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Iron DeficiencyNCT04632771

Nutritional Status and Bouillon Use in Northern Ghana

An observational study of Iron Deficiency and Vitamin A Deficiency, run by University of California, Davis at 1 site in Ghana.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This pilot aims to generate data that are critical for informing the design of a planned, more detailed study to evaluate the effect of multiple micronutrient (MN)-fortified bouillon cube on biomarkers of nutrient status of women and children. Read more about this study

Who is it for?
Ages 2 years and olderHealthy volunteers can take part
What is being tested?
N/A (observational study)
How many people
995 participants
Where
1 siteGhana
Study dates
19 Oct 2020to 28 Feb 2022
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 years and older
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Study population: Households in the urban and rural areas in Tolon and Kumbungu districts, in northern Ghana

Who may be able to join

  • non-pregnant, non-lactating woman of reproductive age (15-49 years) OR child 2-5 years of age OR non-pregnant lactating woman (4-18 mo post-partum, 15-49 years of age)
  • signed informed consent by participant (if adult woman) or by at least one parent or guardian (if child)
  • non-pregnant, nonlactating woman of reproductive age (15-49 years)
  • signed informed consent
  • planning to remain in the study area for the next 1 month
  • not planning to become pregnant during the next 1 month
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  • non-pregnant, nonlactating woman of reproductive age (15-49 years)
  • signed informed consent
  • planning to remain in the study area for the next 4 months
  • not planning to become pregnant during the next 4 months
  • Adults (including women, men, and other key community members such as merchants, etc.)
  • Provision of written informed consent

Who cannot join

  • severe illness warranting hospital referral
  • chronic severe medical condition (e.g. malignancy) or congenital anomalies requiring frequent medical attention or potentially inferring with nutritional status
  • unable to provide informed consent due to impaired decision making abilities (if adult woman, or caretaker of potentially eligible child)
  • current participation in a clinical trial
  • RID Pilot 1
  • unable to provide informed consent due to impaired decision making abilities
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  • pregnancy (as ascertained via urine pregnancy test for human chorionic gonadotropin)
  • severe illness warranting hospital referral
  • reported fever, vomiting or diarrhea (> 3 liquid or semi-liquid stools in 24h) in 7 d prior to data collection
  • chronic medical condition (e.g. malignancy, gastrointestinal disease) or congenital anomalies requiring frequent medical attention or potentially inferring with nutritional status
  • current participation in a clinical trial
  • hemoglobin concentration <80 g/L on the day of isotope dosing
  • C-reactive protein concentration > 5 mg/L on the day of isotope dosing
  • reported use of micronutrient supplements that contain vitamin A more than 1 time/wk in the past 30 days
  • RID Pilot 2
  • unable to provide informed consent due to impaired decision making abilities
  • pregnancy (as ascertained via urine pregnancy test for human chorionic gonadotropin)
  • severe illness warranting hospital referral
  • reported fever, vomiting or diarrhea (> 3 liquid or semi-liquid stools in 24h) in 7 d prior to data collection
  • chronic medical condition (e.g. malignancy, gastrointestinal disease) or congenital anomalies requiring frequent medical attention or potentially inferring with nutritional status
  • current participation in a clinical trial
  • hemoglobin concentration <80 g/L on the day of isotope dosing
  • C-reactive protein concentration > 5 mg/L on the day of isotope dosing
  • reported use of micronutrient supplements that contain vitamin A more than 1 time/wk in the past 30 days
  • Formative Research

Trial locations and contacts

1 site in 1 country.

Ghana1 site
  • University of Ghana

    Accra

Other trials in Ghana

About this study

Official title: A Pilot Study to Evaluate the Nutritional Status of Women and Children in Northern Ghana, and Knowledge, Attitudes and Practices Related to Bouillon Cube Use

This pilot aims to generate data that are critical for informing the design of a planned, more detailed study to evaluate the effect of multiple micronutrient (MN)-fortified bouillon cube on biomarkers of nutrient status of women and children. Data collection includes measures of nutritional status and dietary intake among women and children and their households in communities in northern Ghana.

