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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.
ANF4W Endpoint Survey, Ghana, 2017 ‐8‐
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.
ANF4W Endpoint Survey, Ghana, 2017 ‐9‐
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
ANF4W Endpoint Survey, Ghana, 2017 ‐10‐
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
ANF4W Endpoint Survey, Ghana, 2017 ‐11‐
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.
ANF4W Endpoint Survey, Ghana, 2017 ‐12‐
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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ANF4W Endpoint Survey, Ghana, 2017 ‐14‐
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
ANF4W Endpoint Survey, Ghana, 2017 ‐15‐
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
ANF4W Endpoint Survey, Ghana, 2017 ‐16‐
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.
ANF4W Endpoint Survey, Ghana, 2017 ‐17‐
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
ANF4W Endpoint Survey, Ghana, 2017 ‐18‐
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.
A
3
F
b
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In
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ANF4W Endpoint Su
3.1 Access to m
igure 2 gives the
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oung women of r
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More than half of
ither radio or TV.
PW 7%; YWRA 3%
igure 2 Women’s
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tratifications late
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nformation broke
urvey, Ghana, 2017
mass media
different mass m
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reproductive age.
only 8% reported
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s access to mass m
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r on, e.g. by MPI
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hana 2017
ni and Tamale. Pl
(and this will al
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reasons, it may
‐ 2
milar to baseline f
ore popular amon
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lease note that w
so apply for oth
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be useful to hav
21
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A
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ANF4W Endpoint Su
Television and rad
presents access to
of poor women h
ewspaper, which
More detailed info
igure 3 Women’s
igure 4 Women’s
urvey, Ghana, 2017
dio remain highly
o mass media by p
ad no access to a
is a medium not
ormation stratified
s access to mass m
s access to mass m
predominant in
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channel compare
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e, poor women ha
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2017
portant medium
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vs. 2.6%). The diff
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3, respectively.
in Sunyani than i
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‐ 2
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a higher proportio
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22
e 4
on
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ANF4W E
Figure 5
assessm
and radi
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in Tama
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number
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Figure 5
reprodu
Figure 6
2017
Endpoint Surv
provides inf
ent, televisio
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r week. The
nt difference
ocial media a
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showed that
le, but less f
compared to
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rticipants ha
edia use bet
Frequency o
ctive age (YW
Frequency o
ey, Ghana, 20
formation ab
on is the mo
sed frequent
e differences
es can be se
at least once
al media at
t in Sunyani
frequently. In
o Sunyani (F
pondents, ha
ad slightly le
tween the tw
of women’s
WRA), Ghan
of women’s
017
bout the fre
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tly, with mor
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een for soci
e a week, com
all, compare
the same pr
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igure 6). La
ave been fou
ss access to
wo groups (Fi
mass media
a 2017
mass media
equency of a
essed mass
re than half
osure of PW
al media/ in
mpared to a
ed to about
roportion of
n Tamale sig
rge differen
und between
mass media
igure 7).
a access, by p
a access, by S
ccessing ma
media sourc
of all wome
W and YWRA
nternet and
bout 20% fo
50% of YWR
respondent
gnificantly fe
nces, albeit
poor and no
a, with large
pregnant wo
Sunyani and
ss media. Si
e, followed
n accessing
A to radio an
newspaper.
r PW and alm
RA. Stratifica
s watch TV a
wer people
not significa
on‐ poor resp
est difference
omen (PW) a
Tamale mun
milar to the
by radio. No
TV and radio
nd TV are s
. Over 40%
most three q
ation by geo
and listen to
have access
ant due to t
pondents. In
es in newsp
and young w
nicipalities,
‐ 23
baseline
otably, TV
o at least
mall, but
of YWRA
quarter of
graphical
o radio as
to social
the small
n general,
aper and
women of
Ghana
ANF4W E
Figure 7
2017
The serie
foods/nu
advice fr
they hav
see that
for YWR
source o
posters i
Stratifica
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more fre
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compare
significa
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source (F
poorer w
Endpoint Surv
Frequency o
es of the nex
utritional ad
rom the com
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mothers/m
A. Significan
of nutritiona
in the comm
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source of inf
equent sourc
vey results s
ource of info
% stating co
ed to about
nt was that
nal informati
Figure 10). A
women, whil
ey, Ghana, 20
of women’s
xt figures pro
dvice. Simila
mmunity hea
tact with he
others‐in‐law
tly more YW
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munity.
graphical reg
formation co
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howed some
ormation on
ommunity h
t 20% for t
t women fro
ion. In contra
Also, mothers
e about 15%
017
mass media
ovides an ov
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lth worker (
ealth staff (Fi
w are not a m
WRA than PW
ly few respo
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ompared to
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n healthy foo
ealth officer
the non‐poo
om the poo
ast, respond
s/mothers‐in
% of wealthie
a access, by p
erview of so
ne, pregnant
62.1% vs. 11
igure 8). On
more import
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ondents get
that in Suny
Tamale. On
male (Figure
s between t
od for poor
r, nurse, mi
or women.
or dwellings
dents from w
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er responden
poor and no
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1.3%). It is li
the other h
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and social m
their inform
yani almost t
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9).
he poor and
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more often
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negligible sou
nts mentione
n‐poor strat
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et significan
kely that due
and, it is som
nal advisor f
media/ intern
mation about
wice as man
and radio sh
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markable di
n cited radio
ellings more
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ed them as a
tification, Gh
eceived abou
ntly more n
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mewhat surp
for PW than
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ny women st
hows and fri
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ifference, a
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often cited T
ritional advic
source of ad
‐ 24
hana
ut healthy
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regnancy,
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they are
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ated that
iends are
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with more
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ANF4W E
Figure 8
women
Figure 9
Ghana 2
Endpoint Surv
Source of in
of reproduc
Source of in
2017.
ey, Ghana, 20
nformation f
tive age (YW
nformation f
017
for choosing
WRA), Ghana
for choosing
healthy foo
a 2017
healthy foo
od, by pregna
od, by Sunya
ant women (
ni and Tama
(PW) and yo
ale municipa
‐ 25
oung
alities,
ANF4W E
Figure 10
Ghana 2
3.2 O
As show
*Only the
suppleme
Figure 1
results s
by telev
Obaasim
campaig
almost 6
(n= 43) o
59% pre
were rel
municipa
bought
Obaasim
Obaasim
almost a
mainly b
by pregn
Obaasim
living in
wealthie
with the
Endpoint Surv
0 Source of
2017.
baasima se
wn in
e 5 most cited
entary tables
11 almost 70
showed that
vision. In Ta
ma seal state
gns. Although
60% of those
of the surve
efer those pr
ated to the
ality showed
Obaasima p
ma products
ma products
all women (
because of th
nancy status
ma, many of
poor hous
er household
e Obaasima s
ey, Ghana, 20
information
eal recognit
d response op
0% of respon
the most su
male, but n
ed that they
h awareness
e who have
yed women
roducts over
health benef
d significant
products did
in Sunyani. I
over other
n=21) who
he good pro
s showed th
them at the
seholds had
ds (74.9%) a
seal (see sup
017
for choosin
tion
ptions shown
ndents (n= 3
uccessful ma
not in Sunya
y had seen
was high, o
seen or hea
had ever bo
r products w
fits or good
t differences
d not differ,
nterestingly,
products, w
had ever bo
duct quality
hat significan
health clinic
ever heard
nd none of
plementary t
g healthy fo
for better vis
322) had eve
rketing tools
ani, about 8
the Obaasim
nly a few of
rd of the se
ought produ
without the s
quality of th
s. Although
, considerab
, only 39% o
with the ma
ought (n=23
and health
ntly more p
c/ from the
d of Obaasi
the women
tables 5 and
ood, by poor
sibility, all cite
er heard of
s have been
8% of respo
ma seal on
the women
al did not kn
cts carrying
seal. Most o
he products c
the propor
bly more wo
of the consum
in reason be
) the produc
benefits of O
regnant wo
health office
ma (30.4%)
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
rtion of wom
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
ing some pr
meaning of O
aning. Less t
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
er visibility, all cited
nicipality, Ghana
d responses are pre
2017.
