Improving complementary feeding in Ghana: reaching the vulnerable through innovative business—the case of KOKO Plus

Ghosh, Shibani; Tano‐Debrah, Kwaku; Aaron, Grant J; Otoo, Gloria E.; Strutt, Nicholas; Bomfeh, Kennedy; Kitamura, Satoshi; Suri, Devika; Murakami, Hitoshi; Furuta, Chie; Sarpong, Daniel Bruce; Saalia, Firibu Kwesi; Nakao, Youzou; Amonoo-Kuofi, Harold S.; Uauy, Ricardo; Toride, Yasuhiko

doi:10.1111/nyas.12596

Cited by 23 publications

(35 citation statements)

References 26 publications

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“…Briefly, whole blood was collected from 909 infants at 6–18 mo of age living in Ghana for the 2012–2013 Trial for Reducing Undernutrition through Modified Feeding study (21). Blood was collected in trace metal–certified Vacutainers without anticoagulant (BD) at multiple locations, transported back to a central storage facility, separated into serum samples, and stored at −80°C.…”

Section: Methodsmentioning

confidence: 99%

Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration

Killilea¹,

Rohner²,

Ghosh

et al. 2017

The Journal of Nutrition

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Background: Plasma or serum zinc concentration (PZC or SZC) is the primary measure of zinc status, but accurate sampling requires controlling for hemolysis to prevent leakage of zinc from erythrocytes. It is not established how much hemolysis can occur without changing PZC/SZC concentrations.Objective: This study determines a guideline for the level of hemolysis that can significantly elevate PZC/SZC.Methods: The effect of hemolysis on PZC/SZC was estimated by using standard hematologic variables and mineral content. The calculated hemolysis threshold was then compared with results from an in vitro study and a population survey. Hemolysis was assessed by hemoglobin and iron concentrations, direct spectrophotometry, and visual assessment of the plasma or serum. Zinc and iron concentrations were determined by inductively coupled plasma spectrometry.Results: A 5% increase in PZC/SZC was calculated to result from the lysis of 1.15% of the erythrocytes in whole blood, corresponding to ∼1 g hemoglobin/L added into the plasma or serum. Similarly, the addition of simulated hemolysate to control plasma in vitro caused a 5% increase in PZC when hemoglobin concentrations reached 1.18 ± 0.10 g/L. In addition, serum samples from a population nutritional survey were scored for hemolysis and analyzed for changes in SZC; samples with hemolysis in the range of 1–2.5 g hemoglobin/L showed an estimated increase in SZC of 6% compared with nonhemolyzed samples. Each approach indicated that a 5% increase in PZC/SZC occurs at ∼1 g hemoglobin/L in plasma or serum. This concentration of hemoglobin can be readily identified directly by chemical hemoglobin assays or indirectly by direct spectrophotometry or matching to a color scale.Conclusions: A threshold of 1 g hemoglobin/L is recommended for PZC/SZC measurements to avoid increases in zinc caused by hemolysis. The use of this threshold may improve zinc assessment for monitoring zinc status and nutritional interventions.

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Section: Methodsmentioning

confidence: 99%

Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration

Killilea¹,

Rohner²,

Ghosh

et al. 2017

The Journal of Nutrition

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“…The high coverage in Ghana may also be related to the fact that the program was implemented at small scale, with continual feedback from the coverage surveys, which may have facilitated continual course correction in diverse program activities. Details of the content of that program and communication campaign have been published elsewhere (12, 16). On the contrary, in Bangladesh—also a sales model through home visits by community sales agents—despite the fact that it created awareness in more than one-half of the population (i.e., message coverage), other barriers likely limited contact, and particularly effective coverage.…”

Section: Discussionmentioning

confidence: 99%

“…No specific BCC activities or demand creation activities were implemented related to the product itself. In Ghana, a soy-based product similar to an MNP but with macronutrient content was distributed with the use of 2 different program models at pilot scale (16). Model 1 was implemented in the more rural northern regions.…”

Section: Methodsmentioning

confidence: 99%

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries

et al. 2017

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Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking.Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries.Methods: Programs were implemented in Ghana, Cote d’Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices.Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand.Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.

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“…In the roadmap paper under this theme, Ghosh et al . report a business‐led collaboration around the development and testing of a high–nutrient value complementary food supplement, called KOKO Plus™.…”

Section: Convergence Needs and Mechanismsmentioning

confidence: 99%

Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions

Dubé

Webb

Arora

et al. 2014

Annals of the New York Academy of Sciences

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The causes of many vexing challenges facing 21st-century society are at the nexus of systems involved in agriculture, health and wealth production, consumption, and distribution. Using food as a test bed, and on the basis of emerging roadmaps that set achievable objectives over a 1-to 3-year horizon, we introduce this special feature with convergence thinking and practice at its core. Specifically, we discuss academic papers structured around four themes: (1) evidence for a need for convergence and underlying mechanisms at the individual and societal levels; (2) strategy for mainstreaming convergence as a driver of business engagement and innovation; (3) convergence in policy and governance; (4) convergence in metrics and methods. Academic papers under each theme are accompanied by a roadmap paper reporting on the current status of concrete transformative convergence-building projects associated with that theme. We believe that the insights provided by these papers have the potential to enable all actors throughout society to singly and collectively work to build supply and demand for nutritious food, in both traditional and modern food systems, while placing the burdens of malnutrition and ill health on their core strategic agendas.

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Improving complementary feeding in Ghana: reaching the vulnerable through innovative business—the case of KOKO Plus

Cited by 23 publications

References 26 publications

Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration

Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries

Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions

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