Read the detailed description

Background: Micronutrient (MN) deficiencies are severe and widespread in West Africa including Ghana, which contributes to impaired growth and development in children, increased risk of mortality, and low economic productivity in adults. While large-scale intervention programs (including salt iodization and cooking oil and wheat flour fortification) exist, these programs are often not well-monitored, and they often provide only a subset of nutrients or reach only a subset of the deficient population.

Bouillon cubes may be an ideal fortification vehicle for delivering micronutrients in West Africa because they are purchased by most households (including rural and poorer households), added to home-made meals and consumed by most members of the household in relatively constant amounts, and they are mainly processed centrally at large scale. However, several important questions must be addressed regarding the extent to which multi-fortified bouillon cubes can address inadequate intake of key micronutrients.

Objective: This pilot aims to generate data that are critical for informing the design of a planned, more detailed study to evaluate the effect of multiple micronutrient-fortified bouillon cube on biomarkers of nutrient status of women and children.

Methods: This will be a cross-sectional study, which will be conducted in the Kumbungu and Tolon districts in the Northern Region, where a recent survey showed that micronutrient deficiencies were common. Four sets of research activities will be carried out, including:

  1. Pilot survey: The investigators will recruit non-pregnant, non-lactating women of reproductive age, WRA (n = 250), children 2-5 years of age (n = 250), and lactating women (n= 250) who will be identified from households in selected communities using the random walk method. Information collected will include anthropometric and micronutrient status, hemoglobin concentration, inflammation, morbidity, household-level food consumption, and individual dietary intakes.
  2. Retinol isotope dilution (RID) Pilot Study 1: The investigators will recruit non-pregnant and nonlactating women of reproductive age, WRA (n = 30) from a subset of the same communities as the pilot survey using the random walk method, and quantitatively estimate their total body vitamin A stores after consuming a dose of d6-labelled vitamin A. Total body stores of vitamin A will be estimated at 14 days after dosing.
  3. Retinol isotope dilution (RID) Pilot Study 2 (kinetic study): Based on results from RID pilot study 1, the investigators will recruit non-pregnant and non-lactating women of reproductive age, WRA (n = 123) from a subset of the same communities as the pilot survey using the random walk method, to construct a population-level plasma retinol kinetic curve, after consuming a dose of d6-labelled vitamin A. A compartmental model will be fit to the plasma retinol kinetic data to develop population-specific coefficients for the RID prediction equation to quantitatively estimate total body vitamin A stores of WRA in the study population.
  4. Formative research: The investigators will (a) conduct focus group discussions on knowledge, attitudes and practices related to salt and bouillon cube use, nutrition and health problems in the community, and micronutrient fortification; (b) perform a market assessment of the availability and cost of fortified, non-fortified and potentially fortifiable foods in the communities; and (c) observe how various local food recipes are prepared, including the types and quantities of ingredients used, and cooking duration and temperature.
Being tested
N/A (observational study)
Medical subject headings
Iron Deficiencies, Vitamin A Deficiency, Vitamin B 12 Deficiency, Folic Acid Deficiency, Feeding Behavior, Anemia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • N/A (observational study)Other

    N/A (observational study)

