A Model for Change – Treating Paediatric Anaemia in the High Mountains of Perú
In the country of Perú anaemia is more prevalent than chronic malnutrition in children. In some areas of the country, anaemia rates in children under five are in excess of 60%. In the Department of Arequipa, in the Province of Caylloma and the Districts of Tutti and Sibayo, nearly 1 out of every 2 children between the ages of 6-months and 3-years are anaemic.
In children, severe anaemia can impair growth and motor and mental development. Children may exhibit a shortened attention span and decreased alertness, with severe cases sometimes leading to an increased risk of heart problems and stroke.
One of the biggest challenges in treating anaemia is recognizing the multi-factorial elements that make a person vulnerable to anaemia. These include poverty, education, social and cultural influences, health services access, and geopolitical constraints. Developing a comprehensive program that will not only provide evidence-based treatment for patients with anaemia, but also offer prevention to high-risk populations - requires a comprehensive model.
Currently, the Peruvian Ministry of Health (MINSA) standards for the treatment of paediatric anaemia recommend treatment with ferrous sulfate solution (FeSO4), though a large volume of patients discontinue treatment due to adverse effects.
As such, it’s been difficult to understand the impact of any community-based treatment programmes focusing on the vulnerability of children under 3-years old due to poor treatment adherence.
While treating iron deficiency anaemia is usually relatively straightforward, it does require a holistic approach that focuses on both prevention and treatment - in addition to an understanding of the various cultural and social constraints that influence adherence and knowledge uptake. This project focused on low-income areas in an underserved community and as such, uptake, utilisation and also community acceptance were all anticipated challenges.
Truly tackling the complexity of anaemia and building a sustainable model for change requires collaboration. To this end, a coalition of organisations from a number of sectors have joined together to create a project focused on the prevention and treatment of iron deficiency anaemia in vulnerable populations living in poverty.
A simple solution to a complex problem
Prevention: Lucky Iron Fish
The primary cause of anaemia in Perú is iron deficiency, which results in lower levels of haemoglobin in the blood. The reduced levels of haemoglobin in the blood decreases the transportation of oxygen throughout the body and vitally, to the brain. The condition limits children's growth and development and weakens their defences from infectious diseases.
Iron is a micronutrient required to play essential roles in human development and health such as brain development, cognitive performance, physical growth and immune development. Its availability is fundamental in the early development of children, mainly from gestation to 24 months of age.
The Peruvian government has aggressively targeted anaemia reduction in vulnerable and underserved areas, with ambitious targets set for anaemia reduction in children under 36 months
over the next few years. There is a clear need for an innovative approach to meet or exceed these targets – and, the Canadian social enterprise Lucky Iron Fish has the potential to greatly contribute to the national and regional effort to fight anaemia.
Lucky Iron Fish is a simple solution to a complex problem. Founded in 2012, Lucky Iron Fish is a clinically proven cooking tool that has been shown to significantly reduce iron deficiency and anaemia. The fish is boiled in a litre of water, acidified with 2 or 3 drops of lemon juice, for 10 minutes and releases iron during the cooking process. According to independently supported and confirmed research, boiling of the iron ingot fish releases between 6mh-8mg of bioavailable iron per litre, thus benefiting not only the child but the whole family eating the same food.
Empowering Communities through Education
Education: MINSA Health Promoters
Each participant enrolled in the project received an iron fish and was instructed in the use of the cooking aid through demonstration sessions in various food preparations. In addition to the fish, and also to further extend its benefits, training workshops were provided to participants families enrolled in the project in the treatment and prevention of iron deficiency anaemia.
Home visits were carried out at 3, 6 and 12 months to observe the proper use of the Lucky Iron Fish and verify proper dietary
training. All training was carried out by a dedicated multidisciplinary team from the Professional School of Nutritionists and nutrition students from the Professional School of Nutritional Sciences at the Universidad Nacional de San Agustin de Arequipa.
A series of posters were also designed to help community participants consider the various ways anaemia, food and the Lucky Iron Fish ingot would be used in a holistic approach to the identification and control of anaemia.
