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Ghana Nutrition Improvement Project.

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The Ajinomoto Foundation spearheaded a public private partnership project in Ghana to help tackle childhood malnutrition through KOKO Plus, an affordable complementary feeding nutrition supplement via an inclusive social business model.

About the partnership  
The Ajinomoto Group started the Ghana Nutrition Improvement Project (GNIP) in 2009 as part of initiatives to commemorate its 100th year. The Group has since been steadily implementing the project in cooperation with the government of Ghana, University of Ghana, and other international NGOs and corporates. In April 2017, the project was transferred to The Ajinomoto Foundation to realise more social impact in collaboration with public sectors (such as Ghana Health Service).
Background
Koko is a traditional complementary food in Ghana – porridge made from fermented corn. However, the levels of protein and micronutrients in koko do not meet the WHO’s nutrient requirements and dietary recommendations.
To address this nutrient gap, the Ajinomoto Group, in collaboration with various partners, developed KOKO Plus, a supplement containing amino acids, which is added to koko during cooking and provides sufficient nutrients for children, including Calcium, Iron, Zinc, Iodine, Folic Acid, Vit A, B1, B2, B6, Niacin, K1, D3, B12. The World Food Programme (WFP) verified the efficacy of KOKO Plus and registered it as a “Nutritious powder” in its food basket in February 2018.  The product was designed to meet the needs of local communities: it is affordable (USD 0.10/sachet/day); it is desirable (in line with local tradition and preferences); and it is accessible (available in kiosks and one-year shelf life improves access in rural areas).
The social business model for GNIP is based on national policies and works with private businesses in Ghana. Ajinomoto has provided people, goods, and financial and technical support to help establish a social business model which works with and through local companies, local distribution networks and local products.
Partners
Successful social business models require the input and commitment from a wide range of stakeholders, including for example local government, academia and private companies, as well as international NGOs and aid agencies. For GNIP, The Ajinomoto Foundation partnered with the following:
Plan
CARE International
ESM (social marketing company headquartered in South Africa)
EXP (marketing company headquartered in South Africa)
Ghana Health Service (GHS)
International Nutrition Foundation (INF)
Japan International Cooperation Agency (JICA)
Japanese Organization for International Cooperation in Family Planning (JOICFP)
Ministry of Foreign Affairs of Japan
USAID
University of Cape Coast
University of Ghana
University of Tokyo 
World Food Programme（WFP）
Yedent Agro Group  
Objectives 
To create a sustainable business model and market for a product that can help improve nutritional status of infants as parents begin complementary feeding practices in Ghana.
Overview of activities
The social business model developed for GNIP KOKO Plus programme has four components, which were addressed across four phases (see below). .
Public private engagement was particularly important for Phase 3 of GNIP. To ensure regular consumption of nutritious complementary foods, it was important to change the behaviour of mothers and caregivers. According to consumer research conducted by the Ajinomoto Foundation, GHS community health nurses were ranked as most influential with mothers because they were both familiar and highly trusted. Establishing a PPP between GHS and Ajinomoto was therefore critical to the success of this programme. See more on the KOKO Plus Behaviour Change Model and the rol
Outcomes
In a peer reviewed study conducted by researchers from University of Ghana, Tufts University, Nevin Scrimshaw International Nutrition Foundation and Ajinomoto, the authors concluded that: “KOKO Plus food supplement improved the nutritional profile of koko to satisfy the nutrient intake requirements of young infants as recommended by World Health Organization. KOKO Plus was microbiologically safe, with estimated shelf-life of more than 12 months.”
GNIP estimates that’s KOKO Plus has reached 9,000 children in 2017 and 20,000 children in 2018, with a target to reach 70,000 children in 2019. According to Ghana’s 2014 Demographic and Health Survey (DHS), the stunting rate for children under five is 18.8%. Calculating for population growth would mean in 2018, approximately 600,000 weaning-age children in Ghana are not getting the nutrition they need to grow and thrive.
The Ajinomoto Foundation is planning to expand the project’s activity areas from 2019, so that by 2023, 300,000 weaning-age children will benefit from improved nutrition. Reaching this target would have a positive impact on society.

