Availability, acceptability, and utilization of micronutrient fortification for children 6-23 months in three districts in Ghana
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Date
2024
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World Nutrition
Abstract
Background
Micronutrient deficiencies result from multiple factors, including inadequate intake of
micronutrients (vitamins and minerals) from nutrient-rich diverse diets. Point-of-use
fortification with a nutritional supplement powder is recommended to address
micronutrient deficiencies and anemia among infants and young children (6-23 months),
particularly, in low-income countries. In Ghana, about a quarter of children aged 6-59
months are anemic, or deficient in iron and vitamin A. World Vision Ghana (WVG)
implemented the integrated Improved Feeding Practices (IFP) project between 2020 and
2023 in three districts in Ghana to improve diet quality and practices of women of
reproductive age, and young children below age two years. One component of the project
involved the distribution of a nutritional supplement powder (KOKO Plus). This is the
second in a series of four papers that document the implementation and outcomes of the
IFP project; the other papers are published in this journal. The current paper assessed the
availability, acceptability, and utilization of KOKO Plus to households who participated in
the IFP project as well as lessons learned from implementing the intervention.
Methods
A mixed-methods design was used, triangulating primary and secondary data. Secondary
data originated from a review of IFP project documents, including project mid-year and
annual reports, and implementation plans across the three interdependent components of
the IFP project. Primary data were obtained from interviews in six purposively selected
communities. Key informants included WVG staff, community volunteers, and local
government agency staff from health and agriculture sector agencies, and beneficiaries of
the intervention. Interview respondents answered questions on the project’s mechanism
for KOKO Plus distribution, participant experiences of purchasing and using KOKO Plus,
perceived benefits of using KOKO Plus, and lessons learned about KOKO Plus from the IFP
project. Beneficiaries also provided information on their perceptions of KOKO Plus
acceptability and adverse outcomes.
Results
The project distributed KOKO Plus free of charge to almost 14,000 (13,942) children, more
than its target (4,900). In addition, Village-Based Entrepreneurs (VBE) sold 192,092
sachets of KOKO Plus in the project communities. The KOKO Plus value chain involved
WVG purchased the KOKO Plus from the Ghanaian manufacturer and supplied it to
VBEs either in their respective communities or at distribution centers in their respective
WVG district office. KOKO Plus promotion and marketing were led by trained VBEs, VBE
supervisors, and Community-Based Organizations across multiple settings (homes, child
welfare clinics, markets, community durbars, and religious gatherings). There was high
acceptability of KOKO Plus. Mothers attributed their acceptance of KOKO Plus to its
a Corresponding author: raryeetey@ug.edu.gh
33
potential health and nutrition benefits for children. They also attributed increased child
weight, and less frequent illness, to feeding meals that included KOKO Plus to their young
children. KOKO Plus was added to the diverse local meals fed to young children. Diarrhea
was the only mentioned adverse report, albeit rarely. At the end of the IFP project, WVG
established a fund to ensure the sustainable distribution of KOKO Plus in the project
communities.
Conclusions
The IFP project established a KOKO Plus value chain, increasing the availability, accessibility,
acceptability, and utilization of KOKO Plus in the project communities. VBE successfully
distributed KOKO Plus with support from community volunteers and healthcare workers.
This approach to KOKO Plus distribution is feasible and sustainable and is recommended
for similar contexts.
Description
Research Article
Keywords
micronutrient, Ghana, children
Citation
William E.S. Donkor, Priscilla Babae, Christian Duut, Martha Gyansa-Lutterodt, Lawrence Agyekum, Isaac Boadu, Francis Gumah and Richmond Aryeetey. 2024. “Availability, acceptability, and utilization of micronutrient fortification for children 6- 23 months in three districts in Ghana.” World Nutrition, March, 32–41. https://doi.org/10.26596/wn.202415132-41