Monthly Archives: August 2012

Blood Analysis: Part 2

Picking up from where we left off…

Once the blood arrived at the NIPHL from the field via the Blood Taxi, one of two things happened.

1. For the blood collected in the 4.5 mL tubes containing the EDTA:  a complete blood count (CBC) was conducted. This provides information on the total number of red blood cells, hemoglobin, white blood cells, and platelets present in a person’s bloodstream. The red portion undergoes gel electrophoresis  for hemoglobinopathy testing. This separates proteins in the blood so that the amount and type of hemoglobin can be determined. Low levels of hemoglobin indicate anemia.

2. For the blood collected in the 7 mL trace element free tube: the samples were prepped and sent to UBC. Researchers at UBC will be performing a serum analysis to trace ferritin, vitamin B12, folate, serum retinol (vitamin A) and carotenoids (another form of Vitamin A), and zinc. The data collected should provide us with a clear picture of how much iron, vitamin A, vitamin B12, folate, and zinc was present in a woman’s diet before and after we introduced HFP and aquaculture. These biochemical indicators will allow us to quantify some of the results of our intervention.

Here are some pictures I took in the lab:

Blood Analysis: Part 1

 As promised, I wrote about the “5Ws” of our blood collection: who, what, when, where, and why. I even threw in the “how”. Today’s post focuses on what happened in the field.

One of the most important (and expensive!) components of FoF is the blood collection and subsequent analysis. This process provides us with concrete evidence that there are more (or less) nutrients in a person’s body by looking at biochemical indicators of nutritional status. Obtaining this information is what sets FoF apart from previous homestead food production interventions.

During baseline blood was collected from 450 women. We will collect samples from the same 450 women during endline for a paired analysis. While we considered collecting blood from children as well, it was decided this would be too traumatic. Plus, we had other less-invasive methods available to assess whether or not children were anemic (finger-pricking to measure hemoglobin).

When we arrived in each village, a random lottery was held. Each house was assigned a number (1-10) and slips of paper with those numbers were randomly selected. In the end, we selected 5 women from each village. Women were given an ID number and asked to report to their local Health Center the day after our visit to their village.

The morning of collection, the local Village Health Volunteer (VHV) came with the women and their children to the Health Center. The VHV was responsible for making sure everyone who agreed to provide samples was present. Most mornings everyone was at the Health Center by 7:30 am, as they had to fast for a minimum of 3 hours before providing samples. When all the women assembled, they were briefed by Mr. Tee from HKI.

One at a time, the women entered a room where a technician was working. The technician drew 3 vials of blood. After, the women were given a sarong as a thank you for their participation.

Two of the vials collected were 4.5 mL test tubes containing Ethylenediaminetetraacetic acid(EDTA), which is an anticoagulant, that prevents blood from clotting. They were then packed on ice and transported via a car we dubbed the “Blood Taxi” to the National Institute of Public Health Laboratories (NIPHL) in Phnom Penh for further processing.

The third tube collected was a 7 mL trace element free tube. It was centrifuged in the field. This separated the blood into 3 components: the serum plasma, the buffy coat (most of the white blood cells and platelets), and the erythrocytes (red blood cells). The serum was packed on ice and sent to the NIPHL, where samples were stored at -70 degrees Celcius until the end of baseline.

Some pictures:

Check back tomorrow to find out what happened once the blood arrived at the NIPHL.

World Breastfeeding Week

This week is the 20th World Breastfeeding Week, an initiative started by the WHO (World Health Organization) and UNICEF (United Nations Children’s Fund) to promote breastfeeding, especially in developing countries. While New York City Mayor Bloomberg’s breastfeeding initiative, which was appropriately announced this week, has ignited a heated debate in Western media about a mother’s right to choose formula or breastfeeding, the situation is quite different in developing countries. (To read about Latch On NYC, check out the press release here.)

The benefits of breast milk cannot be overstated in developing countries (and developed too).

  • Breast milk is the only source of Immunoglobulin A, an antibody required to protect newborns from illness.
  • It is a guaranteed source of clean water.
  • Despite a mother’s nutritional status, it will always retain the proper balance of fat, protein, and other nutrients necessary to promote healthy growth in babies and infants, whereas mothers may end up watering down formula to make their supply last longer. Additionally, the fat and protein in breast milk are more easily absorbed than the nutrients in formula, and breast milk is easier for the baby’s sensitive gastrointestinal tract to handle.
  • The iron in breast milk is more readily absorbed than the iron in cow’s milk or formula (50% versus 10%).
  • It’s free!

There are numerous benefits to the mother as well, but I’m only focusing on the nutritional and immunological benefits to children right now.

Formula companies may send representatives to developing countries to promote their product and distribute free samples to new mothers, even though this has been declared illegal by the WHO in a document referred to as “The Code” (The International Code of Marketing of Breast-Milk Substitutes – you can read it here). The problem is that once the mothers go home, they often cannot afford to buy more formula, but they are no longer producing enough milk since they have been feeding their babies formula. In 2012, most (if not all) formula companies ignore The Code; hence the need for World Breastfeeding Week.

Cambodia has the highest rate of mortality for children under 5 in Southeast Asia due to malnutrition and associated illnesses (such as diarrhea and respiratory infections). This is why nutrition education is an important component of FoF. Our baseline survey’s module on knowledge and attitudes should help us identify what information women are lacking so that we can provide them with the tools to help their children. We will also be incorporating the country’s current complementary feeding strategy, which educates parents on how and when to start adding nutritious foods to a breast milk diet. The Phnom Penh Post published an informative article about this two months ago (you can find it here). The WHO recommends that women should breastfeed exclusively until 6 months of age, and then start introducing foods while continuing to breastfeed until their child is at least 2 years old.

The theme of this year’s World Breastfeeding Week in Cambodia is “Baby needs mom made, not man made“. This slogan has been printed on t-shirts and banners to promote the message. In addition, there will be a round-table discussion on the dangers of bottle feeding, a radio call-in program for women to ask questions related to bottle feeding, press releases in local papers and TV spots promoting this year’s theme.

For more information about World Breastfeeding Week, check out the World Breastfeeding Website.

Updates

Unfortunately the blog has been neglected lately due to other projects, such as working on our 6-month Interim Technical Report for the IDRC. It’s a huge undertaking, involving several people in Vancouver and Phnom Penh. Thankfully it’s coming together and should be a wealth of well-organized information on what FoF has accomplished in the past 6 months.

Yesterday we took a time-out from working on the report to go visit the National Institute of Public Health Laboratories (NIPHL) in Toul Kork, which is at the northern end of Phnom Penh. It was interesting to see where the blood collected in the field has gone to be processed, and what kind of machinery is being used. I took pictures that will appear on the blog later.

We also relaxed in the evening by watching a topically relevant film, “Salmon Fishing in the Yemen“. The plot focused on a wealthy sheik in Yemen who wants to introduce the sport of fishing to his country, despite the geography of the region. While there were some obvious differences between a film set in the Middle East and what we’re accomplishing in Cambodia, the sheik makes an astute observation when he says that his project will address the growing need for sustainable food sources and that a river will provide not just fish, but water to the region that can be used to grow fruit as well. Our fishponds will be working in tandem with homestead food production to create a symbiotic relationship between aquaculture and farming to ensure year-round sustainable production of nutritious food. Pretty smart, don’t you think?