The posters included:
- Knowing the foods that fight anaemia
- Knowing the friends and enemies of iron
- The best “bang for the buck” foods with iron
- The brain most vulnerable to anaemia-Use and cleaning of Lucky Iron Fish
Dr Wayne Centrone, Founder and President of Health Bridges International is both an anaemia Subject Matter Expert and an Advisor for the Peruvian project. Speaking about the project, he explained that the education element of this pilot had a huge impact.
“People aren’t lacking knowledge; they are lacking in the clear pathways they can utilize in their lives to apply that knowledge”.
Wayne further commented,
"One of the biggest challenges in global health is the belief in a single intervention, idea, or community based program can be an panacea to change. No single intervention, idea or program is going to be culturally, socially, linguistically and economically diverse enough to work globally. Instead, we should be focusing on the development of flexible, evidence-informed models that can be modified at the local, community-based level to respond to public health challenges. This project did just that. It brought together multidisciplinary, complimentary partners and provided the model framework for sharing resources and ideas. Through this pilot process, we learned that such a model can be applied to address a multitude of community-based global health challenges. Why? Because the model addresses the multitude of issues that sit at the core of global health challenge - poverty, food insecurity, literacy, health disparities, equity and equality."
Putting Actionable Information in the Hands of the Patient
Monitoring: The Aptus Hemoglobinometer
In order to evaluate the impact of treatment with the use of Lucky Iron Fish it was essential that participants had their haemoglobin levels monitored at key points throughout the 12-month pilot project.
Haemoglobin measurements were collected through the use of the Aptus Hemoglobinometer, a point-of-care test providing almost immediate haemoglobin measurements for the research team and the patients enrolled in the study.
Aptus was the first CE marked product created by Entia and since its development has been distributed in 8 countries - primarily for Anaemia management.
The light-weight device operates on the principles of centrifugation and photometric measurements to determine haematocrit and haemoglobin through a simple finger prick blood test. The following features made the device particularly suitable for this project:
The following features made the device particularly suitable for this project:
- 2-year shelf life
- Touch screen device for ease of use
- Rechargeable battery
- 100 test capacity on a single charge
- Blood screening and pregnancy functions
- Small portable size
Blood samples were taken at the beginning of the study as a Baseline, then again at 6 months and 12 months after the registration of the project. While the tracking was intended predominantly for monitoring purposes, the fact that patients could see their results in front of them had an impact. It empowered them with information.
Entia’s mission with Aptus has always been to improve access to care, by taking tests usually done in a medical setting and analysed in a lab and making them more accessible. With the Aptus, healthcare providers can perform tests and access results immediately and recommend appropriate interventions, while a patient can see their results and use that information to make better and more informed decisions about their day-to-day health.
Dr Wayne Centrone commented:
“Entia represented a critical part. If people don’t know their information, how can they be actionable about it in their lives”.
“The Aptus units continue to be very popular and well received by the testers and the participants. We are noting a lot of interest in how this technology. People are asking how they can leverage the technology in a broad continuum of health and medical care environments around Latin America.”
The Future of the Project
By combining prevention, education and monitoring – Health Bridges International in collaboration with Entia and other partners were able to offer a holistic solution to the concerningly high level of iron-deficiency anaemia in this rural area of Perú. Both Health Bridges International and their partners embarked on this mission with the aim to offer a long-term solution to the people in these communities, rather than just a quick fix.
To ensure the solution presented was a long-term one, there was a heavy focus on educating the community. Making sure they had the tools and knowledge they needed to take control of their health well after the project was complete.
The success of the project so far has stimulated much interest and policy level discussions in other parts of Southern Perú, and it’s hoped that this Anaemia Prevention and Control Pilot Project will eventually form a collaborative model that can be rolled out and used to address anaemia challenges in other parts of the world.
If you share our goal of empowering patients through treatment and monitoring in the home, we'd love to discuss partnership opportunities. Get in touch today.
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