Appropriate Solutions for Anaemia Control

Iron deficiency and anemia in Benin and Vietnam

In developing countries, the prevalence of anemia in women and children is as high as 90%. Most of this anaemia is due to dietary iron deficiency, although other nutrient deficiencies and malaria and hookworm infection are also important.

Anaemia can lead to a number of adverse outcomes, including irreversible cognitive impairment and decreased physical capacity. Various interventions have been tried to control anaemia - each has its own strengths and weaknesses.

An ancient, but not well tested, approach is the use of iron cooking pots, which can leach iron into foods as meals are being prepared (see review). While we can be reasonably confident that iron cooking pots work when used regularly, it is difficult to get high usage rates due to the heaviness of the pots, their tendency to rust, and the metallic taste they give some foods. If these obstacles can be overcome, iron pots may be a useful tool for combating iron deficiency anemia.

In partnership with the University of Toronto and CARE Canada, we tested iron cooking pots in populations in Vietnam and Benin.

Objectives

The objective of this project was to test the effectiveness and cost-effectiveness of iron cooking pots in Benin and Vietnam, relative to iron-fortified Sprinkles, iron tablets, insecticide treated bednets (to reduce hemolytic anaemia), and antihelminths (to reduce fecal blood loss). Both cast iron and blue steel cooking pots were tested.

Results

• Procurement of inexpensive pots of suitable form and quality was remarkably difficult, particularly in Benin.
• Blue steel leaches more iron into typical foods prepared for Vietnamese children.
• Baseline levels of anemia in Vietnamese women and adolescent girls were remarkably low; in infants the level was moderate.
• Pot use compliance was reasonably high in both Benin and Vietnam, but various logistical difficulties prevented us from clearly answering the question about the relative cost-effectiveness of iron cooking pots. Most importantly, in Vietnam, the groups that were most in need of increased iron (i.e. infants six to 24 months) did not eat food from the family pot, but rather had their own pots, which were not made of iron (see reports one and two).
• The phenomenon of "regression-to-the-mean" may make iron interventions appear effective due to a statistical artefact. See our INACG 2004 presentation for details.

Recommendations

• A two-layered pot, with an aluminum outer surface and lid and steel inner layer has been developed. This pot has many of the desired properties of appearance and lightness, while still creating contact between the food and the steel (steel is >95% iron) and may be further tested. If you are interested in seeing the prototype, please contact us.
• The iron cooking pot may still be a worthwhile intervention, which requires further testing. HealthBridge is now seeking funding for further study.