A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose–response effect in improving linear growth: a 12-month cluster randomised trial

Ghosh, Shibani; Strutt, Nicholas; Otoo, Gloria E.; Suri, Devika; Ankrah, Judith; Johnson, Thomas; Nsiah, Paul; Furuta, Chie; Murakami, Hitoshi; Perera, Gillian; Chui, Kenneth; Bomfeh, Kennedy; Amonoo-Kuofi, Harold S.; Tano‐Debrah, Kwaku; Uauy, Ricardo

doi:10.1017/jns.2019.18

Cited by 4 publications

(13 citation statements)

References 44 publications

(47 reference statements)

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“…The 12-month intervention, targeting mothers and infants, began when the infants turned 6 months old and ended when they turned 18 months old. One group received KP with NE, a second group received MN with NE, and a third group which is the control group received NE alone ( 16 ).…”

Section: Methodsmentioning

confidence: 99%

“…The educational materials were adapted from the Good Life project, a US Agency for International Development behavior change project conducted from 2009 to 2013, to support GHS in areas of family planning, maternal and child health, malaria, nutrition, water, and sanitation with some modifications so it can follow the trial ( 24 ). Further details of the trial design and interventions are described elsewhere ( 16 ).…”

Section: Methodsmentioning

confidence: 99%

“…This study was embedded in a primary study that had a sample size of 301 per group (final sample size achieved= 298) ( 16 ), which exceeded the sample size required for our secondary analysis. We thus retained the original sample size for the analysis of plasma amino acids (a final sample size of n = 298).…”

Section: Methodsmentioning

confidence: 99%

“…Changes occurred in the total number of clusters per group as study implementation began. Ultimately, the total number of clusters was 38, with 14 in the KP, 13 in the MN (original allocation) and 11 in the NE group ( 16 ).…”

Section: Methodsmentioning

confidence: 99%

“…An analysis of the effect of a macronutrient- and micronutrient-fortified complementary food supplement called KOKO Plus (KP) on linear growth demonstrated a dose–response effect ( 16 ). Given the composition of KP as well as recent findings, assessing plasma amino acid levels and the effect of supplementation might elucidate information that would be critical for an improved understanding of the modifiable factors related to linear growth.…”

Section: Introductionmentioning

confidence: 99%

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Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial

et al. 2021

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Stunting is reportedly associated with low circulating levels of essential amino acids (EAAs). This study examined the effect of a macronutrient- and micronutrient-fortified complementary food supplement (KOKO Plus) on specific plasma EAA levels and stunting in infants aged 6–18 months. In a single-blind cluster-randomized controlled trial conducted in Ghana, infants were enrolled at 6 months and followed until 18 months. Thirty-eight communities were randomly assigned to receive KOKO Plus (KP, fourteen communities, n = 321), multiple-micronutrient powder (MN, thirteen communities, n = 327), or only nutritional education as control group (NE, eleven communities, n = 318), and all groups received nutrition education. Plasma amino acids (AAs) were measured at 6, 12, and 18 months (end point). Mixed-effects models were used to assess the effect of the intervention on plasma AAs, and the relationship between plasma branched-chain AAs (BCAAs) and the risk of stunting was assessed. At the end point, total BCAA concentrations (±standard error) significantly exceeded baseline in the KP (284.2 ± 4.3 μM) and NE (289.1 ± 4.4 μM) groups but not the MN group (264.4 ± 4.1 μM). After adjustment for compliance at 200 sachets, plasma BCAAs exceeded in the KP group (284.5 ± 4.2 μM) compared to the MN group (264.6 ± 4 μM). Plasma BCAAs were positively correlated with changes in length-for-age Z-score from baseline (R = 0.327, p = 0.048). In conclusion, the plasma BCAA concentrations of infants that received KP and the NE group was significantly higher compared to the MN group but there were no differences between the KP and NE group at end point. Improved plasma BCAAs may be due to improved nutrient intake by infants exposed to KP or NE. Low BCAAs were associated with stunting, replicating the previous finding.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03181178?term=NCT03181178&draw=2&rank=1, identifier: NCT03181178.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial

et al. 2021

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Improving Infant Nutrition through the Market: Experimental Evidence in Ghana

2021

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Availability, acceptability, and utilization of micronutrient fortification for children 6-23 months in three districts in Ghana

Donkor,

Babae,

Duut

et al. 2024

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BackgroundMicronutrient 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.MethodsA mixed-methods design was used, triangulating primary and secondary data. Secondary data originated from 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.ResultsThe 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 purchasing the KOKO Plus from the Ghanaian manufacturer and supplying it to VBE’s either in their respective communities, or at distribution centers in their respective WVG district office. KOKO Plus promotion and marketing was led by trained VBE’s, 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 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 sustainable distribution of KOKO Plus in the project communities.ConclusionsThe IFP project established a KOKO Plus value chain, increasing availability, accessibility, acceptability, and utilization of KOKO Plus in the project communities. VBE’s successfully distributed KOKO Plus with support from community volunteers, and health care workers. This approach to KOKO Plus distribution is feasible and sustainable and is recommended for similar contexts.

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A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose–response effect in improving linear growth: a 12-month cluster randomised trial

Cited by 4 publications

References 44 publications

Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial

Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial

Improving Infant Nutrition through the Market: Experimental Evidence in Ghana

Availability, acceptability, and utilization of micronutrient fortification for children 6-23 months in three districts in Ghana

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