Tag Archives: Blood Samples

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.

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?

Baseline: The Survey

My apologies for not posting over the past few days. The posts I’ve planned for the next week take longer to write as they involve some research.

Anyways, to recap: I’ve discussed how we picked the households for FoF and what it’s like to be out in the field. I’ve also briefly mentioned what the purpose of our project is: to improve household food security and the nutritional status of women and children in rural Cambodia by combining HFP and aquaculture (it says so on the site’s banner). The word baseline keeps popping up – in post titles, categories, my writing. But what IS baseline? What are we trying to measure, and how are we measuring it? These are the questions I’ll be answering in my next few posts.

All 900 houses are completing a one-hour survey during baseline. The enumerators have a set of questions they work through, as well as a guide that explains how to record answers. When all of the questions have been answers, the women and any of their children under the age of 5 make their way to the anthropometry station to be measured and pricked. This process will be repeated after the intervention (ie after the farms and fish ponds have been established) during what is called the endline survey.

Half of the women are also completing 24-hour recalls and providing blood samples. I’ll discuss this another day.

Going back to the survey – what are we asking the women? What information do we hope to obtain from their answers?

The survey is divided into 8 modules: Household Information, Water and Sanitation, Homestead Food Production (subcategory: animal raising), Food Consumption, Mother’s Nutrition and Health, Knowledge and Attitudes, Household Food Security, and Measurements and Hemoglobin. The first 7 modules contain questions asked during the interview, and the last module is filled in by the enumerators trained in anthropometry and hemoglobin analysis.

Module 1: Household information

Here we try to ascertain the main characteristics of the household. We want to know how many people live in the house, the highest level of education obtained by the mother and father, annual income, who makes decisions about income, health care, and other important issues (mother, father, both?), what material goods the house has, and what materials the house is made out of. These questions provide a detailed picture of the family’s socioeconomic status.

Module 2: Water and Sanitation

We want to learn about the family’s hygiene (how often they use soap, where they go to the bathroom), and whether or not they have decent access to clean water.

Module 3: Homestead Food Production

We are trying to establish what kind of food, if any, people grow for their own use and to sell. This includes gardens, fishponds, and animal raising. This helps us gain insight into a variety of things, such as what food is available in a household, how familiar people are with HFP and aquaculture, what kind of income they make.

Module 4: Food Consumption

The most direct way of assessing nutritional status. We want to know what people eat, and how often. Because of our interest in aquaculture, we want to get as specific as possible when discussing fish. Therefore we ask people if they consume 10 common species of fish (5 big, 5 small), and we also leave room for any species not on the list. To help with this section, all enumerators carry a fish atlas with them, which has pictures of 36 fish common in Cambodia for easy identification of species consumed. We also want to know what nutrients they are or aren’t getting. Our questions specifically ask about dark, leafy greens (iron), fruit and vegetables with orange insides (vitamin A), grains (carbohydrates), organ meats (iron, protein), animal protein and oil, fat, and butter (dietary fat). Finally, we want to know where their food comes from (home, market, gift).

Module 5: Mother’s Nutrition and Health

The purpose of this section is to look at anemia and pregnancy. We ask if/when women have taken iron tablets, and we write down their current pregnancy status (not pregnant, or pregnant and how many months along they are). We also have a question about night blindness during pregnancy, as night blindness is a strong indicator of vitamin A deficiency.

Module 6: Knowledge and Attitudes – This is where we assess what women know about proper nutrition for themselves and their children. We ask how much they think they should feed their children, when they should introduce solid food, and if they can identify which foods are good sources of certain nutrients such as vitamin A and iron.

Module 7: Household Food Security – The last module in our survey tries to determine how food secure a household is by asking women if they worry about getting enough food for their family, or the right kinds of food, and whether or not they sometimes have to skip meals or eat famine foods (foods that make you feel full but don’t provide a decent amount of nutrients).

Hopefully this provides some insight into the kind of data we are collecting during baseline and why we care about this information. I’m going to try to film videos in the field tomorrow. Between my iPhone, laptop, and camera, I should be able to get some footage. Wish me luck!