Increased Availability of Micronutrient Rich Foods and Income among Women Farmers Participating in a Cluster Randomized Control Trial of Homestead Food Production (HFP) in Cambodia.

Objectives: Household food insecurity and under-nutrition are prevalent in Cambodia where there is a lack of dietary diversity and reliance on rice. To address these issues, HKI has implemented HFP to increase the availability and consumption of micronutrient-rich foods. We are currently integrating household level fishponds to enhance plant-based HFP; small nutrient-rich fish, consumed whole, are raised together with large fish, which can be eaten or sold. We aim to improve household food security, micronutrient intake and status. To report on the progress of our 24-month cluster RCT after one year intervention in Prey Veng Province. Methods: 90 clusters were established each consisting of a village model farm and 10 families headed by women farmers (n=990). Each cluster was randomly assigned to either: 1) HFP, 2) HFP plus aquaculture, or 3) control. A baseline survey was completed and process monitoring onging with production, and income data among other variables. Results: Median vegetable and fruit production increased by 8 kg and 4 kg, respectively in households receiving any HFP. Income generation from the sale of fruit and vegetables in HFP farms increased by 55%. Small and large fish production increased by 1 and 5 kg, respectively. Conclusions: Early in the intervention we are observing increased fish, fruit and vegetables production as well as income generation. We hope that this will translate into an improvement in nutritional and in in particular micronutrient status.

Impact of Infant and Young Child Feeding (IYCF) Practices on Growth in Young Children in Rural Cambodia.

Objectives: To evaluate the impact of IYCF education and practices on growth compared to an ecological control. Methods: As part of a randomized controlled effectiveness trial of micronutrient Sprinkles and IYCF education, all mothers received IYCF education. Group and individual sessions were delivered by health staff and trained village health workers. Anthropometry and IYCF were recorded at baseline (age 6 mo), endline (age 12 mo), and at two follow up points (age 18 mo and 24 mo) and compared with same aged children in the same province from the 2005 Cambodia Demographic and Health Survey (CDHS). Results: There was no treatment effect on growth so intervention and control groups were combined. At 6, 12 and 18 mo, 59%, 86% and 73% of children met minimum adequate WHO IYCF practices respectively in the study group compared to 33%, 62% and 47% for CDHS children. Stunting (HAZ <-2) prevalence at 6, 12, 18 and 24 mo was 11%, 19%, 32% and 38% in the study group compared to 11%, 37%, 62%, and 44% for CDHS children. Underweight (WAZ <-2) prevalence at 6, 12, 18 and 24 mo was 14%, 16%, 21% and 26% in the study group compared to 18%, 28%, 37% and 21% for CDHS children. Differences for stunting and underweight were significant (p<0.05) at 12 and 18 mo. Conclusions: IYCF education to study mothers improved IYCF practices and slowed stunting and underweight significantly at 12 and 18 months of age compared to CDHS children. Strengthened IYCF education and practices improved growth in children in this low-income, rural population.

Impact of Genetic Hemoglobin (Hb) Disorders on the Effectiveness of Micronutrient Sprinkles in Reducing Anemia in Young Children in Rural Cambodia.

Objectives: To evaluate the impact of genetic Hb disorders on the effectiveness of 6 months of daily micronutrient Sprinkles for infants age 6-12 months on anemia. Methods: As part of a randomized controlled effectiveness trial, subjects were screened for genetic Hb disorders at aged 18 months on whole blood using the SEBIA MINICAP analyser, HEMOGLOBIN (E) program, and IC α THAL test to detect major Hb variants and α-thalassemia. Anemia (Hb < 110 g/L) was measured at baseline (age 6 mo), endline (age 12 mo), and at two follow up points (age 18 mo and 24 mo) for children with and without genetic Hb disorders. Results: Half of all children had a genetic haemoglobin disorder (at least 15 types). At baseline, overall prevalence of anemia for children with normal Hb was 81% versus 88% for those with any genetic Hb disorder. At endline, anemia prevalence for the intervention group with normal Hb vs genetic Hb disorder was 60.2% versus 72.0% (P = 0.02) and for the control group 81.1% versus 88.8% (P = 0.03), respectively. At further follow-up, anemia decreased in both the control and intervention groups. However those with any genetic Hb disorder remained more anemic with varying levels of anemia according to the disorder type. Conclusions: Sprinkles had a similar proportional effect regardless of overall genetic Hb status indicating that children with genetic Hb disorders can effectively utilize iron and micronutrients to reduce anemia. Sprinkles can be effective in populations with a high prevalence of genetic Hb disorders.

