Understanding Patterns and Drivers of Bouillon Use in Northern Ghana to Inform Fortification Planning

Abstract

Objectives To explore the potential for bouillon as a micronutrient fortification vehicle in northern Ghana, we assessed market availability, household purchase and consumption of bouillon products, and perceptions of bouillon and salt. Methods We selected 28 clusters in the Tolon and Kumbungu districts of the Northern region of Ghana (7 urban, 4 semi-urban, and 3 rural clusters per district). Among 369 randomly selected households, women of reproductive age (15–49 y; WRA) were interviewed about household bouillon purchasing habits, its use in food preparation, and perceptions about the positive/negative effects of bouillon consumption. Twenty focus groups of 5–6 participants each were held in 11 clusters (10 WRA, 5 men, 5 women > 49y). We also assessed availability of bouillon products for sale from vendors in clusters (n = 11) and major markets (n = 4). Results In the survey, almost all (99%) respondents had ever cooked with bouillon, and 77% reported typically cooking with bouillon at least twice per day. Seven brands and three flavors of bouillon products were for sale. Most households (87%) reported consuming shrimp flavor without other spice most frequently. On average, households purchased bouillon cubes weekly, most from open markets (74%) or kiosks (22%). Most common reasons for bouillon use included taste (98%) and family preference (46%). Economic access was also important: 59% reported purchasing less bouillon or switching bouillon brands (28%) or flavors (11%) when they had less money available. About two-thirds of respondents perceived having bouillon in a person's diet was “good” (vs 43% for salt); reasons provided included: “gives more energy” (43%) and “makes you stronger” (41%). Among the 18% of respondents who perceived having bouillon in a person's diet was “bad”, reasons included: stomach upset (63%) and high blood pressure (39%). High blood pressure (85%) was the most common concern among the 32% perceiving salt as “bad”. Focus groups revealed seasonal variation in quantity of bouillon used. Conclusions Bouillon consumption is common and frequent in northern Ghana, indicating good potential as a micronutrient fortification vehicle. Understanding perceptions of bouillon by different household members will inform research and program messaging. Funding Sources Funded by a grant to the University of California, Davis from Helen Keller International.

Effect of multiple micronutrient-fortified bouillon on micronutrient status among women and children in the Northern Region of Ghana: Protocol for the Condiment Micronutrient Innovation Trial (CoMIT), a community-based randomized controlled trial

“…Bouillon cubes for the trial will be produced based on a non-proprietary formulation that is comparable to commercial cubes sold in Ghana and elsewhere in West Africa [ 12 ], containing ∼52% salt by weight, along with palm fat, corn starch, spices and flavour enhancers, colouring, and micronutrient premix (Nicholas Archer, CSIRO, personal communication). Shrimp flavour was selected, as it was the primary bouillon flavour used by all households in the pilot survey in the study community [ 28 ]. Table 2 presents the micronutrient concentrations, chemical fortificant forms of each nutrient, and equivalent daily target micronutrient doses for women and young children in the active arm of the study.…”

“…The household bouillon ration will be determined based on household size and estimated bouillon consumption (2.5 g/capita/d, based on the number of individuals in the household). This approach was based on previous research in the study community showing that median (p25, p75) per-household bouillon consumption was 20 (12, 24) g/d and that bouillon consumption was 2.4 g/d among WRA and 1.0 g/d among children, similar to the assumptions in Table 2 [ 28 ]. The household bouillon ration may be revised over the course of the study based on observations and questionnaire responses (e.g., changes to household composition) but will not exceed 4 g/capita/d.…”

Effect of household use of multiple micronutrient-fortified bouillon on micronutrient status among women and children in two districts in the Northern Region of Ghana: Protocol for the Condiment Micronutrient Innovation Trial (CoMIT), a community-based randomized controlled trial

“…Bouillon cubes for the trial will be produced based on a non-proprietary formulation that is comparable to commercial cubes sold in Ghana, containing ~52% salt by weight, along with palm fat, corn starch, spices and flavour enhancers, colouring, and micronutrient premix (Nicholas Archer, CSIRO, personal communication). Shrimp flavour was selected, as it was the primary bouillon flavour used by all households in the pilot survey in the study community [28].…”

“…The household bouillon ration will be determined based on household size and estimated bouillon consumption (2.5 g/capita/d). This approach was based on previous research in the study community showing that median per household bouillon consumption was 20 (12,24) g/d (median, p25, p75) and that bouillon consumption was 2.4 g/d among WRA and 1.0 g/d among children, similar to the assumptions in Table 2 [28]. The household bouillon ration may be revised over the course of the study based on observations and questionnaire responses (e.g., changes to household composition) but will not exceed 4 g/capita/d.…”

Consumption of Discretionary Salt and Salt from Bouillon among Households, Women, and Young Children in Northern Region, Ghana: A Mixed-Methods Study with the Condiment Micronutrient Innovation Trial (CoMIT) Project

“…In Ghana, important sources of dietary salt are discretionary salt, including salt added at the table or during cooking, and salt from condiments such as bouillon cubes [ 20 , 21 ]. Salt iodization has been mandatory in Ghana since 1996 [ 22 ], and table salt and commonly used condiments such as bouillon cubes and tomato paste are now produced with iodized salt [ 23 , 24 ].…”