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ANF4W Endpoint Survey, Ghana, 2017 ‐ iii ‐

TABLE OF CONTENTS

List of figures ............................................................................................................................. iv

List of tables ............................................................................................................................... v

ACKNOWLEDGEMENTS ............................................................................................................. vi

ABBREVIATIONS ........................................................................................................................ vi

EXECUTIVE SUMMARY .............................................................................................................. 7

1 INTRODUCTION .................................................................................................................. 12 1.1 Background ............................................................................................................. 12 1.2 ANF4W Project Overview ....................................................................................... 12 1.3 Survey objectives and indicators ............................................................................ 13

2 METHODOLOGY ................................................................................................................. 14 2.1 Survey design and sampling procedure .................................................................. 14 2.2 Study populations ................................................................................................... 15 2.3 Sample size determination ..................................................................................... 15 2.4 Approvals and ethical considerations ..................................................................... 16 2.5 Training of survey teams ........................................................................................ 16 2.6 Field work ................................................................................................................ 16 2.7 Data management and analysis .............................................................................. 17

2.7.1 Data analysis ............................................................................................ 17 2.7.2 Calculation of awareness, access, desirability, purchase and consumption

.................................................................................................................. 17 2.7.3 Calculation of wealth ............................................................................... 17 2.7.4 Minimum dietary diversity in women ...................................................... 17 2.7.5 Water and sanitation ............................................................................... 17

3 RESULTS ............................................................................................................................. 19 3.1 Access to mass media ............................................................................................. 21 3.2 Obaasima seal recognition ..................................................................................... 26 3.3 Information about consumer behaviour: Lola Milk biscuits .................................. 30 3.4 Information about consumer behaviour: Samba Shito sauce ................................ 33 3.5 Information about consumer behaviour: Tom Vita porridge ................................. 35

4 Discussion .......................................................................................................................... 38

5 INTERPRETATION & RECOMMENDATIONS ....................................................................... 38 5.1 Interpretation of findings in more detail ................................................................ 40

6 REFERENCES ....................................................................................................................... 43

7 APPENDIX 1 ‐ SUPPLEMENTARY TABLES .......................................................................... 44

APPENDIX 2 – SAMPLING FRAME ............................................................................................ 82

8 APPENDIX 3 – ENDPOINT SURVEY QUESTIONNAIRE ......................................................... 84

ANF4W Endpoint Survey, Ghana, 2017 ‐ iv ‐

List of figures Figure 1 Poster of the product marketing campaign ............................................................... 13

Figure 2 Women’s access to mass media, by pregnant women (PW) and young women

of reproductive age (YWRA), Ghana 2017 ............................................................ 21

Figure 3 Women’s access to mass media, by Sunyani and Tamale municipalities, Ghana

2017 ....................................................................................................................... 22

Figure 4 Women’s access to mass media, by poor and non‐poor stratification, Ghana

2017 ....................................................................................................................... 22

Figure 5 Frequency of women’s mass media access, by pregnant women (PW) and

young women of reproductive age (YWRA), Ghana 2017 .................................... 23

Figure 6 Frequency of women’s mass media access, by Sunyani and Tamale

municipalities, Ghana 2017 ................................................................................... 23

Figure 7 Frequency of women’s mass media access, by poor and non‐poor

stratification, Ghana 2017 ..................................................................................... 24

Figure 8 Source of information for choosing healthy food, by pregnant women (PW)

and young women of reproductive age (YWRA), Ghana 2017 ............................. 25

Figure 9 Source of information for choosing healthy food, by Sunyani and Tamale

municipalities, Ghana 2017. .................................................................................. 25

Figure 10 Source of information for choosing healthy food, by poor and non‐poor

stratification, Ghana 2017. .................................................................................... 26

Figure 11 Obaasima seal recognition, all women, Ghana 2017 ............................................... 27

Figure 12 Obaasima seal recognition in Sunyani municipality, Ghana 2017. .......................... 28

Figure 13 Obaasima seal recognition in Tamale municipality, Ghana 2017. ........................... 29

Figure 14 Market share of different biscuit brands, by population group (A),

municipality (B) and MPI score (C), Ghana 2017 ................................................... 30

Figure 15 Frequency and amount of Lola biscuit consumption, all women, Ghana 2017 ...... 31

Figure 16 Key outcomes for Lola biscuits, all women, Ghana 2017 ........................................ 32

Figure 17 Frequency and amount of Samba Shito Sauce consumption, all women,

Ghana 2017 ........................................................................................................... 33

Figure 18 Key outcomes for Samba Shito Sauce, Ghana 2017 ................................................ 34

Figure 19 Market share of different porridges, by population group, municipality and

MPI score, Ghana 2017 ......................................................................................... 36

Figure 20 Frequency and amount of Tom Vita porridge consumption, all women, Ghana

2017 ....................................................................................................................... 36

Figure 21, Key outcomes for TomVita porridge, Ghana 2017.................................................. 37

ANF4W Endpoint Survey, Ghana, 2017 ‐ v ‐

List of tables Table 1 Prevalence estimates for nutrition‐relevant data in the recent past in

Ghana .................................................................................................................... 12

Table 2 Inclusion criteria by targeted population group .................................................. 15

Table 3 Demographic characteristics of the survey sample, pregnant and non‐

pregnant women, Ghana 2016 .............................................................................. 19

ANF4W Endpoint Survey, Ghana, 2017 ‐ vi ‐

ACKNOWLEDGEMENTS

We acknowledge all study participants for their time and willingness to participate in the

baseline and endpoint surveys. We would also like to express thanks to the Ghana Statistical

Service for providing maps of the selected supervisory enumeration areas as well as the field

workers for their dedicated work.

Research for this report was funded by The Children’s Investment Fund Foundation (UK)

(“CIFF”). The views, opinions, assumptions or any other information set out in this report are

solely those of the authors and should not be attributed to CIFF or any person connected

with CIFF.

ABBREVIATIONS

ANF4W Affordable nutritious foods for women

CI Confidence Interval

CIFF Children's Investment Fund Foundation

DHS Demographic and Health Survey

IYCF Infant and young child feeding

EA Enumeration Area

MICS Multiple Indicator Cluster Survey

MPI Multi‐dimensional poverty index

NPW Non‐pregnant woman/women

PW Pregnant woman/women

UNICEF United Nations Children’s Fund

WDDS Women’s Dietary Diversity Score

WHO World Health Organization

WRA Women of reproductive age; generally defined as 15‐49 years old

YWRA Young women of reproductive age; defined here as 15‐24 years old

ANF4W Endpoint Survey, Ghana, 2017 ‐7‐

EXECUTIVE SUMMARY

Introduction

Women of reproductive age, particularly during pregnancy and lactation, have increased nutrient

needs and are therefore more vulnerable to nutritional deficiencies. In Ghana, despite two decades

of sustained economic growth and reductions in some forms of malnutrition, progress on eliminating

micronutrient deficiency has been slow. The “Affordable Nutritious Foods for Women” (ANF4W)

program thus aimed to increase the local supply of and demand for affordable nutritious foods for

women of reproductive age in developing countries. Ghana was included in this pilot stage of the

ANF4W based on the country’s suitability and readiness for such market‐driven programs. The

ANF4W pilot in Ghana supported the development and nutritional optimization of 3 fortified

products targeting mainly women during pregnancy and pre‐pregnancy. These products (hereafter

referred to as ‘ANF4W products’) are: a) High‐protein/condensed milk biscuits “Lola Biscuit”

(produced by Mass Industries Ltd.); b) Instant porridge “Tom Vita” (Yedent Agrofoods Ltd.); and c)

hot pepper sauce “Samba Shito” (Samba Foods Ltd.). The product launch took place in March 2017

and was accompanied by unbranded and branded marketing campaigns. Part of the unbranded

campaign was the launch of the ‘Obaasima’ seal, a seal which was awarded to manufacturers after

passing a thorough audit of the criteria of the “Code of Practice for Micronutrient Fortification of

Processed and Packaged Foods”. Campaigning on the seal included a variety of activities aiming to

convey certain key messages about the added nutritional value of products having this seal to

encourage women to take their own nutrition needs seriously and to promote better food choices.

Objectives

The ANF4W evaluation included two cross‐sectional surveys, and this report presents the situation

after a 6 months branded and unbranded marketing campaign, which followed the product launch in

March 2017. The primary outcomes have been ‘Obaasima’ seal awareness and product awareness,

accessibility, desirability, affordability, purchase, and consumption.

Methodology

The ANF4W pilot product launch took place in Tamale Municipality in the Northern Region and

Sunyani Municipality in the Brong‐Ahafo Region; therefore, the endpoint survey was implemented in

these areas in August/September 2017; the endpoint survey was preceded by a baseline survey prior

to product launch (May/June 2016), using a similar methodology to that described here. Pregnant

women and young non‐pregnant women 15‐24 years were the target populations. In the first stage

of sampling, 25 clusters were randomly selected from each of the two municipalities with the

probability of selection being proportionate to population size. In these clusters, updated household

lists were generated listing the households with pregnant women and young non‐pregnant women.

In each cluster, 13 households with at least one pregnant woman and nine households with at least

one non‐pregnant woman 15‐24 years of age were randomly selected. This sample size was

calculated to detect with statistical significance a minimum increase from 0% consumption of the

fortified product at the time of the baseline survey to 5% consumption at the time of the endpoint

survey. However, since none of the speciality products were available during baseline assessment,

comparison of product specific awareness, accessibility, purchase, desirability and consumption was

not possible.


After random selection of households and having obtained written informed consent from the pre‐

identified respondent(s) in a selected household, a questionnaire was administered using direct

electronic data collection. Questionnaire modules contained questions about household composition

and characteristics, water supply, sanitation and hygiene facilities and practices, pregnancy history,

household food security, the woman's dietary diversity, Obaasima seal awareness and awareness,

desirability, purchase and consumption of the 3 specialty food products for women before or during

pregnancy.

For this endpoint survey, data analysis consisted mainly of descriptive statistics, but additionally,

bivariate and multivariate analyses were included where useful and comparisons between baseline

and endpoint were done where possible.


Results

This executive summary presents some of the major findings, disaggregated by target group. For

other disaggregation and precision estimates, please refer to the main report.

Variable Pregnant

women

Young non‐

pregnant women

Basic socio‐demographic information

Mean age, years 28.2 18.7

Women without formal education, % 23.4 10.9

Dietary diversity score (out of 10), mean 4.74 4.17

Women with adequate dietary diversity, % 54.0 36.1

Household at risk for poverty, % 6.7 3.1

Access to safe drinking water, % 71.2 73.7

Access to mass media

Television, % 88.5 89.7

Radio, % 72.6 75.7

Newspaper, % 8.0 21.3

Social media, % 27.6 49.0

Access to television at least once/week, % 81.4 77.7

Access to radio at least once/week, % 51.6 51.1

Access to newspaper at least once/week, % 5.6 10.6

Access to social media at least once/week, % 20.0 44.0

Information sources for ‘healthy foods’

Television shows, % 35.2 53.6

Radio, % 21.0 35.1

Health personnel, % 62.1 11.3

Seal recognition and product exposure

Obaasima seal

Proportion ever heard of/ seen Obaasima seal, % 57.8 69.8

Billboard main site where Obaasima was heard of/ seen,% a 20.7 27.7

Proportion knowing what Obaasima seal means, % a 32.6 28.3

Good for health main response for meaning of Obaasima; % a 19.1 17.8

Proportion ever bought products with seal, % 14.2 13.6

Lola Biscuits

Proportion consuming biscuits in general, % 77.0 92.7

Proportion ever heard of/ seen Lola biscuits, % 20.7 16.8

Shopkeeper main place where Lola was heard of/ seen, %a 29.6 31.9

Proportion ever eaten Lola, % 6.4 7.6

Shito sauce

Proportion consuming Shito in general, % 73.2 79.9

Proportion ever heard of/ seen Samba Shito, % 18.2 13.4

Shopkeeper main place where Samba Shito was heard of/ seen, %a 19.4 23.9

Proportion ever eaten Samba Shito, % 6.3 1.8

Tom Vita porridge

Proportion consuming porridge in general, % 92.0 96.3

Proportion ever heard of/ seen Tom Vita, % 28.4 33.1

Shopkeeper main place where Tom Vita was heard of/ seen, %a 14.7 28.1

Proportion ever eaten Tom Vita, % 7.7 3.8a Only those who had ever seen or heard of the product are included in the calculations


Discussion and recommendations

The report presents the main findings from a product availability and consumption endpoint survey

investigating three fortified specialty products. These products were designed for pregnant women

and young non‐ pregnant women, and marketed in two test communities, Sunyani and Tamale

municipalities. As none of the products investigated as part of this endpoint survey were available in

the market at the time of the baseline survey, we were unable to directly measure changes in

product‐related perceptions between the two surveys. Moreover, the product launch and marketing

campaign took place at the same time. As such, the survey did not allow us assessing to what extent

the marketing campaign increased the demand for the products and what proportion of the products

would have been sold without the campaign. A notable limitation of the survey was the low sales

figures. The small number of respondents purchasing and consuming the products prevented the

endpoint survey from yielding actionable results for most of the main outcomes for the three

specialty products.

Findings from the assessment showed that almost 70% of the surveyed women had seen or heard of

the Obaasima seal, which is encouraging, especially considering the relatively short campaign

exposure of only 6 months. However, more than half of the women who had ever seen or heard of

the seal did not know its meaning and only about 40% associated Obaasima with some sort of health

benefit.

The survey results show that the market entry proved to be difficult for all of the three specialty

products. Reasons for the rather challenging market entry and rather modest market coverage of the

products could be manifold. We would hypothesize that the modest success could at least be

partially ascribed to the duration of marketing campaign, as product awareness ranged from 17%‐

33%. Adding to this, the already relatively low awareness did not translate into actual product

purchase, resulting in very few women who had ever bought or eaten the products. Reasons for this

could either be a lack of demand or limited product availability or a combination of both. The survey

results indicate that price might have been a factor guiding sales as none of the women living in poor

households and being more price sensitive had ever consumed one of the products. Other reasons

might be the market domination of already existing products (biscuit market) or that there is no

convenience product market for Shito sauce and porridge, as people prefer homemade and

unbranded Shito sauce or ‘koko’ and ‘hausa koko’ porridge. Furthermore, albeit anecdotally, we

visited retailers selling the products in Sunyani during the survey and found that most of them had

run out of stock. This was mainly the case for Lola biscuits which could not be found in any of the

shops. Further inquiries revealed that most of the retailers received a small amount of products only

once and did not know whom to contact in order to get resupplied. For all products, respondents

gave “product not easily available” as one of the answers when asked for negative characteristics of

the products. Weak supply and distribution at such an early stage might have suffocated the demand

for products before they had a chance to expand. In brief, while the marketing campaign aimed to

increase demand for nutritious food products, the campaign may have been undercut by poor supply

and distribution.

One of the main objectives of the marketing campaign was to increase demand for nutritious food

products amongst women of reproductive age and encourage them to take their own nutrition needs


seriously; only a small proportion (<10%) of the planned sales had been realized at the time of the

endpoint survey, most likely reflecting a combination of low demand and supply problems.

It also has to be noted that due to the relatively low product consumption of consumers, the fortified

products hardly contributed to the daily micronutrient intake. Most of the consumers ate the

products less than once a months and the median daily product consumption ranged from 0.02‐0.1

products, which will have to be considerably increased in the future in order to be beneficial for the

micronutrient status of consumers.

It is questionable if product demand will remain at that level or further decrease after the marketing

campaign ended, especially since the majority of the consumers did not express to perceive the

products as nutritious or healthy foods. For a project extension, we would therefore recommend that

the supply chain be addressed first, so that where demand exists, consumers can successfully access

the products. In tandem, modifications to the marketing campaign can be made with a focus on a)

altering the perception of the Obaasima seal, so that more women perceive products carrying the

seal as healthy and b) increasing the association between the Obaasima seal and the specific

products. Once the supply chain is strengthened and marketing campaign is refined, prolonging the

marketing campaign should be envisioned. In particular for targeting PW, focus should be on

‘classical’ media channels (radio/TV, NOT newspapers). TV and radio could be complemented by

social media, as this channel is frequently used by young women. An additional source of health‐

related information seems to be health workers (in particular for pregnant women) and a project

extension should explore how this source could be used. Further, the results indicate that products

might be too pricy as none of the women classified as poor had ever bought one of the products. In

order to make products affordable for the poor a price correction should be taken into consideration.


1 INTRODUCTION

1.1 Background

Women of reproductive age, particularly during pregnancy and lactation, have increased nutrient

needs and are therefore more vulnerable to nutritional deficiencies. Additionally, public health

efforts focusing on the ’1000 day window‘ (the period from conception to a child’s second birthday)

concern the nutritional/micronutrient status of women because of the critical link between maternal

and child nutrition. For example, during pregnancy, adequate vitamin A supply is essential for the

development of the fetal organs and skeleton. After delivery, infant vitamin A supply through breast

milk depends on the vitamin A status of the mother [1]. Furthermore, vitamin A improves the

mother's mobilization and utilization of iron, which must be provided in adequate amounts during

pregnancy to prevent iron deficiency anemia; reducing iron deficiency anemia during pregnancy has

been associated with a reduced prevalence of low birth weight, perinatal mortality, maternal

mortality and improved behavioural and cognitive development as well as child survival [2, 3]. Zinc

nutrition in utero is essential for cellular differentiation and maturation, and maternal zinc deficiency

might lead to growth retardation and other developmental defects [4]. In addition, periconceptional

folate nutrition is an important determinant of embryogenesis and therefore essential for neural

tube and neural crest development [5].

In Ghana, despite two decades of sustained economic growth and reductions in some forms of

malnutrition, progress on eliminating micronutrient deficiencies has been slow. While scarce, the

available data on micronutrient status of women of reproductive age indicates that micronutrient

deficiencies are of public health concern (see Table 1).

Table 1 Prevalence estimates for nutrition‐relevant data in the recent past in Ghana

Most recent estimate Year of estimate Source

Women 15‐49 years, non‐pregnant

Anemia (%) 48.1% 2008 [6]

Iron deficiency (%)1 13.2% 2008 [6]

Iodine Deficiency (%) 47.2% 2010 [7]

Pregnant women

Anemia (%) 64.9% 2003 [8] 1 Defined as serum ferritin <15 ug/L for WRA, no adjustment for inflammation made

1.2 ANF4W Project Overview

The Bill and Melinda Gates Foundation and German Federal Ministry for Economic Cooperation and

Development work together to reduce malnutrition while maintaining their commitments to support

sustainable, healthy and local food systems. A notable component of this effort is the joint funding of

the “Affordable Nutritious Foods for Women” (ANF4W) program, which aims to increase the local

supply and demand of affordable nutritious foods for women of reproductive age in developing

countries. The initiative connects private‐sector partners working in different intervention areas and

different target locations, with the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)

GmbH as the collective implementing partner. In 2013, the project was officially launched in three

pilot locations, 1) Ghana, 2) Bangladesh, and 3) Kenya and Tanzania. Ghana was included in this pilot

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This survey collected information about consumption, purchase, price sensitivity and access of the

three speciality products by pregnant women (PW) and young non‐pregnant women of reproductive

age (YWRA; 15‐24 years of age) as well as on the awareness and recognition of the Obaasima seal

and seal‐related messages. Along with information about these outcomes of primary interest,

additional variables which may influence those outcomes have been assessed. Such additional

variables included the assessment of socio‐economic status, household food security (using

household hunger scale[10]), individual dietary diversity (MDD‐W; [11]), water, hygiene and

sanitation, and general health‐related questions. Socio‐economic status has been assessed using the

multi‐dimensional poverty index (MPI), whereby information on three domains ‐ living standards,

education, and health and nutrition – has been used to calculate the MPI; mid‐upper arm

circumference of participating women was also measured.

Intended primary outcomes:

• Awareness: What proportion of target consumers recognize the Obaasima seal and associated

positive attributes with it? What proportion of the target customers are aware of the ANF4W

products?

This component will include collection of information about types of information/media channels

and type of information recalled by interview participants;

• Access: What proportion of the target group have seen the ANF4W products sold at nearby

retailer? This component will include information about usual sales points for similar types of

products and approximate distances (subjective travel time estimates);

• Desirability: What proportion of target consumers think that the ANF4W product is attractive?

• Affordability: Are ANF4W products priced in a range that target consumers find reasonable and are

willing to pay? Are there factors that motivate target consumers to pay more?

• Purchase: What proportion of target consumers have ever purchased the ANF4W products? Have

target consumers 'recently' purchased the ANF4W products?

Distinguishing between 'ever purchased' and 'recently purchased' is important to extrapolate to

effective coverage, a measure of product adherence that would be expected to produce a

measurable biologic effect.

• Consumption: What proportion of target consumers has ever eaten the ANF4W product? Does the

fortified product replace other micronutrient rich foods?

Additional components to adequately determine consumption by target individuals will be intra‐

household sharing of the ANF4W food and other relevant eating habits.

2 METHODOLOGY

2.1 Survey design and sampling procedure

The ANF4W survey was designed as a one‐ stratum cross sectional survey for two target populations,

where the two selected municipalities (Tamale, Sunyani) were treated as one stratum for PW and

YWRA. Multi‐stage cluster sampling was applied: in the first sampling stage, 25 enumeration areas

(EAs) were randomly selected with probability proportional to size. In each selected EA, a household


listing exercise was conducted to list all PW and all YWRA. In the second sampling stage, households

with PW and/or YWRA were separately selected from the list using simple random sampling via a

random number table. A detailed list of EAs selected is presented in Appendix 2.

2.2 Study populations

All PW and/or YWRA living in randomly selected households were included in the survey. Table 2

below lists the inclusion criteria for enrolment into the survey, disaggregated by target population

group. There were no specific exclusion criteria other than the negation of the inclusion criteria.