Study groups in NCT04632771
Study groupRoleWhat they receive
Pilot survey: non-pregnant, non-lactating womenSurvey of non-pregnant, non-lactating women 15-49 years of age (n=250)
Receives: Other: N/A (observational study)
Pilot survey: lactating womenSurvey of lactating women 15-49 years of age who are currently breastfeeding a child 4-18 months of age (n=250)
Receives: Other: N/A (observational study)
Pilot survey: childrenSurvey of children 2-5 years of age (n=250)
Receives: Other: N/A (observational study)
RID Pilot 1Two-week study to assess total body vitamin A stores in a sample of non-pregnant, non-lactating women 15-49 years of age (n=30)
Receives: Other: N/A (observational study)
RID Pilot 2Kinetic study with "Super-woman" design to develop a prediction equation to assess total body vitamin A stores among non-pregnant, non-lactating women 15-49 years of age (n=123)
Receives: Other: N/A (observational study)
Focus group discussionsFocus group discussions conducted among women of reproductive age, older women, and men (n=120 total)
Receives: Other: N/A (observational study)
Market assessmentSurvey of retail outlets selling fortified staple foods and/or bouillon (n=50 shop owners or operators)
Receives: Other: N/A (observational study)
Recipe observationsObservations of cooking of local dishes by selected participants (n=50) enrolled in the pilot survey.
Receives: Other: N/A (observational study)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Hemoglobin

    Hemoglobin concentration in venous blood (g/dL) among women and children

    Measured: Day 1

  2. Iron status

    Concentrations of iron status biomarkers (serum iron, ferritin, and soluble transferrin receptor) among women and children

    Measured: Day 1

  3. Vitamin A status

    Concentrations of vitamin A status biomarkers (serum retinol and retinol-binding protein) among women and children

    Measured: Day 1

  4. Vitamin B12 status

    Concentrations of vitamin B12 in serum among women and children

    Measured: Day 1

  5. Folate status

    Concentrations of folate in serum (among women and children) and whole blood and erythrocytes (women only)

    Measured: Day 1

  6. Zinc status

    Serum zinc concentration among women and children

    Measured: Day 1

  7. Breast milk vitamin A concentration

    Vitamin A concentration in breast milk, expressed per unit volume and per gram fat

    Measured: Day 1

  8. Breast milk vitamin B12 concentration

    Vitamin B12 concentration in breast milk

    Measured: Day 1

  9. Total body vitamin A stores

    Distribution of total body vitamin A stores among non-pregnant, non-lactating women, expressed as total mass and per gram of liver, estimated by retinol isotope dilution

    Measured: Day 7

  10. Total body vitamin A stores

    Distribution of total body vitamin A stores among non-pregnant, non-lactating women, expressed as total mass and per gram of liver, estimated by retinol isotope dilution

    Measured: Day 14

  11. Coefficient "Fa"

    Defined as the fraction of the oral tracer dose absorbed and retained in stores, estimated by modeling of data on labeled and unlabelled vitamin A in plasma collected using a "Super Woman" design and used to calculate total body stores for individual participants.

    Measured: Blood samples from RID Pilot 2 participants collected at randomly assigned time points over a 90-day time frame

  12. Coefficient "S"

    Defined as retinol specific activity in plasma/stores at time "t", estimated by modeling of data on labeled and unlabelled vitamin A in plasma collected using a "Super Woman" design and used to calculate total body stores for individual participants.

    Measured: Blood samples from RID Pilot 2 participants collected at randomly assigned time points over a 90-day time frame

  13. Prevalence of anemia and micronutrient deficiencies

    Prevalence of hemoglobin and micronutrient biomarkers above or below relevant cutoffs

    Measured: Day 1

  14. Urinary iodine concentration

    Iodine concentration of urine among women and children

    Measured: Day 1

  15. Themes from focus group discussions

    Perceptions of bouillon and salt use, cooking practices, noncommunicable disease, and other nutrition and diet-related issues

    Measured: Day 1

  16. Recipe ingredients

    Quantity of each recipe ingredient (including bouillon and salt) used in common local recipes; interpreted in relation to cooking duration and temperature (type and duration, e.g. of boiling) used in common recipes

    Measured: Day 1

  17. Fortified food accessibility

    Availability, price, and fortification levels of fortified food products in markets

    Measured: Day 1

Secondary outcomes (15)
  1. Blood pressure

    Blood pressure measured among women and children (mm Hg, systolic and diastolic)