Ghana Nutrition Improvement Project: A Genuinely Synergistic Public Private Partnership.

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At the first N4G Summit in 2013, 110 stakeholders committed to prevent at least 20 million children from being stunted – saving at least 1.7 million lives by 2020. These commitments deliver much-needed action on policy and financing commitments to the Sustainable Development Goal (SDG) 2—Ending Hunger in All its Forms—which is an underlying driver of 12 of the 17 SDGs. As we continue the Nutrition for Growth Year of Action, take a look at how pledges made during the N4G summits in London (2013) and Milan (2017), have brought about positive impacts on global nutrition.


According to the latest Ghana Demographic and Health Survey (2014), nearly 1 in 5 children under age 5 is stunted. The Ghana Nutrition Improvement Project (GNIP) aims to solve the problem of stunting during the weaning period (from 6 months to 2 years of age), which is caused mainly due to the insufficient content of essential nutrients in the traditional complementary food “koko” (fermented corn porridge). The mission of GNIP is to create a “Social Business Model” for improving child nutrition in a sustainable way without continuous aid. The Ajinomoto Foundation (TAF), a public interest foundation, acquired GNIP in 2017, after its launch in 2009 by Ajinomoto Co. Inc.,1 a global food and amino acid company. TAF is not involved in business but supports local partners to establish sustainable business. 

TAF has been working to improve the nutritional status of infants in Ghana through the introduction of a complementary food supplement named “KOKO Plus.” KOKO Plus is produced locally using locally available ingredients (soybean) supplemented with micronutrients and lysine to improve the amino acid balance. KOKO Plus is an evidence-based product (World Food Programme [WFP] registers KOKO Plus as a “Nutritious powder” in its food basket) and is designed to meet local needs: it is affordable (USD 0.10 /sachet /day); acceptable (for local tradition and preferences); and accessible (available in kiosks near health facilities and with a one-year shelf life). 

A sustainable social business model should be scalable and inclusive, meaning that all processes from product development, production, and distribution would be primarily carried out by local people. GNIP officially collaborated with Ghana Health Service (GHS) (concluding Memorandum of Cooperation in 2018) to co-create nutrition education tools and design a behavior-change process that applies the private sectors’ marketing intelligence. The process centers on a cycle of Awareness, Understanding, and Action. Health workers monitor and record children’s nutritional status (Awareness), and then they use simple pictures to educate mothers about basic nutrition knowledge and introduce KOKO Plus as a practical solution to improve child nutrition (Understanding). Once mothers understand the importance of nutrition and how to improve it, they get interested in KOKO Plus, and they purchase it from shops at the nearest health facility (Action).2 Mothers continue to use KOKO Plus once they see their children’s improved growth, and they become more confident. This cycle (Awareness, Understanding and Action) continues monthly and reinforces the mother’s behavior change.

Collaboration with GHS started in 2018, and in 2019, an estimated 47,000 beneficiaries (children fed KOKO Plus) and 3,000 nurses participated in the collaboration. The number of beneficiaries is expected to increase to 450,000 children by 2023. The growth in the number of beneficiaries has been significantly accelerated. The following factors contributed to this success:

For the successful duplication or scaling up of the public-private partnership (PPP) model, it is important to establish a memorandum of understanding/cooperation at the national level; additionally, to execute the collaborative activities, it is also essential to have mutual communication on the ground at the regional and district levels. By openly sharing challenges/problems and understanding the competencies/assets of each party, we could work together successfully and produce genuinely synergistic impacts.3  
We believe our efforts with KOKO Plus will contribute to strengthening the nutrition services of GHS’s health facilities, and after scaling up in Ghana, will eventually contribute to establishing Universal Health Coverage by duplicating this PPP model in other countries, which is an ultimate goal of Sustainable Development Goal 3.