_
esented in supplemmentary tables
___________‐ 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
er visibility, all cited
nicipality, Ghana 2
d responses are pre
2017.
_
esented in supplemmentary tables
___________‐ 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’
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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
er visibility, all cited
na 2017
_________
d responses are pre
______________
esented in supplemmentary tables
____
___‐ 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
ANF4W Endpoint Survey, Ghana, 2017 ______________________
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.
ANF4W Endpoint Survey, Ghana, 2017 ______________________
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.
ANF4W Endpoint Survey, Ghana, 2017 ______________________
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
ANF4W Endpoint Survey, Ghana, 2017 ______________________
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.
ANF4W Endpoint Survey, Ghana, 2017 ______________________
6 REFERENCES
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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.
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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.
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19981.
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and Scope of the Multidimensional Poverty Index. World Dev 2014; 59: 251‐74.
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http://www.fao.org/3/a‐i5486e.pdf: FAO, FHI 306; 2016.
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and Health Survey 2008: GSS, GHS, and ICF Macro; 2009.
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Health Survey 2014. Accra, Ghana: GSS, GHS, ICF; 2015.
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obesity and stall underweight trends among Ghanaian women. BMC public health
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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
At least once a week 148 51.6% (43.5, 59.6) 157 51.1% (43.2, 59.0)
Less than once a week 54 21.0% (14.4, 29.5) 64 24.6% (18.3, 32.2)
Not at all 85 27.4% (21.1, 34.8) 73 24.3% (17.6, 32.4)
Television 0.178
At least once a week 232 81.4% (73.4, 87.5) 239 77.7% (69.5, 84.1)
Less than once a week 18 7.1% (3.9, 12.7) 30 12.1% (8.5, 16.9)
Not at all 37 11.4% (6.6, 19.2) 25 10.2% (6.4, 16.1)
Social media <0.001
At least once a week 58 20.0% (13.1, 29.2) 114 44.0% (33.6, 54.9)
Less than once a week 18 7.6% (4.9, 11.5) 12 5.0% (2.3, 10.7)
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
ANF4W Endpoint Survey, Ghana, 2017 45 ‐
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.
ANF4W Endpoint Survey, Ghana, 2017 46 ‐
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 Television 77 23.5% (16.4, 32.7) 141 35.6% (29.9, 41.9)
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)
Radio, Television, and Internet 62 28.4% (20.8, 37.5) 62 28.4% (20.8, 37.5)
All 22 13.8% (7.4, 24.4) 22 13.8% (7.4, 24.4)
Frequency of access
Newspaper 0.082
At least once a week 17 8.8% (4.8, 15.8) 29 12.4% (7.5, 19.9)
Less than once a week 19 12.8% (8.2, 19.5) 13 5.6% (3.7, 8.3)
Not at all 200 78.4% (71.9, 83.7) 303 82.0% (74.1, 87.9)
Radio 0.075
At least once a week 110 46.9% (37.0, 57.0) 195 58.0% (49.6, 66.0)
Less than once a week 66 29.2% (21.7, 38.0) 52 16.4% (11.0, 23.8)
Not at all 60 23.9% (15.3, 35.3) 98 25.6% (19.7, 32.5)
Television <0.05
At least once a week 185 73.2% (63.6, 81.0) 286 85.6% (79.0, 90.4)
Less than once a week 30 16.0% (12.3, 20.6) 18 4.8% (2.2, 10.2)
Not at all 21 10.8% (6.2, 18.2) 41 9.7% (5.2, 17.1)
Social media <0.05
At least once a week 84 49.2% (36.2, 62.3) 88 30.8% (24.4, 38.2)
Less than once a week 18 6.1% (2.5, 14.3) 12 3.7% (1.7, 7.7)
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
ANF4W Endpoint Survey, Ghana, 2017 47 ‐
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
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.
ANF4W Endpoint Survey, Ghana, 2017 48 ‐
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 Television 9 45.0% (16.6, 77.0) 154 27.7% (21.1, 35.6)
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)
Radio, Television, and Internet 4 29.7% (8.1, 67.0) 90 25.8% (19.9, 32.9)
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
At least once a week 12 43.0% (16.0, 74.9) 214 51.0% (41.8, 60.2)
Less than once a week 4 34.1% (9.5, 71.7) 94 26.6% (20.2, 34.1)
Not at all 8 22.9% (6.7, 55.4) 117 22.4% (15.9, 30.6)
Television 0.707
At least once a week 14 68.6% (35.8, 89.5) 346 78.5% (70.5, 84.7)
Less than once a week 2 16.5% (3.5, 51.5) 36 12.3% (8.0, 18.4)
Not at all 8 14.9% (3.5, 45.7) 43 9.2% (6.3, 13.2)
Social media 0.377
At least once a week 3 27.3% (6.6, 66.6) 130 43.5% (34.2, 53.2)
Less than once a week 1 2.4% (0.3, 15.9) 26 6.3% (2.9, 13.2)
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
ANF4W Endpoint Survey, Ghana, 2017 49 ‐
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
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.
ANF4W Endpoint Survey, Ghana, 2017 50 ‐
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)
Is good for health 14 27.0 (9.5; 56.5)
Is good for young women/ pregnant women 4 1.7 (0.4; 6.3)
Gives strength 11 32.4 (15.0; 56.5)
Keeps energy level high 4 5.1 (1.0; 23.2)
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)
ANF4W Endpoint Survey, Ghana, 2017 51 ‐
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.
ANF4W Endpoint Survey, Ghana, 2017 52 ‐
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
What does the Obaasima seal mean
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
products with the Obaasima seal
19 58.6 (25.9; 85.2) 13 57.6 (35.6; 77.0) 0.95
Reasons for preferring products
with Obaasima seal
Is good quality/trustworthy
product
8 33.0 (13.7; 60.5) 7 55.9 (21.5; 85.5) 0.26
Contains vitamin and minerals 5 21.1 (6.6; 50.3) 6 32.8 (12.3; 63.1) 0.44
Is good for health 6 25.3 (7.4; 58.9) 8 53.6 (20.6; 83.7) 0.19
Is good for young women/ 0 ‐‐ 4 26.8 (7.1; 63.8) 0.89
ANF4W Endpoint Survey, Ghana, 2017 53 ‐
Variable
Young women of reproductive
age
Pregnant women P‐value
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
Keeps energy level high 1 4.3 (0.5; 28.9) 3 18.7 (6.6; 43.0) 0.18
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
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.
