Assessing Program Coverage of Two Approaches to Distributing a Complementary Feeding Supplement to Infants and Young Children in Ghana

• Published in: PloS one 2016-10, Vol.11 (10), p.e0162462-e0162462
• Main Authors: Aaron, Grant J, Strutt, Nicholas, Boateng, Nathaniel Amoh, Guevarra, Ernest, Siling, Katja, Norris, Alison, Ghosh, Shibani, Nyamikeh, Mercy, Attiogbe, Antoine, Burns, Richard, Foriwa, Esi, Toride, Yasuhiko, Kitamura, Satoshi, Tano-Debrah, Kwaku, Sarpong, Daniel, Myatt, Mark
• Format: Article
• Language: English
• Subjects: Age; Biology and Life Sciences; Breastfeeding & lactation; Children; Children & youth; Communications; Consumer protection; Cross-Sectional Studies; Demand; Dietary supplements; Distributing; Female; Food; Ghana; Health care; Health services; Humans; Infant; Infant Nutritional Physiological Phenomena; Infants; Male; Medicine and Health Sciences; Models, Theoretical; Nutrition; Occupational health; People and Places; Physical growth; Physical Sciences; Pilot Projects; Polls & surveys; Product development; Program Evaluation; Risk; Sales; Social marketing; Social Sciences; Supermarkets; Surveys and Questionnaires; Urban environments; Workers
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0162462

The work reported here assesses the coverage achieved by two sales-based approaches to distributing a complementary food supplement (KOKO Plus™) to infants and young children in Ghana. Delivery Model 1 was conducted in the Northern Region of Ghana and used a mixture of health extension workers (delivering behavior change communications and demand creation activities at primary healthcare centers and in the community) and petty traders recruited from among beneficiaries of a local microfinance initiative (responsible for the sale of the complementary food supplement at market stalls and house to house). Delivery Model 2 was conducted in the Eastern Region of Ghana and used a market-based approach, with the product being sold through micro-retail routes (i.e., small shops and roadside stalls) in three districts supported by behavior change communications and demand creation activities led by a local social marketing company. Both delivery models were implemented sub-nationally as 1-year pilot programs, with the aim of informing the design of a scaled-up program. A series of cross-sectional coverage surveys was implemented in each program area. Results from these surveys show that Delivery Model 1 was successful in achieving and sustaining high (i.e., 86%) effective coverage (i.e., the child had been given the product at least once in the previous 7 days) during implementation. Effective coverage fell to 62% within 3 months of the behavior change communications and demand creation activities stopping. Delivery Model 2 was successful in raising awareness of the product (i.e., 90% message coverage), but effective coverage was low (i.e., 9.4%). Future programming efforts should use the health extension / microfinance / petty trader approach in rural settings and consider adapting this approach for use in urban and peri-urban settings. Ongoing behavior change communications and demand creation activities is likely to be essential to the continued success of such programming.