Anemia affects 45% of women of childbearing age in Cambodia. Iron supplementation is recommended in populations in which anemia prevalence is high. However, there are issues of cost, distribution, and adherence. A potential alternative is a reusable fish-shaped iron ingot, which, when added to the cooking pot, leaches iron into the fluid in which it is prepared. We sought to determine whether there was a difference in hemoglobin concentrations in rural Cambodian anemic women (aged 18-49 y) who cooked with the iron ingot or consumed a daily iron supplement compared with a control after 1 y. In Preah Vihear, 340 women with mild or moderate anemia were randomly assigned to ) an iron-ingot group,) an iron-supplement (18 mg/d) group, or ) a nonplacebo control group. A venous blood sample was taken at baseline and at 6 and 12 mo. Blood was analyzed for hemoglobin, serum ferritin, and serum transferrin receptor. Hemoglobin electrophoresis was used to detect structural hemoglobin variants. Anemia prevalence was 44% with the use of a portable hemoglobinometer during screening. At baseline, prevalence of iron deficiency was 9% on the basis of a low serum ferritin concentration. There was no significant difference in mean hemoglobin concentrations between the iron-ingot group (115 g/L; 95% CI: 113, 118 g/L; = 0.850) or iron-supplement group (115 g/L; 95% CI: 113, 117 g/L; = 0.998) compared with the control group (115 g/L; 95% CI: 113, 117 g/L) at 12 mo. Serum ferritin was significantly higher in the iron-supplement group (73 μg/L; 95% CI: 64, 82 μg/L; = 0.002) than in the control group at 6 mo; however, this significance was not maintained at 12 mo (73 μg/L; 95% CI: 58, 91 μg/L; = 0.176). Neither the iron ingot nor iron supplements increased hemoglobin concentrations in this population at 6 or 12 mo. We do not recommend the use of the fish-shaped iron ingot in Cambodia or in countries where the prevalence of iron deficiency is low and genetic hemoglobin disorders are high. This trial was registered at clinicaltrials.gov as NCT02341586.

Iron deficiency anemia, found in both the developed and developing world, is the most common cause of anemia. Despite efforts over the last 25 years to reduce the prevalence of iron deficiency anemia, the number of years lived with disability as a result of this condition has increased. Iron deficiency anemia presents with a range of signs and symptoms, from fatigue and an inability to concentrate at work or at school to permanent stunting and impairment of cognitive development to serious complications in pregnancy and childbirth. In addition to the negative health impacts, iron deficiency is estimated to result in a loss of US $70 billion in the global economy each year. Technically, treating iron deficiency anemia should be simple; diversifying the diet or supplementing the diet with iron will alleviate the condition. However, for many people, access to varied diets is neither affordable nor possible, and supplements are expensive, not consistently available, and often culturally unacceptable. In addition, supplementation programs rely mostly on government programs for support and are not sustainable. The Lucky Iron Fish is a simple solution to this complex problem. Based on the age-old concept that food cooked in an iron pot will absorb iron leached from the pot, the iron fish is an ingot designed to deliver a standard amount of iron that can be absorbed by the body when it is used as directed during the cooking process. Clinical tests have shown that daily use of the Lucky Iron Fish can restore circulating and stored levels of iron and reduces the prevalence of anemia by ;43%.Download or subscribe to the Blood Advances Talk podcast at https://soundcloud. com/blooddvances.

The current review identifies the root causes of the problem, assesses the clinical impact of iron deficiency and iron deficiency anemia with a specific focus on the condition in developing countries, and outlines the potential solutions to address the problem. Iron deficiency, the most common micronutrient deficiency in the world, results from an imbalance in the access and use of iron in the body. Although it is found in the developing and developed world, it predominantly affects women and children especially those living in poverty. The clinical effects of iron deficiency are profound: mild deficiency results in the loss of concentration in children -affecting their performance at school, and reduces work capacity in adults -affecting their ability to work a full week of work; more profound effects can seriously and permanently damage cognitive development and pose serious health issues in pregnancy and child birth. Despite substantial international efforts to address iron deficiency, the levels have continued to rise over the last decade. As we have the technology to solve this problem, the Copenhagen Consensus Centre (which meets every four years) has identified iron deficiency as the principal health challenge facing the world: the health and economic burden falling predominantly on women of reproductive age.

Objectives: Iron deficiency -particularly affects women and children, especially those living in poverty. Lack of iron leads to weakness, hampers cognitive development, reduces the capacity to work and increases susceptibility to disease. Most treatments involve supplementation but these are often not affordable nor available consistently. Such approaches are not sustainable. Methods: We are commercializing a health innovation in Cambodia that, with ensuring social enterprise is included in every step of the process, has the capacity not only to cure iron deficiency but also be a sustainable approach. The innovation is known as the Lucky Iron Fish™: a small fish made of iron that weighs approximately 175g. Placing the fish in the cooking pot when preparing meals or sterilizing water releases sufficient concentrations of iron to alleviate iron deficiency (Charles et al., 2011; 2014). Results: In the commercialization process, we are including social enterprise at every step in the process. The fish are made from local scrap metal by local dealers and the quality control and safety assurance are carried out by the Royal University of Phnom Penh -rejected fish are recycled into machine tools. The fish are packaged in containers made of recycled garbage, constructed by landmine victims and the product is sold through local sales teams. Conclusions: The elements of successful social entrepreneurial activities will be discussed.