ANF4W Endpoint Survey, Ghana, 2017 54 ‐
Supplementary table 6 Obaasima seal recognition, Sunyani and Tamale, Ghana 2017
Variable Sunyani Tamale P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)3
Proportion of women ever
seen/heard of Obaasima seal
173 80.5 (67.9; 89.0) 149 50.0 (38.6; 61.3) <0.0001
Where women have seen/heard of
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
Posters/ street median 37 26.1 (17.5; 37.1) 24 21.9 (12.2; 36.2) 0.57
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
Relatives/ friends/ neighbours 6 2.4 (0.6; 8.3) 5 3.1 (0.9; 10.0) 0.73
Shopkeeper/pharmacy 4 3.0 (0.9; 9.6) 5 2.7 (0.8; 9.0) 0.91
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
Movie event/ roving cinema 2 0.2 (0.0; 1.2) 5 1.4 (0.3; 6.2) 0.06
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
What does the Obaasima seal mean
Is good quality/trustworthy
product
16 7.6 (4.2; 13.3) 23 17.9 (9.5; 31.3) <0.05
Contains vitamin and minerals 22 10.4 (6.1; 17.0) 15 15.4 (7.8; 28.2) 0.32
Is good for health 32 17.5 (8.8; 32.0) 29 18.7 (10.3; 31.5) 0.88
Is good for young women/
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
Keeps energy level high 5 4.0 (1.5; 10.7) 14 10.8 (4.0; 26.1) 0.13
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
Proportion of women ever bought
products with the Obaasima seal
20 12.7 (8.0; 19.7) 23 16.1 (8.2; 29.2) 0.836
Proportion of women preferring
products with the Obaasima seal
11 39.0 (13.5; 72.4) 21 98.9 (95.1; 99.8) 0.54
Reasons for preferring products
with Obaasima seal
Is good quality/trustworthy
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
ANF4W Endpoint Survey, Ghana, 2017 55 ‐
Variable Sunyani Tamale P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)3
Is good for young women/
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
Keeps energy level high 2 1.9 (0.4; 9.0) 2 7.8 (0.9; 43.0) 0.24
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
Helps to become pregnant 0 ‐‐ 0 ‐‐ ‐‐
Protects unborn baby 0 ‐‐ 0 ‐‐ ‐‐
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
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.
ANF4W Endpoint Survey, Ghana, 2017 56 ‐
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)
Proportion of women ever
seen/heard of Obaasima seal
5 30.4 (8.5; 67.2) 263 74.9 (64.1; 83.4) <0.01
Where women have seen/heard of
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
Movie event/ roving cinema 1 2.2 (0.2; 19.7) 4 0.3 (0.1; 1.0) 0.07
Don´t know 0 ‐‐ 8 4.6 (1.8; 11.5) 0.76
Other 0 ‐‐ 8 5.0 (2.3; 10.3) 0.71
What does the Obaasima seal mean
Is good quality/trustworthy
product
28 9.9 (6.2; 15.3) 0.62
Contains vitamin and minerals 24 8.8 (5.6; 13.5) 0.63
Is good for health 2 4.6 (0.7; 25.3) 43 15.6 (9.7; 24.2) 0.16
Is good for young women/
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
Proportion of women ever bought
products with the Obaasima seal
0 ‐‐ 36 15.0 (9.9; 22.1) 0.54
Proportion of women preferring
products with the Obaasima seal
0 ‐‐ 25 51.6 (22.4; 79.7) ‐‐
Reasons for preferring products
with Obaasima seal
Is good quality/trustworthy
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) ‐‐
ANF4W Endpoint Survey, Ghana, 2017 57 ‐
Variable Poor Non‐ poor P‐value
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) ‐‐
Helps to become pregnant 0 ‐‐ 0 ‐‐ ‐‐
Protects unborn baby 0 ‐‐ 0 ‐‐ ‐‐
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) ‐‐
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.
ANF4W Endpoint Survey, Ghana, 2017 58 ‐
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;
ANF4W Endpoint Survey, Ghana, 2017 59 ‐
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
data; 2Percentages and medians are weighted for inaccurate EA size used during the first stage of sampling;
ANF4W Endpoint Survey, Ghana, 2017 60 ‐
Supplementary table 10 Information about biscuit brands, stratified by MPI score, Ghana 2017
Variable
Poor Non‐ poor
N1 %2 N1 %2
Main brand of biscuit consumed, %
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
data; 2Percentages and medians are weighted for inaccurate EA size used during the first stage of sampling;
ANF4W Endpoint Survey, Ghana, 2017 61 ‐
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)
Posters/ street median 5 4.6 (1.5; 13.0)
Religious/ social gatherings
Health clinic/health worker 15 6.8 (2.5; 17.0)
Community leaders
Relatives/ friends/ neighbours 9 11.0 (5.1; 22.0)
Shopkeeper/pharmacy 33 31.7 (18.7; 48.3)
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)
Market/street stand 16 42.1 (24.8; 61.6)
Moving street vendor 3 6.3 (1.5; 22.7)
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)
ANF4W Endpoint Survey, Ghana, 2017 62 ‐
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)
Market/street stand 5 35.2 (11.9; 68.7)
Moving street vendor 4 11.7 (3.5; 32.9)
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)
Is good for health 6 11.1 (3.1; 32.9)
Is good for young women/ pregnant women 4 6.4 (1.0; 31.6)
Keeps energy level high 5 6.7 (1.1; 31.1)
Product gives strength 5 15.4 (5.0; 38.5)
Helps to become pregnant 2 5.9 (0.8; 33.1)
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)
ANF4W Endpoint Survey, Ghana, 2017 63 ‐
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
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.
ANF4W Endpoint Survey, Ghana, 2017 64 ‐
Supplementary table 12 Information about consumer behaviour with regard to Lola biscuits,
pregnant and young women of reproductive age, Ghana 2017
Variable
Young women of reproductive
age
Pregnant women P‐value
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
Posters/ street median 3 4.7 (1.4; 14.7) 2 3.7 (0.7; 16.8) 0.80
Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐‐
Health clinic/health worker 3 4.4 (0.9; 18.9) 12 32.0 (16.5; 52.8) <0.005
Community leaders 0 ‐‐ 0 ‐‐ ‐‐
Relatives/ friends/ neighbours 7 11.8 (5.3; 24.2) 2 2.7 (0.6; 11.7) <0.05
Shopkeeper/pharmacy 16 31.9 (17.6; 50.7) 17 29.6 (17.6; 45.1) 0.85
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
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.