Japan supports WFP to scale up nutrition programme in Ghana

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ACCRA–The United Nations World Food Programme (WFP) has received a contribution of US$5 million from the Government of Japan which will enable the scale-up of an important programme addressing undernutrition, micronutrient deficiencies and obesity in Ghana.

“We’re extremely grateful for Japan’s generous donation which will allow more pregnant and nursing women, children, and adolescent girls to access nutritious foods,” said Rukia Yacoub, WFP Representative and Country Director in Ghana. “In 2019, we’ll expand the programme from the Northern Region where it is currently implemented to the Ashanti Region which also has high numbers of stunted children.”

Women without sufficient means will receive electronic commodity vouchers for locally- produced special blends of maize and soya beans mixed with vitamins and minerals. Children will receive special food supplements produced in Ghana including one developed by a Japanese private company. 

Ghana’s Northern Region has the highest rate of stunting in the country; one in three children is stunted compared with the national average of one in five. The Ashanti Region has the second highest number of stunted children nationwide. 

Stunting is caused mainly by insufficient nutrition and care during the crucial first 1,000 days of life and often leads to impaired physical and cognitive development which in turn diminishes productivity and earning capacity in later life. 

According to the Cost of Hunger in Africa study, Ghana loses 6.4 percent of its GDP each year, estimated at GHC4.6 billion (US$2.6 billion) in 2012, because of costs associated with child undernutrition. 

The United Nations World Food Programme – saving lives in emergencies and changing lives for millions through sustainable development. WFP works in more than 80 countries around the world, feeding people caught in conflict and disasters, and laying the foundations for a better future.

Source: wfp.org

Development and Sensory Shelf-Life Testing of KOKO Plus: A Food Supplement for Improving the Nutritional Profiles of Traditional Complementary Foods

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Abstract

Background: Providing nutritionally adequate complementary foods is essential in preventing malnutrition in young infants. Koko made from fermented corn dough constitutes the most common complementary food in Ghana. However, these do not meet the nutrient requirements.

Objective: To develop and test the acceptability and shelf-life of an energy-dense complementary food supplement for improving the nutritional profile of traditional complementary foods.

Methods: Surveys of families in urban and rural communities and stakeholder engagements with health professionals were done to identify the most predominant traditional complementary foods and young infants’ feeding practices. A food supplement, KOKO Plus, that would improve the nutritional profile of koko and other complementary foods needed to be developed. Linear programming was used in ingredient formulations for the food supplement based on locally available foods. The acceptability of the food supplement, KOKO Plus, in koko and soup was assessed using 14 trained assessors in a 2 × 2 crossover design. Shelf-life of the product was estimated using the difference in control sensory test method at different storage temperatures (24°C, 34°C, and 44°C).

Results: Koko was the most predominant complementary food in many homes. The KOKO Plus food supplement improved the nutritional profile of koko to satisfy the nutrient intake requirements of young infants as recommended by World Health Organization. KOKO Plus was microbiologically safe, with estimated shelf-life of more than 12 months.

Conclusion: The development of KOKO Plus as a food supplement provides a practical solution to improve the nutritional status of weaning children in Ghana.

Keywords: complementary food supplement; koko; sensory tests; shelf-life.

Effect of the provision of a macro‐ and micro‐nutrient fortified complementary food supplement on nutritional status of Ghanaian infants

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Abstract

Background

Only 13% of Ghanaian infants 6–23 months have a minimum acceptable diet. The study examined the effect of a macro‐ and micro‐nutrient fortified complementary food supplement (KokoPlus™) on growth and nutritional status of Ghanaian infants.