Table 2 Inclusion criteria by targeted population group

Target Inclusion criteria

Pregnant

Women

(including

pregnant girls)

Currently pregnant by self‐report Gives written informed consent for survey data collection

Currently resides in one of the two municipalities included in the sampling

universe and is considered a household member by other adults living in the

household

Young women of

reproductive age

Age 15‐24 years at the time of the survey data collection

Currently non‐pregnant by self‐report Gives written informed consent for survey data collection

Currently resides in one of the two municipalities included in the sampling

universe and is considered a household member by other adults living in the

household

2.3 Sample size determination

To determine the sample size required for the baseline survey, Fleiss’ formula [9] was used for

estimating the minimum sample size required to enable the comparison of a one‐stratum baseline

survey to future surveys.

The sample size calculation was done for the outcome 'respondent has recently consumed one of the

fortified products'. The follow‐up survey measured change over time in consumption, and a sample

size for the follow‐up survey was calculated to ensure statistical significance of a change from 0%

consumption at baseline and 5% consumption for endpoint. All sample size calculations assume a

household response rate of 95%, an individual response rate of 95% and a relatively low design effect

of 2.0 because the geographic area in which the survey population lives is relatively small and it is

assumed that the marketing and distribution program will extend to all parts of the two

municipalities.

The minimum sample size to detect with statistical significance a difference of 5 percentage points or

more between the baseline constant of 0% and the endline 5% would be 32 women. Applying the

assumed design effect of 2.0 increased the sample size to 64 women. This sample size would have

resulted in 2‐3 women per cluster; however, this is too small a number to make stable estimates of

variance during computer data analysis. Therefore, the survey selected 13 households with at least


one PW and nine households with at least one YWRA per cluster, for a total sample size of 325 PW

and 225 YWRA households, resulting in an individual sample size of 325 PW and 270 YWRA according

to the latest census data.

2.4 Approvals and ethical considerations

Ethical approval for the study was obtained from the University of Ghana's Ethics Committee for

Basic and Applied Sciences (ECBAS); reference no. ECBAS 034/15‐16. Written consent was requested

from all interviewees following an explanation of the survey’s objectives.

2.5 Training of survey teams

One week prior to the start of the ANF4W Endpoint Survey, all field workers (supervisors, team

leaders, interviewers) were trained on household listing (mini census), random selection of

participants and data collection procedures. The training consisted of 2 days of theoretical training

and one day of role play to familiarize field workers with the survey procedures, instruments, and

equipment. As part of the role play, interviewers conducted several interviews using electronic data

collection on tablet devices. Of note, all but 1 field workers were already part in the baseline survey

and thus, they already had experience from the previous round. Following classroom training, two

days of field testing were undertaken in the project areas (Tamale, Sunyani), but in EAs that were not

included in the ANF4W Endpoint Survey sample. Based on this pilot testing, the questionnaire was

updated.

2.6 Field work

The endpoint survey data collection was conducted from 24 August – 07 September 2017. Data

collection was conducted by four teams, two in Tamale and two in Sunyani municipality. Each team

was comprised of one team leader, two interviewers, and two local guides from Ghana Statistical

Service. Prior to the random selection of households in each selected EA, the teams conducted a

“mini‐census” of each EA, whereby all households residing within each EA were visited and listed,

and all households containing PW and/or YWRA were noted. EA boundaries were identified using

maps provided by the Ghana Statistical Services. In households with at least one eligible woman, the

name of the household, the location of the household, and number of eligible women was recorded.

For selected clusters that were small and contained less than 13 PW, a previously‐selected

supplementary cluster was visited, and all households in that cluster counted and households with

PW listed. Using the completed households’ lists, 13 households with at least one PW and nine

households with at least one YWRA were selected at random using a random number table.

Interviews were conducted on tablet computers after obtaining informed written consent (on

separate paper‐based forms). Interviewers were instructed to request that interviews were

conducted in privacy to enable participants to respond candidly to sensitive questions.


2.7 Data management and analysis

2.7.1 Data analysis

Data analysis was done using SPSS version 22.0 using the complex survey module. Standardized

statistical weights were calculated to account for the difference between the estimated size of the

EAs before sampling and the actual size of the EAs as measured during the mini census.

Data analysis included calculation of proportions to derive the prevalence of primary and secondary

outcomes and mean and median as average measures of continuous variables, as appropriate.

Secondary outcomes were calculated in aggregate (i.e. for the entire sample) and for the different

target groups. Primary outcome measures were calculated in aggregate (i.e. for the entire sample),

and separately for each municipality, target group, and household poverty category.

For selected variables, the statistical precision of prevalence estimates were assessed using 95%

confidence intervals which were calculated accounting for the complex sampling used in this survey.

The statistical significance of differences between subgroups was assessed using Chi square using

weighted analysis and adjusted for complex sampling.

2.7.2 Calculation of awareness, access, desirability, purchase and consumption

Proportions were calculated for awareness, access, desirability, purchase, and consumption

indicators. When necessary, median quantities of those responding positively were calculated by

combining the purchase/consumption frequency and the quantity purchased/consumed each time.

2.7.3 Calculation of wealth

The multidimensional poverty index (MPI) was constructed according to Alkire and Santos [10],

whereby living standards, education, health and nutrition, and household assets are combined to

create an index ranging from 0 to 1. Using this approach, a MPI of 0‐0.33 denotes a household as not

at risk of poverty, and a MPI of ≥ 0.33 denotes a household as being at risk for poverty. In this report,

the terms "non‐poor" and "poor" are used, respectively.

2.7.4 Minimum dietary diversity in women

Dietary diversity in women was measured using the newly proposed Minimum Dietary Diversity‐

Women (MDD‐W) approach, based on foods in 10 separate food groups [11]. Consuming five or

more food groups in the 24 hours prior to the interview was used as the threshold for minimum

dietary diversity among women.

2.7.5 Water and sanitation

Case definitions from the WHO/UNICEF Joint Monitoring Programme for Water Supply and

Sanitation were used classify households with improved/unimproved sanitation facilities and

safe/unsafe drinking water [12]. A household was considered to use an improved sanitation facility if

the facility was a ventilated improved pit (VIP) latrine or a pit latrine with slab and the facility was not

shared with other households. Flush or pour flush toilets are considered improved. Unimproved

sanitation facilities included any facility shared with another household, an open pit, bucket latrine,

no facility, bush, or field. Drinking water was considered safe if it came from a “safe” source (e.g.

water from piped system, tube well or borehole, protected well, protected spring, rainwater


collection, or bottled water) or was treated with bleach or boiled prior drinking. Unimproved drinking

water sources include water from unprotected well, unprotected spring, tanker truck or cart, surface

water.

ANF4W Endpoint Survey, Ghana, 2017 ‐ 19 ‐

3 RESULTS

We anticipated including 325 households with PW and 225 households with YWRA, which would

have been equivalent to 325 PW and 270 YWRA according to the latest census data. Based on the

census data we anticipated 325 PW. At the time of data collection only 282 PW were present,

despite additional clusters. The actual sample size achieved was 282 PW and 292 YWRA, representing

an achievement rate of 87% for pregnant women and 108% for YWRA.

Table 3 provides an overview of demographic characteristics of PW and YWRA, which are similar to

the baseline survey. Not surprisingly, the pregnant women surveyed are considerably older than the

YWRA, as YWRA were selected based on a restrictive age criterion while PW were not. Similarly,

marital status and occupation differed, for the same reason. The YWRA tend to have higher

education, but a smaller proportion had a tertiary education, likely due again to their younger age.

Reasons for this slightly better educational level are hard to isolate. Thus, it could be that the

sampling has resulted in a population of slightly better‐off YWRA; but also, it could be that in the

recent past, school enrolment has further improved in the two municipalities surveyed. Huge

differences have also been found in the main occupation as the majority of YWRA were students

compared to only 1% of PW. This is related to age, but also to the higher educational level of YWRA,

and additionally the fact that women who are pregnant may have decided they did not want to

pursue education at this particular life stage. Compared to baseline, fewer PW (6.7% vs. 11.3%) and

YWRA (3.1% vs. 6.5%) were at risk of poverty (MPI> 0.33). No differences have been detected

between the population groups at endpoint, although the proportion of PW at risk was double

compared to YWRA (6.7% vs. 3.1%). Almost two‐ thirds of PW and YWRA consumed safe drinking

water without differences between the groups, which was similar to the baseline assessment.

However, with regard to the sanitation situation differences were identified, with about 30% of

YWRA and only 20% of PW having access to improved sanitation. These differences have not been

detected at baseline, where about 20% of PW and YWRA had access to improved sanitation. Contrary

to the aforementioned education indicators, handwashing knowledge seemed to be slightly better in

the pregnant women. A higher proportion of PW than YWRA consumed a diet with minimum

diversity, but with just about half of the PW having consumed 5 or more food groups in the past 24

hours, still almost half did not achieve minimum dietary diversity, indicating a significant risk of

nutrient inadequacy in their diets. The proportion of PW with MDD (53% vs. 54%) and mean number

of food groups consumed by PW (4.8 vs. 4.7) was similar between baseline and endpoint. For YWRA

the mean number of food groups did not differ between the two surveys with 4.4 and 4.2, but the

proportion of YWRA with minimum dietary diversity was slightly higher in the baseline assessment

(46% vs. 36%).

Table 3 Demographic characteristics of the survey sample, pregnant and non‐ pregnant

women, Ghana 2016

Variable Pregnant women Young non‐ pregnant women P‐value

between

groups

N1 mean;

%2

(95% CI)3 N1 mean;

%2

(95% CI)3

Age of woman, mean (years) 281 28.2 (27.1, 29.2) 292 18.7 (18.2, 19.2) <0.001

Marital status of woman, % <0.001

Married 264 90.0 (83.1, 94.3) 15 4.0 (2.1, 7.6)

Widowed 1 0.2 (0.0, 1.7) 0 0 ‐

ANF4W Endpoint Survey, Ghana, 2017 ‐ 20 ‐

Single 22 9.8 (5.5, 16.8) 277 95.5 (91.4, 97.7)

Separated 0 0 ‐ 2 0.5 (0.1, 2.1)

Number of times pregnant, % <0.001

0 0 0 ‐ 270 90.3 (85.0, 93.9)

1‐2 148 52.1 (47.7, 56.6) 23 9.3 (6.1, 14.0)

3+ 139 47.9 (43.4, 52.3) 1 0.4 (0.0, 2.9)

Education of woman, % <0.001

None 81 23.4 (15.5, 33.8) 14 3.3 (1.5, 6.7)

Primary school 35 9.8 (6.1, 15.6) 38 10.9 (6.5, 17.5)

Middle 2 0.6 (0.1, 2.9) 1 0.6 (0.1, 4.4)

JSS/ JHS 84 35.3 (27.4, 44.0) 117 37.9 (30.9, 45.5)

SSS/ SHS 47 16.3 (12.4, 21.2) 108 39.1 (31.6, 47.3)

Tertiary Higher 37 14.4 (8.0, 24.7) 16 8.2 (2.9, 21.0)

Other 1 0.2 (0.0, 1.3) 0 0 ‐

Main occupation of woman, % <0.001

Apprenticeship 19 8.9 (5.0, 15.1) 23 7.2 (4.6, 11.1)

Agriculture‐ own farm 3 1.2 (0.3, 4.6) 0 0 ‐

Agriculture – someone else’s

farm

3 0.8 (0.1, 6.4) 1 0.2 (0.0, 1.4)

Salaried employee 31 13.0 (6.9, 23.4) 4 2.0 (0.7, 5.6)

Petty trade 94 31.1 (23.8, 39.5) 13 4.6 (2.8, 7.7)

Self‐ employed 60 19.3 (14.6, 25.2) 8 3.0 (1.3, 6.8)

Student 4 1.0 (0.3, 2.9) 188 61.2 (53.8, 68.1)

Unemployed 72 24.5 (19.3, 30.4) 56 21.4 (15.7, 28.4)

Overall risk of poverty 0.248

MPI score ≥0.33, % 17 6.7 (2.5, 16.6) 7 3.1 (1.4, 7.0)

Drink safe water, % 4 0.703

Yes 216 71.2 (51.9, 85.0) 162 73.7 (61.2, 83.2)

No 56 28.8 (15.0, 48.1) 43 26.3 (16.8, 38.8)

Household sanitation, %5 <0.05

Improved 49 20.3 (11.8, 32.7) 53 30.3 (19.4, 44.0)

Unimproved 223 79.7 (67.3, 88.2) 151 69.7 (56.0, 80.6)

Hand washing, % 0.070

≥ 3 critical times 182 55.3 (45.2, 65.0) 166 46.3 (35.9, 57.1)

< 3 critical times 105 44.7 (35.0, 54.8) 128 53.7 (42.9, 64.1)

Minimum dietary diversity, % <0.01

Yes6 164 54.0 (45.2, 62.5) 118 36.1 (28.5, 44.5)

No 123 46.0 (37.5, 54.8) 176 63.9 (55.5, 71.5)

Number food groups, mean 282 4.74 (4.41, 5.07) 292 4.17 (3.91, 4.43) <0.011 The n’s are un‐weighted numbers in each subgroup; sum of subgroups may not equal total because of missing data; 2 All figures are proportions except for mean age of respondents. Percentages are weighted for inaccurate EA size used

during the first stage of sampling; 3 CI=confidence interval, calculated taking into account the complex sampling design; 4Improved source = water from piped system, tube well or borehole, protected well, protected spring, rainwater collection,

or bottled water. Unimproved source = water from unprotected well, unprotected spring, tanker truck or cart, surface

water or other; composite variable of main source of drinking water and treating water to make safe for drinking; 5Composite variable of toilet type and if toilet facilities are shared with non‐household members; 6 Minimum dietary diversity defined as consuming foods from ≥5 food groups in the past 24 hours.

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‐ 23

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Ghana 2

3.2 O

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*Only the

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Figure 1

results s

by telev

Obaasim

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almost 6

(n= 43) o

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were rel

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almost a

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with the

Endpoint Surv

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2017.

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11 almost 70

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60% of those

of the surve

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all women (

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information

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the women

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with risk of

7) .

and non‐po

ed responses

or seen the

billboards a

ndents who

T‐shirts duri

knew the m

now the mea

the Obaasim

f the reason

carrying the

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omen had e

mers in Suny

eing preferr

cts preferred

Obaasima pr

men had ev

er. Also, sign

compared

f poverty ev

oor stratificat

are presente

e Obaasima

and posters,

o were awar

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ma seal and

ns for the pr

seal. Stratifi

men who h

ever heard

yani stated p

red taste. In

d those ove

roducts. Stra

ver seen or

nificantly les

to women

ver bought a

‐ 26

tion,

d in

seal. The

followed

re of the

romotion

Obaasima,

than 15%

of those,

reference

cation by

ave ever

of/ seen

preferring

n Tamale,

er others,

atification

heard of

s women

living in

a product

A

*

F

ANF4W Endpoint Su

Only the 5 most cit

igure 11 Obaasim

urvey, Ghana, 2017

ted response optio

ma seal recognitio

ons shown for bette

on, all women, Gh

er visibility, all cited

hana 2017

d responses are pre

_

esented in supplemmentary tables

_______

____‐ 27

A

*

F

ANF4W Endpoint Su

Only the 5 most cit

igure 12 Obaasim

urvey, Ghana, 2017

ted response optio

ma seal recognitio

ons shown for bette

on in Sunyani mun


nicipality, Ghana

d responses are pre

2017.

_


___________‐ 28

A

*

F

ANF4W Endpoint Su

Only the 5 most cit

igure 13 Obaasim

urvey, Ghana, 2017

ted response optio

ma seal recognitio

ons shown for bette

on in Tamale mun


nicipality, Ghana 2

d responses are pre

2017.

_


___________‐ 29

ANF4W E

3.3 In

Although

status, s

(Figure 1

‘Digestiv

most of

respond

Currentl

the usua

Figure 14

MPI scor

Overall,

(n= 57)

about 7%

the wom

“contain

baseline

positive

This is lo

women

however

Lola bisc

or more

biscuits

of Lola w

biscuits w

The resu

Stratifica

none of

Endpoint Surv

nformation

h there are

some biscuit

14). Similar t

ve’ across th

ften cited. S

ents, which

y, the ‘Lola M

ally consume

4 Market sh

re (C), Ghana

17% (n= 101

knew where

% of the stu

men mentio

ns vitamins

, were abou

characterist

ower compar

(about 40%

r, collect inf

cuits cannot

e biscuits (Fig

per day, com

was mainly o

were availab

ults showed s

ation by wea

them ever a

ey, Ghana, 20

about cons

some differe

t brands see

to baseline

e different s

Similar to b

might be rel

Milk biscuit’

ed biscuit bra

are of differ

a 2017

1) of respon

e to buy and

udy populatio

ned taste (7

and minera

t 80% of wo

tic. The majo

red to the ba

%) ate any b

formation ab

be quantifie

gure 15). Th

mpared to 0.

wed to the l

ble was 500 m

significant d

alth showed

te Lola biscu

A

017

sumer beha

ences betwe

em to domin

these are ‘C

subgroups, w

aseline ‘Cre

ated to the r

brand is cle

and of about

rent biscuit b

dents had e

d 44% (n= 4

on. When as

75%; n= 34

als” as a po

men liked th

ority of wom

aseline asses

biscuits once

bout consum

ed. When ea

e median da

55 biscuits p

ow frequenc

meters.

ifferences be

that only 9.

uits.

aviour: Lola

een the targe

nate the ma

Cream Crack

with ‘Perk’ (

eam Cracker

relatively low

arly not a m

t 1% of respo

brands, by p

ever seen or/

2) had ever

sked for pos

). About 26

ositive chara

he taste and

en ate Lola

ssment of an

e or twice

mption of ‘an

ating Lola bis

aily consum

per day of an

cy of consum

etween PW

1% of wome

a Milk biscu

et populatio

arkets in Su

ers’, ‘King C

26.5%) and

rs’ are the

w price.

market leader

ondents (sup

opulation gr

/ heard of Lo

eaten Lola

sitive charac

6% liked the

acteristic. Th

about 20% m

biscuits less

ny biscuit con

a week; the

ny’ biscuits,

scuits, more

ption of Lola

ny biscuits at

mption. The m

vs. YWRA an

en living in a

B

its

ns, geograp

nyani and T

rackers’, ‘Pe

‘King Cracke

favourite bi

r in these tw

plementary

roup (A), mu

ola biscuits.

biscuits, the

teristics of L

e packaging

his is somew

mentioned “

than once a

nsumption, w

e endpoint

so parallel c

than half of

a biscuits wa

baseline. Lo

median dista

nd Sunyani vs

a poor house

hic areas an

Tamale muni

erk’, ‘Jack ‘n

ers’ (19.9%) b

iscuit brand

wo municipal

table 8).

unicipality (B

Of those, ab

e latter equi

Lola biscuits,

and only 1

what compa

“good for hea

a month (abo

where the m

assessment

consumption

f the women

as very low,

ow daily cons

ance to a pla

s. Tamale su

ehold ever h

‐ 30

nd wealth

icipalities

’ Jill’ and

being the

of poor

ities; it is

B) and

bout 60%

valent to

, most of

4% cited

arable to

alth” as a

out 60%).

ajority of

did not,

n of non‐

n ate four

with 0.1

sumption

ce where

ubgroups.

eard and

C

ANF4W E

Due to t

done for

Lola bisc

PW had

biscuits

access, b

Sunyani.

compare

month

consump

once a m

(63.4%).

Figure 1

Endpoint Surv

the small nu

r all variable

cuits and kne

only one b

per serving

but significa

. In Sunyani

ed to Tamale

(83.5%), mo

ption was si

month, but t

5 Frequency

ey, Ghana, 20

mber of res

es. Subgroup

ew where to

iscuit. This w

. Stratificatio

antly more w

biscuits hav

e. The vast m

ost of them

gnificantly h

the amount

y and amoun

017

pondents co

p analyses sh

buy them co

was differen

on by distri

women livin

e been cons

majority of t

m 4 or mor

higher with

consumed w

nt of Lola bis

onsuming Lo

howed that

ompared to

nt for YWRA

ct showed n

g in Tamale

umed less fr

he women l

re per serv

only 23.6%

was lower, m

scuit consum

ola biscuits s

significantly

PW. When e

, more than

no significan

e saw Lola b

requently, bu

iving in Suny

ving (70.4%)

of women c

most of them

mption, all wo

ubgroup ana

y more YWR

eating Lola b

n half of the

nt difference

biscuits on p

ut in higher q

yani ate bisc

. In Tamale

consuming t

m having on

omen, Ghan

alyses have

RA had ever

iscuits almo

em had four

es in aware

posters com

quantities pe

cuits less tha

e, the frequ

the biscuits

ne biscuit pe

na 2017

‐ 31

not been

heard of

st 70% of

or more

ness and

pared to

er serving

an once a

uency of

less than

er serving

A

*

F

ANF4W Endpoint Su

Only up to the 5 m

igure 16 Key outc

urvey, Ghana, 2017

most cited response

comes for Lola bis

e options shown for

scuits, all women

r better visibility, a

n, Ghana 2017

all cited responses a

are presented in suupplementary table

es

‐ 32

ANF4W E

3.4 In

Almost 8

consumi

remainin

vendor.