ANF4W Endpoint Survey, Ghana, 2017 65 ‐
Supplementary table 13 Information about consumer behaviour with regard to Lola biscuits,
Sunyani and Tamale, Ghana 2017
Variable Sunyani Tamale P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Proportion of women consuming
biscuits
203 93.5 (87.3; 96.8) 293 88.4 (79.5; 93.7) 0.2
Awareness ‐ Proportion of women
ever seen/heard of Lola Milk
biscuits
45 16.4 (10.7; 24.2) 56 18.2 (13.4; 24.1) 0.68
Awareness ‐ Where women have
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
Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐‐
Health clinic/health worker 11 6.7 (2.2; 18.3) 4 6.9 (1.1; 33.2) 0.98
Community leaders 0 ‐‐ 0 ‐‐ ‐‐
Relatives/ friends/ neighbours 1 6.1 (1.1; 26.8) 8 18.3 (7.9; 36.6) 0.19
Shopkeeper/pharmacy 16 30.1 (12.1; 57.4) 17 34.0 (23.6; 46.1) 0.77
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
Access ‐ Proportion of women know
where to buy Lola Milk biscuits
22 60.7 (26.3; 87.1) 35 66.9 (51.9; 79.1) 0.74
Access ‐ Where women know to buy
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
Moving street vendor 1 5.6 (0.7; 34.8) 2 7.3 (1.2; 34.6) 0.85
Other 0 ‐‐ 1 0.4 (0.0; 2.9) 0.30
Access ‐ Distance to closest place in
meters
20 450 (150; 750) 35 500 (300; 1250) 0.74
Consumption ‐ Proportion of
women who have ever eaten Lola
Milk biscuits
16 41.8 (18.4; 69.6) 26 47.3 (27.5; 68.0) 0.76
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.
ANF4W Endpoint Survey, Ghana, 2017 66 ‐
Supplementary table 14 Information about consumer behaviour with regard to Lola
biscuits, stratified by MPI score, Ghana 2017
Variable Poor Non‐ poor P‐value
between
groups N1
Median,
%2 (95% CI)3 N Median, %2 (95% CI)
Proportion of women consuming
biscuits
14 59.2 (25.8; 85.8) 365 91.8 (85.9; 95.4)
Awareness ‐ Proportion of women
ever seen/heard of Lola Milk
biscuits
2 9.1 (1.3; 43.7) 77 17.5 (11.9; 25.1)
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.
ANF4W Endpoint Survey, Ghana, 2017 67 ‐
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)
Posters/ street median 2 2.5 (0.3; 15.6)
Religious/ social gatherings 0 ‐‐
Health clinic/health worker 0 ‐‐
Community leaders 0 ‐‐
Relatives/ friends/ neighbours 9 6.8 (1.7; 23.4)
Shopkeeper/pharmacy 16 23.4 (12.3; 39.9)
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)
Market/street stand 10 18.9 (5.3; 49.4)
Moving street vendor 1 0.3 (0.0; 2.5)
Other 3 2.3 (0.6; 8.8)
Access ‐ Distance to closest place in meters 31 750 (500; 1000)
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 or twice a week 2 1.7 (0.3; 8.0)
Less than once a week 1 0.8 (0.1; 6.4)
Every second week 1 1.6 (0.2; 12.3)
Once a month 3 2.9 (0.7; 10.8)
Less than once a month 13 91.4 (75.7; 97.3)
Consumption ‐ Quantity consumed
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)
ANF4W Endpoint Survey, Ghana, 2017 68 ‐
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)
Another female adult or teenager 5 65.6 (16.7; 94.8)
A male adult or teenager 7 73.8 (22.5; 96.5)
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)
Received for free 14 59.9 (22.3; 88.6)
Purchase ‐ Place bought
Supermarket 1 43.0 (5.1; 91.4)
Shop 3 52.2 (7.6; 93.6)
Market/street stand 1 2.1 (0.2; 19.1)
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 a good quality /trustworthy product 2 1.8 (0.4; 8.0)
IS locally produced 0 ‐‐
Carries the Obaasima seal 0 ‐‐
Contains minerals and vitamins 1 1.0 (0.1; 7.6)
Is good for health 1 0.8 (0.1; 6.4)
Is good for young women/ pregnant women 2 1.8 (0.4; 8.0)
Keeps energy level high 2 2.4 (0.5; 10.7)
Product gives strength 2 2.4 (0.5; 10.7)
Helps to become pregnant 1 1.0 (0.1; 7.6)
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 ‐‐
Dislikes packaging 0 ‐‐
Is too expensive 0 ‐‐
Dislikes how it is promoted 0 ‐‐
Is not easily available 3 12.4 (2.6; 43.0)
Carries the Obaasima seal 0 ‐‐
Is not a good quality/ trustworthy product 0 ‐‐
Contains added artificial ingredients such as vitamins and minerals 0 ‐‐
Is not good for health 0 ‐‐
ANF4W Endpoint Survey, Ghana, 2017 69 ‐
Variable All women
N1 Median, %2 (95% CI)3
Is not good for young women/ pregnant women 0 ‐‐
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
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.
ANF4W Endpoint Survey, Ghana, 2017 70 ‐
Supplementary table 16 Information about consumer behaviour with regard to Samba Shito Sauce,
pregnant and young women of reproductive age, Ghana 2017
Variable
Young women of reproductive
age
Pregnant women P‐value
between
groups
N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Proportion of women consuming
Shito sauce
222 79.9 (72.1; 86.0) 207 73.2 (63.3; 81.3) 0.18
Main brand of Shito consumed, %
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)
Awareness ‐ Proportion of women
ever seen/heard of Samba Shito
Sauce
28 13.4 (9.2; 19.2) 42 18.2 (13.0; 24.8) 0.06
Awareness ‐ Where women have
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
Posters/ street median 1 2.6 (0.3; 18.9) 1 1.3 (0.1; 10.5) 0.64
Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐
Health clinic/health worker 4 11.9 (3.7; 32.3) 13 40.9 (22.4; 62.5) <0.05
Community leaders 0 ‐‐ 0 ‐‐ ‐
Relatives/ friends/ neighbours 2 6.1 (1.1; 27.4) 7 12.7 (4.2; 32.5) 0.43
Shopkeeper/pharmacy 8 23.9 (11.6; 42.8) 8 19.4 (7.0; 43.6) 0.74
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
Access ‐ Proportion of women know
where to buy Samba Shito Sauce
14 47.8 (26.7; 69.8) 17 38.1 (21.4; 58.3) 0.55
Access ‐ Where women know to buy
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
Market/street stand 2 16.5 (3.4; 52.7) 8 46.0 (18.3; 76.5) 0.22
Moving street vendor 0 ‐‐ 1 4.2 (0.6; 25.4) 0.31
Other 0 ‐‐ 3 29.4 (7.5; 68.1) 0.11
Access ‐ Distance to closest place in
meters
14 625 (200; 2250) 17 750 (500; 1250) 0.9
Consumption ‐ Proportion of
women who have ever eaten Samba
Shito Sauce
5 13.6 (4.0; 37.2) 16 34.5 (22.4; 48.9) 0.11
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;