Methods

In a cluster randomized study, 38 communities were randomly assigned to three arms: KokoPlus™ and nutrition education (KP), Micronutrient powder and nutrition education (MN) and Nutrition education alone (NE) (n=301 infants/group). KP and MN received the same micronutrient dosage. Supplements were to be delivered weekly with instructions to use one sachet daily. Monthly nutrition education sessions included recipe demonstration and emphasized breastfeeding, complementary feeding and WASH practices. Baseline (B), midline (M) and endline (E) data collected at 6, 12 months and 18 months of age respectively. Research protocol included a venous blood draw, dietary assessment, SE status, morbidity, WASH and food security at B, M and E, monthly anthropometry assessments and weekly morbidity assessment and compliance with protocol. Length for age (LAZ), Weight for age (WAZ) and Weight for height (WLZ) Z‐scores were computed using the 2006 WHO‐MGRS growth reference. Serum hemoglobin, retinol binding protein, ferritin, zinc, C‐reactive protein and alpha glycoprotein, IGF‐1 and cortisol were assessed. Iron markers were corrected for infection. Analysis was intent to treat and included post hoc compliance modeling with mixed effects linear regressions adjusting for community clustering, age, baseline outcome measure, maternal height or maternal BMI.

Results

Mean LAZ scores at B time point were −0.74 ±1.02, −0.74 ±0.97 and −0.64 ±1.01 and E time point were −1.219 ± 0.06, 1.211 ± 0.03, and −1.266 ± 0.03 in groups KP, MN and NE respectively. At E, serum hemoglobin was significantly higher in the KP (114.02 ± 1.87 g/L) than MN (107.8 ± 2.5 g/L) or NE (108.8 ± 0.99 g/L) correcting for acute infection. Compliance (% of delivered supplement consumed) for KP and MN were 86.2% and 88.4% respectively; however, only 60% of supplement delivery was achieved. Post hoc modeling showed significant associations between higher supplement consumption with LAZ gain and serum zinc levels in KP, but not MN, indicating potential effects of KP masked by incomplete supplement delivery.

Conclusions

A macronutrient‐micronutrient fortified complementary food supplement significantly improved hemoglobin in infants with no acute infection but showed no significant difference in LAZ scores. Modeling using intended delivery rates and observed compliance shows significant improvement in LAZ and serum zinc implying a dose response effect of the intervention. Further work optimizing delivery and uptake of this intervention is required to validate this finding.

Support or Funding Information

This study was supported by Ajinomoto Inc and JICA.

The “Africa Health And Wellbeing Initiative”

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The Government of Japan and Ghana have been collaborating in many spheres for the improved health system in Ghana. Despite the challenges of COVID-19, there is commendable progress towards achieving Universal Health Coverage.

Under the auspices of the Cabinet Secretariat, the Government of Japan, and the Japan Business Council for Africa (JBCA), a virtual seminar was held on 25th February 2022, focusing on innovative healthcare-related technologies and services by Japanese companies in addressing healthcare challenges in Ghana. Thus, achieving Universal Health Coverage. The event was a build-up on the bilateral Memorandum of Cooperation signed in 2019 under the “Africa Health and Wellbeing Initiative” (AfHWIN), through business-based collaborations.

The Ajinomoto Foundation (TAF) / KOKO Plus Foundation (KPF) amongst the six participants in the event, showcased their public-private partnership through the AfHWIN project: partnering with NEC, Sysmex, the Ghana Health Service, and the United Nation World Food Programme with funding from the Japanese Government.

The project focuses on the common goal of improving child nutrition by multi-stakeholder’s approach. It embraces a comprehensive approach of promoting behavior change among mothers, prevention of maternal and infant malnutrition through using our nutrient supplement powder KOKO Plus, digital health services (NEC), and early diagnosis of anaemia and malaria (Sysmex), provision of nutritious foods and livelihood support.

As a result, a multifaceted approach to promoting behavior change, prevention, and early diagnosis can be taken at various stages of maternal and child health care.

The Director General of the Ghana Health Service, Dr. Patrick Aboagye and the Japanese Ambassador commended the project.

The Japanese Ambassador in his speech demonstrated Japan and Ghana’s long-standing cooperation in the healthcare sector and encouraged future collaborations to strengthen the Ghana-Japan relationship in the healthcare sector. Moreover, his excellency admired Ajinomoto Foundation and KOKO Plus Foundation’s efforts. Similarly, the Director General of the Ghana Health Service in his closing remarks showed Ghana’s willingness for continued collaboration with Japanese healthcare companies. He believed that the potential for partnerships among the public and private sectors with these companies could contribute to future Human Capital Development in Ghana!

