Futoshi Yamauchi The 8th Tokyo International Conference on African Development (TICAD8) Side Event: How Japan’s know-how can help address Africa’s food and nutrition challenges: Interventions and impacts SEP 28, 2022 - 6:00 TO 7:30PM JST

1. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
Outline
❑Improve nutrition situation and growth among young children in vulnerable
communities hosting refugees in Ghana
❑Western, Central, Bono and Accra regions
❑Target children at 6 to 24 months
❑Ajinomoto’s KOKO Plus – nutrition power to mix in koko (maize porridge)
❑Collaboration with Ajinomoto/KOKO Plus Foundation, Ministry of Health (Ghana
Health Services) and Noguchi Memorial Institute for Medical Research
❑More than 2000 children benefited from KOKO Plus supplementation
❑Detected improvements in hemoglobin and weight adjusted for age or height
especially among households facing greater food insecurity - analysis is on-going

2. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
KOKO Plus
❑Developed by Ajinomoto Co Inc., University of Ghana, and INF (International
Nutrition Foundation (USA)
❑A macro- and micronutrient fortified complementary food supplement
formulated to improve nutritional quality of complementary (baby) foods.
❑Contains soya powder, sugar and oil along with the essential amino acid
lysine and a micronutrient mix.
❑Complies with WHO’s complementary feeding guidelines, FAO/WHO
recommended micronutrient intake (RNI) and the WHO’s guidelines for
protein and essential amino acid intake for children in the age group of 6 to
24 months.
❑A daily supply of KOKO Plus achieves 30% of the total recommended energy,
60% of total protein and 40% of total fat requirements from complementary
foods. It also meets 35-55% of minimum intake of essential amino acids and
50-150% RNI based on the total daily requirements.
❑Ajinomoto Co., Inc. launched Ghana Nutrition Improvement Project in 2009
to develop a social business model to solve stunting and anemia among the
infants and handed it over to The Ajinomoto Foundation in 2017, currently
being carried out through public-private partnership.

3. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
Intervention
❑Ampain, Ellembelle district, Western Region; Egyeikrom, Komenda-Edina Eguafo
district, Central Region; Fatentaa, Brekum-West district, Bono Region
❑KOKO Foundation (Ajinomoto Foundation) in Bono region supplies KOKO Plus, and
then transported to intervention areas
❑Ghana Health Services
❑KOKO Plus was distributed to mothers on monthly basis; empty sachets were
collected to check intake; enrollment to admit new children who reached target ages
❑Initial scoping visit, orientations, community entry, community sensitization,
selection and registration of beneficiaries, program implementation and monitoring
works

4. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus

5. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
Region Month No. of children registered
No. of children receiving
Koko Plus
WESTERN
Dec-20 67 67
Jan-21 126 109
Feb-21 260 158
Mar-21 346 205
Apr-21 368 264
May-21 368 175
Jun-21 368 51
Jul-21 456 322
Aug-21 488 361
Sep-21 591 299
Total number of children who have received KOKO Plus: 411
BONO
Jan-21 137 137
Feb-21 180 148
Mar-21 207 195
Apr-21 299 223
May-21 299 208
Jun-21 299 223
Jul-21 334 231
Aug-21 353 235
Sep-21 376 255
Oct-21 382 257
The total number of children who have received KOKO Plus: 283
CENTRAL
Apr-21 459 459
May-21 536 397
Jun-21 536 374
Jul-21 536 181
Aug-21 536 226
Sep-21 557 455
Oct-21 557 494
Nov-21 750 744
Dec-21* 750 743
Jan-22* 750 670
The total number of children who have received KOKO Plus: 807
Region Month No. of children registered
No. of children receiving
Koko Plus

6. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
Impacts - Method
❑Noguchi Memorial Institute for Medical Research
❑Collaborate with local hospitals and GHS in Greater Accra
❑Randomized control trial
❑6 months intervention to treatment
❑The total sample size attained was 680 (treatment and control)
❑Control receives KOKO Plus after 6 months
❑Baseline, monthly, midline and endline
❑Socio-economic backgrounds, hemoglobin, anthropometric measures, etc
❑Initial conditions (mean ± std)
Treatment Control
HAZ -0.31 ± 1.5 -0.42 ± 1.6 (p-value 0.366)
WAZ -0.63 ± 1.2 -0.66 ± 1.2 (p-value 0.789)
WHZ -0.58 ± 1.3 -0.53 ± 1.2 (p-value 0.628)
Hb g/dl 10.21 ± 1.5 10.13 ± 1.8 (p-value 0.536)

7. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
Impacts – Preliminary findings
Height for age Weight for age Weight for height Hemoglobin
Panel A: Full sample
Age>=6 & Age<=24 -0.0310 -0.0474 0.0009 0.0856
Age>=6 & Age<=15 0.0438 -0.0071 0.0198 -0.0061
Age>=16 & Age<=24 0.0842 0.4621* 0.6758*** -0.0102
Panel B: Food unsecured
Age>=6 & Age<=24 -0.0187 0.0842 0.1449 0.2298
Age>=6 & Age<=15 0.0572 0.0273 0.0239 0.2698*
Age>=16 & Age<=24 -0.0324 0.5681* 0.8780*** -0.1816

8. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
Impacts – Preliminary findings continued
❑KOKO Plus had statistically significant positive
impacts on weight standardized for age as well as
standardized for height among children aged 16 to
24 months, and the impacts are found larger
(more significant) when facing food insecurity.
❑The impact on hemoglobin was positive and
significant for children aged 6 to 15 months when
facing food insecurity.
❑The impacts of KOKO Plus on child growth and
hemoglobin are expected to be greater (and more
significant) among children facing a greater degree
of food insecurity.
❑While the impact on height was not detected over
6 months, it is common that it normally takes
longer to observe the impact on height than that
on weight.
Figure 1 Marginal impact relative to standard deviation

9. Improving Early Childhood Nutrition and Growth in
Vulnerable Communities Hosting Refugees in Ghana
An Intervention with KOKO Plus
Outcomes
❑The preliminary evidence support the Japanese partner, that is, Ajinomoto
Foundation to promote KOKO Plus in private-public partnership with Ghanaian
counterparts (however, to be verified in a further analysis)
❑Children in vulnerable situations, especially facing food insecurity, benefit more
from the KOKO Plus supplementation
❑The utilization of amino acids to enhance nutrition effects – Japan’s contribution is
built in KOKO Plus
❑KOKO Plus can be potentially an instrument to tackle the high prevalence of anemia
in the country (potentially for school age children too)
❑A good case/example of
(a) build up resilience via human capital formation
(b) introduce advanced technologies – nutrition supplement from Japanese company
(c) randomized control trials to assess impacts
(d) show the contributions of Japan’s advanced technologies with evidence
(e) scoping for evidence-based policy making (EBPM) and scaling up