ANF4W Endpoint Survey, Ghana, 2017 71 ‐
3 CI=confidence interval, calculated taking into account the complex sampling design.
ANF4W Endpoint Survey, Ghana, 2017 72 ‐
Supplementary table 17 Information about consumer behaviour with regard to Samba Shito Sauce,
Sunyani and Tamale, Ghana 2017
Variable Sunyani Tamale P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Proportion of women consuming
Shito Sauce
194 84.4 (76.7; 89.9) 235 71.3 (60.3; 80.3) <0.03
Main brand of biscuit consumed, %
Samba Shito Sauce 0 ‐‐ 0 ‐‐ 0.52
Homemade 104 56.6 (47.0; 65.8) 162 64.8 (48.8; 78.0)
Unbranded Shito from chop bar/
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 ‐‐
Awareness ‐ Proportion of women
ever seen/heard of Samba Shito
Sauce
41 17.4 (12.7; 23.5) 29 7.8 (4.4; 13.4) <0.01
Awareness ‐ Where women have
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
Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐‐
Health clinic/health worker 14 14.4 (5.5; 32.8) 3 15.3 (2.1; 60.1) 0.95
Community leaders 0 ‐‐ 0 ‐‐ ‐‐
Relatives/ friends/ neighbours 4 5.8 (0.9; 30.3) 5 10.3 (2.5; 34.1) 0.61
Shopkeeper/pharmacy 10 20.2 (8.6; 40.4) 6 35.0 (16.5; 59.5) 0.28
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
Access ‐ Proportion of women know
where to buy Samba Shito Sauce
18 44.2 (23.5; 67.1) 13 56.3 (23.2; 84.7) 0.57
Access ‐ Where women know to buy
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
Market/street stand 7 24.2 (5.8; 62.1) 3 3.8 (0.6; 19.8) 0.05
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
Access ‐ Distance to closest place in
meters
18 500 (200; 875) 13 1500 (500; 2250) 0.06
Consumption ‐ Proportion of
women who have ever eaten Samba
Shito Sauce
12 14.5 (4.4; 38.5) 9 19.6 (4.1; 58.4) 0.75
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.
ANF4W Endpoint Survey, Ghana, 2017 73 ‐
Supplementary table 18 Information about consumer behaviour with regard to Samba Shito,
stratified by MPI score, Ghana 2017
Variable Poor Non‐ poor P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Proportion of women consuming
Shito
14 74.4 (43.2; 91.7) 333 83.6 (76.3; 89.0) 0.38
Main brand of Shito consumed, %
Samba Shito Sauce 0 ‐‐ 0 ‐‐ 0.27
Homemade 8 37.5 (10.5; 75.4) 208 60.8 (52.1; 68.9)
Unbranded Shito from chop bar/
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)
Awareness ‐ Proportion of women
ever seen/heard of Samba Shito
Sauce
1 1.2 (0.1; 8.9) 58 15.7 (10.9; 22.2) <0.005
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.
ANF4W Endpoint Survey, Ghana, 2017 74 ‐
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)
Posters/ street median 9 4.4 (1.6; 11.4)
Religious/ social gatherings 0 ‐‐
Health clinic/health worker 22 4.2 (1.7; 10.4)
Community leaders 0 ‐‐
Relatives/ friends/ neighbours 19 13.8 (7.9; 22.9)
Shopkeeper/pharmacy 26 27.2 (10.4; 54.7)
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)
Market/street stand 17 24.3 (8.8; 51.6)
Moving street vendor 3 2.8 (0.5; 12.9)
Other 3 1.0 (0.2; 4.1)
Access ‐ Distance to closest place in meters 53 500 (250; 750)
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)
ANF4W Endpoint Survey, Ghana, 2017 75 ‐
Variable All women
N1 Median, %2 (95% CI)3
Once a day 1 4.5 (0.5; 29.0)
Once or twice a week 3 5.4 (0.8; 29.0)
Less than once a week 3 22.7 (7.0; 53.4)
Every second week 2 8.8 (1.2; 44.0)
Once a month 1 8.5 (1.0; 47.3)
Less than once a month 13 49.5 (33.6; 65.5)
Consumption ‐ Quantity consumed
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)
Another female adult or teenager 7 19.5 (4.7; 54.4)
A male adult or teenager 4 27.8 (10.5; 55.7)
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)
Received for free 7 10.4 (2.9; 30.7)
Purchase ‐ Place bought
Supermarket 1 1.4 (0.2; 11.4)
Shop 5 60.9 (21.4; 90.0)
Kiosk 1 0.6 (0.1; 4.9)
Market/street stand 5 24.7 (5.8; 63.3)
Moving street vendor 3 11.7 (2.2; 44.3)
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)
ANF4W Endpoint Survey, Ghana, 2017 76 ‐
Variable All women
N1 Median, %2 (95% CI)3
How it is promoted 1 4.6 (0.5; 29.4)
Is a good quality /trustworthy product 3 9.6 (1.9; 37.3)
IS locally produced 0 ‐‐
Carries the Obaasima seal 1 0.4 (0.0; 3.7)
Contains minerals and vitamins 2 10.2 (1.6; 44.1)
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 ‐‐
Product gives strength 1 8.1 (0.9; 45.9)
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)
Dislikes packaging 0 ‐‐
Is too expensive 0 ‐‐
Dislikes how it is promoted 0 ‐‐
Is not easily available 1 4.6 (0.5; 29.4)
Carries the Obaasima seal 0 ‐‐
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 ‐‐
Is not good for health 0 ‐‐
Is not good for young women/ pregnant women 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
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.
ANF4W Endpoint Survey, Ghana, 2017 77 ‐
Supplementary table 20 Information about consumer behaviour with regard to Tom Vita porridge,
pregnant and young women of reproductive age, Ghana 2017
Variable
Young women of reproductive
age
Pregnant women P‐value
between
groups
N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Proportion of women consuming
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)
Awareness ‐ Proportion of women
ever seen/heard of Tom Vita
porridge
75 33.1 (24.3; 43.1) 58 28.4 (18.9; 40.2) 0.41
Awareness ‐ Where women have
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
Posters/ street median 6 4.6 (1.6; 12.5) 3 2.7 (0.7; 9.4) 0.42
Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐‐
Health clinic/health worker 3 2.2 (0.4; 10.6) 19 34.6 (23.9; 47.2) <0.0001
Community leaders 0 ‐‐ 0 ‐‐ ‐‐
Relatives/ friends/ neighbours 11 13.7 (7.4; 23.8) 8 15.0 (8.1; 26.1) 0.80
Shopkeeper/pharmacy 18 28.1 (10.1; 57.7) 8 14.7 (6.4; 30.4) 0.37
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
Access ‐ Proportion of women know
where to buy Tom Vita porridge
32 48.1 (26.2; 70.8) 21 31.5 (22.5; 42.3) 0.28
Access ‐ Where women know to buy
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
Market/street stand 7 23.0 (7.5; 52.3) 10 52.0 (37.3; 66.4) 0.05
Moving street vendor 2 2.8 (0.5; 14.4) 1 2.3 (0.3; 16.7) 0.88
Other 0 ‐‐ 3 23.4 (9.7; 46.4) <0.05
ANF4W Endpoint Survey, Ghana, 2017 78 ‐
Variable
Young women of reproductive
age
Pregnant women P‐value
between
groups
N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Access ‐ Distance to closest place in
meters
32 250 (250; 750) 21 500 (500; 1000) 0.50
Consumption ‐ Proportion of
women who have ever eaten Tom
Vita porridge
10 11.4 (5.0; 24.1) 14 27.1 (20.4; 35.1) <0.05
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.
