"Work-place Nutrition Improvement Project by Introduction of Fortified Rice in Cambodia"

Feasibility study (1997-1998)
The National Anemia and Nutrition Risk Factor Survey (1995) reported that anemia is highly prevalent (40-50%) among children and women of reproductive age. The study concluded that more than 80% of the national population consumes commercially produced fish sauce regularly. Also the study concluded that NaFeEDTA has high potential as an iron fortificant in fish sauce due to favorable taste, color and smell.

Storage and stability test and sensory evaluation (1999)
The storage and stability test concluded that the addition of NaFeEDTA makes fish sauce slightly darker, but this color change occurs to ordinary fish sauce by a natural degradation process. Also the study recommended using amber glass bottles or clear bottles under indirect or limited sunlight to prevent accelerated degradation (1). The bioavailability trial confirmed that daily intake of iron fortified fish sauce positively influenced the iron status of the study participants (2). The sensory evaluation was conducted using 85 Vietnamese women, who compared the color, flavor, taste and overall acceptability of iron-fortified fish sauce (5mg Fe/10ml) and ordinary fish sauce. No significant difference in sensory profile between two types of fish sauce was found.

Efficacy Study (April to October, 2000)
A randomized controlled trial was conducted with 152 anemic women in the Red River Delta of Vietnam. The study participants received either 10mg iron as NaFeEDTA / 10ml fish sauce or non-fortified fish sauce with lunch, six days per week for 6 months. At the conclusion of the trial, hemoglobin and serum ferritin concentrations were found to have improved in the intervention group. The study identified that regular consumption of fish sauce fortified with NaFeEDTA improved iron status significantly and decreases the prevalence of anemia (3).

Effectiveness study / market trial (2001-2003)
A randomized double blind village-based intervention study was conducted over 18 months. All families of two communes (an estimated 14,000 people) received iron fortified fish sauce (5mg/10ml). Results obtained from selected group of 288 women verified that the hemoglobin concentration increased and the prevalence of anemia decreased following daily intake of iron fortified fish sauce (4).

National launch (2005-2009)
Based on these findings, NIN received financial support from GAIN (Global Alliance for Improved Nutrition) to initiate the national launch of an iron fortified fish sauce program. The program called for 10 large fish sauce factories to produce iron fortified fish sauce over 5 years. The program consisited of production/distribution, quality assurance, social marketing/consumer education and monitoring/surveillance. ILSI Japan CHP provided professional support to ensure a successful national launch. By the end of the program, more than 575,000 people had access to iron fortified fish sauce nationwide.

Feasibility study (2004)
According to the Demographic Health Survey (2000), the anemia prevalence is approximately 57% among children, and 62% among women of reproductive age. The study conducted in Kampot province showed that 62% of families used fish sauce 7 days a week, for an average of 26ml/meal/family. The study concluded that the fish sauce is an appropriate food vehicle for fortification with iron in order to decrease the high prevalence of anemia in Cambodia.

Storage and stability test and sensory evaluation (2004)
The storage and stability test conducted in Japan showed that the iron fortified fish sauce darkened the fish sauce slightly, particularly fish sauce made with river fish which start as a clear amber color. The sensory evaluation was conducted using 90 Cambodian people using iron fortified soy sauce and iron fortified fish sauce. There was no difference in the preference scores between iron fortified soy sauce and ordinary soy sauce. For the iron fortified fish sauce, the preference scores of aroma, color, and taste were significantly higher than those of ordinary fish sauce.

Efficacy Study (Jan-Jun 2005)
The randomized controlled trial was conducted with 140 anemic school children (6-21 years old) in Kampot province. 10ml of fish sauce were served as lunch meal for 17 weeks. The study indicated that regular consumption of iron fortified fish sauce under strict control significantly improved iron status among anemic school children (7).

Effectiveness study / market trial (2007-2009)
A market trial using iron fortified fish sauce and soy sauce was conducted in Kampot province, Siem Reap province and Phnom Penh for 2 years. Three fish sauce and soy sauce factories at each study site installed fortification facility and produced iron fortified fish sauce and soy sauce containing 4mg Fe/10ml. The iron fortified fish sauce and soy sauce were distributed through normal market channels, its quality was checked in provincial laboratories. The social marketing and health education was provided through RACHA's network. The result demonstrated that the consumption of fortified fish sauce and soy sauce significantly reduced anemia prevalence and improved iron status among anemic people.

National launch (2010〜)
In July 2010, the workshop was held to develop consensus among stakeholders on action necessary to sustain and expand iron fortification programs using fish sauce and soy sauce as a strategy for reducing IDA throughout Cambodia. A proposal for a national launch was agreed to by the Global Alliance for Improved Nutrition (GAIN) in March 2011. Inviting industries and government officials, the national workshop for launching project iron fortified fish sauce and soy sauce was held in Novermber 2011. A national kick-off meeting will be held in 2012.

India
Partner: ILSI India

Flour/ Rice fortification with iron and lysine

Feasibility study (2012)
To be up-dated