Shito sa

“other”

respond

those, a

equivale

most of

surveyed

Most of

sachet p

equivale

assessed

househo

heard of

differenc

in the he

eat Shito

sub‐ gro

Figure 1

Endpoint Surv

nformation

80% of respo

ing Shito sau

ng 40% of

Similar to t

uce from a

Shito brand

ents had eve

about half kn

ent to 6% (n

the women

d population

the women

per serving (

ent to 0.3g p

d at baseline

old had ever

f and ever co

ces have bee

ealth clinic co

o sauce at al

up analyses

7 Frequency

ey, Ghana, 20

about cons

ondents rep

uce about 6

respondents

this, at base

shop/ resta

ds, none of

er heard of S

new where

= 31) and 2

who had ev

n ever purcha

n consuming

(see Figure 1

per day and

e (10g). Sub

r eaten Sam

onsumed Sam

en found bet

ompared to

ll and fewer

are presente

y and amoun

017

sumer beha

orted consu

60% stated t

s consumed

eline almost

urant. Less

f which wa

Samba Shito

to buy it an

2% (n= 21) o

ver consume

ased the pro

Samba Shit

17), which re

considerable

bgroup analy

ba Shito Sau

mba Shito, w

tween PW an

YWRA. Strat

were aware

ed in the ann

nt of Samba

aviour: Sam

ming Shito s

that the mai

mainly unb

all women

than 1% of

s Samba Sh

Sauce, main

nd one‐ qua

of the total s

ed Samba Sh

oduct.

to ate it less

esulted in a

e lower than

yses showed

uce. Due to

we did not co

nd YWRA, ex

tification by

e of Samba S

nex (supplem

Shito Sauce

mba Shito sa

sauce. As sh

in ‘brand’ th

branded Shi

consumed e

women rep

hito Sauce.

ly from relat

arter had ev

study popula

hito, received

s than once

median dai

n the media

d that none

the small n

onduct subgr

xcept that m

district show

Shito Sauce c

mentary table

consumptio

auce

own in Figu

hey consume

ito from a

either home

orted predo

Overall, 13

tives/ friends

ver eaten Sa

ation, respe

d it for free a

a month (>7

ily consumpt

n daily Shito

of the wom

umber of w

roup analyse

ore PW hear

wed that few

compared to

es 16‐18).

on, all wome

re 18, of the

e is homem

shop/ resta

emade or un

ominantly co

3.8% (n= 70

s or in the m

amba Shito,

ectively. Inte

and below 1

70%) and ha

tion of 0.02

o Sauce cons

men living i

women who

es for all varia

rd about Sam

wer women i

o Sunyani. Co

en, Ghana 20

‐ 33

e women

ade. The

aurant or

nbranded

onsuming

0) of the

market. Of

which is

restingly,

1% of the

alf or one

2 sachets,

sumption

n a poor

had ever

ables. No

mba Shito

n Tamale

onducted

017

A

*

F

ANF4W Endpoint Su

Only up to the 5 m

igure 18 Key outc

urvey, Ghana, 2017

most cited response

comes for Samba

e options shown for

Shito Sauce, Gha

r better visibility, a

ana 2017

all cited responses a

are presented in suupplementary table

es

‐ 34

ANF4W Endpoint Survey, Ghana, 2017 ‐ 35

3.5 Information about consumer behaviour: Tom Vita porridge

Overall, 96% of the respondents eat porridge. As shown in Figure 19, only few women stated that

instant porridge was the main porridge they consumed. The most frequently mentioned instant

porridge was Zimbegu (Tom Brown). Only 1 woman mentioned TomVita as her predominantly

consumed porridge. The most frequently mentioned porridge was Koko (unbranded), which was

most popular in Tamale and among women living in poor households. Oats and wheat porridge was

reported to be consumed as the main porridge almost exclusively in Sunyani and by the non‐ poor

respondents (see Figure 19).

Overall, about 33% (n= 133) of the respondents had ever heard of TomVita porridge, mainly on TV

from the shopkeeper or in the market. Of those, about 50% (n= 53) knew where to buy TomVita and

less than one‐ fifth (about 4% of all respondents; n= 24) had ever eaten TomVita. Unlike Samba Shito

sauce, almost all women who had ever eaten TomVita also bought the product; only about 10%

received it for free.

Most of the surveyed women ate TomVita less than once a month (>50%) and one sachet per serving

(38.5%, see Figure 20), which resulted in a median daily consumption of 0.01 sachets. This small

quantity is not surprising as median daily instant porridge in general was already low at baseline

(0.06 sachets). Due to the small number of women who had ever consumed TomVita, we did not

conduct sub‐ group analyses for all variables. Similar to the other products, stratification by

pregnancy status showed that significantly more PW heard about TomVita at the health clinic

compared to YWRA, which is most likely due to the antenatal care visits. Interestingly, awareness was

much higher in Sunyani than in Tamale with more than 40% of the surveyed women having ever

seen/ heard of TomVita compared to only 17% in Tamale. Similar to the other products, none of the

women living in poor households had ever consumed TomVita. Sub‐ group analyses can be found in

the annex (supplementary tables 20‐22).

A

F

F

ANF4W Endpoint Su

igure 19 Market s

igure 20 Frequen

urvey, Ghana, 2017

share of different

ncy and amount o

t porridges, by po

of Tom Vita porrid

A

opulation group,

dge consumption

municipality and

, all women, Gha

MPI score, Ghan

na 2017

B

na 2017

‐ 36 ‐

C

A

*

F

ANF4W Endpoint Su

Only the 5 most cit

igure 21, Key out

urvey, Ghana, 2017

ted response optio

tcomes for TomVi

ons shown for bette

ita porridge, Gha


na 2017

_________

d responses are pre

______________


____

___‐ 37 ‐

ANF4W Endpoint Survey, Ghana, 2017 ______________________

4 Discussion

The report presents the main findings from a product availability and consumption endpoint survey

investigating three fortified speciality products. These products were designed for pregnant women

and young non‐pregnant women, and marketed in two test communities, Sunyani and Tamale

municipalities.

It has to be noted that none of the products investigated as part of this endpoint survey were

available in the market at the time of the baseline survey. As such, we were unable to directly

measure changes in product‐related perceptions between the two surveys. Moreover, the product

launch and marketing campaign took place at the same time. As such, the survey did not allow us

assessing to what extent the marketing campaign increased the demand for the products and what

proportion of the products would have been sold without the campaign.

The survey has notable limitations that warrant discussion:

First, the low sales figures – and thus small number of respondents consuming the products by the

endpoint – prevented the endpoint survey from yielding actionable results for most of the main

outcomes for the three speciality products. To illustrate, most of the main outcomes in this report

are based on only a small number of respondents that responded positively to questions about

awareness and consumption of the products making the confidence intervals very wide. Thus, the

results from sub‐group analyses in this report should be interpreted with caution. Complete

subgroup analyses were only possible for questions about the Obaasima seal, however, even in this

instance there was a low proportion of women who had ever bought/consumed products carrying

the seal. As few respondents ever consumed or bought the products, we could only conduct in‐depth

subgroup analyses for awareness; this was not possible for other product‐related variables.

Second, PW and YWRA were pooled together in some figures and tables for (e.g. subgroup analysis

by municipality or by MPI‐score). This is not correct from a statistical standpoint, since the sampling

approach treated PW and YWRA as separate population groups. Therefore, the PW, when pooled

with the YWRA, are massively overrepresented compared to the typical Ghanaian population.

Therefore, this results from this pooling cannot be extrapolated to the general population, but

because the ANF4W project targeted both groups, results are valid for programmatic decision for

these two population groups.

Lastly, to measure household wealth, this survey used the multi‐dimensional poverty index in

contrast to wealth quintile approach used in large‐scale surveys. The multi‐dimensional poverty

index is the appropriate choice for a small‐scale surveys, but resulted in only a small number of

households classified as “poor”. Thus, the estimates from women residing in poor households were

based on a small number of observations and have wide confidence intervals and should be

interpreted with caution.

5 INTERPRETATION & RECOMMENDATIONS

It is important to note that the following interpretation of the survey results was done by the

research team (i.e. GroundWork and University of Ghana) in charge of the endpoint assessment, not

stakeholders or managers of the ANF4W project. The research team does not have an insight into the

project development and evolution of the various projects or the marketing campaigns. As such, the


interpretations and recommendations below are based almost entirely on the results from the

endpoint survey.

Findings from the endpoint assessment showed that almost 70% of the surveyed women had seen or

heard of the Obaasima seal, which is encouraging, especially when considering the relatively short

exposure of only 6 months. However, more than half of the women who had ever seen or heard of

the seal did not know its meaning and only about 40% associated Obaasima with some sort of health

benefit, indicating that the campaign, if prolonged, should be modified in order to increase the

proportion of women perceiving products with the seal as “nutritious”.Putting our results into

context by comparing them to another product launch (young child complementary feeding

supplement) in Ghana [16], which used similar distribution channels and which was accompanied by

a behavior change communication campaign and other marketing activities confirms that awareness

and consumption of our products were relatively low even for 6 months exposure period. Two

months after market entry about 64% of respondents were aware and about 24% of respondents

had ever bought the IYCF supplement, a much higher proportion than for any of our products after 6

months. However, it has to be noted that the type of product cannot be directly compared and

subsequently, results may be expected to differ. Before looking into the results for each of the

products in more detail, it has to be stressed again that the low sales figures led to a considerable

loss of precision. Reasons for the rather challenging market entry and rather modest success of the

products in terms of purchase and consumption could be manifold. We would hypothesize that the

modest success could at least be partially ascribed to the short duration of the marketing campaign,

as product awareness was ranged from 17%‐33%. Adding to this, the already relatively low

awareness did not translate into actual product purchase, resulting in very few women who had ever

bought or eaten the products. Reasons for this could either be a lack of demand or limited product

availability or a combination of both. The survey results indicate that the low demand might have

been due to the high product price as none of the women living in poor households – who are likely

more price sensitive and might not have been willing to pay for these products – had ever consumed

one of the products. Other reasons might be the market domination of already existing products (e.g.

biscuit market) or the fact that there is no convenience product market for Shito sauce and porridge

as people prefer homemade and unbranded Shito sauce or koko and hausa koko porridge. The latter

would not be surprising as baseline assessment showed that almost 100% of respondents mainly

consumed homemade Shito sauce and only about 25% of women consumed instant porridge at all. Furthermore, we visited retailers selling the products in Sunyani during the survey and found that

most of them had run out of stock. This was mainly the case for Lola biscuits which could not be

found in any of the shops. Further inquiries revealed that most of the retailers received a small

amount of products only once and did not know whom to contact in order to get resupplied. For all

products, respondents reported “product not easily available” as one of the answers when asked for

negative characteristics of the products. Weak supply and distribution at such an early stage might

have suffocated the demand for products before they had a chance to expand. In brief, while the

marketing campaign aimed to increase demand for nutritious food products, the campaign may have

been undercut by poor supply and distribution.


5.1 Interpretation of findings in more detail

Obaasima seal recognition:

Findings from the assessment showed that almost 70% of the surveyed women had seen or

heard of the Obaasima seal. This is encouraging, especially since most of the women knew

the seal from billboards and posters, which have been major marketing campaign tools.

Unfortunately, more than half of the women who had ever seen or heard of the seal did not

know its meaning and only about 40% of women ever heard or seen the seal associated

Obaasima with some sort of health benefit. This suggests that the main slogan (I eat foods

with the OBAASIMA symbol! Love yourself. Stay strong for your family) might not have been

sufficiently clear to trigger an association of the seal with nutritious food and health benefits.

Some rethinking and modification of the slogan may be required in order to deliver a clearer

message directly related to health and nutritious food.

Interestingly, it seems that Obaasima has been more successfully established as a

trustworthy symbol of “nutritiousness” and “healthiness” in Tamale than in Sunyani.

Although significantly more women living in Sunyani were aware of Obaasima, more women

living in Tamale cited health‐related attributes when asked what Obaasima stands for. In

addition, of those women who had ever bought products carrying the seal, 99% preferred

those over other products in Tamale compared to only 39% in Sunyani, mainly because of

their health benefits. Why the Obaasima seal had been perceived differently in the two test

markets is unclear, but might be worth elucidating. Also stratification by pregnancy status

showed that significantly more PW were aware of Obaasima compared to YWRA. The reason

might be the antenatal care visits, as the main source of information were the health clinic/

health officers.

Lola biscuits:

Only 17% of the surveyed women had ever seen or heard of Lola biscuits. Of those women

the majority had heard of the biscuits from the shopkeepers or in the market place and

seemed not to have been reached by the marketing channels (posters, billboards, TV, radio

etc.). Only 6% of those who knew Lola biscuits recognized them from billboards, which is

surprising as this was the most frequently given answer for the Obaasima seal. Similar

observations have been made for the other products, indicating that the branded marketing

campaign did not manage to connect the products to the seal and promote them as

individual brands under the “umbrella brand” of the Obaasima seal. When asked for positive

characteristics of Lola biscuits, the majority of women responded “taste” (75%), followed by

“packaging” (26%), “product gives strength” (15%) and “contains minerals and vitamins”,

indicating that either a) the taste of the biscuit is more important to consumers than health

benefits, or b) only few of the women perceived the biscuits as nutritious. Interestingly,

when women were asked for positive aspects of biscuits at baseline, about 80% mentioned

“taste” and about 20% “good for health”, indicating that the marketing campaign did not

change the perception towards a more nutritious product. “Packaging” was mentioned by

less than 1% at baseline clearly showing that package design of Lola was acknowledged. It

has to be noted that those results have to be interpreted with caution as only women who

consumed the biscuits (n=42) were included in the analyses.


Overall, only 7% of the surveyed women had ever consumed Lola biscuits. Of those, the

majority ate them less frequently than once a month, resulting in a daily consumption of 0.1

biscuits. As it is now, the biscuits did not make a significant contribution to the micronutrient

intake of consumers. We did not detect any noteworthy significant differences after

stratification by pregnancy status or geographical region.

Samba Shito Sauce:

Although almost 14% of the respondents had heard of or seen Samba Shito sauce, only 2%

ever consumed it and less than 1% ever purchased Samba Shito sauce. Consumption and

purchase was considerably lower compared to Lola biscuits indicating that Samba Shito sauce

was less attractive for the target groups than the biscuits. This might have traditional

reasons, since Shito sauce is normally produced at home or served with a meal in the

restaurant or chop bar. It is also possible that consumer acceptance was slowed due to the

novelty of the product as it is one of the first Shito sauces available in sachets. Similar to Lola

biscuits, most women mentioned “taste” as a positive characteristic and almost no women

gave any health related positive characteristic, indicating that the messages transported via

the marketing campaign did not reach them. Also, similar to Lola biscuits, the intake of

consumers is very low and Samba Shito Sauce rarely contributed to the micronutrient intake.

Subgroup analyses showed that awareness was significantly higher in Sunyani; stratification

by pregnancy status did not yield any noteworthy significant differences.

TomVita:

TomVita was the product with the highest awareness among the investigated products,

which however did not translate in a higher proportion of consumption or purchase. Only 4%

of women consumed or bought the porridge.

At this point, no real breakthrough has been achieved for any of the products and due to the small

daily quantities consumed, the fortified products hardly contributed in a meaningful way to the daily

micronutrient intake. Most of the consumers ate the products less than once a months and the

median daily product consumption ranged from 0.02‐0.1 products, which will have to be

considerably increased in the future in order to be beneficial for the micronutrient status of

consumers.

It is currently unclear if product demand will remain at that level or further decrease after the

marketing campaign ended, especially since the majority of the consumers do not perceive the

products as nutritious or healthy foods. Considering the various limitations, we recommend the

following. First, issues related to the supply chain must be addressed, so that where demand exists,

consumers can successfully access the products. In tandem, modifications to the marketing campaign

can be made with a focus on a) altering the perception of the Obaasima seal, so that more women

perceive products carrying the seal as healthy and of good quality and b) increasing the association

between the Obaasima seal and the specific products. Once the supply chain is strengthened and

marketing campaign is refined, prolonging the marketing campaign should be envisioned.

In particular for targeting PW, focus should be on ‘classical’ media channels (radio/TV, NOT

newspapers). TV and radio could be complemented by social media, as this channel is frequently


used by young women. Also, seal recognition from billboards was relatively high and thus, is

potentially a good entry point for seal recognition, but would need to be followed‐up somehow to fill

the recognition with content.

Further, the results indicate that products might be too pricy as none of the women classified as poor

had ever bought one of the products. In order to make products affordable for the poor a price

correction should be taken into consideration. When targeting the poor, we would recommend

focusing on biscuits as they have a good value for money and are not traditionally homemade and

cannot easily be prepared at home.


6 REFERENCES

1. WHO. Vitamin A supplementation in pregnant women: World Health Organisation;

2011.

2. Black MM, Quigg AM, Hurley KM, Pepper MR. Iron deficiency and iron‐deficiency

anemia in the first two years of life: strategies to prevent loss of developmental

potential. Nutr Rev 2011; 69: S64‐S70.

3. Black MM. Integrated strategies needed to prevent iron deficiency and to promote

early child development. J Trace Elem Med Bio 2012; 26: 120‐3.

4. Christian P, Stewart CP. Maternal Micronutrient Deficiency, Fetal Development, and

the Risk of Chronic Disease. J Nutr 2010; 140: 437‐45.

5. Rosenquist TH, van Waes JG, Shaw GM, Finnell RD. Nutrient effects upon

embryogenesis: Folate, vitamin A and iodine. Impact of Maternal Nutrition on the

Offspring 2005; 55: 29‐48.

6. Ghana Health Service. Report on baseline survey for evaluating the Ghana food

fortification project (unpublished report); 2008

7. Ghana Health Service, Global Allliance for Improved Nutrition, UNICEF. Report on the

Combined Survey on the Food Fortification Project and Prevalence of Iodine Deficiency

in Ghana.; 2010.

8. Ghana Statistical Service, Noguchi Memorial Institute for Medical Research, ORC

Macro. Ghana Demographic and Health Survey 2003; 2004.

9. Fleiss J. Statstical Methods for Rates and Proportions John Wiley and Sons, New York

19981.

10. Alkire S, Santos ME. Measuring Acute Poverty in the Developing World: Robustness

and Scope of the Multidimensional Poverty Index. World Dev 2014; 59: 251‐74.

11. FAO. Minimum Dietary Diversity for Women: A Guide for Measurement, Rome.

http://www.fao.org/3/a‐i5486e.pdf: FAO, FHI 306; 2016.

12. WHO, UNICEF. Definitions and methods ‐ WHO/UNICEF Joint Monitoring Programme

(JMP) for Water Supply and Sanitation. [cited June 10, 2015]; Available from:

http://www.wssinfo.org/definitions‐methods/

13. Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF. Ghana Demographic

and Health Survey 2008: GSS, GHS, and ICF Macro; 2009.

14. Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF. Demographic and

Health Survey 2014. Accra, Ghana: GSS, GHS, ICF; 2015.

15. Doku DT, Neupane S. Double burden of malnutrition: increasing overweight and

obesity and stall underweight trends among Ghanaian women. BMC public health

2015; 15: 670.

16. Grant JA, Strutt N, Boateng NA, et all. Assessing Program Coverage of Two Approaches

to Distributing a Complementary Feeding Supplement to Infants and Young Children in

Ghana. PLOS ONE 2016

ANF4W Endpoint Survey, Ghana, 2017 44 ‐

7 APPENDIX 1 ‐ SUPPLEMENTARY TABLES

Supplementary Table 1 Mass media and health information access, pregnant and young women of

reproductive age, Ghana 2017

Variable

Pregnant women Young women of

reproductive age

P‐value

betwee

n groups

N1 %2 (95% CI)3 N % (95% CI)

Access to mass media <0.001

None 21 7.0% (3.9, 12.3) 11 3.2% (1.3, 7.9)

Newspaper only 0 0% ‐ 0 0% ‐

Radio only 14 4.0% (1.9, 8.1) 6 1.5% (0.6, 3.4)

Television only 44 14.7% (9.9, 21.3) 35 11.7% (7.7, 17.4)

Internet only 0 0% ‐ 3 1.4% (0.4, 4.4)

Newspaper and Television 3 1.4% (0.3, 5.5) 6 1.9% (0.8, 4.3)

Newspaper and Internet21 1 0.2% (0.0, 2.0)

Radio and Television 126 44.0% (36.9, 51.2) 92 26.9% (20.6, 34.3)

Radio and Internet 1 0.2% (0.0, 1.5) 3 3.0% (0.7, 12.4)

Television and Internet 13 3.4% (1.6, 7.0) 13 4.7% (2.7, 7.9)

Newspaper, Radio, and Television 3 1.4% (0.4, 5.4) 18 5.9% (3.2, 10.7)

Newspaper, Radio, and Internet 2 1.2% (0.3, 5.3)

Newspaper, Television, and Internet 3 0.7% (0.2, 2.2) 5 1.4% (0.6, 3.6)

Radio, Television, and Internet 46 18.7% (12.4, 27.2) 75 26.5% (20.3, 33.7)

All 12 4.3% (2.3, 8.0) 25 10.8% (6.0, 18.9)

Frequency of access

Newspaper or magazine <0.001

At least once a week 15 5.6% (3.3, 9.4) 31 10.6% (6.9, 16.0)

Less than once a week 7 2.4% (1.0, 5.6) 25 10.7% (7.0, 15.8)

Not at all 265 92.0% (88.0, 94.7) 238 78.8% (73.3, 83.3)

Radio 0.462



Not at all 85 27.4% (21.1, 34.8) 73 24.3% (17.6, 32.4)

Television 0.178



Not at all 37 11.4% (6.6, 19.2) 25 10.2% (6.4, 16.1)

Social media <0.001



Not at all 211 72.5% (62.4, 80.6) 168 51.0% (39.1, 62.8)

Source of information to help

choose healthy food

Mother/mother in law 44 15.0% (9.8, 22.3) 49 15.5% (11.2, 21.1) 0.903

Friends 58 14.3% (8.3, 23.5) 53 14.5% (9.5, 21.6) 0.925

Community health officer,

nurse, doctor 189 62.1% (54.2, 69.3) 32 11.3% (7.1, 17.6) <0.001

Nurse, midwife or doctor 27 10.4% (7.0, 15.3) 27 10.4% (7.0, 15.3) <0.001


Traditional birth attendant 1 0.2% (0.0, 2.0) 1 0.2% (0.0, 1.9) 0.980

Local chemists 2 0.8% (0.2, 4.3) 0 0% ‐ 0.211

Posters in the community 6 2.1% (0.8, 5.3) 8 2.2% (1.0, 4.9) 0.916

Radio shows 61 21.0% (16.4, 26.6) 105 35.1% (29.9, 40.8) 0.002

TV shows 109 35.2% (30.1, 40.7) 159 53.6% (48.6, 58.4) <0.001

Social media/ internet/ facebook 28 10.7% (6.1, 18.2) 48 19.0% (11.7, 29.3) <0.001

School or teachers 2 0.8% (0.2, 3.7) 35 11.5% (6.7, 19.0) <0.001

Books or reading 6 2.1% (0.8, 5.4) 5 1.8% (0.7, 4.4) 0.792

Other mass media 4 2.0% (0.6, 6.6) 13 4.8% (2.7, 8.4) 0.115

Don’t know 8 2.2% (0.9, 5.1) 9 2.7% (1.3, 5.7) 0.6941 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing

data; 2Percentages are weighted for inaccurate EA size used during the first stage of sampling; 3 CI=confidence interval, calculated taking into account the complex sampling design.


