, the most common form is iron deficiency anemia (IDA), which can lead to adverse perinatal health outcomes. In Cambodia, there is evidence that suggests hemoglobinopathies (genetic hemoglobin [Hb] disorders) are prevalent (~50%) and are a major contributor to anemia. In Preah Vihear province, Cambodia, the estimated prevalence of malaria is ~12.3%. Malaria contributes to anemia through a decrease in the production of red blood cells, and an increased destruction of red blood cells.
In Cambodia, iron supplements are recommended to treat anemia, however there is evidence of low compliance among women. The use of cast iron pots has proven to be an effective alternative to prevent and reduce IDA in developing countries. However, cast iron pots are not commonly used in Cambodia because they are expensive, difficult to clean, and heavy. A novel alternative is the Lucky Iron Fish (LIF), which is an iron ingot used during cooking as an in-home fortification system of iron transfer. The LIF ingot is small, lightweight, and easy to clean. Previous research in Cambodia confirmed the acceptance of the LIF to be high, but findings from this study were inconclusive and had several limitations.
Objective: The primary objective of this study is to determine the efficacy of the LIF to increase Hb concentration in Cambodian women of reproductive age.
Methods: A total of 330 women (18-49 y) with mild or moderate anemia (Hb 80-120 g/L) from rural Preah Vihear, Cambodia will be recruited to one of three arms to receive LIF, 18 mg elemental iron, or a placebo. Women with severe anemia will be excluded and referred for treatment. All three groups will receive nutrition education. Monitoring will be conducted monthly to measure compliance.
A trained, Khmer-speaking interviewer will meet with the women to explain the details of the study as per the consent form. Once consent is obtained the trained interviewer will measure hemoglobin status using a hemocue device to confirm eligibility of the study. If eligible, the trained interviewer will then administer the baseline questionnaire in the participant's home.
The questionnaire will collect demographic data, as well as information on current dietary intake, drinking water treatment, knowledge of iron deficiency anemia, knowledge of malaria, and perceptions of supplement use.
Participants will have a venous blood sample taken at 0, 6, and 12 months and analyzed for hemoglobin and multiple biomarkers of iron status (e.g. soluble transferrin receptor, ferritin, and retinol binding protein (RBP)). Ferritin will be corrected for inflammation using measures of alpha-1 acid glycoprotein (AGP, g/L) and C-reactive protein (CRP, mg/L) which are biomarkers of chronic and acute inflammation, respectively.
Genotyping will be conducted to determine the prevalence of hemoglobinopathies among women. The prevalence of malaria in this cohort will be determined using rapid diagnostic test kits for P. Falciparum, and P. Vivax at baseline, midline, and endline.
Potential Significance: The LIF has the potential to be a low cost, effective and simple-to-use product to prevent and reduce iron deficiency anemia in Cambodia.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Preah Vihear
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Rovieng, Preah Vihear, Cambodia
- Rovieng Health Centre
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Mild or Moderate Anemia [Hb 80-119]
- Willing to provide a fingerprick sample of blood at baseline
- Willing to provide 10 mL of venous blood at 0, 6 & 12 months
- Not planning on moving in the next 12 months
- Not participating in any other nutrition intervention
- Be able to provide written and information consent
Exclusion Criteria:
- Be ill or taking any medications [Hb < 80]
- Have normal Hb status [Hb > 120]
- Currently consuming or planning to consume Fe supplements in the next 12 months
- Pregnant (based on self report)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Lucky Iron Fish
This group will receive a Lucky Iron Fish to use during cooking.
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The Lucky Iron Fish (LIF) is an ingot used during cooking as an in-home fortification system of iron.
The LIF works on the same principle as cast iron pots and pans by increasing dietary intake of iron but is small and lightweight.
The LIF was designed in collaboration with village elders and community members to ensure it would be accepted in Cambodia.
The iron ingot resembles a local fish believed to be lucky among villages in Cambodia, contributing to the acceptability of the ingot.
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Active Comparator: 18 mg iron
This group will receive a daily oral iron supplement.
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This dose of iron is the recommend dietary allowance (RDA) for iron for this cohort.
Women will receive one-on-one instructions on how best to consume their tablet (for example, with food).
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Other: Control group
This group will receive nutrition education
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This group will receive education containing key messages around anemia, malaria, iron intake, and dietary diversity.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
hemoglobin concentration at endline
Time Frame: 12 months
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12 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in ferritin concentration
Time Frame: Baseline (t=0), midline (t=6 months), and endline (t=12 months)
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Ferritin is a biomarker of iron status.
Ferritin will be corrected with measures using measures of alpha-1 acid glycoprotein and C-reactive protein.
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Baseline (t=0), midline (t=6 months), and endline (t=12 months)
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Number of women in Preah Vihear, Cambodia with a genetic hemoglobin disorder
Time Frame: Midline (t=6 months)
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Midline (t=6 months)
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How the prevalence of malaria changes in women living in Preah Vihear Cambodia over one year
Time Frame: Baseline (t=0), midline (t=6 months), and endline (t=12 months)
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Baseline (t=0), midline (t=6 months), and endline (t=12 months)
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Change in soluble transferrin receptor (sTfR) concentration
Time Frame: Baseline (t=0), midline (t=6 months), and endline (t=12 months)
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sTfR is a biomarker of iron status
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Baseline (t=0), midline (t=6 months), and endline (t=12 months)
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Tim J Green, PhD, University of British Columbia
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- H14-02551
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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