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. 2016 Oct 18;11(10):e0162462.
doi: 10.1371/journal.pone.0162462. eCollection 2016.

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

Grant J Aaron  1 , Nicholas Strutt  2 , Nathaniel Amoh Boateng  3 , Ernest Guevarra  4 , Katja Siling  4 , Alison Norris  4 , Shibani Ghosh  2   5 , Mercy Nyamikeh  6 , Antoine Attiogbe  6 , Richard Burns  7 , Esi Foriwa  8 , Yasuhiko Toride  9 , Satoshi Kitamura  9 , Kwaku Tano-Debrah  3 , Daniel Sarpong  3 , Mark Myatt  10
Affiliations

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

Grant J Aaron et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

All co-authors have full freedom regarding the publication of results from this study. There are no financial conflicts of interest to declare. GJA is employed by the Global Alliance to Improve Nutrition (GAIN); NS and SG are employed by the International Nutrition Foundation; EG, KS, and AN are employed by Valid International Ltd (a public health consultancy firm); NAB, KT-D, and DS are employed by the University of Ghana; MN and AA are employed by CARE International in Ghana; RB is employed by Exp Social Marketing; EF is employed by the Ghana Health Service; YT and SK are employed by Ajinomoto Co., Inc, Tokyo, Japan; MM is director of Brixton Health (a public health consultancy firm). These affiliations do not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Component indicators and weightings used to calculate the MPI.
HH = Household; HHS = Household Hunger Score; JMP = WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation; MUAC = Mid-upper arm circumference; PBH = Previous birth history; BCG = Bacillus Calmette–Guérin vaccine; WAZ = Weight-for-age z-score (WHO Growth Standards); Edema = the presence of bilateral pitting edema.
Fig 2
Fig 2. MN Is the Proportion of Children Defined as At-Risk Who Are Covered.
Fig 3
Fig 3. Two-by-Two Table Showing the Definitions of RC, MN, and CR.
Fig 4
Fig 4. Graphs Showing Observed Coverage Measures for Both Delivery Models.
Fig 5
Fig 5. Maps of the Raw Coverage Achieved by Delivery Model 2.
Fig 6
Fig 6. A simple Model of How Program Coverage Changes over Time.
See this image and copyright information in PMC

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