Supplementary Table 2 Mass media and health information access, Sunyani and Tamale, Ghana

2017

Variable Sunyani Tamale P‐value

betwee

n

groups

N1 %2 (95% CI)3 N % (95% CI)

Access to mass media 0.055

None 10 2.9% (0.8, 10.1) 22 4.5% (2.0, 9.7)

Newspaper only 0 0% ‐ 0 0% ‐

Radio only 5 0.6% (0.1, 2.6) 15 3.4% (1.7, 6.5)

Television only 31 12.3% (7.3, 19.9) 48 11.4% (7.1, 17.9)

Internet only 2 1.6% (0.4, 6.0) 1 0.8% (0.1, 5.9)

Newspaper and Television 5 1.4% (0.4, 4.9) 4 2.5% (1.0, 6.1)

Newspaper and Internet 0 0% ‐ 1 0.1% (0.0, 0.4)


Radio and Internet 3 4.4% (1.1, 16.1) 1 0.0% (0.0, 0.3)

Television and Internet 10 4.6% (2.2, 9.4) 16 4.5% (2.7, 7.3)

Newspaper, Radio, and Television 6 4.0% (1.4, 11.2) 15 8.0% (4.6, 13.6)

Newspaper, Radio, and Internet 1 1.3% (0.2, 8.0) 1 0.8% (0.1, 5.9)

Newspaper, Television, and Internet 2 1.1% (0.3, 4.4) 2 1.1% (0.3, 4.4)


All 22 13.8% (7.4, 24.4) 22 13.8% (7.4, 24.4)

Frequency of access

Newspaper 0.082



Not at all 200 78.4% (71.9, 83.7) 303 82.0% (74.1, 87.9)

Radio 0.075



Not at all 60 23.9% (15.3, 35.3) 98 25.6% (19.7, 32.5)

Television <0.05



Not at all 21 10.8% (6.2, 18.2) 41 9.7% (5.2, 17.1)

Social media <0.05



Not at all 134 44.7% (30.6, 59.7) 245 65.5% (57.4, 72.7)

Source of information to help choose

healthy food

Mother/mother in law 38 14.8% (9.7, 22.0) 55 16.5% (11.2, 23.6) 0.693

Friends 15 7.9% (4.6, 13.5) 96 25.2% (18.2, 33.9) <0.001

Community health officer, nurse,

midwife, doctor 73 14.5% (8.5, 23.8) 148 16.3% (11.8, 22.1) 0.711

Nurse, midwife or doctor 76 15.3% (10.6, 21.6) 139 12.8% (8.9, 18.2) 0.529

Traditional birth attendant 0 0% ‐ 2 0.6% (0.1, 3.7) 0.167

Local chemists 1 0.1% (0.0, 0.6) 1 0.0% (0.0, 0.3) 0.584


Posters in the community 5 1.4% (0.4, 5.3) 9 3.5% (1.6, 7.4) 0.236

Radio shows 64 32.5% (26.9, 38.7) 102 36.5% (28.3, 45.6) 0.450

TV shows 99 50.0% (44.5, 55.4) 169 55.8% (48.7, 62.7) 0.202

Social media, internet, facebook 37 21.3% (11.7, 35.5) 39 13.7% (9.7, 19.0) 0.191

School or teachers 10 7.5% (2.9, 18.0) 27 15.8% (9.5, 25.0) 0.143

Books or reading 6 2.5% (1.0, 6.1) 5 0.8% (0.2, 3.3) 0.168

Other mass media 10 5.5% (2.9, 10.1) 7 3.2% (1.3, 7.8) 0.320

Don´t know 6 3.7% (1.7, 7.9) 11 3.7% (1.7, 7.9) 0.3891 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 3 Mass media and health information access, stratified by MPI score, Ghana

2017

Variable Poor Non‐ poor

P‐value

betwee

n

groups

N1 %2 (95% CI)3 N % (95% CI)

Access to mass media 0.827

None 5 12.6% (2.4, 45.3) 23 2.6% (1.1, 6.2)

Newspaper only 3 2.4% (0.5, 10.5) 0 0% ‐

Radio only 3 10.4% (1.8, 42.3) 12 1.4% (0.6, 3.4)

Television only 0 0% ‐ 55 10.3% (6.9, 15.2)

Internet only 0 0% ‐ 2 1.2% (0.3, 4.9)

Newspaper and Television 0 0% ‐ 8 1.9% (0.8, 4.5)

Newspaper and Internet 0 0% ‐ 1 0.0% (0.0, 0.2)


Radio and Internet 0 0% ‐ 3 2.4% (0.7, 8.2)

Television and Internet 0 0% ‐ 23 4.9% (2.6, 9.0)

Newspaper, Radio, and Television 0 0% ‐ 17 6.2% (3.5, 10.7)

Newspaper, Radio, and Internet 0 0% ‐ 2 1.6% (0.4, 6.3)

Newspaper, Television, and Internet 0 0% ‐ 5 1.3% (0.4, 3.9)


All 0 0% ‐ 30 12.5% (6.4, 23.0)

Frequency of access

Newspaper 0.311

At least once a week 0 0% ‐ 38 12.4% (8.3, 18.1)

Less than once a week 0 0% ‐ 25 11.2% (6.9, 17.6)

Not at all 24 100.0% (100, 100) 362 76.5% (69.6, 82.2)

Radio 0.853



Not at all 8 22.9% (6.7, 55.4) 117 22.4% (15.9, 30.6)

Television 0.707



Not at all 8 14.9% (3.5, 45.7) 43 9.2% (6.3, 13.2)

Social media 0.377



Not at all 20 70.3% (33.0, 91.9) 269 50.2% (39.3, 61.1)

Source of information to help choose

healthy food

Mother/mother in law 4 5.2% (1.7, 15.0) 71 15.5% (11.2, 21.0) <0.05

Friends 8 23.4% (6.7, 56.5) 67 12.2% (8.0, 18.3) 0.258

Community health officer, nurse,

midwife, doctor 15 49.8% (20.0, 79.8) 167 14.7% (10.3, 20.5) <0.01

Nurse, midwife or doctor 12 32.4% (9.0, 69.9) 166 14.5% (11.2, 18.5) 0.208

Traditional birth attendant 0 0% ‐ 2 0.3% (0.1, 2.1) 0.842


Local chemists 0 0% ‐ 1 0.1% (0.0, 0.5) 0.858

Posters in the community 0 0% ‐ 12 2.5% (1.1, 5.5) 0.713

Radio shows 10 52.9% (22.2, 81.6) 120 33.9% (27.9, 40.4) 0.286

TV shows 6 15.3% (3.8, 45.4) 188 50.9% (45.1, 56.7) <0.05

Social media, internet, facebook 1 17.0% (2.3, 64.4) 61 19.5% (12.3, 29.5) 0.883

School or teachers 0 0% ‐ 30 12.7% (7.4, 20.9) 0.333

Books or reading 1 2.4% (0.3, 15.9) 10 2.5% (1.1, 5.5) 0.998

Other mass media 0 0% ‐ 14 5.3% (2.8, 9.8) 0.471

Don´t know 0 0% ‐ 15 2.4% (1.0, 5.4) 0.6811 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 4 Obaasima seal recognition, all women, Ghana 2017

Variable All women

N1 Median, %2 (95% CI)3

Proportion of women ever seen/heard of Obaasima seal 322 68.9 (57.8; 78.2)

Where women have seen/heard of Obaasima seal

TV 72 19.5 (14.4; 25.9)

Radio 37 11.0 (6.3; 18.6)

Billboards 143 49.6 (41.2; 58.0)

Posters/ street median 61 25.0 (18.1; 33.3)

Religious/ social gatherings 1 0.1 (0.0; 0.5)

Health clinic/health worker 39 3.6 (1.7; 7.4)

Community leaders 1 0.3 (0.0; 2.4)

Relatives/ friends/ neighbours 11 2.6 (1.0; 6.3)

Shopkeeper/pharmacy 9 2.9 (1.2; 7.0)

Social media 3 0.8 (0.1; 4.6)

Market place 52 16.6 (10.8; 24.6)

Movie event/ roving cinema 7 0.5 (0.2; 1.8)

Don´t know 8 3.6 (1.4; 9.0)

Other 10 4.5 (2.3; 8.6)

What does the Obaasima seal mean

Is good quality/trustworthy product 39 10.4 (6.8; 15.7)

Contains vitamin and minerals 37 11.8 (7.9; 17.2)

Is good for health 61 17.8 (10.9; 27.8)

Is good for young women/ pregnant women 28 4.8 (2.4; 9.5)

Gives strength 35 8.7 (5.6; 13.3)

Keeps energy level high 19 5.9 (3.0; 11.2)

Boosts immune system 14 6.0 (3.3; 10.5)

Is important for a long life 10 2.8 (0.9; 8.4)

Helps to become pregnant 9 2.2 (0.7; 6.8)

Protects unborn baby 10 2.0 (0.6; 6.7)

Helps to be smart 7 1.9 (0.5; 6.7)

Don´t know/ don´t remember 178 58.6 (51.6; 65.2)

Other 5 1.3 (0.4; 4.2)

Proportion of women ever bought products with the

Obaasima seal

43 13.7 (9.6; 19.1)

Proportion of women preferring products with the

Obaasima seal

32 58.5 (28.2; 83.5)

Reasons for preferring products with Obaasima seal

Is good quality/trustworthy product 15 34.4 (15.9; 59.2)

Contains vitamin and minerals 11 21.9 (7.9; 47.7)



Gives strength 11 32.4 (15.0; 56.5)


Boosts immune system 2 9.1 (2.2; 30.7)

Is important for a long life 1 5.8 (0.7; 34.6)

Helps to become pregnant 0 ‐‐

Protects unborn baby 0 ‐‐

Don´t know/ don´t remember 2 7.4 (2.1; 23.1)


Variable All women

N1 Median, %2 (95% CI)3

Other 2 20.8 (4.6; 58.7)

Place bought

Supermarket 6 7.9 (2.8; 20.1)

Shop 15 32.4 (15.8; 55.2)

Kiosk 1 1.8 (0.2; 13.4)

Market/street stand 12 39.1 (26.8; 53.1)

Moving street vendor 3 5.9 (1.3; 23.6)

Other 4 6 12.9 (2.8; 43.2) 1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing

data; 2Percentages and medians are weighted for inaccurate EA size used during the first stage of sampling; 3 CI=confidence interval, calculated taking into account the complex sampling design.


Supplementary table 5 Obaasima seal recognition, pregnant and young non‐ pregnant women,

Ghana 2017

Variable

Young women of reproductive

age

Pregnant women P‐value

between

groups

N1

Median,

%2 (95% CI)3 N

Median,

% (95% CI)3

Proportion of women ever

seen/heard of Obaasima seal

179 30.2 (20.2; 42.5) 143 42.2 (31.7; 53.5) <0.05

Where women have seen/heard of

Obaasima seal

TV 41 11.0 (8.1; 14.6) 31 7.3 (3.9; 13.5) 0.59

Radio 23 6.3 (3.3; 11.6) 14 3.4 (1.5; 7.3) 0.33

Billboards 80 27.7 (21.9; 34.4) 63 20.7 (15.8; 26.8) 0.61

Posters/ street median 41 14.1 (9.9; 19.7) 20 8.5 (4.5; 15.3) 0.33

Health clinic/health worker 4 1.1 (0.3; 3.8) 35 12.5 (9.3; 16.6) <0.0001

Relatives/ friends/ neighbours 6 1.4 (0.5; 3.8) 5 1.4 (0.5; 3.6) 0.61

Shopkeeper/pharmacy 5 1.6 (0.6; 4.4) 4 0.8 (0.3; 2.5) 0.28

Social media 1 0.4 (0.1; 3.3) 2 0.5 (0.1; 2.4) 0.25

Market place 27 9.2 (5.9; 14.2) 25 7.5 (3.7; 14.6) 0.52

Movie event/ roving cinema 1 0.2 (0.0; 1.3) 6 1.9 (0.7; 4.9) 0.23

Don´t know 6 2.1 (0.7; 5.6) 2 0.7 (0.1; 3.1) 0.41

Other 8 2.6 (1.4; 5.0) 2 0.3 (0.1; 1.6) 0.11


Is good quality/trustworthy

product

22 10.3 (6.4; 16.1) 17 13.6 (9.5; 19.2) 0.33

Contains vitamin and minerals 23 11.9 (7.7; 18.0) 14 10.5 (7.3; 14.9) 0.62

Is good for health 32 17.8 (10.4; 28.7) 29 19.1 (13.5; 26.2) 0.83

Is good for young women/

pregnant women

11 4.3 (1.8; 9.7) 17 13.7 (8.7; 20.8) <0.05

Gives strength 16 8.5 (5.2; 13.6) 19 11.5 (7.0; 18.4) 0.28

Keeps energy level high 12 6.1 (3.0; 12.0) 7 3.0 (0.9; 9.0) 0.22

Boosts immune system 11 6.3 (3.4; 11.3) 3 1.5 (0.4; 5.2) <0.05

Is important for a long life 8 3.0 (0.9; 9.3) 2 0.8 (0.2; 3.5) <0.05

Helps to become pregnant 7 2.3 (0.7; 7.6) 2 1.0 (0.2; 4.7) 0.26

Protects unborn baby 6 2.0 (0.5; 7.6) 4 1.7 (0.6; 4.9) 0.74

Helps to be smart 6 2.0 (0.5; 7.6) 1 0.4 (0.0; 3.5) <0.05

Don´t know/ don´t remember 105 59.0 (51.3; 66.2) 73 52.6 (44.2; 60.8) 0.31

Other 2 1.2 (0.3; 4.8) 3 3.8 (1.4; 9.8) 0.20

Proportion of women ever bought

products with the Obaasima seal

24 13.6 (9.3; 19.7) 19 14.2 (9.0; 21.6) 0.82

Proportion of women preferring


19 58.6 (25.9; 85.2) 13 57.6 (35.6; 77.0) 0.95

Reasons for preferring products

with Obaasima seal


product

8 33.0 (13.7; 60.5) 7 55.9 (21.5; 85.5) 0.26



Is good for young women/ 0 ‐‐ 4 26.8 (7.1; 63.8) 0.89


Variable


age


between

groups

N1

Median,

%2 (95% CI)3 N

Median,

% (95% CI)3

pregnant women

Gives strength 7 33.2 (14.5; 59.3) 4 20.1 (6.2; 48.9) 0.34


Boosts immune system 2 9.8 (2.3; 33.4) 0 ‐‐ 0.21

Is important for a long life 1 6.3 (0.7; 38.0) 0 ‐‐ 0.38

Helps to become pregnant 0 ‐‐ 0 ‐‐ ‐‐

Protects unborn baby 0 ‐‐ 0 ‐‐ ‐‐

Don´t know/ don´t remember 2 8.0 (2.2; 25.1) 0 ‐‐ 0.19

Other 2 22.0 (4.7; 62.1) 0 ‐‐ 0.18

Place bought 0.27

Supermarket 3 6.8 (1.9; 20.9) 3 25.4 (8.8; 54.7)

Shop 8 31.9 (14.3; 56.9) 7 39.8 (21.4; 61.6)

Kiosk 1 1.9 (0.2; 15.2) 0 ‐‐

Market/street stand 9 41.2 (28.0; 55.7) 3 7.5 (0.9; 41.3)

Moving street vendor 2 6.2 (1.2; 26.5) 1 2.5 (0.3; 16.6)

Other 1 12.1 (2.0; 48.2) 5 24.8 (8.0; 55.7) 1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 6 Obaasima seal recognition, Sunyani and Tamale, Ghana 2017


between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)3



173 80.5 (67.9; 89.0) 149 50.0 (38.6; 61.3) <0.0001


Obaasima seal

TV 26 17.3 (11.7; 24.9) 46 25.4 (14.9; 39.7) 0.21

Radio 22 11.2 (5.1; 22.7) 15 10.6 (5.8; 18.5) 0.91

Billboards 95 56.4 (47.9; 64.5) 48 31.8 (19.4; 47.6) <0.01


Religious/ social gatherings 1 0.1 (0.0; 0.8) 0.59

Health clinic/health worker 27 3.7 (1.5; 8.7) 12 3.3 (0.7; 14.0) 0.91

Community leaders 0 ‐‐ 1 1.1 (0.2; 7.9) 0.10



Social media 2 1.1 (0.2; 7.0) 1 0.1 (0.0; 0.8) <0.05

Market place 27 16.9 (9.8; 27.6) 25 15.6 (7.1; 31.0) 0.85


Heard of seal from T‐ shirt 1 0.7 (0.1; 5.8) 7 8.4 (3.8; 17.8) 0.07

Don´t know 6 3.9 (1.1; 12.6) 2 2.8 (0.7; 10.7) 0.71

Other 3 3.8 (1.3; 10.4) 7 6.1 (2.6; 13.8) 0.48



product

16 7.6 (4.2; 13.3) 23 17.9 (9.5; 31.3) <0.05




pregnant women

15 3.2 (1.3; 7.6) 13 9.2 (3.3; 23.1) 0.09

Gives strength 15 6.7 (3.7; 12.0) 20 13.8 (6.8; 26.0) 0.1


Boosts immune system 6 5.0 (2.3; 10.7) 8 8.5 (3.0; 21.8) 0.38

Is important for a long life 0 ‐‐ 10 10.3 (3.8; 25.1) <0.005

Helps to become pregnant 1 0.0 (0.0; 0.4) 8 7.8 (2.5; 21.6) <0.001

Protects unborn baby 1 0.0 (0.0; 0.3) 9 7.0 (2.1; 21.5) <0.001

Helps to be smart 0 ‐‐ 7 6.8 (1.9; 21.6) <0.05

Don´t know/ don´t remember 96 58.9 (49.5; 67.8) 82 57.6 (46.9; 67.6) 0.39

Other 5 1.8 (0.5; 6.3) 0 ‐‐ 0.27



20 12.7 (8.0; 19.7) 23 16.1 (8.2; 29.2) 0.836



11 39.0 (13.5; 72.4) 21 98.9 (95.1; 99.8) 0.54


with Obaasima seal


product

3 5.1 (1.0; 22.8) 12 58.4 (30.7; 81.6) <0.001

Contains vitamin and minerals 2 1.9 (0.4; 9.0) 9 38.2 (15.3; 67.9) <0.001

Is good for health 4 4.8 (1.2; 17.3) 10 45.2 (16.7; 77.2) <0.001



between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)3


pregnant women

3 3.0 (0.5; 15.3) 1 0.6 (0.1; 4.6) 0.18

Gives strength 2 15.6 (1.8; 65.2) 9 46.1 (24.3; 69.6) 0.19


Boosts immune system 0 ‐‐ 2 16.6 (4.2; 47.4) 0.17

Is important for a long life 0 ‐‐ 1 10.6 (1.1; 55.1) 0.40



Don´t know/ don´t remember 0 ‐‐ 0 ‐‐ ‐‐

Tastes good 4 45.7 (11.4; 84.6) 2 13.5 (4.5; 34.0) 0.06

Other 2 46.1 (10.7; 85.8) 0 ‐‐ 0.09

Place bought <0.05

Supermarket 2 2.1 (0.4; 10.0) 4 19.9 (9.1; 38.1)

Shop 9 34.7 (11.6; 68.2) 6 27.8 (12.7; 50.4)

Kiosk 0 ‐‐ 1 5.4 (0.6; 36.8)

Market/street stand 5 44.7 (29.5; 60.9) 7 27.6 (12.0; 51.5)

Moving street vendor 0 ‐‐ 3 18.2 (3.6; 57.1)

Pharmacy 0 ‐‐ 0 ‐‐

Other 4 18.5 2 1.3 (0.3; 5.5)

1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 7 Obaasima seal recognition, stratified by MPI score, Ghana 2017

Variable Poor Non‐ poor P‐value

between

groups N1

Median,

%2 (95% CI)3 N

Median,

% (95% CI)



