Fortified Rice for School Children in Cambodia
Condition: Micronutrient Status
Study type: Interventional

Summary: 
      Rice fortification has been shown to be safe and effective in improving micronutrient status
      in many studies around the world. However, most studies have been done in Latin America,
      Africa and India. There are no studies available from Cambodia. Moreover, there is no data
      available on whether fortified rice can reduce the prevalence of anemia in school children in
      Cambodia, nor whether there will be additional benefits, such as better learning capability
      of school children or fewer days missed due to better health. To inform WFP, Cambodian policy
      and the public on the potential benefits of fortified rice on health and development for
      Cambodian school children, an intervention study will be conducted in Kampung Speu province
      during the 2012 - 2013 school year. The study will be conducted by IRD, PATH and WFP. Sixteen
      schools will be selected to receive either the normal rice provided by the WFP school meal
      program, or fortified rice instead of normal rice. Three (3) different types of fortified
      rice will be tested, to identify the best type of fortified rice. In addition, 4 schools with
      no school meal program will be selected to serve as control. School attendance and morbidity
      will be followed in all children in the participating schools over the whole school year.
      Biochemical indicators of micronutrient status will be determined in a subgroup of children
      (25% of the children), which requires collection of blood, urine and stool samples.
    

Detailed description: 
      Micronutrient deficiencies are a major health problem in many developing countries, including
      Cambodia. Micronutrient deficiency results in poor health, with a much higher risk for
      mortality in vulnerable groups such as pregnant women and young infants, and delayed physical
      and cognitive development, resulting in retarded growth and stunting. It thereby prevents
      children from reaching their full potential as micronutrients play an important role in
      children's cognitive and motor development.

      The UN World Food Program (WFP) provides a daily school meal to ~500,000 school children in
      Cambodia. The main objective of the school meal program is to increase school attendance.
      Although the school meal provides salt fortified with iodine, and vegetable oil fortified
      with vitamin A, the school meal provides an excellent opportunity to improve micronutrient
      status of school children by providing them with rice fortified with vitamins and minerals
      such as zinc, vitamin A, iron, folic acid and vitamin B12. This is likely to reduce the
      prevalence of anemia in school children and improve health and school performance. Anemia is
      a major problem in school children in Cambodia. A recent study by WFP showed that more than
      half of the school children were anemic.

      Rice fortification has been shown to be safe and effective in improving micronutrient status
      in many studies. However, most studies have been done in Latin America, Africa and India.
      There are no studies available from Cambodia, except for an acceptability study of fortified
      rice conducted by WFP and the Institute of Research for Development (IRD) in 2010 in Kampung
      Speu. This acceptability study showed that fortified rice has an excellent acceptability
      among school children, parents and teachers. However, there is no data available on whether
      fortified rice can reduce the prevalence of anemia in school children in Cambodia, nor
      whether there will be additional benefits, such as better learning capability of school
      children or fewer days missed due to better health.

      To inform WFP, Cambodian policy and the public on the potential benefits of fortified rice on
      health and development for Cambodian school children, an intervention study will be conducted
      in Kampung Speu province during the 2012 - 2013 school year. The study will be conducted by
      IRD, PATH and WFP. Sixteen (16) schools will be selected to receive either the normal rice
      provided by the WFP school meal program, or fortified rice instead of normal rice. Three (3)
      different types of fortified rice will be tested, to identify the best type of fortified
      rice. In addition, 4 schools with no school meal program will be selected to serve as
      control. School attendance and morbidity will be followed in all children in the
      participating schools over the whole school year. Biochemical indicators of micronutrient
      status will be determined in a subgroup of children (25% of the children), which requires
      collection of blood, urine and stool samples.

      The study will be submitted to the Ethical Committee of the Ministry of Health for approval,
      and the Ethical Review Board of PATH, USA. Furthermore, approval will be obtained from the
      Ministries of Health, Education and Planning prior to the commencement of the study.

      Potential benefits of the study includes the immediate treatment of school children found to
      have severe anemia (hemoglobin < 70 g/L) and improved health and cognitive development for
      all children receiving fortified rice. Potential disadvantages and risks of the study include
      side effects of blood taking in the subgroup of children and the disruption of classes for a
      few days during the data collection.

      If the results of the study show improved health and cognition for school children receiving
      fortified rice, provision of fortified rice to all 500,000 Cambodian school children taking
      part in the WFP school meal program in Cambodia could become a priority.
    

Intervention name(s): Fortified rice cold extruded kernel; fortified rice warm extruded kernel; fortiified rice hot extruded kernel
Intervention type(s): Dietary Supplement; Dietary Supplement; Dietary Supplement
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: vitamin A; iron; zinc; school children; fortified rice; morbidity; growth