ANF4W Endpoint Survey, Ghana, 2017 79 ‐
Supplementary table 21 Information about consumer behaviour with regard to Tom Vita porridge,
Sunyani and Tamale, Ghana 2017
Variable Sunyani Tamale P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Proportion of women consuming
porridge
224 96.2 (91.6; 98.4) 322 95.6 (90.1; 98.1) 0.80
Main brand of porridge consumed,
%
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)
Tom Brown (unbranded) 14 8.2 (4.5; 14.3) 10 2.2 (0.9; 5.4)
Koko (unbranded) 120 47.3 (37.2; 57.7) 244 75.9 (66.9; 83.1)
Hausa koko (unbranded) 55 28.3 (18.9; 39.9) 42 12.6 (6.8; 22.3)
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)
Awareness ‐ Proportion of women
ever seen/heard of Tom Vita
porridge
87 42.2 (33.1; 51.9) 46 17.2 (11.2; 25.5) <0.001
Awareness ‐ Where women have
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
Religious/ social gatherings 0 ‐‐ 0 ‐‐ ‐‐
Health clinic/health worker 18 3.5 (1.3; 8.8) 4 7.2 (1.1; 35.1) 0.47
Community leaders 0 ‐‐ 0 ‐‐ ‐‐
Relatives/ friends/ neighbours 15 14.8 (7.9; 26.1) 4 9.7 (3.5; 24.2) 0.46
Shopkeeper/pharmacy 17 29.2 (9.4; 62.0) 9 19.6 (9.1; 37.2) 0.52
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
Access ‐ Proportion of women know
where to buy Tom Vita porridge
32 48.0 (24.0; 73.0) 21 43.7 (23.8; 65.9) 0.81
Access ‐ Where women know to buy
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
Market/street stand 11 26.1 (7.7; 59.7) 6 16.5 (4.1; 47.8) 0.58
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
ANF4W Endpoint Survey, Ghana, 2017 80 ‐
Variable Sunyani Tamale P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
meters
Consumption ‐ Proportion of
women who have ever eaten Tom
Vita porridge
13 9.3 (3.0; 25.1) 11 24.7 (15.7; 36.6) 0.07
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.
ANF4W Endpoint Survey, Ghana, 2017 81 ‐
Supplementary table 22 Information about consumer behaviour with regard to Tom Vita porridge,
stratified by MPI score, Ghana 2017
Variable Poor Non‐ poor P‐value
between
groups N1
Median,
%2 (95% CI)3 N
Median,
%2 (95% CI)
Proportion of women consuming
porridge
22 89.8 (53.3; 98.5) 397 96.2 (92.6; 98.1) 0.28
Main brand of porridge consumed,
%
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)
Tom Brown (unbranded) 1 0.9 (0.1; 6.7) 19 5.8 (2.7; 12.2)
Koko (unbranded) 15 77.2 (42.1; 94.1) 259 57.4 (48.8; 65.5)
Hausa koko (unbranded) 3 19.2 (4.3; 55.7) 70 22.4 (15.7; 30.8)
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)
Awareness ‐ Proportion of women
ever seen/heard of Tom Vita
porridge
1 8.4 (1.0; 44.8) 114 37.2 (28.2; 47.2) 0.06
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.
ANF4W Endpoint Survey, Ghana, 2017 82 ‐
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
ANF4W Endpoint Survey, Ghana, 2017 83 ‐
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
ANF4W Endpoint Survey, Ghana, 2017 84 ‐
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
ANF4W Endpoint Survey, Ghana, 2017 85 ‐
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
ANF4W Endpoint Survey, Ghana, 2017 86 ‐
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
ANF4W Endpoint Survey, Ghana, 2017 87 ‐
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
Type the “other” option
Single Choice
HHC6 What is the main
material of the roof
of the dwelling?
Observe the material
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
ANF4W Endpoint Survey, Ghana, 2017 88 ‐
36= Roofing shingles 37= Asbestos/slate roofing sheets (skip to HHC8)_____________ 96 = Other (specify)
Text HHC6other
Type the “other” option
Single Choice
HHC8 What is the main material of the exterior walls of the dwelling?
Observe the material
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
Type the “other” option
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
ANF4W Endpoint Survey, Ghana, 2017 89 ‐
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
Type the “other” option
ANF4W Endpoint Survey, Ghana, 2017 90 ‐
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
Type the “other” option
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 /
ANF4W Endpoint Survey, Ghana, 2017 91 ‐
field (Skip to WSH8) 71= Don’t know (Skip to WSH7)____________ 88= Other (specify)
Text WSH5other
Type the “other” option
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
Type the “other” option
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
ANF4W Endpoint Survey, Ghana, 2017 92 ‐
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?
1= passed away 2= alive, no matter, where
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?
1= passed away 2= alive, no matter, where
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
ANF4W Endpoint Survey, Ghana, 2017 93 ‐
MEO2other
Type the “other” option
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
Type the “other” option
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
ANF4W Endpoint Survey, Ghana, 2017 94 ‐
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
ANF4W Endpoint Survey, Ghana, 2017 95 ‐
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?
1= At least one a week 2= Less than once a week 3= Not at all
Single choice
AMM3 Do you watch television 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
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
ANF4W Endpoint Survey, Ghana, 2017 96 ‐
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
Type the “other” option
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
Do not prompt. Probe “Anything else?”.
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
Type the “other” option
ANF4W Endpoint Survey, Ghana, 2017 97 ‐
Multiple choice
OSR3 What does the Obaasima seal/logo on a product mean?
Do not prompt. Probe “Anything else?”.
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
Don´t know/ don´t remember
1=Yes 2=No
OSR3_13
Other (specify) 1=Yes 2=No (skip to OSR4)
Text OSR3_13other
Type the “other” option
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
ANF4W Endpoint Survey, Ghana, 2017 98 ‐
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
Protects unborn baby
1=Yes 2=No
OSR6_11
Don´t know/ don´t remember
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?
1=Yes 2=No (skip to SLB3)
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
ANF4W Endpoint Survey, Ghana, 2017 99 ‐
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”
Do not prompt. Probe “Anything else?”.
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
Market place/ market
1=Yes 2=No
SLB4_12
Don´t know/ don´t remember
1=Yes 2=No
SLB4_13
Other 1=Yes 2=No (skip to SLB5)
Text SLB4_13other
Type the “other” option
Single choice SLB5 Do you know where to buy “Lola milk biscuits”?
1=Yes 2=No (skip to SLB7)
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
ANF4W Endpoint Survey, Ghana, 2017 100 ‐
SLB5_5 Other (specify) 1=Yes 2=No (skip to SLB6)
SLB5_6other
Type the “other” option
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?
Do not prompt. Probe “Anything else?”