5 30.4 (8.5; 67.2) 263 74.9 (64.1; 83.4) <0.01


Obaasima seal

TV 0 ‐‐

Radio 2 58.4 (10.0; 94.6) 28 9.5 (4.7; 18.5) 0.48

Billboards 4 97.8 (80.3; 99.8) 122 51.8 (42.3; 61.2) <0.05

Posters/ street median 0 ‐‐ 43 21.6 (14.3; 31.3) <0.001

Religious/ social gatherings 0 ‐‐ 1 0.1 (0.0; 0.7) 0.45

Health clinic/health worker 0 ‐‐ 36 3.8 (1.8; 7.9) 0.92

Community leaders 0 ‐‐ 0 ‐‐ ‐‐

Relatives/ friends/ neighbours 0 ‐‐ 8 2.3 (0.9; 6.0) 0.82

Shopkeeper/pharmacy 0 ‐‐ 8 3.1 (1.2; 8.2) 0.80

Social media 0 ‐‐ 1 0.1 (0.0; 0.4) 0.92

Market place 0 ‐‐ 41 15.1 (8.1; 26.6) 0.57


Don´t know 0 ‐‐ 8 4.6 (1.8; 11.5) 0.76

Other 0 ‐‐ 8 5.0 (2.3; 10.3) 0.71



product

28 9.9 (6.2; 15.3) 0.62

Contains vitamin and minerals 24 8.8 (5.6; 13.5) 0.63



pregnant women

20 3.4 (1.6; 7.2) 0.78

Gives strength 1 2.2 (0.2; 19.7) 22 6.4 (3.3; 11.9) 0.38

Keeps energy level high 0 ‐‐ 9 3.8 (1.5; 9.6) 0.76

Boosts immune system 0 ‐‐ 6 4.3 (1.8; 9.7) 0.73

Is important for a long life 0 ‐‐ 3 1.2 (0.2; 8.6) 0.89

Helps to become pregnant 0 ‐‐ 2 0.4 (0.1; 2.5) 0.91

Protects unborn baby 0 ‐‐ 3 0.1 (0.0; 0.3) 0.89

Helps to be smart 0 ‐‐ 4 0.9 (0.2; 3.6) ‐‐

Don´t know/ don´t remember 3 95.4 (74.7; 99.3) 148 57.5 (47.9; 66.6) <0.001

Other 0.89



0 ‐‐ 36 15.0 (9.9; 22.1) 0.54



0 ‐‐ 25 51.6 (22.4; 79.7) ‐‐


with Obaasima seal


product

0 ‐‐ 13 35.8 (15.2; 63.5) ‐‐

Contains vitamin and minerals 0 ‐‐ 10 23.7 (7.5; 54.1) ‐‐

Is good for health 0 ‐‐ 13 35.0 (12.4; 67.3) ‐‐

Is good for young women/ 0 ‐‐ 3 1.6 (0.4; 5.5) ‐‐



between

groups N1

Median,

%2 (95% CI)3 N

Median,

% (95% CI)

pregnant women

Gives strength 0 ‐‐ 11 42.8 (19.3; 70.1) ‐‐

Keeps energy level high 0 ‐‐ 2 0.9 (0.2; 4.0) ‐‐

Boosts immune system 0 ‐‐ 2 12.1 (3.0; 37.8) ‐‐

Is important for a long life 0 ‐‐ 1 7.7 (0.9; 42.7) ‐‐



Don´t know/ don´t remember 0 ‐‐ 1 4.4 (0.8; 21.3) ‐‐

Other 0 ‐‐ 2 27.5 (6.1; 68.7) ‐‐

Place bought

Supermarket 0 ‐‐ 5 6.4 (1.9; 18.9) ‐‐

Shop 0 ‐‐ 14 35.1 (15.7; 61.1) ‐‐

Kiosk 0 ‐‐ ‐‐

Market/street stand 0 ‐‐ 10 39.6 (26.8; 54.0) ‐‐

Moving street vendor 0 ‐‐ 2 4.2 (0.5; 26.3) ‐‐

Pharmacy 0 ‐‐ ‐‐

Other 4 0 ‐‐ 5 14.7 (3.2; 47.4) ‐‐




Supplementary table 8 Information about biscuit brands, pregnant and young women of

reproductive age, Ghana 2017

Variable

Non pregnant

women

Pregnant women All women P

value

N1 %2 N1 %2 N1 %2

Main brand of biscuit consumed, % 0.062

Lola Milk biscuit 4 1.1 4 1.4 8 1.2

Lola other biscuits 1 0.4 0 ‐‐ 1 0.2

Digestive 32 13.2 14 6.7 46 10.3

Perk 79 30.3 52 21.8 131 26.5

Jack & Jill 26 8.8 18 6.6 44 7.8

Bonita 3 0.8 6 2.1 9 1.4

Cream Cracker 28 10.0 46 20.9 74 14.9

King Cracker 50 17.7 53 22.6 103 19.9

Malt n Milk 17 5.3 19 8.5 36 6.7

Milk biscuit 5 1.5 3 2.1 8 1.8

Munchee 3 1.9 0 ‐‐ 3 1.1

Milky Magic 9 4.8 4 1.2 13 3.2

Other brands 11 4.1 9 6.0 20 4.9 1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing

data; 2Percentages and medians are weighted for inaccurate EA size used during the first stage of sampling;


Supplementary table 9 Information about biscuit brands, Sunyani and Tamale, Ghana 2017

Variable

Sunyani Tamale

N1 %2 N1 %2

Main brand of biscuit consumed, %

Lola Milk biscuit 2 0.6 6 2.1

Lola other biscuits 1 0.6 0 ‐‐

Digestive 19 13.0 27 12.4

Perk 57 30.5 74 28.5

Jack & Jill 18 9.1 26 8.0

Bonita 0 ‐‐ 9 2.4

Cream Cracker 34 12.3 40 8.1

King Cracker 37 15.3 66 22.6

Malt n Milk 10 4.4 26 7.3

Milk biscuit 3 1.2 5 2.1

Munchee 2 2.4 1 0.7

Milky Magic 5 5.3 8 3.4

Other brands 15 5.2 5 2.5 1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 10 Information about biscuit brands, stratified by MPI score, Ghana 2017

Variable

Poor Non‐ poor

N1 %2 N1 %2


Lola Milk biscuit 0 ‐‐ 6 0.8

Lola other biscuits 0 ‐‐ 1 0.5

Digestive 1 4.1 37 14.3

Perk 3 6.6 88 28.4

Jack & Jill 1 1.3 23 5.6

Bonita 1 2.0 6 0.5

Cream Cracker 3 52.6 57 9.8

King Cracker 1 4.1 90 21.5

Malt n Milk 3 13.1 22 4.9

Milk biscuit 1 16.1 6 1.4

Munchee 0 ‐‐ 3 2.5

Milky Magic 0 ‐‐ 11 5.9

Other brands 0 ‐‐ 15 3.9 1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 11 Information about consumer behaviour with regard to Lola biscuits, all

women, Ghana 2017

Variable All women

N1 Median, %2 (95% CI)3

Proportion of women consuming biscuits 496 91.6 (86.5; 94.9)

Awareness ‐ Proportion of women ever seen/heard of Lola Milk

biscuits

101 17.0 (12.9; 22.2)

Awareness ‐ Where women have seen/heard of Lola Milk biscuits

TV 14 14.6 (5.9; 32.0)

Radio 3 3.1 (0.5; 16.2)

Billboards 7 6.0 (1.9; 17.1)


Religious/ social gatherings


Community leaders



Social media 3 0.6 (0.2; 2.1)

Market place 28 34.0 (19.3; 52.6)

Don´t know 2 1.6 (0.3; 8.2)

Other 4 6.4 (2.2; 17.3)

Access ‐ Proportion of women know where to buy Lola Milk

biscuits

57 63.2 (40.1; 81.6)

Access ‐ Where women know to buy Lola Milk biscuits

Shop 41 64.5 (43.3; 81.3)

Kiosk 13 15.2 (5.7; 34.8)



Other 1 0.2 (0.0; 1.2)

Access ‐ Distance to closest place in meters 55 500 (300; 1000)

Consumption ‐ Proportion of women who have ever eaten Lola

Milk biscuits (of those aware)

42 44.0 (26.5; 63.1)

Consumption ‐ Last time Lola biscuits consumed in weeks, median 42 3.0 (2.0; 4.3)

Consumption ‐ Frequency of Lola biscuit consumption

Several times a day 3 2.9 (0.5; 15.6)

Once a day 2 7.3 (1.8; 25.5)

Every other day 1 4.1 (0.5; 26.5)

Once or twice a week 4 2.7 (0.6; 11.3)

Less than once a week 5 13.0 (4.6; 31.4)

Every second week 3 4.8 (0.8; 24.0)

Once a month 4 7.9 (2.4; 22.8)

Less than once a month 20 57.4 (32.5; 79.1)

Consumption ‐ Quantity consumed

Half a biscuit 1 0.4 (0.1; 3.1)

One biscuit 21 30.1 (14.7; 51.7)

Two biscuits 3 16.4 (2.9; 56.1)

Three biscuits 1 0.2 (0.0; 1.6)

Four or more biscuits 16 52.9 (29.0; 75.5)


Variable All women

N1 Median, %2 (95% CI)3

Consumption ‐ Number of Lola Milk biscuits eaten per day each

month among those consuming, median

42 0.1 (0.08; 0.15)

Consumption ‐ Other individuals in household consuming Lola Milk

biscuits

16 17.9 (7.1; 38.6)

Another female adult or teenager 8 37.7 (9.5; 77.7)

A male adult or teenager 2 13.4 (3.0; 43.9)

A child 12 87.9 (64.5; 96.7)

Proportion of women ever bought or received free Lola Milk

biscuits

42 3.0 (2.0; 4.3)

Purchased 26 79.6 (56.1; 92.3)

Received for free 15 19.5 (7.2; 43.4)

Purchase ‐ Place bought

Supermarket

Shop 15 52.5 (25.0; 78.6)

Kiosk 1 0.2 (0.0; 1.8)



Other 4 1 0.3 (0.0; 2.7)

Number of packages bought last time Lola Milk biscuits was

purchased, median

24 1.0 (1.0; 1.5)

Price paid per package last time Lola Milk biscuits was purchased

(GHS), median

26 0.6 (0.5; 1.0)

Positive characteristics of Lola biscuits

Taste 34 74.8 (43.6; 91.9)

Packaging 6 25.7 (8.2; 57.2)

Price 8 14.4 (5.2; 34.1)

Easily available 2 5.9 (0.8; 33.1)

How it is promoted 2 5.9 (0.8; 33.1)

Is a good quality /trustworthy product 6 12.8 (4.2; 33.3)

IS locally produced 2 5.9 (0.8; 33.1)

Carries the Obaasima seal 4 6.4 (1.0; 31.6)

Contains minerals and vitamins 7 14.1 (4.8; 34.7)

Contains small amount of sugar/ not too sweet 6 7.1 (1.3; 30.4)




Product gives strength 5 15.4 (5.0; 38.5)


Helps to be smart 2 5.9 (0.8; 33.1)

Don´t know 4 12.9 (3.7; 36.8)

Other

Negative characteristics of Lola biscuits

Dislikes taste 4 24.4 (7.5; 56.2)

Dislikes packaging 0 ‐‐

Is too expensive 0 ‐‐

Dislikes how it is promoted 0 ‐‐

Is not easily available 1 4.3 (0.6; 25.8)


Variable All women

N1 Median, %2 (95% CI)3

Carries the Obaasima seal 0 ‐‐

Is not a good quality/ trustworthy product 0 ‐‐

Contains added artificial ingredients such as vitamins and minerals 0 ‐‐

Contains too much sugar/ too sweet 2 2.3 (0.4; 12.1)

Is not good for health 0 ‐‐

Is not good for young women/ pregnant women 0 ‐‐

Don´t know 20 43.6 (23.2; 66.4)

Other 5 0 ‐‐ 1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 12 Information about consumer behaviour with regard to Lola biscuits,

pregnant and young women of reproductive age, Ghana 2017

Variable


age


between

groups

N1

Median,

%2 (95% CI)3 N

Median,

% (95% CI)

Proportion of women consuming

biscuits

268 92.7 (87.0; 96.1) 228 77.0 (68.3; 83.8) <0.005

Awareness ‐ Proportion of women

ever seen/heard of Lola Milk

biscuits

49 16.8 (12.3; 22.5) 52 20.7 (16.5; 25.6) 0.14

Awareness ‐ Where women have

seen/heard of Lola Milk biscuits

TV 7 14.9 (5.5; 34.7) 7 10.3 (3.7; 25.6) 0.62

Radio 2 2.8 (0.3; 20.4) 1 5.8 (0.8; 32.2) 0.61

Billboards 4 6.2 (1.8; 19.3) 3 3.6 (1.0; 12.4) 0.48


Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐‐



Relatives/ friends/ neighbours 7 11.8 (5.3; 24.2) 2 2.7 (0.6; 11.7) <0.05


Social media 0 ‐‐ 3 7.0 (2.4; 19.2) 0.05

Market place 17 35.7 (19.1; 56.6) 11 16.7 (7.5; 32.9) 0.55

Don´t know 1 1.4 (0.2; 10.6) 1 3.3 (0.5; 19.6) 0.72

Other 3 6.6 (2.1; 19.1) 1 4.3 (0.6; 26.7) 0.55

Access ‐ Proportion of women know

where to buy Lola Milk biscuits

33 65.7 (38.7; 85.3) 24 38.1 (23.8; 54.7) <0.05

Access ‐ Where women know to buy

Lola Milk biscuits

Shop 23 64.1 (41.2; 82.0) 18 72.1 (38.9; 91.3) 0.69

Kiosk 8 15.3 (5.3; 37.0) 5 14.5 (5.2; 34.7) 0.93

Market/street stand 12 43.4 (24.6; 64.2) 4 17.5 (6.4; 39.7) 0.08

Moving street vendor 2 6.5 (1.5; 24.8) 1 2.6 (0.3; 18.6) 0.45

Other 0 ‐‐ 1 2.6 (0.3; 18.6) 0.25

Access ‐ Distance to closest place in

meters

31 500 (250; 1000) 24 625 (250; 1000) 0.75

Consumption ‐ Proportion of

women who have ever eaten Lola

Milk biscuits

23 45.3 (25.7; 66.5) 19 31.1 (17.8; 48.5) 0.13




Supplementary table 13 Information about consumer behaviour with regard to Lola biscuits,

Sunyani and Tamale, Ghana 2017


between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


biscuits

203 93.5 (87.3; 96.8) 293 88.4 (79.5; 93.7) 0.2



biscuits

45 16.4 (10.7; 24.2) 56 18.2 (13.4; 24.1) 0.68


seen/heard of Lola Milk biscuits

TV 4 16.1 (4.5; 44.2) 10 12.4 (4.6; 29.0) 0.73

Radio 1 0.8 (0.1; 6.4) 2 6.3 (0.8; 36.4) 0.11

Billboards 1 3.6 (0.5; 23.4) 6 9.4 (2.6; 28.9) 0.40

Posters/ street median 1 0.4 (0.0; 3.1) 4 10.8 (4.1; 25.4) <0.0001






Social media 2 0.9 (0.2; 3.9) 1 0.2 (0.0; 1.5) 0.24

Market place 11 35.1 (14.6; 63.1) 17 32.3 (16.8; 53.0) 0.86

Don´t know 1 0.5 (0.1; 3.7) 1 3.2 (0.4; 19.4) 0.13

Other 3 8.9 (2.9; 24.4) 1 2.6 (0.3; 17.8) 0.26


where to buy Lola Milk biscuits

22 60.7 (26.3; 87.1) 35 66.9 (51.9; 79.1) 0.74


Lola Milk biscuits

Shop 15 62.0 (33.1; 84.3) 26 68.0 (38.3; 87.9) 0.76

Kiosk 1 0.4 (0.0; 3.2) 12 34.9 (16.5; 59.2) <0.001

Market/street stand 8 56.3 (29.1; 80.3) 8 23.0 (10.6; 43.0) <0.05


Other 0 ‐‐ 1 0.4 (0.0; 2.9) 0.30


meters

20 450 (150; 750) 35 500 (300; 1250) 0.74


women who have ever eaten Lola

Milk biscuits

16 41.8 (18.4; 69.6) 26 47.3 (27.5; 68.0) 0.76




Supplementary table 14 Information about consumer behaviour with regard to Lola

biscuits, stratified by MPI score, Ghana 2017


between

groups N1

Median,

%2 (95% CI)3 N Median, %2 (95% CI)


biscuits

14 59.2 (25.8; 85.8) 365 91.8 (85.9; 95.4)



biscuits

2 9.1 (1.3; 43.7) 77 17.5 (11.9; 25.1)




Supplementary table 15 Information about consumer behaviour with regard to Samba Shito Sauce,

all women, Ghana 2017

Variable All women

N1 Median, %2 (95% CI)3

Proportion of women consuming Shito sauce 429 79.4 (72.4; 85.1)

Main brand of Shito consumed, %

Samba Shito 0 ‐‐

Homemade 266 59.4 (51.1; 67.2)

Unbranded Shito from chop bar/ restaurant/ vendor 161 39.8 (32.8; 47.2)

Other brands 2 0.8 (0.1; 5.3)

Awareness ‐ Proportion of women ever seen/heard of Samba Shito Sauce 70 13.8 (9.9; 18.9)

Awareness ‐ Where women have seen/heard of Samba Shito Sauce

TV 9 15.4 (5.4; 36.7)

Radio 5 1.3 (0.4; 4.0)

Billboards 6 13.3 (4.3; 34.5)


Religious/ social gatherings 0 ‐‐

Health clinic/health worker 0 ‐‐

Community leaders 0 ‐‐



Social media 0 ‐‐

Market place 17 21.4 (10.4; 39.2)

Don´t know 2 7.4 (1.7; 26.5)

Other 4 7.3 (1.9; 24.2)

Access ‐ Proportion of women know where to buy Samba Shito Sauce 31 46.8 (28.1; 66.5)

Access ‐ Where women know to buy Samba Shito Sauce

Shop 20 81.4 (57.0; 93.5)

Kiosk 4 18.2 (5.2; 47.6)



Other 3 2.3 (0.6; 8.8)


Consumption ‐ Proportion of women who have ever eaten Samba Shito

Sauce

21 15.6 (5.9; 35.4)

Consumption ‐ Last time Samba Shito Sauce consumed in weeks, median 21 4.3 (2.0; 8.6)

Consumption ‐ Frequency of Samba Shito Sauce consumption

Every other day 1 1.6 (0.2; 12.3)




Once a month 3 2.9 (0.7; 10.8)



Half sachet 8 12.6 (4.2; 32.2)

One sachet 11 75.9 (49.0; 91.1)

Two sachets 1 1.4 (0.2; 10.8)

More than two sachets 1 10.1 (1.5; 45.0)


Variable All women

N1 Median, %2 (95% CI)3

Consumption ‐ Number of Samba Shito Sauce eaten per day each month

among those consuming, median

21 0.02 (0.02; 0.04)

Consumption ‐ Other individuals in household consuming Samba Shito

Sauce

10 10.6 (3.2; 30.0)



A child 6 45.5 (8.4; 88.3)

Proportion of women ever bought or received free Samba Shito Sauce 21 15.6 (5.9; 35.4)

Purchased 6 37.2 (9.9; 76.0)



Supermarket 1 43.0 (5.1; 91.4)

Shop 3 52.2 (7.6; 93.6)


Other 1 2.6 (0.3; 21.7)

Number of packages bought last time Samba Shito Sauce was purchased,

median

5 5 (1.0; 20.0)

Price paid per package last time Samba Shito Sauce was purchased (GHS),

median

6 0.75 (0.5; 0.09)

Positive characteristics of Samba Shito Sauce

Taste 19 73.9 (24.7; 96.1)

Packaging 4 19.2 (3.2; 62.7)

Price 2 17.4 (2.5; 63.3)

Easily available 0 ‐‐

How it is promoted 0 ‐‐


IS locally produced 0 ‐‐








Helps to be smart 0 ‐‐

Don´t know 1 1.0 (0.1; 7.6)

Other 2 26.7 (4.2; 75.2)

Negative characteristics of Samba Shito Sauce

Dislikes taste 0 ‐‐






Is not a good quality/ trustworthy product 0 ‐‐

Contains added artificial ingredients such as vitamins and minerals 0 ‐‐



Variable All women

N1 Median, %2 (95% CI)3


Don´t know 11 52.3 (17.3; 85.1)

Other 4 27.8 (7.6; 64.4)1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing





Variable


age


between

groups

N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


Shito sauce

222 79.9 (72.1; 86.0) 207 73.2 (63.3; 81.3) 0.18


Samba Shito Sauce 0 ‐‐ 0 ‐‐ 0.75

Homemade 132 59.2 (50.1; 67.7) 134 62.0 (48.8; 73.6)

Unbranded Shito from chop bar/

restaurant/ vendor

89 40.0 (32.4; 48.1) 72 37.6 (25.9; 51.0)

Other brands 1 0.8 (0.1; 6.1) 1 0.4 (0.1; 3.1)


ever seen/heard of Samba Shito

Sauce

28 13.4 (9.2; 19.2) 42 18.2 (13.0; 24.8) 0.06


seen/heard of Samba Shito Sauce

TV 4 15.7 (4.9; 40.4) 5 11.4 (4.0; 28.5) 0.72

Radio 0 ‐‐ 5 13.3 (5.2; 30.1) 0.05

Billboards 2 13.5 (3.8; 38.2) 4 11.3 (3.7; 29.7) 0.69


Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐


Community leaders 0 ‐‐ 0 ‐‐ ‐



Social media 0 ‐‐ 0 ‐‐ ‐

Market place 7 21.4 (9.4; 41.8) 10 21.9 (8.2; 46.8) 0.95

Don´t know 2 8.2 (1.9; 29.4) 0 ‐‐ 0.11

Other 2 7.7 (1.8; 27.4) 2 3.4 (0.8; 13.4) 0.4


where to buy Samba Shito Sauce

14 47.8 (26.7; 69.8) 17 38.1 (21.4; 58.3) 0.55


Samba Shito Sauce

Shop 11 83.5 (54.8; 95.4) 9 57.7 (33.4; 78.7) 0.15

Kiosk 3 19.5 (5.1; 51.9) 1 4.2 (0.6; 25.4) 0.17


Moving street vendor 0 ‐‐ 1 4.2 (0.6; 25.4) 0.31

Other 0 ‐‐ 3 29.4 (7.5; 68.1) 0.11


meters

14 625 (200; 2250) 17 750 (500; 1250) 0.9


women who have ever eaten Samba

Shito Sauce

5 13.6 (4.0; 37.2) 16 34.5 (22.4; 48.9) 0.11




3 CI=confidence interval, calculated taking into account the complex sampling design.





between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


Shito Sauce

194 84.4 (76.7; 89.9) 235 71.3 (60.3; 80.3) <0.03



Homemade 104 56.6 (47.0; 65.8) 162 64.8 (48.8; 78.0)


restaurant/ vendor

88 42.1 (34.7; 50.0) 73 35.2 (22.0; 51.2)