WFP Ghana Country Brief, October 2019

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In Numbers

45,000 beneficiaries targeted for nutrition support in 2019.

22,020 smallholder farmers, 12 Nucleus farmers and 8 aggregators targeted for capacity strengthening and market linkages in 2019.

US$ 2.1 m six months (November 2019 -April 2020) net funding requirements.

22,611 beneficiaries received direct food assistance through vouchers in October 2019

Operational Updates

• The stunting prevention programme in the three Northern regions conducted two separate distributions for pregnant and lactating women (PLW) and caregivers with children aged 6-23 months, where specialized nutritious foods (SNFs) and non-SNFs were redeemed by the beneficiaries. Social Behaviour Change Communication (SBCC) on health, Water and Sanitation (WASH) and nutrition key messages were given to the beneficiaries by Ghana Health Service staff at the various implementing facilities for improved lifestyle and to increase to redemption of the commodities.

• The third durbar for the quarter, one of the SBCC strategies being employed by GHS in Asokore Mampong to reach out to people on the benefits of KOKO Plus, was organized in the reporting period. There was demonstration of various nutritious local recipes with KOKO Plus added.

• The National Disaster Management Organization (NADMO) reported heavy and continuous rains in the Upper East region which led to the loss of lives (28), injuries (19), collapsed houses and displacement in nine districts. Some relief items were mobilized by the Government and distributed to the affected victims by NADMO. Appeals are ongoing by NADMO for relief items especially NFIs and food.

• GSFP/NEPAD/WFP/PCD Collaboration; WFP collaborated with NEPAD to provide nutrition training on school meals to caterers in the Ashanti Region. This is part of a wider programme of support to improving nutrition quality of meals provided under the school feeding programme. Africa Union Development Agency (formerly NEPAD), PCD, WIAD and Yedent as well as caterers and cooks school children, egg producers’ association and the media were also present. The event was followed by some cooking demonstrations

Koko Plus Foundation Donates To Kumasi Children’s Home

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Koko Plus Foundation, manufacturers of popular food supplements, on Thursday donated boxes of its products to children at the Kumasi Children’s Home.

Speaking succinctly after presenting the items, Country Director for the Foundation, Yusuke Takahashi said the gesture was to help correct any malnutrition in the children at the home.

The Koko Plus supplement, he reiterated, contained vitamins and minerals that enhance good growth and vitality among children.

“Infants who are fed with Koko Plus alongside normal breast milk are very healthy and functional at all times since they possess the nutrients necessary for proper development’’, he disclosed.

DIRECTOR OF NUTRITION-GHS:

Speaking to the media, Ashanti Regional Nutrition Director at the Ghana Health Service (GHS), Madam Olivia Tempo applauded the gesture by Koko Plus Foundation.

She noted that the GHS was dealing with major cases of stunted growth in children across the Ashanti Region with some 420 cases recorded annually.

The Director, therefore, stressed that any effort or measure taken to halt such development, especially in infants and children was welcome.

‘’Even though we recommend exclusive breastfeeding for infants in the country, any additional food must be in the shape of what Koko Plus offers since it has every nutrient or supplement that enhances proper human growth’’, Madam Tempo stated.

 

APPRECIATION:

Expressing appreciation to the Koko Plus Foundation, Madam Mabel Boamah, Home Manager at Kumasi Children’s Home said the gesture was timely.

She noted that kids brought to the home are screened and those with any deformity or irregular growth are treated specially.

Currently, the Home Manager disclosed that 94 children are in her outfit with 45 being girls and the rest boys.

‘’With the availability of the Koko Plus food supplements at Home, each child will have a sachet to put into his or her food so as to enhance proper growth’’, Madam Boamah noted.

STORY BY MICHAEL OFOSU-AFRIYIE, KUMASI.

We aim to achieve Sustainable Development Goals (SDGs) through the Ghana Nutrition Improvement Project (GNIP)

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