ANN ARBOR—The University of Michigan School of Public Health has received a $1.3 million grant from the Bill & Melinda Gates Foundation to study the impact of the fish processing industry on persistent anemia among adolescent girls and women in Ghana.
Andrew Jones, the John G. Searle Assistant Professor of Nutritional Sciences in the School of Public Health, leads a team that will determine if increased consumption of fish produced in an environmentally safe way, along with additional interventions, could be answers to one of the greatest public health concerns in this region and many other low- and middle-income countries.
"Anemia is a challenging disease to address because it has multiple causes," Jones said. "Our goal with this project is to simultaneously address several of the causes including improving diets to include more iron-rich fish, promoting behavior change to prevent infection and illness, increase the incomes of women who are involved in fish processing—as the additional income could lead to multiple health benefits—and, reduce exposure to harmful biomass fuel smoke, which can contribute to anemia as well as respiratory illness."
In sub-Saharan Africa, 38 percent of nonpregnant women and 48 percent of pregnant women of reproductive age are anemic. In addition to higher mortality and reduced aerobic work capacity, extreme iron deficiency among pregnant women can result in preterm delivery, babies with low birth weight, and even child death, Jones said.
Women in Ghana and throughout West Africa are integral to the region's fishing industry with roles having to do with processing, selling and storing fish. And while some of the protein-rich fish makes its way into homes it is not enough to improve diets.
"What is challenging is that nutritionally vulnerable groups like women and children don't always consume enough fish or other animal-based foods to positively impact health," Jones said. "In addition, while nutritional deficiencies, especially iron deficiency, are very important causes of anemia, they only contribute to about 25-50 percent of the problem in most contexts. Other factors like infection and environmental exposures also play a role."
Specifically, the team that also includes the University of Ghana and several nongovernmental organizations will conduct a pilot-scale randomized trial involving 120 subjects from 12 communities among fisheries along the Gulf of Guinea and Lake Volta.
Three interventions will focus on education to increase fish consumption and improve water, sanitation and hygiene practices; improving women's income from fish processing through a group-based microcredit scheme; and introducing better technology and practices for fish smoking.
Current methods used to smoke fish—the culturally preferred way to preserve it for consumption in Ghana—have harmful health effects. In fact, some studies have shown that the toxins and pollutants created by smoking fish for hours in open barrels that burn biomass fuels could be contributing to anemia and other illnesses.
"Use of improved smoke ovens can help make the smoking process less hazardous for women, but also make the smoked fish product safer to eat," Jones said.
The team will use survey data, direct observations, participant diaries, dietary and occupational exposure assessments, and blood and stool specimens to evaluate changes in anemia, micronutrient states, inflammation and infection, as well as changes in knowledge, attitudes and behaviors.
They will conduct much of this research with the help of mobile monitoring devices through a partnership with Viamo, a social enterprise tech company.
The Gates Foundation funded preliminary work by the team that led to the current project. The original research was aimed at understanding if and how livestock rearing and fisheries more broadly influenced anemia among adolescent girls and women. The current research grant is co-funded with the Gates Foundation by the United Kingdom Department for International Development.
From the earlier work, the team identified fisheries as a very promising sector for intervention, given that women are central to fisheries supply chains in Ghana, and since there are multiple pathways through which their involvement in the industry could influence anemia.