Other brands 2 1.2 (0.2; 7.9) 0 ‐‐



Sauce

41 17.4 (12.7; 23.5) 29 7.8 (4.4; 13.4) <0.01


seen/heard of Samba Shito Sauce

TV 4 16.7 (4.9; 43.7) 5 10.6 (2.6; 34.6) 0.61

Radio 3 1.3 (0.3; 5.3) 2 1.3 (0.3; 5.7) 0.98

Billboards 4 16.6 (5.5; 40.8) 2 1.3 (0.3; 5.7) <0.005

Posters/ street median 0 ‐‐ 2 11.4 (2.1; 44.2) <0.05






Social media 0 ‐‐ 0 ‐‐ ‐‐

Market place 8 17.1 (6.2; 39.3) 9 37.2 (20.8; 57.2) 0.13

Don´t know 1 7.4 (1.3; 33.5) 1 7.3 (1.0; 37.4) 0.99

Other 3 9.0 (2.3; 29.9) 1 1.0 (0.1; 7.3) <0.05


where to buy Samba Shito Sauce

18 44.2 (23.5; 67.1) 13 56.3 (23.2; 84.7) 0.57


Samba Shito Sauce

Shop 13 87.9 (53.5; 97.9) 7 62.9 (42.3; 79.7) 0.14

Kiosk 2 13.3 (1.7; 57.9) 2 32.1 (15.1; 55.7) 0.34


Moving street vendor 1 0.4 (0.1; 3.6) 0 ‐‐ 0.64

Other 2 2.7 (0.5; 12.8) 1 1.2 (0.1; 10.0) 0.55


meters

18 500 (200; 875) 13 1500 (500; 2250) 0.06


women who have ever eaten Samba

Shito Sauce

12 14.5 (4.4; 38.5) 9 19.6 (4.1; 58.4) 0.75




Supplementary table 18 Information about consumer behaviour with regard to Samba Shito,

stratified by MPI score, Ghana 2017


between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


Shito

14 74.4 (43.2; 91.7) 333 83.6 (76.3; 89.0) 0.38



Homemade 8 37.5 (10.5; 75.4) 208 60.8 (52.1; 68.9)


restaurant/ vendor

6 62.5 (24.6; 89.5) 124 39.1 (31.1; 47.8)

Other brands 0 ‐‐ 1 0.0 (0.0; 0.3)



Sauce

1 1.2 (0.1; 8.9) 58 15.7 (10.9; 22.2) <0.005




Supplementary table 19 Information about consumer behaviour with regard to Tom Vita

porridge, all women, Ghana 2017

Variable All women

N1 Median, %2 (95% CI)3

Proportion of women consuming porridge 546 96.0 (92.8; 97.8)

Main brand of porridge consumed, %

Tom Vita 1 0.0 (0.0; 0.1)

Cerelac 5 1.2 (0.4; 3.1)

Yumvita 1 0.0 (0.0; 0.2)

Bledine 2 0.0 (0.0; 0.2)

Zimbegu 17 2.8 (1.5; 5.2)

Tom Brown (unbranded) 24 5.9 (3.3; 10.3)

Koko (unbranded) 364 58.2 (48.9; 66.9)

Hausa koko (unbranded) 97 22.3 (15.6; 30.8)

Wheat porridge (unbranded) 14 4.3 (2.1; 8.5)

Oats porridge 11 2.2 (0.9; 5.4)

Other brands 10 3.1 (1.4; 6.8)

Awareness ‐ Proportion of women ever seen/heard of Tom Vita

porridge

133 32.7 (24.7; 41.8)

Awareness ‐ Where women have seen/heard of Tom Vita

porridge

TV 25 20.7 (14.1; 29.2)

Radio 9 3.0 (1.0; 9.0)

Billboards 13 10.8 (6.2; 18.1)


Religious/ social gatherings 0 ‐‐


Community leaders 0 ‐‐



Social media 1 0.1 (0.0; 1.2)

Market place 32 21.1 (13.1; 32.2)

Don´t know 2 1.6 (0.3; 7.1)

Other 7 10.7 (3.3; 29.5)

Access ‐ Proportion of women know where to buy Tom Vita

porridge

53 47.1 (26.9; 68.4)

Access ‐ Where women know to buy Tom Vita porridge

Shop 36 77.7 (51.3; 92.0)

Kiosk 7 9.2 (2.5; 29.0)



Other 3 1.0 (0.2; 4.1)


Consumption ‐ Proportion of women who have ever eaten Tom

Vita porridge

24 12.4 (6.1; 23.3)

Consumption ‐ Last time Tom Vita consumed in weeks, median 24 4.3 (2.0; 4.3)

Consumption ‐ Frequency of Tom Vita consumption

Several times a day 1 0.5 (0.1; 4.5)


Variable All women

N1 Median, %2 (95% CI)3

Once a day 1 4.5 (0.5; 29.0)




Once a month 1 8.5 (1.0; 47.3)



Quarter of a sachet 5 33.1 (17.3; 53.9)

Half sachet 6 18.7 (5.3; 48.7)

Two thirds of a sachet 1 0.9 (0.1; 7.1)

One sachet 11 46.4 (28.3; 65.5)

More than one sachet 1 0.9 (0.1; 7.1)

Consumption ‐ Number of Tom Vita porridge eaten per day each

month among those consuming, median

24 0.02 (0.01; 0.08)

Time of the day Tom Vita is consumed

Breakfast 15 66.3 (44.4; 82.9)

Snack between breakfast and lunch 4 27.0 (10.4; 53.9)

Lunch 0 ‐‐

Snack between lunch and dinner 1 1.2 (0.1; 9.8)

Dinner 0 ‐‐

After dinner 4 5.5 (1.0; 25.8)

Other 0 ‐‐

Consumption ‐ Other individuals in household consuming Tom

Vita porridge

21 14.7 (7.9; 25.9)



A child 17 82.5 (46.5; 96.2)

Proportion of women ever bought or received free Tom Vita

porridge

24 12.4 (6.1; 23.3)

Purchased 16 88.1 (67.3; 96.3)



Supermarket 1 1.4 (0.2; 11.4)

Shop 5 60.9 (21.4; 90.0)

Kiosk 1 0.6 (0.1; 4.9)



Other 4 1 0.8 (0.1; 6.7)

Number of packages bought last time Tom Vita porridge was

purchased, median

16 1.0 (1.0; 2.0)

Price paid per package last time Tom Vita porridge was

purchased (GHS), median

15 1.5 (1.5; 1.5)

Positive characteristics of Tom Vita

Taste 15 63.2 (44.1; 78.9)

Packaging 4 11.7 (2.7; 38.9)

Price 3 7.1 (1.5; 28.4)

Easily available 2 24.6 (8.7; 53.0)


Variable All women

N1 Median, %2 (95% CI)3

How it is promoted 1 4.6 (0.5; 29.4)


IS locally produced 0 ‐‐

Carries the Obaasima seal 1 0.4 (0.0; 3.7)


Contains small amount of sugar/ not too sweet 1 6.2 (0.7; 39.0)

Is good for health 0 ‐‐

Is good for young women/ pregnant women 0 ‐‐

Keeps energy level high 0 ‐‐


Helps to become pregnant 0 ‐‐

Helps to be smart 0 ‐‐

Don´t know 4 4.7 (1.1; 18.5)

Other 0 ‐‐

Negative characteristics of Tom Vita

Dislikes taste 2 2.6 (0.4; 14.5)






Is not a good quality/ trustworthy product 1 1.2 (0.1; 10.0)

Contains added artificial ingredients such as vitamins and

minerals

0 ‐‐

Contains too much sugar/ too sweet 0 ‐‐



Don´t know 11 47.0 (30.7; 63.9)

Other 5 4 31.4 (13.9; 56.4)1 The n’s are un‐weighted numbers in each subgroup; the sum of subgroups may not equal the total because of missing



Supplementary table 20 Information about consumer behaviour with regard to Tom Vita porridge,


Variable


age


between

groups

N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


porridge

283 96.3 (92.7; 98.2) 263 92.0 (85.8; 95.7) 0.09

Main brand of porridge consumed,

%

Tom Vita 0 ‐‐ 1 0.1 (0.0; 0.9) 0.12

Cerelac 4 1.2 (0.4; 3.5) 1 0.3 (0.0; 2.2)

Yumvita 0 ‐‐ 1 0.3 (0.0; 2.3)

Bledine 0 ‐‐ 2 0.5 (0.1; 2.4)

Zimbegu 11 2.9 (1.5; 5.6) 6 1.7 (0.6; 4.5)

Tom Brown (unbranded) 12 5.9 (3.1; 10.9) 12 5.5 (3.4; 8.8)

Koko (unbranded) 180 57.5 (47.4; 67.0) 184 66.8 (57.0; 75.3)

Hausa koko (unbranded) 59 23.0 (15.7; 32.4) 38 13.3 (7.8; 21.8)

Wheat porridge (unbranded) 6 4.2 (1.9; 9.1) 8 5.0 (1.9; 12.7)

Oats porridge 5 2.1 (0.7; 5.8) 6 4.0 (1.9; 8.3)

Other brands 6 3.2 (1.3; 7.4) 4 2.4 (0.6; 8.7)


ever seen/heard of Tom Vita

porridge

75 33.1 (24.3; 43.1) 58 28.4 (18.9; 40.2) 0.41


seen/heard of Tom Vita porridge

TV 15 21.0 (13.9; 30.4) 10 15.4 (8.6; 26.0) 0.37

Radio 2 2.5 (0.6; 10.2) 7 11.0 (5.0; 22.6) 0.06

Billboards 8 10.8 (5.9; 18.9) 5 10.9 (5.0; 22.2) 0.99







Social media 0 ‐‐ 1 2.4 (0.3; 17.2) 0.30

Market place 17 21.0 (12.5; 33.2) 15 22.9 (8.9; 47.3) 0.83

Don´t know 2 1.7 (0.4; 8.0) 0 ‐‐ 0.25

Other 6 11.4 (3.4; 31.8) 1 1.4 (0.2; 12.0) 0.07


where to buy Tom Vita porridge

32 48.1 (26.2; 70.8) 21 31.5 (22.5; 42.3) 0.28


Tom Vita porridge

Shop 25 79.0 (50.7; 93.2) 11 46.4 (27.1; 66.8) <0.05

Kiosk 4 9.3 (2.3; 31.2) 3 7.7 (1.9; 26.4) 0.82



Other 0 ‐‐ 3 23.4 (9.7; 46.4) <0.05


Variable


age


between

groups

N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


meters

32 250 (250; 750) 21 500 (500; 1000) 0.50


women who have ever eaten Tom

Vita porridge

10 11.4 (5.0; 24.1) 14 27.1 (20.4; 35.1) <0.05







between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


porridge

224 96.2 (91.6; 98.4) 322 95.6 (90.1; 98.1) 0.80


%

Tom Vita 0 ‐‐ 1 0.0 (0.0; 0.4) <0.0001

Cerelac 1 0.5 (0.1; 3.9) 4 2.2 (0.8; 6.3)

Yumvita 0 ‐‐ 1 0.1 (0.0; 0.4)

Bledine 0 ‐‐ 2 0.1 (0.0; 0.5)

Zimbegu 1 0.7 (0.1; 5.2) 16 6.2 (3.9; 9.8)


Koko (unbranded) 120 47.3 (37.2; 57.7) 244 75.9 (66.9; 83.1)


Wheat porridge (unbranded) 14 6.9 (3.7; 12.3) 0 ‐‐

Oats porridge 10 3.5 (1.4; 8.6) 1 0.0 (0.0; 0.4)

Other brands 9 4.6 (2.1; 9.9) 1 0.6 (0.1; 4.3)



porridge

87 42.2 (33.1; 51.9) 46 17.2 (11.2; 25.5) <0.001


seen/heard of Tom Vita porridge

TV 16 22.6 (14.9; 32.8) 9 12.9 (5.0; 29.4) 0.23

Radio 8 3.7 (1.1; 11.4) 1 0.3 (0.0; 2.0) <0.01

Billboards 8 9.9 (4.9; 18.8) 5 14.4 (5.5; 32.7) 0.51

Posters/ street median 2 1.4 (0.2; 9.3) 7 16.6 (7.7; 32.2) <0.01






Social media 1 0.2 (0.0; 1.5) 0 ‐‐ 0.67

Market place 16 18.0 (9.7; 31.2) 16 33.5 (21.8; 47.6) 0.08

Don´t know 1 1.2 (0.1; 9.2) 1 3.3 (0.5; 20.5) 0.45

Other 5 11.5 (3.0; 35.3) 2 7.7 (1.9; 26.3) 0.66


where to buy Tom Vita porridge

32 48.0 (24.0; 73.0) 21 43.7 (23.8; 65.9) 0.81


Tom Vita porridge

Shop 23 80.9 (48.8; 94.9) 13 63.5 (40.2; 81.8) 0.31

Kiosk 1 4.9 (0.5; 34.3) 6 28.2 (14.9; 46.7) 0.07


Moving street vendor 0 ‐‐ 3 14.9 (3.2; 48.3) <0.05

Other 3 1.2 (0.2; 5.5) 0 ‐‐ 0.67

Access ‐ Distance to closest place in 32 500 (250; 500) 21 750 (250; 1750) 0.07



between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)

meters


women who have ever eaten Tom

Vita porridge

13 9.3 (3.0; 25.1) 11 24.7 (15.7; 36.6) 0.07





stratified by MPI score, Ghana 2017


between

groups N1

Median,

%2 (95% CI)3 N

Median,

%2 (95% CI)


porridge

22 89.8 (53.3; 98.5) 397 96.2 (92.6; 98.1) 0.28


%

0.72

Tom Vita 0 ‐‐ 1 0 (0.0; 0.2)

Cerelac 0 ‐‐ 4 1.3 (0.4; 4.0)

Yumvita 1 0.9 (0.1; 6.9) 0 ‐‐

Bledine 0 ‐‐ 1 0.1 (0.0; 0.3)

Zimbegu 2 1.8 (0.2; 12.8) 11 2.4 (1.0; 5.5)


Koko (unbranded) 15 77.2 (42.1; 94.1) 259 57.4 (48.8; 65.5)


Wheat porridge (unbranded) 0 ‐‐ 12 4.5 (1.8; 11.1)

Oats porridge 0 ‐‐ 11 3.1 (1.2; 7.3)

Other brands 0 ‐‐ 8 3.1 (1.1; 8.5)



porridge

1 8.4 (1.0; 44.8) 114 37.2 (28.2; 47.2) 0.06




APPENDIX 2 – SAMPLING FRAME

District EACode EABase Name Locality Name

Selected or

Backup EA

Sunyani 0708200016 BENU NKWANTA BENU NKWANTA 1

Sunyani 0708200017 TWEREDUA TWEREDUA BU‐1

Sunyani 0708200032 AGAPE EVANGELIGAL CHURCH ABESIM 2

Sunyani 0708200033 ABESIM LORRY PARK ABESIM BU‐2

Sunyani 0708200042 ST. JAMES SEMINARY SECONDARY SCHOOL ABESIM 3

Sunyani 0708200055 BETHEL PRAYER CAMP SUNYANI 4

Sunyani 0708200056 GNAT HOSTEL/SECRETARIAT SUNYANI BU‐4

Sunyani 0708200066 H/NO. NT.68/4 SUNYANI 5

Sunyani 0708200079 REGIONAL HOUSE OF CHIEFS SUNYANI 6

Sunyani 0708200080 HOTEL DE NIMPONG SUNYANI BU‐6

Sunyani 0708200096 H/NO.B.4/3 (UNIQUE INSURANCE OFFICE) SUNYANI 7

Sunyani 0708200097 ECOBANK SUNYANI BRANCH SUNYANI ZONGO BU‐7

Sunyani 0708200115 H/NO.B.221/2 SUNYANI 8

Sunyani 0708200116 H/NO.B.206/2 SUNYANI BU‐8

Sunyani 0708200128 ROMAN CATHOLIC CHURCH SUNYANI PENKWASE 9

Sunyani 0708200140 ROMAN CATHOLIC CHURCH SUNYANI 10

Sunyani 0708200152 GLORY OIL FILLING STATION NEW DORMAA 11

Sunyani 0708200172 CHURCH OF PENTECOST YAWHIMAKROM 12

Sunyani 0708200173 PRESBY CHURCH YAWHIMAKROM BU‐12a

Sunyani 0708200174 NEW APOSTOLIC CHURCH YAWHIMAKROM BU‐12b

Tamale 0811301027 TUUTINGLE TUUTINGLE 13

Tamale 0811301044 EARLY CHILDHOOD DEVELOPMENT PRIMARY SCHOOL ZUTUNG 14

Tamale 0811301045 DINI VATA HAZIB ISMALIC SCHOOL (ZUJUNG PRIMARY SCHOOL) ZUTUNG BU‐14

Tamale 0811301074 LAMASHEGU LAMASHEGU 15

Tamale 0811301075 SABAT MOTORS WORKSHOP LAMASHEGU BU‐15

Tamale 0811301093 DATOYILI CONTAINMENT CASE DATOYILI 16

Tamale 0811301094 DATOYILI J.H.S DATOYILI BU‐16

Tamale 0811302009 H/NO. (NL 115) ZOGBELI 17

Tamale 0811302010 RADIO JUSTICE LAMASHEGU BU‐17

Tamale 0811302038 NAWARIA PRIMARY SCHOOL DABOKPA 18

Tamale 0811302039 MOSQUE DABOKPA BU‐18

Tamale 0811302059 NABB'S VIDEO CENTRE TUTINGLI 19

Tamale 0811302083 YAKUBU IDDRISU'S HOUSE E.221 GUKPEGU 20

Tamale 0811302084 JIMO GBADAMOSI LICENSED CHEMICAL SELLER F. 46 HAVSA ZONGO BU‐20


Tamale 0811302108 SOCOMEX PHARMACY ZOGBELI 21

Tamale 0811302128 NPP REGIONAL SECRETARY OFFICE ABOABO 22

Tamale 0811302129 NYAMISAT TI YILI HOUSE (I.99) ABOABO BU‐22a

Tamale 0811302130 SECOND BAPIST CHURCH ABOABO BU‐22b

Tamale 0811302131 WATHNIYA ENG/ARABIC PRIMARY SCHOOL ABOABO BU‐22c

Tamale 0811302157 HOUSE No. (B.241) TISHIGU 23

Tamale 0811302180 H/NO. JSQ 120 SAKASAKA 24

Tamale 0811302181 HUMBLE YOURSELF BEFORE GOD CHEMICALS SAKASAKA BU‐24

Tamale 0811302203 SAKASAKA POLICE STATION MOSHIE ZONGO 25

Tamale 0811302204 PRESBYTERIAN CHURCH & SCHOOL MOSHIE ZONGO BU‐25


8 APPENDIX 3 – ENDPOINT SURVEY QUESTIONNAIRE

CIFF Evaluation Questionnaire ENDLINE, version 22 August 2017

Section Name

Question Type

Question ID

Question Hint Options

General Background (GB)

Single Choice

GB 1 Interviewer ID 1= Interviewer 1 2= Interviewer 2 3= Interviewer 3 4= Interviewer 4 5= Interviewer 5 6= Interviewer 6 7= Interviewer 7 8= Interviewer 8 9= Interviewer 9 10= Interviewer 10 11= Interviewer 11 12= Interviewer 12

Single Choice

GB2 District 1= Sunyani Municipal 2= Tamale Metropolis (skip to GB4)

Single Choice

GB3 Note cluster in Sunyani Municipal

1= Cluster 1 2= Cluster 2 3= Cluster 3 4= Cluster 4 5= Cluster 5 6= Cluster 6 7= Cluster 7 8= Cluster 8 9= Cluster 9 10= Cluster 10 11= Cluster 11 12= Cluster 12 13= Cluster 13 (skip to GB5)

Single Choice

GB4 Note cluster in Tamale Metropolis

14= Cluster 1 15= Cluster 2 16= Cluster 3 17= Cluster 4 18= Cluster 5 19= Cluster 6 20= Cluster 7 21= Cluster 8 22= Cluster 9 23= Cluster 10 24= Cluster 11 25= Cluster 12


Integer GB5 Household number from woman and household listing

Column 2 on cluster control form (Confirm with team leader if you are unsure of the household number)

Integer GB5_1 Household identification number from household label

Record number from label starting with H. Column 5 on cluster control form

Integer GB5_2 Reenter household identification number from household label

Record number from label starting with H Column 5 on cluster control form

Single choice

GB6 Household selected for which target group?

From household listing form

1= pregnant women only 2= non‐pregnant women only 3= both pregnant and non‐pregnant women

Text GB7 What is your name?

Enter name of the woman to be interviewed

Single Choice

GB8 Written consent provided?

Proceed with consent procedure and have woman separate consent form

1=Yes 2=No (skip to MFR2)

Single Choice

GB9 Mother tongue of the respondent

1= Akan 2= Bono 3= Asante 4= Ewe 5= Nafaana 6= Dagbani 7= Gonja 8= Ga 9= Wangara 10= Dagare 11= Mampruli 12= Hausa (skip to GB11)_______________ 96= Other (specify)

Text GB10 Type the “other” option


Single Choice

GB11 Is it the first eligible woman you are interviewing in that household

Don’t ask this question, this is for you

1= Yes (skip to HR2) 2= No

Household Roster (HR)

Text HR2a_1 Name of household member 1

Start with first respondent

Single choice

HR2b_1 Gender of household member 1

1=male (skip to HR2d_1) 2=Female

HR2c_1 Are you pregnant? No need to ask the respondent if already stated, just check accordingly

1=Yes 2=No

Year HR2d_1 Age of respondent Note age in years; if less than 1 year=0

Single choice

HR2e_1 Member 1 currently attending school?

