Perception and acceptance of micronutrient-Fortified Bouillon among Non-Index Household Members: A longitudinal sub-study nested within a randomized trial in Northern Ghana

Clinical Snapshot

Key Findings

• P Value: Not reported (Bayesian analysis)

• Effect Size: Adjusted posterior mean difference = 0.69 for perception improvement

• Primary Outcome: Perception scores increased significantly from 3.4 to 4.1 over 7 months

• Nnt Or Sensitivity: Acceptance remained consistently high (>4.5/5.0) throughout study period

• Confidence Interval: 95% credible interval: 0.57 to 0.81

Clinical Application

High feasibility in settings with existing bouillon cube consumption patterns and appropriate supply chains Limited direct applicability to Australian populations due to different dietary patterns and lower prevalence of micronutrient deficiencies. May inform food fortification strategies for specific at-risk groups including Indigenous communities or recent migrants from micronutrient-deficient regions Populations at risk of micronutrient deficiencies in resource-limited settings, particularly where bouillon cubes are culturally accepted food items

Abstract

BACKGROUND: Fortified bouillon cubes offer a scalable strategy to address micronutrient deficiencies in West Africa. However, success depends on household members' perceptions and acceptance. This study assessed changes in perception and acceptance of fortified bouillon cubes over time and explored factors influencing these outcomes among non-index household members (NIHMs) from trial households in Northern Ghana. METHODS: This longitudinal mixed-methods study was nested within a double-masked randomised controlled trial. Households received micronutrient-fortified bouillon cubes (vitamin A, vitamin B12, folic acid, iron, zinc, iodine) or control cubes (iodine only) for nine months. One NIHM (≥15 years) per household (n = 1,047) was enrolled. Structured interviews were conducted during early (months 1-2; n = 731) and late (months 7-9; n = 796) phases. Composite perception (8 items) and acceptance (10 items) scores (range: 1-5; higher scores = more positive perceptions/greater acceptance) were derived from an 18-item validated instrument. Bayesian linear mixed-effects models assessed temporal changes and associated individual and household factors. Twenty-four focus group discussions (months 4-5) explored drivers and barriers. RESULTS: Mean age of NIHMs was 40 ± 14.7 years; 59% were female. Perception scores increased over seven months, from 3.4 to 4.1 (adjusted posterior mean difference [aPMD] = 0.69; 95% credible interval [CrI]: 0.57, 0.81). Acceptance remained high (4.59 to 4.58; aPMD = -0.02; 95% CrI: -0.07, 0.03). No differences were observed between trial arms. At early timepoint, perception scores were lower among household heads compared with other household members, and lower among formal employees compared with farmers. Acceptance was higher among individuals from severely food-insecure households and lower among those from mildly food-insecure households. Focus groups revealed that perceived health benefits, sensory appeal, and cultural fit drove acceptance, while infertility-related myths and food colour changes were barriers. CONCLUSION: Fortified bouillon cubes were accepted, with perceptions improving over time. Public education will be essential to address misconceptions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05178407); Pan-African Clinical Trial Registry (PACTR202206868437931). The authors confirm that all ongoing and related trials for this intervention are registered.

References

1. 1.Kyereh, F. K., Ohemeng, A. N., Engle-Stone, R., Wessells, K. R., Kumordzie, S. M., Arnold, C. D., Davis, J. N., Becher, E. R., Fuseini, A. D., Nyaaba, K. W., Tan, X., Vosti, S. A., & Adu-Afarwuah, S. (2024). Perception and acceptance of micronutrient-Fortified Bouillon among Non-Index Household Members: A longitudinal sub-study nested within a randomized trial in Northern Ghana. *PLoS One*, Article 0345106. https://doi.org/10.1371/journal.pone.0345106