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
ANF4W Endpoint Survey, Ghana, 2017 101 ‐
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
Type the “other” option
(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
ANF4W Endpoint Survey, Ghana, 2017 102 ‐
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
Type the “other” option
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
Type the “other” option
Skip to SLB20
Integer SLB18 The last time you bought “Lola milk biscuits”, how
If ‘don’t know’, record 888
ANF4W Endpoint Survey, Ghana, 2017 103 ‐
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”
Do not prompt. Probe “Anything else?”
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
Helps to be smart 1=Yes 2=No
SLB20_17
Don´t know/ don´t remember
1=Yes 2=No
SLB20_18
Other (specify) 1=Yes 2=No (skip to SLB 22)
ANF4W Endpoint Survey, Ghana, 2017 104 ‐
Text SLB20_18other
Type the “other” option
Multiple choice
SLB21 What do you not like about “Lola milk biscuits”
Do not prompt. Probe “Anything else?”
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
Carries the Obaasima seal
1=Yes 2=No
SLB21_7
Is not a good quality/ trustworthy product
1=Yes 2=No
SLB21_8
Contains added artificial ingredients such as vitamins and minerals
1=Yes 2=No
SLB21_9
Contains too much sugar/ too sweet
SLB21_10
Is not good for health
1=Yes 2=No
SLB21_11
Is not good for young women/ pregnant women
1=Yes 2=No
SLB21_12
Don´t know/ don´t remember
1=Yes 2=No
SLB2_13
Other (specify) 1=Yes 2=No (skip to SLB 23)
Text SLB21_13other
Type the “other” option
Single choice SLB22 Can you tell me any health benefits of ‘Lola milk biscuits’?
1=Yes 2=No (skip to SLB24)
Text SLB23 Which health benefits does it have?
SLB23_1
Contains vitamin and minerals
1=Yes 2=No
SLB23_2
Is good for young women/ pregnant women
1=Yes 2=No
SLB23_3
Contains small amount of sugar
1=Yes 2=No
ANF4W Endpoint Survey, Ghana, 2017 105 ‐
SLB23_4
Helps to be smart 1=Yes 2=No
SLB23_5
Gives strength 1=Yes 2=No
SLB23_6
Keeps energy level high
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
Helps to become pregnant
1=Yes 2=No
SLB23_10
Protects unborn baby
1=Yes 2=No
SLB23_11
Don´t know/ don´t remember
1=Yes 2=No
SLB23_12
Other (specify) 1=Yes 2=No (skip to SBS1))
SLB23_12other
Type the “other” option
Specialty Product “SAMBA SHITO sauce” (SBS)
Single choice
SBS1 Do you eat Shito Sauce at all?
1=Yes 2=No (skip to SBS3)
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
What is the name of the other brand?
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”
Do not prompt. Probe “Anything else?”.
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
ANF4W Endpoint Survey, Ghana, 2017 106 ‐
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
Social media/facebook
1=Yes 2=No
SBS4_11
Market place/ market
1=Yes 2=No
SBS4_12
Don´t know/ don´t remember
1=Yes 2=No
SBS4_13
Other 1=Yes 2=No (skip to SBS5)
Text SBS4_13other
Type the “other” option
Single choice
SBS5 Do you know where to buy “Samba Shito Sauce”?
1=Yes 2=No (skip to SBS7)
Multiple choice
SBS5 Where can you buy the product?
Do not prompt. Probe “Anything else?”
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
Type the “other” option
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
Do not prompt. Probe “Anything else?”
ANF4W Endpoint Survey, Ghana, 2017 107 ‐
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
Has not seen other women use it
1=Yes 2=No
SBS8_1
2
Other family members discourage using it
1=Yes 2=No
SBS8_1
3
Contains added artificial ingredients such as vitamins and minerals
1=Yes 2=No
SBS8_1
4
Is not good for health
1=Yes 2=No
SBS8_1
5
Is not good for young women/ pregnant women
1=Yes 2=No
SBS8_1
6
Don’t know / Don’t remember
1=Yes 2=No
SBS8_1
7
Other 1=Yes 2=No (skip to SBS14)
Text SBS8_1
7other
Type the “other” option
(enter, then skip to SBS14)
Single choice
SBS9 How often do you usually eat “Samba
1= several times a day 2= once a day
ANF4W Endpoint Survey, Ghana, 2017 108 ‐
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
Another female adult or teenager
1=Yes 2=No
SBS16_2
A male adult or teenager
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)
ANF4W Endpoint Survey, Ghana, 2017 109 ‐
Single choice
SBS17_1
From where did you purchase them?
1= Supermarket 2= Shop 3= Kiosk 4= Market/ street stand 5= Moving street vendor (skip to SBS 18)___________ 88= other (specify)
SBS17_1other
Type the “other” option
Skip to SBS18
Single choice
SBS17_2
From where did you receive them for free?
1= Relatives/ friends/ neighbor 2= Health worker 3= NGO/ religious association (skip to SBS20)___________ 88= other (specify)
Text SBS17_2 other
Type the “other” option
Skip to SBS20
Integer SBS18 The last time you bought “Samba Shito Sauce”, how many sachets did you buy ?
If ‘don’t know’, record 888
Integer SBS19 The last time you bought “Samba Shito Sauce”, how much did you pay for the sachet purchased?
In GHS. If ‘don’t know’, record 888
Multiple choice
SBS20 What do you like about “Samba Shito Sauce”
Do not prompt. Probe “Anything else?”
SBS20_1
Likes the taste 1=Yes 2=No
SBS20_2
Likes the packaging 1=Yes 2=No
SBS20_3
Likes the price 1=Yes 2=No
SBS20_4
Is easily available 1=Yes 2=No
SBS20_5
Likes how it is promoted
1=Yes 2=No
SBS20_6
Is a good quality /trustworthy product
1=Yes 2=No
SBS20_7
Is locally produced 1=Yes 2=No
ANF4W Endpoint Survey, Ghana, 2017 110 ‐
SBS20_8
Carries the Obaasima seal
1=Yes 2=No
SBS20_9
Contains minerals and vitamins
1=Yes 2=No
SBS20_10
Is good for health
SBS20_11
Is good for young women/ pregnant women
1=Yes 2=No
SBS20_12
Keeps energy level high
1=Yes 2=No
SBS20_13
Product gives strength
1=Yes 2=No
SBS20_14
Helps to become pregnant
1=Yes 2=No
SBS20_15
Helps to be smart 1=Yes 2=No
SBS20_16
Don´t know/ don´t remember
1=Yes 2=No
SBS20_17
Other (specify) 1=Yes 2=No (skip to SBS 21)
Text SBS20_17other
Type the “other” option
Multiple choice
SBS21 What do you not like about “Samba Shito Sauce”
Do not prompt. Probe “Anything else?”