1= Yes 2= No

Single choice

HR2f_1 Member 1 has 5 or more years of schooling?

1= Yes 2= No

Single choice

HR2g_1 More members living in household?

Type 1 to add more HH members

1= Yes (add HR module) 2= No (skip to HHC 1)

Text HR2a_2 Name of household member 2

Single choice

HR2b_2 Gender of household member 2

1=male (skip to HR2d_2) 2=Female

HR2c_2 Is (name of member 2) pregnant?

1=Yes 2=No

Integer HR2d_2 Age of household member 2

[ ] [ ] skip to HR2g_2 if ≤5 years

Single choice

HR2e_2 Member 2 currently attending school?

1= Yes 2= No

Single choice

HR2f_2 Member 2 has 5 or more years of schooling?

1= Yes 2= No

Single choice

HR2g_2 More members living in household?

1= Yes (add HR module) 2= No

Household Characteristics (HHC)

Single Choice

HHC1 Does your household have

Mark yes if electricity from

1=Yes 2=No


electricity? any source, e.g. power grid, generator, solar panel, etc.

Single Choice

HHC2 What fuel does

your household

mainly use for

cooking?

Only one answer

1=Electricity 2=Liquefied Petroleum Gas 3=Natural gas 4=Biogas 5=Kerosene 6=Coal, Lignite 7= Charcoal 8=Wood/Firewood 9=Straw / Shrubs / Grass 10=Agricultural crop 11=Animal dung 10=No food cooked in household 11=Don’t know (skip to HC4)_______________ 96= Other (specify)

Text HHC2other

Type the “other” option

Single Choice

HHC4

What is the main

material of the

floor of the

dwelling?

Observe the material

11= Earth / sand 12= Dung 21= Wood planks 31= Parquet or polished wood 32= Vinyl or asphalt tiles 33= Ceramic tiles or marble or porcelain tiles or terrazzo 34= Cement 35= Wooden carpet/Synthetic carpet 36= Linoleum/ rubber carpet (skip to HHC6)_____________ 96= Other (specify)

Text HHC4other


Single Choice

HHC6 What is the main

material of the roof

of the dwelling?


11= No roofing 12= Thatch / palm leaves 21= Rustic mat 22= Palm/ Bamboo 23= Wood planks 24= Cardboard 31= Metal 32= Wood 33= Calamine/Cement fiber 34= Ceramic/brick tiles 35= Cement


36= Roofing shingles 37= Asbestos/slate roofing sheets (skip to HHC8)_____________ 96 = Other (specify)

Text HHC6other


Single Choice

HHC8 What is the main material of the exterior walls of the dwelling?


11= No walls 12= Cane / palm / trunks 13= Dirt/ landcrete 21= Bamboo with mud 22= Stone with mud 23= Uncovered adobe 24= Plywood 25= Cardboard 26= Reused wood 31= Cement 32= Stone with lime / cement 33= Bricks 34= Cement blocks 35= Covered adobe 36= Wood planks / shingles (skip to HHC10)_____________ 96= Other (specify)

Text HHC8other


Single Choice

HHC10 Do you or anyone in this household own this dwelling?

1=Yes 2=No

Integer HHC11 In this household, how many rooms do you use for sleeping?

Enter number of rooms

Multiple Choice

HHC12 Does your household or anyone in the household have a…

Prompt for each item

HHC12_1

Radio 1=Yes 2=No

HHC12_2

Black/white television

1=Yes 2=No

HHC12_3

Color television 1=Yes 2=No

HHC12_4

Mobile telephone 1=Yes 2=No

HHC12_5

Land‐line telephone 1=Yes 2=No


HHC12_6

Refrigerator 1=Yes 2=No

HHC12_7

Freezer 1=Yes 2=No

HHC12_8

Electric generator/Invertor

1=Yes 2=No

HHC12_9

Washing machine 1=Yes 2=No

HHC12_10

Computer/Tablet computer

1=Yes 2=No

HHC12_11

Photo camera (not on phone)

1=Yes 2=No

HHC12_12

Access to internet in any device

1=Yes 2=No

HHC12_13

A wall clock 1=Yes 2=No

HHC12_14

Video deck/ DVD/ VCD

1=Yes 2=No

HHC12_15

Sewing machine 1=Yes 2=No

HHC12_16

Bed 1=Yes 2=No

HHC12_17

Table 1=Yes 2=No

HHC12_18

Cabinet/cupboard 1=Yes 2=No

Wash, Sanitation and Hygiene (WSH)

Single Choice

WSH1 What is the main source of drinking water for the members of your household?

Only one answer 11= Piped water into dwelling 12= Yard/ plot 13= Public tap/ standpipe 21= Tube well or borehole 31= Protected Dug well 32= Unprotected dug well 41= Protected spring 42= Unprotected spring 51= Rainwater 61= Tanker truck 71= Cart with small tank 81= Surface water (river / dam / lake / pond / stream / canal / irrigation channel) 91= Bottled 92= sachet water 93= Don’t know (skip to WSH3)____________ 96= Other (specify)

Text WSH1other



Single Choice

WSH3 Do you usually do anything to your drinking water to make it safer to drink?

1=Yes 2=No (skip to WSH5)

Multiple Choice

WSH4 What do you

usually do to make

the water safer to

drink?

Do not prompt.

Probe “Anything

else?”.

WSH4_1

Boil 1=Yes 2=No

WSH4_2

Add bleach/ chlorine tablet/ alum

1=Yes 2=No

WSH4_3

Use a water filter (ceramic/ sand/ composite/…

1=Yes 2=No

WSH4_4

Solar disinfection 1=Yes 2=No

WSH4_5

Strain through a cloth

1=Yes 2=No

WSH4_6

Let it stand and settle

1=Yes 2=No

WSH4_7

Camphor/ Naphthalene

1=Yes 2=No

WSH4_8

Purification Tablet 1=Yes 2=No

WSH4_9

Other (specify) 1=Yes 2=No (skip to WSH5)

Text WSH4_10


Single Choice

WSH5 What kind of toilet facility do members of your household usually use?

Do not prompt. If “flush”, probe: WHERE DOES IT FLUSH TO?

11= Flush or pour flush to piped sewer system 12= Flush or pour flush to septic tank 13= Flush or pour flush to pit latrine 14= Flush or pour flush to elsewhere 15= Flush, don`t know where 21= Ventilated improved pit latrine 22= Pit latrine with slab 23= Pit latrine without slab /open pit 41= Bucket toilet 51= Hanging toilet / hanging latrine 61= No facilities / bush /


field (Skip to WSH8) 71= Don’t know (Skip to WSH7)____________ 88= Other (specify)

Text WSH5other


Single Choice

WSH7 Do you share this facility with other households?

1=Yes 2=No

Multiple choice

WSH8 Please tell me all of the occasions when it is important for you to wash hands.

Do not prompt.

Probe “Anything

else?”.

WSH8_1

Before eating 1=Yes 2=No

WSH8_2

Before feeding a child

1=Yes 2=No

WSH8_3

Before cooking or preparing food

1=Yes 2=No

WSH8_4

After defecation or urination

1=Yes 2=No

WSH8_5

After cleaning a child that has defecated,changing nappes, or washing diaper

1=Yes 2=No

WSH8_6

After contact with animal feces

1=Yes 2=No

WSH8_7

Don´t know 1=Yes 2=No

WSH8_8

Other (specify) 1=Yes 2=No (skip to PMM1)

Text WSH8_9


Pregnancy and MPI mortality (PMM)

Single choice

PMM1 Are you pregnant now?

May not be necessary to ask, if the respondent already told you that

1=Yes 2=No (skip to PMM3)

Integer PMM2 How many months pregnant are you?

Integer PMM3 How many times, in total, have you been pregnant?

Include current pregnancy, if pregnant

(if 0, skip to MEO1)

Single choice

PMM4 Have you taken iron tablets during your last pregnancy?

1=Yes 2=No


Single choice

PMM5 During your last pregnancy, did you take drugs to keep you from getting malaria?

1=Yes 2=No

Integer PMM6 How many times, in total, have you given birth to a baby?

Include still births and live births

(if 0, skip to MEO1)

Months PMM7 When was your most recent birth?

Tell the mother : I will be asking about your recent births. I am interested in the three most recent births. I am interested in all children that were born alive.

Text PMM8 Where is that child now?

1= passed away 2= alive, no matter, where

Single choice

PMM9 Did you have a live baby before this most recent one?

1=Yes 2=No (skip to PMM 13)

Text PMM10 Where is the child now?


Single choice

PMM11 Did you have a birth before that one?

1=Yes 2=No (skip to PMM 13)

Text PMM12 Where is the child now?


Single choice

PMM13 Are you currently breastfeeding a child?

1=Yes 2=No

Marital status/education/occupation (MEO)

Single choice

MEO1 What is your marital status?

Introduce this and the following modules in that you explain the respondent that you are asking about her specifically now.

1= Married 2 = Widowed 3 = Single 4= Separated 5 = Divorced

Single choice

MEO2 What is the highest level of school you attended?

0= None 1=Primary 2=Middle 3=JSS/JHS 4=SSS/SHS 5=Higher 6= other


MEO2other


Integer ME04 What is the highest (grade) you completed at that level?

If completed less than one year at that level, Record '00'.

Single choice

MEO5 What is your main occupation?

1=Agriculture – own farm 2=Agriculture – on someone else’s farm 3=Salaried employee 4=Petty trade 5=Self‐employed 6=Student 7=Unemployed (Skip to AMM1)____________ 8=Other

MEO5_other


Dietary Diversity (DD)

Multiple choice

DD1 Yesterday during the day or night, did you eat any of the following foods? Please also mention the foods that were part of a mixed dish.

Help the respondent define the 24h period Do not mark food group unless 15 grams or more eaten. Show woman spoon/cube to indicate quantity.

DD1_1 Starchy staples (maize, millet, wheat, sorghum, rice, sweetpotatoes, potatoes, cassava, cocoyam, plantain)

Examples of local dishes containing these

1=Yes 2=No

DD1_2 Legumes (Cooked dry beans and peas)

1=Yes 2=No

DD1_3 Nuts and seeds (palm nut, groundnuts, white‐melon seed, agushi)

1=Yes 2=No

DD1_4 Dairy (Milk/yogurt, milk products, cheese)

1=Yes 2=No

DD1_5 Organ meat (liver, kidney, heart, or other organ meats)

1=Yes 2=No

DD1_6 Eggs (from chicken, guinea‐fowl, ducks, quail)

1=Yes 2=No

DD1_7 Small fish eaten whole with bones (Keta school boys)

1=Yes 2=No

DD1_8 Large fresh or dried fish, shellfish, or seafood, snails, crabs (koobi, tilapia, tuna, shrimps)

1=Yes 2=No


DD1_9 Flesh foods and animal protein (Beef, pork, veal, lamb, mutton, goat, game meat, Chicken, duck, guinea fowl, pigeon, game birds)

1=Yes 2=No

DD1_10 Dark green leafy vegetables (spinach, kale, cassava leaves, lettuce, amaranth, potato leaves, cowpea leaves, moringa leaves, okra leaves, cocoyam leaves, bokoboko, ayoyo, alefu, bra)

1=Yes 2=No

DD1_11 Red, orange yellow vegetables that have yellow or orange flesh (carrots, squash, orange fleshed sweetpotatoes)

1=Yes 2=No

DD1_12 Red, orange yellow fruits (mangoes, papaya, melon) and 100% fruit juices made from these fruits

1=Yes 2=No

DD1_13 Vitamin C rich vegetables (onion, pepper, tomato, okra, cauliflower)

1=Yes 2=No

DD1_14 Vitamin C rich fruits (Lemon, lime, grapefruit, orange, apricots, pineapple, banana) and 100% fruit juices made from these fruits

1=Yes 2=No

DD1_15 Any other fruits (coconut, apple) and 100% fruit juices

1=Yes 2=No

DD1_16 Any other vegetables (eggplant, avocado, zucchini, cucumber)

1=Yes 2=No

DD1_17 Edible oil 1=Yes 2=No

DD1_18 Sugar, honey 1=Yes 2=No

DD1_19 Condiments/spices 1=Yes 2=No

DD1_20 Miscellaneous (tea, soft drinks, juice)

1=Yes 2=No

DD1_21 Foods made with red palm oil, red palm nut, or red palm nut pulp sauce

1=Yes 2=No

DD1_22 Salty or fried snacks: Crisps and chips, fried dough or other fried snacks

1=Yes 2=No

DD1_23 Sugar‐sweetened beverages (soft

drinks/fizzy drinks, chocolate

drinks, malt drinks, yoghurt drinks,

sweet tea or coffee with sugar,

sweetened fruit juices and “juice

drinks”)

1=Yes

2=No

DD1_24 Sweets: Sugary foods, such as 1=Yes


chocolates, candies, cookies/sweet biscuits, cakes, sweet pastries or ice cream

2=No

Access to mass media (AMM)

Single choice

AMM1 Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

1= At least one a week 2= Less than once a week 3= Not at all

Single choice

AMM2 Do you listen to the radio at least once a week, less than once a week or not at all?


Single choice

AMM3 Do you watch television at least once a week, less than once a week or not at all?


Single choice

AMM4 Do you access internet/social media/facebook at least once a week, less than once a week or not at all?

1= At least once a week 2= Less than once a week 3= Not at all

Multiple choice

AMM5 Where do you get information from to help you choose healthy food for your baby and yourself?

Do not prompt. Probe “Anything else?”.

AMM5_1

Mother/mother in law

1=Yes 2=No

AMM5_2

Friends 1=Yes 2=No

AMM5_3

Community health officer

1=Yes 2=No

AMM5_4

Nurse, midwife or doctor

1=Yes 2=No

AMM5_5

Traditional birth attendant

1=Yes 2=No

AMM5_6

Local chemists 1=Yes 2=No

AMM5_7

Posters in the community

1=Yes 2=No

AMM5_8

Radio shows 1=Yes 2=No


AMM5_9

TV shows 1=Yes 2=No

AMM5_10

Don´t know 1=Yes 2=No

AMM5_11

Social media/ internet/facebook

1=Yes 2=No

AMM5_12

Other mass media 1=Yes 2=No (skip to OSR1)

AMM5_12other


Obaasima seal recognition (OSR)

Single choice OSR1 Have you ever seen/ heard of the “Obaasima” seal/logo

Show the seal 1=Yes 2=No (skip to SLB1)

Multiple choice

OSR2 Where did you see/ hear of the “Obaasima” seal/logo


OSR2_1 TV 1=Yes 2=No

OSR2_2 Radio 1=Yes 2=No

OSR2_3 Billboards 1=Yes 2=No

OSR2_4 Posters/ Street Median

1=Yes 2=No

OSR2_5 Church meeting 1=Yes 2=No

OSR2_6 Health clinic/ health worker

1=Yes 2=No

OSR2_7 Community leaders 1=Yes 2=No

OSR2_8 Relative/ friends/ neighbor

1=Yes 2=No

OSR2_9 Shopkeeper/ pharmacy

1=Yes 2=No

OSR2_10

Social media 1=Yes 2=No

OSR2_11

Market place/ market

1=Yes 2=No

OSR2_12

Movie event/roving cinema

1=Yes 2=No

OSR2_13

Don´t know/ don´t remember

1=Yes 2=No

OSR2_14

Other 1=Yes 2=No (skip to OSR3)

Text OSR2_14other



Multiple choice

OSR3 What does the Obaasima seal/logo on a product mean?


OSR3_1 Is good quality/trustworthy product

1=Yes 2=No

OSR3_2 Contains vitamin and minerals

1=Yes 2=No

OSR3_3 Is good for health 1=Yes 2=No

OSR3_4 Is good for young women/ pregnant women

1=Yes 2=No

OSR3_5 Gives strength 1=Yes 2=No

OSR3_6 Keeps energy level high

1=Yes 2=No

OSR3_7 Boosts immune system

1=Yes 2=No

OSR3_8 Is important for a long life

1=Yes 2=No

OSR3_9 Helps to become pregnant

1=Yes 2=No

OSR3_10

Protects unborn baby

1=Yes 2=No

OSR3_11

Helps to be smart 1=Yes 2=No

OSR3_12


1=Yes 2=No

OSR3_13

Other (specify) 1=Yes 2=No (skip to OSR4)

Text OSR3_13other


Single choice OSR4 Have you ever bought products with the “Obaasima” seal/logo

1=Yes 2=No (skip to SLB1)

Single choice OSR5 Do you prefer products with “Obaasima” seal/logo over products without logo

1=Yes 2=No (skip to OSR 7)

OSR6 Why do you prefer Obaasima products?

OSR6_1 Is good quality/trustworthy product

1=Yes 2=No


OSR6_2 Contains vitamin and minerals

1=Yes 2=No

OSR6_3 Is good for health 1=Yes 2=No

OSR6_4 Is good for young women/ pregnant women

1=Yes 2=No

OSR6_5 Gives strength 1=Yes 2=No

OSR6_6 Keeps energy level high

1=Yes 2=No

OSR6_7 Boosts immune system

1=Yes 2=No

OSR6_8 Is important for a long life

1=Yes 2=No

OSR6_9 Helps to become pregnant

1=Yes 2=No

OSR6_10


1=Yes 2=No

OSR6_11


1=Yes 2=No

OSR6_12

Other (specify) 1=Yes 2=No (skip to OSR4)

Single choice

OSR7 Last time you bought products with “Obaasima” seal/logo from where did you purchase them?

1= Supermarket 2= Shop 3= Kiosk 4= Market/ street stand 5= Moving street vendor 6= Pharmacy (skip to SAB 18)___________ 88= other (specify)

Specialty Product “ Lola milk biscuits” (SLB)

Single choice SLB1 Do you ever eat biscuits?


Single choice SLB2 What is the name of biscuit you usually eat?

clarify with: the name of biscuit that you consume most

1= Lola milk biscuit 2= Lola other biscuits 3= Digestive 4= Perk 5= Jack ‘n’ Jill 6= Bonita 7= Cream Cracker 8= King Cracker 9= Malt & Milk 10= Milk biscuit 11= Munchee 12= Milky Magic (Skip to SLB3)_____________ 11= Other brand


Text SLB2other

What is the name of the other brand?

Single choice SLB3 Have you ever seen or / heard of “Lola milk biscuits”

Show the package of Lola biscuits

1=Yes 2=No (skip to SBS1)

Multiple choice

SLB4 Where did you see/ hear of “Lola milk biscuits”


SLB4_1 TV 1=Yes 2=No

SLB4_2 Radio 1=Yes 2=No

SLB4_3 Billboards 1=Yes 2=No

SLB4_4 Posters/ Street Median

1=Yes 2=No

SLB4_5 Church meeting 1=Yes 2=No

SLB4_6 Health clinic/ health worker

1=Yes 2=No

SLB4_7 Community leaders 1=Yes 2=No

SLB4_8 Relative/ friends/ neighbor

1=Yes 2=No

SLB4_9 Shopkeeper/ pharmacy

1=Yes 2=No

SLB4_10

Social media/facebook

1=Yes 2=No

SLB4_11


1=Yes 2=No

SLB4_12


1=Yes 2=No

SLB4_13

Other 1=Yes 2=No (skip to SLB5)

Text SLB4_13other


Single choice SLB5 Do you know where to buy “Lola milk biscuits”?


Multiple choice

SLB5 Where can you buy the products?

Do not prompt. Probe “Anything else?”

SLB5_1 Shop 1=Yes 2=No

SLB5_2 Kiosk 1=Yes 2=No

SLB5_3 Market/street stand

1=Yes 2=No

SLB5_4 Moving street vendor

1=Yes 2=No


SLB5_5 Other (specify) 1=Yes 2=No (skip to SLB6)

SLB5_6other


Single choice SLB6 How far is the closest place you can buy the product?

1= Time 2= Distance (skip to SLB6_2) 8= Don´t know (skip to SLB7)

Number SLB6_1 Time in minutes Enter time in minutes

(record, then skip to SLB7)

Number SLB6_2 Distance in meters Enter distance in meters

Single choice SLB7 Have you ever eaten “Lola milk biscuits”?

1=Yes (skip to SLB 9) 2=No

Multiple choice

SLB8 Why have you never eaten “Lola milk biscuits” before?


SLB8_1 Dislikes taste 1=Yes 2=No

SLB8_2 Dislikes packaging 1=Yes 2=No

SLB8_3 Is too expensive 1=Yes 2=No

SLB8_4 Is not easily available

1=Yes 2=No

SLB8_5 Dislikes how it is promoted

1=Yes 2=No

SLB8_6 Is not a good quality/ trustworthy product

1=Yes 2=No

SLB8_7 Don’t eat biscuits 1=Yes 2=No

SLB8_8 Do not see a need for the Lola milk biscuits

1=Yes 2=No

SLB8_9 Heard of bad experience of someone else

1=Yes 2=No

SLB8_1

0

Advised not to use it

1=Yes 2=No

SLB8_1

1

Has not seen other women use it

1=Yes 2=No

SLB8_1

2

Other family members discourage using it

1=Yes 2=No


SLB8_1

3

Contains added artificial ingredients such as vitamins and minerals

1=Yes 2=No

SLB8_1

4

Too much sugar/ too sweet

1=Yes 2=No

SLB8_1

5

Is not good for health

1=Yes 2=No

SLB8_1

6

Is not good for young women/ pregnant women

1=Yes 2=No

SLB8_1

7

Don’t know / Don’t remember

1=Yes 2=No

SLB8_1

8

Other 1=Yes 2=No (skip to SLB15)

Text SLB8_1

8other


(enter, then skip to SLB15)

Single choice SLB9 How often do you usually eat “Lola milk biscuits”?

