High Awareness but Low Coverage of a Locally Produced Fortified Complementary Food in Abidjan, Côte d’Ivoire: Findings from a Cross-Sectional Survey
November
High Awareness but Low Coverage of a Locally Produced Fortified Complementary Food in Abidjan, Coà te d'Ivoire: Findings from a Cross-Sectional Survey
Magali Leyvraz 1 2 3
Fabian Rohner 1 3
Amoin G. Konan 0 1 3
Lasme J. C. E. Esso 0 1 3
Bradley A. Woodruff 1 3
Augusto Norte 1 3
Adiko F. Adiko 0 1 3
Bassirou Bonfoh 0 1 3
Grant J. Aaron 1 2 3
0 Centre Suisse de Recherches Scientifiques en Coà te d'Ivoire , Abidjan , Coà te d'Ivoire, 4 Universit e F eÂlix Houphou eÈt-Boigny , Abidjan , Coà te d'Ivoire, 5 Swiss Tropical and Public Health Institute, University of Basel , Basel , Switzerland
1 Data Availability Statement: Data are available by request to the Global Alliance for Improved Nutrition (GAIN). Requests can be directed to
2 Global Alliance for Improved Nutrition , Geneva, Switzerland, 2 GroundWork, FlaÈ sch , Switzerland
3 Editor: Frank Wieringa, Institut de recherche pour le developpement , FRANCE
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OPEN ACCESS
Funding: This work was supported by the Bill and
Melinda Gates Foundation (http://www.
gatesfoundation.org/). The funders had no role in
study design, data collection and analysis, decision
to publish, or preparation of the manuscript.
Poor complementary feeding practices among infants and young children in Coà te d'Ivoire
are major contributing factors to the country's high burden of malnutrition. As part of a
broad effort to address this issue, an affordable, nutritious, and locally produced fortified
complementary food product was launched in the Coà te d'Ivoire in 2011. The objective of
the current research was to assess various levels of coverage of the program and to identify
coverage barriers. A cross-sectional household survey was conducted among caregivers
of children less than 2-years of age living in Abidjan, Coà te d'Ivoire. Four measures of
coverage were assessed: ªmessage coverageº (i.e., has the caregiver ever heard of the
product?), ªcontact coverageº (i.e., has the caregiver ever fed the child the product?), ªpartial
coverageº (i.e., has the caregiver fed the child the product in the previous month?), and
ªeffective coverageº (i.e., has the caregiver fed the child the product in the previous 7
days?). A total of 1,113 caregivers with children between 0 and 23 months of age were
interviewed. Results showed high message coverage (85.0%), moderate contact coverage
(37.8%), and poor partial and effective coverages (8.8% and 4.6%, respectively). Product
awareness was lower among caregivers from poorer households, but partial and effective
coverages were comparable in both poor and non-poor groups. Infant and young child
feeding (IYCF) practices were generally poor and did not appear to have improved since
previous assessments. In conclusion, the results from the present study indicate that availability
on the market and high awareness among the target population is not sufficient to achieve
high and effective coverage. With market-based delivery models, significant efforts are
needed to improve demand. Moreover, given the high prevalence of malnutrition and poor
IYCF practices, additional modes of delivering IYCF interventions and improving IYCF
practices should be considered.
Introduction
The prevalence of malnutrition in infants and young children in Côte d’Ivoire is high. A national
survey conducted in 2007 found that 72% of children between 6 and 59 months were anemic,
24% were vitamin A deficient, 15% had iron deficiency, 41% were stunted, 14% were wasted,
and 29% were underweight [
1
]. A more recent national survey conducted in 2011–2012, which
assessed the prevalence of anemia, stunting, wasting, and underweight, indicated some progress,
but persistently high prevalence rates of malnutrition: 75% of children between 6 and 59 months
were anemic, while 30% were stunted, 8% were wasted, and 15% were underweight [
2
].
It is widely recognized that exclusive breastfeeding provides the optimal diet for children
under 6 months [
3
]. However, after 6 months of age, the nutritional requirements of infants
increase for all macro- and micronutrients such that breast milk alone can no longer cover the
infants’ needs [
4, 5
]. Thus, to ensure adequate nutrition and healthy growth outcomes, it is
essential that a variety of nutrient-dense foods be introduced into children’s diets to
complement breast milk. The main strategies to increase nutrient density in children’s diet are dietary
diversification, supplementation, and fortification [
6
]. The appropriateness and suitability of a
particular approach depends on the context and nutritional needs of the target population as
discussed elsewhere [
6
].
Infant and young child feeding (IYCF) practices are poor in Côte d’Ivoire: Only 12% of
children are exclusively breastfed until 6 months of age [
7
] and fewer than 5% of the children
between 6 and 23 months are fed according to the World Health Organization’s optimal
feeding recommendations [
8
].
In 2009, the Global Alliance for Improved Nutritio (...truncated)