    Measured: Day 1

  2. Hypertension

    Prevalence of blood pressure measurements above cutoffs for hypertension

    Measured: Day 1

  3. Height, cm

    Standing height measured among women and children

    Measured: Day 1

  4. Weight, kg

    Weight measurement among women and children

    Measured: Day 1

  5. Waist to hip ratio

    Waist and hip circumference (measured in cm) among women and their ratio

    Measured: Day 1

  6. Mid-upper arm circumference, cm

    Mid-upper arm circumference measured among children

    Measured: Day 1

  7. Anthropometric Z-scores

    Z-scores calculated for young children based on WHO growth standards (height-for-age, weight-for-height, height-for-age, BMI-for-age)

    Measured: Day 1

  8. Prevalence of undernutrition

    Prevalence of anthropometric Z-scores or mid-upper arm circumference below WHO cutoffs to indicate child undernutrition

    Measured: Day 1

  9. Prevalence of overweight and obesity

    Prevalence of body mass index (women) or BMI-for-age Z-score (children) above WHO cutoffs

    Measured: Day 1

  10. Morbidity symptoms

    Reported malaria, diarrhea, fever, or vomiting in the past 7 days (all survey participants)

    Measured: Day 1

  11. Inflammation

    Serum concentrations of CRP, AGP, amyloid A, MCP-1, IL-6, IL-10, IL-1b, adiponectin

    Measured: Day 1

  12. Household-food consumption

    Calculated daily household level consumption and individual apparent consumption of fortified foods (wheat flour, oil, salt) and bouillon estimated using 1-month recall

    Measured: Day 1

  13. Individual dietary intake

    Dietary intake of fortified foods and bouillon, measured by 24h recall among a subset of women participating in the survey who also participate in cooking observations

    Measured: Day 1

  14. Urinary sodium concentration

    Expressed per unit volume and in relation to urinary creatinine concentration

    Measured: Day 1

  15. Status of other micronutrients

    Concentrations of micronutrients in serum and breast milk (vitamins E, B1, B2, B3, B5, B6, B7)

    Measured: Day 1

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Nov 2020
  2. Study start19 Oct 2020
  3. Primary completion28 Feb 2022
  4. Study completion28 Feb 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Cross-sectional
Enrolment
995 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04632771
Sponsor's protocol ID
1536100
Status last verified
Apr 2022
First submitted
27 Oct 2020
Last updated
18 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Green MH, Lopez-Teros V, Green JB, Lietz G, Kumordzie SM, Oxley A, Fuseini AD, Nyaaba KW, Becher E, Davis JN, Wessells KR, Adu-Afarwuah S, Engle-Stone R, Haskell MJ. Use of Population-Based Compartmental Modeling and Retinol Isotope Dilution to Study Vitamin A Kinetics and Total Body Stores among Ghanaian Women of Reproductive Age. Curr Dev Nutr. 2024 Oct 18;8(11):104484. doi: 10.1016/j.cdnut.2024.104484. eCollection 2024 Nov.

    PubMed 39634788
  • Davis JN, Kumordzie SM, Arnold CD, Wessells KR, Nyaaba KW, Adams KP, Tan XJ, Becher E, Vosti SA, Adu-Afarwuah S, Engle-Stone R. Consumption of Discretionary Salt and Salt from Bouillon among Households, Women, and Young Children in Northern Region, Ghana: A Mixed-Methods Study with the Condiment Micronutrient Innovation Trial (CoMIT) Project. Curr Dev Nutr. 2024 Feb 6;8(3):102088. doi: 10.1016/j.cdnut.2024.102088. eCollection 2024 Mar.

    PubMed 38419834

Questions about this trial

What is this clinical trial studying?

An observational study of Iron Deficiency and Vitamin A Deficiency, run by University of California, Davis at 1 site in Ghana.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Ghana. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hemoglobin (time frame: Day 1). The study lists 17 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04632771, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Apr 2022.

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