Effect of a macro and micronutrient fortified complementary food supplement (KokoPlus) on linear growth of children 18 months of age in Ghana
Authors: Ghosh Shibani , Strutt Nicholas , Otoo Gloria , Suri Devika J , Addison Judith Cato , Chui Kenneth , Debrah Kwaku Tano , Uauy Ricardo 
Published: November 2023

BackgroundIn Ghana, 13% of infants 6–23 months have an acceptable diet and linear growth fails to meet WHO standards. Interventions using micronutrient powders, cereal‐legume blends and lipid nutrient supplements have shown variable results. The effect on linear growth of a macro‐ and micro‐nutrient fortified complementary food supplement (KokoPlus) was examined in a single blind cluster randomized controlled trial conducted in Central region, Ghana.MethodsOf 61 communities in 3 districts, 38 communities were selected (population < 1000) and randomly allocated to (A) KokoPlus and nutrition education, (B) Micronutrient powder and nutrition education, (C) Nutrition education alone (n=301 per group). All supplements had the same micronutrient composition and were delivered on a weekly basis; mothers were instructed to use one sachet daily. Monthly nutrition education sessions emphasized breastfeeding, appropriate complementary feeding, water, hygiene, sanitation practices and recipe demonstrations. Infants were recruited at age 6 months and baseline data (B) collected following informed consent with midline (M) and endline (E) at 12 months and 18 months respectively. Data included dietary intake, socio‐economic characteristics, morbidity, water, hygiene and sanitation practices, food security at B, M and E, anthropometric data monthly and morbidity and compliance weekly. A venous blood draw (< 5ml) was collected at B, M and E.ResultsHeight for age Z scores (HAZ) were estimated using the 2006 WHO growth reference on 892 infants who completed the study. All analyses were intent to treat and included mixed effects linear regression modeling accounting for clustering adjusted for age, height, baseline HAZ and maternal education. No differences were found in baseline characteristics across the three groups. Over the 12‐month study period, change in HAZ score was −0.49 in A, −0.52 in B and −0.54 in C (p >0.05). Compliance for A and B was 86% and 88% respectively. Delivery of supplements was suboptimal (~60% of intended delivery for both groups) actual consumption was half of expected (186 of 365). Adjusting for actual supplements consumed revealed a significant difference between A and B groups in HAZ scores especially as consumption increased. Modeling the data for 86% compliance and 100% delivery yielded a difference of 0.2 HAZ‐score between A and B (p=0.026).ConclusionsA 12‐month intervention of a macronutrient‐ micronutrient fortified complementary food supplement showed no significant difference in HAZ scores. The findings are confounded by incomplete delivery of the supplements to study participants, modeling using the intended delivery rates with observed compliance showed a marked improvement in Z‐scores with a potential dose response effect of the macro‐micronutrient intervention. Further work optimizing delivery and uptake of this intervention is required to validate this finding.Support or Funding InformationThis study was supported through a grant from Ajinomoto Inc, Japan.