1= several times a day 2= once a day 3= Every other day 4= once or twice a week 5= less than once a week 6= every second week 7=once a month 8= less than once a month

Single choice SLB10 Each time you eat “Lola milk biscuits”, how much do you usually eat?

1= half a biscuit 2= one biscuit 3= two biscuits 4= three biscuits 5= four or more biscuits

Single choice SLB11 How long ago did you last eat “Lola milk biscuits”

1=today (skip to SLB15) 2=day(s) ago 3=week(s) ago (skip to SLB13) 4=month(s) ago (skip to SLB14)

Integer SLB12 Number of days (skip to SLB15)

Integer SLB 13 Number of weeks If greater than 8 weeks, record time as months

(skip to SLB15)

Integer SLB 14 Number of months

Single choice SLB15 Does anyone else in the household eat “Lola milk biscuits”

1=Yes 2=No (enter, then skip to SBS1 if 2=No in SLB7 or to


SLB17 if 1=Yes in SLB7) 3= don´t know (enter, then skip to SBS1 if 2=No in SLB7 or to SLB17 if 1=Yes in SLB7)

Multiple choice

SLB 16 Who else? Do not prompt. Probe “Anybody else?”

SLB16_1

Another female adult or teenager

1=Yes 2=No

SLB16_2

A male adult or teenager

1=Yes 2=No

SLB16_3

A child 1=Yes 2=No

Single choice SLB17 The last time you got “Lola milk biscuits”, how did you get them?

1= Bought/purchased them 2= Received them for free (Skip to SLB17_2) 3= Never got “Lola milk biscuits” (skip to SBS1) 4= Don't remember (Skip to SLB20)

Single choice

SLB17_1

From where did you purchase them?

1= Supermarket 2= Shop 3= Kiosk 4= Market/ street stand 5= Moving street vendor (skip to SLB 18)___________ 88= other (specify)

SLB17_1other


Skip to SLB18

Single choice

SLB17_2

From where did you receive them for free?

1= Relatives/ friends/ neighbor 2= Health worker 3= NGO/ religious association (skip to SLB20)___________ 88= other (specify)

Text SLB17_2 other


Skip to SLB20

Integer SLB18 The last time you bought “Lola milk biscuits”, how

If ‘don’t know’, record 888


many packages did you buy?

Integer SLB19 The last time you bought “Lola milk biscuits”, how much did you pay for the unit purchased?

In GHS. If ‘don’t know’, record 888

Multiple choice

SLB20 What do you like about “Lola milk biscuits”


SLB20_1

Likes the taste 1=Yes 2=No

SLB20_2

Likes the packaging 1=Yes 2=No

SLB20_3

Likes the price 1=Yes 2=No

SLB20_4

Is easily available 1=Yes 2=No

SLB20_5

Likes how it is promoted

1=Yes 2=No

SLB20_6

Is a good quality /trustworthy product

1=Yes 2=No

SLB20_7

Is locally produced 1=Yes 2=No

SLB20_8

Carries the Obaasima seal

1=Yes 2=No

SLB20_9

Contains minerals and vitamins

1=Yes 2=No

SLB20_10

Contains small amount of sugar/ not too sweet

1=Yes 2=No

SLB20_11

Is good for health 1=Yes 2=No

SLB20_12

Is good for young women/ pregnant women

1=Yes 2=No

SLB20_13

Keeps energy level high

1=Yes 2=No

SLB20_14

Product gives strength

1=Yes 2=No

SLB20_15

Helps to become pregnant

1=Yes 2=No

SLB20_16


SLB20_17


1=Yes 2=No

SLB20_18

Other (specify) 1=Yes 2=No (skip to SLB 22)


Text SLB20_18other


Multiple choice

SLB21 What do you not like about “Lola milk biscuits”


SLB21_1

Dislikes taste 1=Yes 2=No

SLB21_2

Dislikes packaging 1=Yes 2=No

SLB21_3

Is too expensive 1=Yes 2=No

SLB21_4

Dislikes how it is promoted

1=Yes 2=No

SLB21_5

Is not easily available

1=Yes 2=No

SLB21_6


1=Yes 2=No

SLB21_7

Is not a good quality/ trustworthy product

1=Yes 2=No

SLB21_8


1=Yes 2=No

SLB21_9

Contains too much sugar/ too sweet

SLB21_10


1=Yes 2=No

SLB21_11


1=Yes 2=No

SLB21_12


1=Yes 2=No

SLB2_13

Other (specify) 1=Yes 2=No (skip to SLB 23)

Text SLB21_13other


Single choice SLB22 Can you tell me any health benefits of ‘Lola milk biscuits’?


Text SLB23 Which health benefits does it have?

SLB23_1

Contains vitamin and minerals

1=Yes 2=No

SLB23_2


1=Yes 2=No

SLB23_3

Contains small amount of sugar

1=Yes 2=No


SLB23_4


SLB23_5

Gives strength 1=Yes 2=No

SLB23_6


1=Yes 2=No

SLB23_7

Boosts immune system

1=Yes 2=No

SLB23_8

Is important for a long life

1=Yes 2=No

SLB23_9


1=Yes 2=No

SLB23_10


1=Yes 2=No

SLB23_11


1=Yes 2=No

SLB23_12

Other (specify) 1=Yes 2=No (skip to SBS1))

SLB23_12other


Specialty Product “SAMBA SHITO sauce” (SBS)

Single choice

SBS1 Do you eat Shito Sauce at all?


Single choice

SBS2 What is the main brand of Shito Sauce consumed by you?

clarify with: the brand that you consume most

1= Samba Shito 2= Homemade 3= unbranded Shito from chop bar/ restaurant/ vendor (Skip to SBS3)_____________ 11= Other brand

Text SBS2other


Single choice

SBS3 Have you ever seen/ heard of “Samba Shito Sauce”

Show the package of Samba Shito Sauce

1=Yes 2=No (skip to STV1)

Multiple choice

SBS4 Where did you see/ hear of “Samba Shito Sauce”


SBS4_1 TV 1=Yes 2=No

SBS4_2 Radio 1=Yes 2=No

SBS4_3 Billboards 1=Yes 2=No

SBS4_4 Posters/ Street Median

SBS4_5 Church meeting 1=Yes 2=No


SBS4_6 Health clinic/ health worker

1=Yes 2=No

SBS4_7 Community leaders 1=Yes 2=No

SBS4_8 Relative/ friends/ neighbor

1=Yes 2=No

SBS4_9 Shopkeeper/ pharmacy

1=Yes 2=No

SBS2_10


1=Yes 2=No

SBS4_11


1=Yes 2=No

SBS4_12


1=Yes 2=No

SBS4_13

Other 1=Yes 2=No (skip to SBS5)

Text SBS4_13other


Single choice

SBS5 Do you know where to buy “Samba Shito Sauce”?


Multiple choice

SBS5 Where can you buy the product?


SBS5_1 Shop 1=Yes 2=No

SBS5_2 Kiosk 1=Yes 2=No

SBS5_3 Market/street stand

1=Yes 2=No

SBS5_4 Moving street vendor

1=Yes 2=No

SBS5_6 Other (specify) 1=Yes 2=No (skip to SBS6)

SBS5_6other


Single choice

SBS6 How far is the closest place you can buy the product?

1= Time 2= Distance (skip to SBS6_2) 8= Don´t know (skip to SBS7)

Number SBS6_1 Time in minutes Enter time in minutes

(record, then skip to SBS7)

Number SBS6_2 Distance in meters Enter distance in meter

Single choice

SBS7 Have you ever eaten “Samba Shito Sauce”?

1=Yes (skip to SBS 9) 2=No

Multiple choice

SBS8 Why have you never eaten “Samba Shito



Sauce” before?

SBS8_1 Dislikes taste 1=Yes 2=No

SBS8_2 Dislikes packaging 1=Yes 2=No

SBS8_3 Is too expensive 1=Yes 2=No

SBS8_4 Is not easily available

1=Yes 2=No

SBS8_5 Dislikes how it is promoted

1=Yes 2=No

SBS8_6 Is not a good quality/ trustworthy product

1=Yes 2=No

SBS8_7 Don’t eat Shito Sauce

1=Yes 2=No

SBS8_8 Do not see a need for Samba Shito Sauce

1=Yes 2=No

SBS8_9 Heard of bad experience of someone else

1=Yes 2=No

SBS8_1

1


1=Yes 2=No

SBS8_1

2


1=Yes 2=No

SBS8_1

3


1=Yes 2=No

SBS8_1

4


1=Yes 2=No

SBS8_1

5


1=Yes 2=No

SBS8_1

6


1=Yes 2=No

SBS8_1

7

Other 1=Yes 2=No (skip to SBS14)

Text SBS8_1

7other


(enter, then skip to SBS14)

Single choice

SBS9 How often do you usually eat “Samba

1= several times a day 2= once a day


Shito Sauce”? 3= Every other day 4= once or twice a week 5= less than once a week 6= every second week 7=once a month 8= less than once a month

Single choice

SBS10 Each time you eat “Samba Shito Sauce”, how much do you usually eat?

1= half a sachet 2= one sachet 3= one and a half sachet 4= two sachets 5= more than two sachets

Single choice

SBS11 How long ago did you last eat “Samba Shito Sauce”

1=today (skip to SBS15) 2=day(s) ago 3=week(s) ago (skip to SBS13) 4=month(s) ago (skip to SBS14)

Integer SBS12 Number of days (skip to SBS15)

Integer SBS 13 Number of weeks If greater than 8 weeks, record time as months

(skip to SBS15)

Integer SBS 14 Number of months

Single choice

SBS15 Does anyone else in the household eat “Samba Shito Sauce”

1=Yes 2=No (enter, then skip to STV1 if 2=No in SBS7 or to SBS17 if 1=Yes in SBS7) 3= don´t know (enter, then skip to STV1 if 2=No in SBS7 or to SBS17 if 1=Yes in SBS7)

Multiple choice

SBS 16 Who else? Do not prompt. Probe “Anybody else?”

SBS16_1


1=Yes 2=No

SBS16_2


1=Yes 2=No

SBS16_3

A child 1=Yes 2=No

Single choice

SBS17 The last time you got “Samba Shito Sauce”, how did you get them?

1= Bought/purchased them2= Received them for free (Skip to SBS17_2) 3= Never got “Samba Shito Sauce” (skip to SBS1) 3= Don't remember (Skip to SBS20)


Single choice

SBS17_1


1= Supermarket 2= Shop 3= Kiosk 4= Market/ street stand 5= Moving street vendor (skip to SBS 18)___________ 88= other (specify)

SBS17_1other


Skip to SBS18

Single choice

SBS17_2


1= Relatives/ friends/ neighbor 2= Health worker 3= NGO/ religious association (skip to SBS20)___________ 88= other (specify)

Text SBS17_2 other


Skip to SBS20

Integer SBS18 The last time you bought “Samba Shito Sauce”, how many sachets did you buy ?


Integer SBS19 The last time you bought “Samba Shito Sauce”, how much did you pay for the sachet purchased?


Multiple choice

SBS20 What do you like about “Samba Shito Sauce”


SBS20_1


SBS20_2


SBS20_3


SBS20_4


SBS20_5


1=Yes 2=No

SBS20_6


1=Yes 2=No

SBS20_7



SBS20_8


1=Yes 2=No

SBS20_9


1=Yes 2=No

SBS20_10

Is good for health

SBS20_11


1=Yes 2=No

SBS20_12


1=Yes 2=No

SBS20_13


1=Yes 2=No

SBS20_14


1=Yes 2=No

SBS20_15


SBS20_16


1=Yes 2=No

SBS20_17

Other (specify) 1=Yes 2=No (skip to SBS 21)

Text SBS20_17other


Multiple choice

SBS21 What do you not like about “Samba Shito Sauce”


SBS21_1


SBS21_2


SBS21_3


SBS21_4


1=Yes 2=No

SBS21_5


1=Yes 2=No

SBS21_6


1=Yes 2=No

SBS21_7


1=Yes 2=No

SBS21_8


1=Yes 2=No

SBS21_9


1=Yes 2=No

SBS21_10


1=Yes 2=No



SBS21_11

Other (specify) 1=Yes 2=No (skip to SBS 22)

Text SBS21_11other


Single choice

SBS22 Can you tell me any the health benefits of ‘Samba Shito Sauce’?


Text SBS23 Which health benefits does it have?

SBS23_1


1=Yes 2=No

SBS23_2


1=Yes 2=No

SBS23_3


SBS23_4


SBS23_5


1=Yes 2=No

SBS23_6


1=Yes 2=No

SBS23_7


1=Yes 2=No

SBS23_8


1=Yes 2=No

SBS23_9


1=Yes 2=No

SBS23_10


1=Yes 2=No

SBS23_11

Other (specify) 1=Yes 2=No (skip to STV1)

SBS23_11other


Specialty Product “Tom Vita” porridge (STV)

Single choice

STV1 Do you eat porridge at all?


Single choice

STV2 What is the main type of porridge consumed by you?

clarify with: the brand that you consume most

1= Tom Vita 2= Cerevita 3= Cerelac 4= Yumvita 5= Bledine 6= Maisoyforte 7= Zimbegu 8= Tom Brown (unbranded) 9= koko (unbranded) 10= hausa koko


(unbranded) 11= wheat porridge (unbranded) 12= oats porridge (unbranded) (Skip to STV3)_____________ 13= Other brand/type

Text STV2other


Single choice

STV3 Have you ever seen/ heard of „Tom Vita” porridge

Show the package of Tom Vita

1=Yes 2=No (skip to MFR1)

Multiple choice

STV4 Where did you see/ hear of „Tom Vita” porridge


STV4_1 TV 1=Yes 2=No

STV4_2 Radio 1=Yes 2=No

STV_3 Billboards 1=Yes 2=No

STV4_4 Posters/ Street Median

1=Yes 2=No

STV4_5 Church meeting 1=Yes 2=No

STV4_6 Health clinic/ health worker

1=Yes 2=No

STV4_7 Community leaders 1=Yes 2=No

STV4_8 Relative/ friends/ neighbor

1=Yes 2=No

STV4_9 Shopkeeper/ pharmacy

1=Yes 2=No

STV2_10


1=Yes 2=No

STV4_11


1=Yes 2=No

STV4_12


1=Yes 2=No

STV4_13

Other 1=Yes 2=No (skip to STV5)

Text STV4_13other


Single choice

STV5 Do you know where to buy „Tom Vita” porridge?


Multiple choice

STV5 Where can you buy the product?



STV5_1 Shop 1=Yes 2=No

STV5_2 Kiosk 1=Yes 2=No

STV5_3 Market/street stand

1=Yes 2=No

STV5_4 Moving street vendor

1=Yes 2=No

STV5_5 Pharmacy 1=Yes 2=No

STV5_6 Other (specify) 1=Yes 2=No (skip to STV6)

STV5_6other


Single choice

STV6 How far is the closest place you can buy the product?

1= Time 2= Distance (skip to STV6_2) 8= Don´t know (skip to STV7)

Number STV6_1 Time in minutes Enter time in minutes

(record, then skip to STV7)

Number STV6_2 Distance in meters Enter distance in meter

Single choice

STV7 Have you ever eaten „Tom Vita” porridge?

1=Yes (skip to STV 9) 2=No

Multiple choice

STV8 Why have you never eaten „Tom Vita” porridge before?


STV8_1 Dislikes taste 1=Yes 2=No

STV8_2 Dislikes packaging 1=Yes 2=No

STV8_3 Is too expensive 1=Yes 2=No

STV8_4 Is not easily available

1=Yes 2=No

STV8_5 Dislikes how it is promoted

1=Yes 2=No

STV8_6 Is not a good quality/ trustworthy product

1=Yes 2=No

STV8_7 Don’t eat porridge 1=Yes 2=No

STV8_8 Too much sugar/ too sweet

1=Yes 2=No

STV8_9 Do not see a need for „Tom Vita” porridge

1=Yes 2=No


STV8_10

Heard of bad experience of someone else

1=Yes 2=No

STV8_11

Advised not to use it

1=Yes 2=No

STV8_12


1=Yes 2=No

STV8_13


1=Yes 2=No

STV8_14


1=Yes 2=No

STV8_15


1=Yes 2=No

STV8_16


1=Yes 2=No

STV8_17


1=Yes 2=No

STV8_18

Other 1=Yes 2=No (skip to STV16)

Text STV8_18other


(enter, then skip to STV14)

Single choice

STV9 How often do you usually eat „Tom Vita” porridge?

1= several times a day 2= once a day 3= Every other day 4= once or twice a week 5= less than once a week 6= every second week 7=once a month 8= less than once a month

Single choice

STV10 Each time you eat „Tom Vita” porridge, how much do you usually eat?

1= quarter of a sachet 2= half sachet 3= two thirds of a sachet 4= one sachet 5= more than one sachet

Single choice

STV11 How long ago did you last eat „Tom Vita” porridge

1=today (skip to STV15) 2=day(s) ago 3=week(s) ago (skip to STV13) 4=month(s) ago (skip to STV14)

Integer STV12 Number of days (skip to STV15)

Integer STV 13 Number of weeks If greater than 8 weeks, record time as months

(skip to STV15)

Integer STV 14 Number of months


Single choice

STV_15 At what time of the day do you eat “Tom Vita” porridge

1= for breakfast 2= snack between breakfast and lunch 3= lunch 4= snack between lunch and dinner 5= dinner 6= after dinner (skip to STV16) 7= other

STV_15other


Single choice

STV16 Does anyone else in the household eat „Tom Vita” porridge

1=Yes 2=No (enter, then skip to MFR1 if 2=No in STV7 or to STV18 if 1=Yes in STV7) 3= don´t know (enter, then skip to MFR1 if 2=No in STV7 or to STV18 if 1=Yes in STV7)

Multiple choice

STV 17 Who else? Do not prompt. Probe “Anybody else?”

STV17_1


1=Yes 2=No

STV17_2


1=Yes 2=No

STV17_3

A child 1=Yes 2=No

Single choice

STV18 The last time you got „Tom Vita” porridge, how did you get them?

1= Bought/purchased them 2= Received them for free (Skip to STV18_2) 3= Never got „Tom Vita” porridge (skip to MFR1) 3= Don't remember (Skip to STV21)

Single choice

STV18_1


1= Supermarket 2= Shop 3= Kiosk 4= Market/ street stand 5= Moving street vendor 6= Pharmacy (skip to STV 19)___________ 88= other (specify)

STV18_1other


Skip to STV19

Single choice

STV18_2


1= Relatives/ friends/ neighbor 2= Health worker


3= NGO/ religious association (skip to STV21)___________ 88= other (specify)

Text STV18_2 other


Skip to STV21

Integer STV19 The last time you bought „Tom Vita” porridge, how many sachets did you buy?


Integer STV20 The last time you bought „Tom Vita” porridge, how much did you pay for one sachet?


Multiple choice

STV21 What do you like about „Tom Vita” porridge


STV21_1


STV21_2


STV21_3


STV21_4


STV21_5


1=Yes 2=No

STV21_6


1=Yes 2=No

STV21_7


STV21_8


1=Yes 2=No

STV21_9


1=Yes 2=No

STV21_10

Contains small amount of sugar/ not too sweet

1=Yes 2=No

STV21_11

Is good for health 1=Yes 2=No

STV21_12


1=Yes 2=No

STV21_13


1=Yes 2=No

STV21_14


1=Yes 2=No


STV21_15


1=Yes 2=No

STV21_16


STV21_17


1=Yes 2=No

STV21_18

Other (specify) 1=Yes 2=No (skip to STV 22)

Text STV21_18other


Multiple choice

STV22 What do you not like about „Tom Vita” porridge


STV22_1


STV22_2


STV22_3


STV22_4


1=Yes 2=No

STV22_5


1=Yes 2=No

STV22_6


1=Yes 2=No

STV22_7


1=Yes 2=No

STV22_8


1=Yes 2=No

STV22_9

Contains too much sugar/ too sweet

1=Yes 2=No

STV22_10


1=Yes 2=No

STV22_11


1=Yes 2=No

STV22_12


1=Yes 2=No

STV22_13

Other (specify) 1=Yes 2=No (skip to STV 23)

Text STV22_13other


Single choice

STV23 Can you tell me any the health benefits of “Tom Vita” porridge”?



Text STV24 Which health benefits does it have?

STV24_1


1=Yes 2=No

STV24_2


1=Yes 2=No

STV24_3

Contains small amount of sugar

1=Yes 2=No

STV24_4


STV24_5


STV24_6


1=Yes 2=No

STV24_7


1=Yes 2=No

STV24_8


1=Yes 2=No

STV24_9


1=Yes 2=No

STV24_10


1=Yes 2=No

STV24_11


1=Yes 2=No

STV24_12

Other (specify) 1=Yes 2=No (skip to MFR 1)

STV24_12other


MUAC and final result (MFR)

Integer MFR1 MUAC Take the MUAC of the woman on her left arm Record MUAC in millimeter; if arm too large, record 777

Single Choice

MFR2 Questionnaire successfully completed

1=Yes (end of questionnaire) 2=No

Single Choice

MFR3 Reasons for not completing the questionnaire

1= woman not at home (in this case questionnaire must remain active, so that it might be filled in at second visit) 2= woman refused interview 3= other (in this case questionnaire must remain


active, so that it might be filled in at second visit)

Text MFR4 Type the “other” option

Geopoint

MFR5 Record your location:

You need to be outside to record the location. If the accuracy is less or equal to 12 meter, you can save the location. Do not forget to SWITCH ON YOUR GPS and switch off afterwards.

Date MFR7 Date of interview Autofilled

Time MFR8 Start time Autofilled

Time MFR9 End time Autofilled

Date post:	21-Dec-2021
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