Genetic Hemoglobin Disorders and Anemia in Cambodian Women of Reproductive Age.

Objectives: To examine associations between anemia (Hb <120 g/L) and genetic hemoglobin disorders in Cambodian women (18-45 y). Methods: Blood samples of 450 women from Prey Veng province were analyzed with consent. A complete blood count was performed and the presence and typing of hemoglobin disorders was carried out by PCR and hemoglobin electrophoresis. Serum ferritin, serum transferrin receptor, c-reactive protein and other micronutrients were also assessed. Results: Overall, the prevalence of anemia in women was 33.1%, of which 61% was microcytic (Hb <120 g/L and MCV <80 fl). The prevalence of genetic hemoglobin disorders was > 55% (most commonly alpha-thalassemia, Hb E and Hb Constant Spring) and were significantly correlated with anemia. Of women with anemia, over two-thirds had an abnormal genetic hemoglobin type. Less than 5% of women had a low serum ferritin (< 15 µg/L). Conclusions: The most common form of anemia in Cambodian women is microcytic anemia. Genetic Hb disorders are major contributors to anemia in this region. Low serum ferritin was uncommon suggesting that iron deficiency is not a major problem. However, genetic Hb disorders and concurrent infections may be confounding the interpretation of ferritin and leading to an underestimation of iron-deficiency anemia. Other indicators of iron status and other micronutrients involved in anemia are being examined.

Suboptimal Thiamin Status is Common in Women of Childbearing Age in Rural and Urban Cambodia.

Objectives: Thiamin deficiency causes beriberi, which is often fatal in infants who do not receive rapid treatment. Infantile beriberi appears to be common in Cambodia, likely because thiamin deficient mothers produce breast milk low in thiamin. Strategies may be needed to improve thiamin status; however, population representative thiamin data is required. Therefore, we measured erythrocyte thiamin diphosphate (TDP) concentration to assess thiamin status in Cambodian women of childbearing age. Methods: A representative sample of non-pregnant and non-lactating women of childbearing age (20-45 y) in urban Phnom Penh (n=146) and rural Prey Veng (n=156), and for comparison purposes, a convenience sample of urban women in Vancouver, Canada (n=49) were recruited. TDP was measured using HPLC. Results: The response rates were 91% in Phnom Penh and 98% in Prey Veng. Mean ± SD erythrocyte TDP was 100±38 and 87±26 nmol/L in Phnom Penh and Prey Veng, respectively; which were lower than in Canadian women, [128±38 nmol/L (P<0.001)]. Among Cambodian women, thiamin deficiency (TDP < 70 nmol/L) was more prevalent in Prey Veng (24%) than Phnom Penh (12%). Similarly, insufficient thiamin status (TDP < 90 nmol/L) was more prevalent among women living in Prey Veng (59%) than Phnom Penh (39%). Of Canadian women, 84% were thiamin sufficient (TDP > 90 nmol/L). Conclusions: We found a high prevalence of suboptimal thiamin status in Cambodian women of childbearing age, particularly in rural Prey Veng. Supplementation, fortification, and/or food-based strategies may be required to improve thiamin intake in Cambodian women. Funding: UBC Vitamin Research Fund.