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).
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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.