SBS21_1
Dislikes taste 1=Yes 2=No
SBS21_2
Dislikes packaging 1=Yes 2=No
SBS21_3
Is too expensive 1=Yes 2=No
SBS21_4
Dislikes how it is promoted
1=Yes 2=No
SBS21_5
Is not easily available
1=Yes 2=No
SBS21_6
Carries the Obaasima seal
1=Yes 2=No
SBS21_7
Is not a good quality/ trustworthy product
1=Yes 2=No
SBS21_8
Contains added artificial ingredients such as vitamins and minerals
1=Yes 2=No
SBS21_9
Is not good for health
1=Yes 2=No
SBS21_10
Is not good for young women/ pregnant women
1=Yes 2=No
ANF4W Endpoint Survey, Ghana, 2017 111 ‐
Don´t know/ don´t remember
SBS21_11
Other (specify) 1=Yes 2=No (skip to SBS 22)
Text SBS21_11other
Type the “other” option
Single choice
SBS22 Can you tell me any the health benefits of ‘Samba Shito Sauce’?
1=Yes 2=No (skip to STV1)
Text SBS23 Which health benefits does it have?
SBS23_1
Contains vitamin and minerals
1=Yes 2=No
SBS23_2
Is good for young women/ pregnant women
1=Yes 2=No
SBS23_3
Helps to be smart 1=Yes 2=No
SBS23_4
Gives strength 1=Yes 2=No
SBS23_5
Keeps energy level high
1=Yes 2=No
SBS23_6
Boosts immune system
1=Yes 2=No
SBS23_7
Is important for a long life
1=Yes 2=No
SBS23_8
Helps to become pregnant
1=Yes 2=No
SBS23_9
Protects unborn baby
1=Yes 2=No
SBS23_10
Don´t know/ don´t remember
1=Yes 2=No
SBS23_11
Other (specify) 1=Yes 2=No (skip to STV1)
SBS23_11other
Type the “other” option
Specialty Product “Tom Vita” porridge (STV)
Single choice
STV1 Do you eat porridge at all?
1=Yes 2=No (skip to STV3)
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
ANF4W Endpoint Survey, Ghana, 2017 112 ‐
(unbranded) 11= wheat porridge (unbranded) 12= oats porridge (unbranded) (Skip to STV3)_____________ 13= Other brand/type
Text STV2other
What is the name of the other brand?
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
Do not prompt. Probe “Anything else?”.
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
Social media/facebook
1=Yes 2=No
STV4_11
Market place/ market
1=Yes 2=No
STV4_12
Don´t know/ don´t remember
1=Yes 2=No
STV4_13
Other 1=Yes 2=No (skip to STV5)
Text STV4_13other
Type the “other” option
Single choice
STV5 Do you know where to buy „Tom Vita” porridge?
1=Yes 2=No (skip to STV7)
Multiple choice
STV5 Where can you buy the product?
Do not prompt. Probe “Anything else?”
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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
Type the “other” option
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?
Do not prompt. Probe “Anything else?”
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
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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
Has not seen other women use it
1=Yes 2=No
STV8_13
Other family members discourage using it
1=Yes 2=No
STV8_14
Contains added artificial ingredients such as vitamins and minerals
1=Yes 2=No
STV8_15
Is not good for health
1=Yes 2=No
STV8_16
Is not good for young women/ pregnant women
1=Yes 2=No
STV8_17
Don’t know / Don’t remember
1=Yes 2=No
STV8_18
Other 1=Yes 2=No (skip to STV16)
Text STV8_18other
Type the “other” option
(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
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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
Type the “other” option
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
Another female adult or teenager
1=Yes 2=No
STV17_2
A male adult or teenager
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
From where did you purchase them?
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
Type the “other” option
Skip to STV19
Single choice
STV18_2
From where did you receive them for free?
1= Relatives/ friends/ neighbor 2= Health worker
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3= NGO/ religious association (skip to STV21)___________ 88= other (specify)
Text STV18_2 other
Type the “other” option
Skip to STV21
Integer STV19 The last time you bought „Tom Vita” porridge, how many sachets did you buy?
If ‘don’t know’, record 888
Integer STV20 The last time you bought „Tom Vita” porridge, how much did you pay for one sachet?
In GHS. If ‘don’t know’, record 888
Multiple choice
STV21 What do you like about „Tom Vita” porridge
Do not prompt. Probe “Anything else?”
STV21_1
Likes the taste 1=Yes 2=No
STV21_2
Likes the packaging 1=Yes 2=No
STV21_3
Likes the price 1=Yes 2=No
STV21_4
Is easily available 1=Yes 2=No
STV21_5
Likes how it is promoted
1=Yes 2=No
STV21_6
Is a good quality /trustworthy product
1=Yes 2=No
STV21_7
Is locally produced 1=Yes 2=No
STV21_8
Carries the Obaasima seal
1=Yes 2=No
STV21_9
Contains minerals and vitamins
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
Is good for young women/ pregnant women
1=Yes 2=No
STV21_13
Keeps energy level high
1=Yes 2=No
STV21_14
Product gives strength
1=Yes 2=No
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STV21_15
Helps to become pregnant
1=Yes 2=No
STV21_16
Helps to be smart 1=Yes 2=No
STV21_17
Don´t know/ don´t remember
1=Yes 2=No
STV21_18
Other (specify) 1=Yes 2=No (skip to STV 22)
Text STV21_18other
Type the “other” option
Multiple choice
STV22 What do you not like about „Tom Vita” porridge
Do not prompt. Probe “Anything else?”
STV22_1
Dislikes taste 1=Yes 2=No
STV22_2
Dislikes packaging 1=Yes 2=No
STV22_3
Is too expensive 1=Yes 2=No
STV22_4
Dislikes how it is promoted
1=Yes 2=No
STV22_5
Is not easily available
1=Yes 2=No
STV22_6
Carries the Obaasima seal
1=Yes 2=No
STV22_7
Is not a good quality/ trustworthy product
1=Yes 2=No
STV22_8
Contains added artificial ingredients such as vitamins and minerals
1=Yes 2=No
STV22_9
Contains too much sugar/ too sweet
1=Yes 2=No
STV22_10
Is not good for health
1=Yes 2=No
STV22_11
Is not good for young women/ pregnant women
1=Yes 2=No
STV22_12
Don´t know/ don´t remember
1=Yes 2=No
STV22_13
Other (specify) 1=Yes 2=No (skip to STV 23)
Text STV22_13other
Type the “other” option
Single choice
STV23 Can you tell me any the health benefits of “Tom Vita” porridge”?
1=Yes 2=No (skip to STV25)
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Text STV24 Which health benefits does it have?
STV24_1
Contains vitamin and minerals
1=Yes 2=No
STV24_2
Is good for young women/ pregnant women
1=Yes 2=No
STV24_3
Contains small amount of sugar
1=Yes 2=No
STV24_4
Helps to be smart 1=Yes 2=No
STV24_5
Gives strength 1=Yes 2=No
STV24_6
Keeps energy level high
1=Yes 2=No
STV24_7
Boosts immune system
1=Yes 2=No
STV24_8
Is important for a long life
1=Yes 2=No
STV24_9
Helps to become pregnant
1=Yes 2=No
STV24_10
Protects unborn baby
1=Yes 2=No
STV24_11
Don´t know/ don´t remember
1=Yes 2=No
STV24_12
Other (specify) 1=Yes 2=No (skip to MFR 1)
STV24_12other
Type the “other” option
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
ANF4W Endpoint Survey, Ghana, 2017 119 ‐
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