Effect of Household Use of Multiple Micronutrient-fortified Bouillon on Micronutrient Status Among Women and Children in Two Districts in the Northern Region of Ghana

Inclusion/exclusion criteria at recruitment (home visit): Household Inclusion criteria: \- Head of household provides oral consent for the participation of household members (index participants), and willingness to have study-provided bouillon cubes used in their household for the next 10 months. Exclusion criteria: * Reported chronic medical condition requiring frequent blood transfusion (e.g. severe forms of thalassemia) among any household members; * Current participation of any household member in a clinical trial; * Reported shrimp, wheat, milk, soy, eggs, celery, fish, or mollusk allergy, or a previous adverse reaction to bouillon by the participant or any member of their household. Non-pregnant, non-lactating women of reproductive age Inclusion criteria: * Non-pregnant non-lactating women of reproductive age (15 - 49 years); * Signed the informed consent form (or in the case of adolescents 15-17 years of age, unmarried and still living with their parents, assent provided from the index participant and consent from a parent or guardian) ; * Planning to remain in the study area for the next 10 months; * Willing to use study-provided bouillon in household cooking for the next 10 months; * Not planning to become pregnant during the next 10 months. Exclusion criteria: * Severe illness warranting immediate hospital referral; * COVID-19 diagnosis or exposure in the previous two weeks \[individual may repeat eligibility assessment after deferral\]; * Presence of morbidity symptoms suggesting COVID-19 infection (fever \[temperature \> 38°C\], chills/shaking, dry cough, shortness of breath or difficulty breathing, loss of smell or taste within the past 72 hours) \[individual may repeat eligibility assessment after deferral\]; * Chronic severe medical condition (e.g. malignancy) or congenital anomalies requiring frequent medical attention or potentially interfering with nutritional status; * Unable to provide informed consent due to impaired decision-making abilities. Children 2-5 years of age (24-59 mo) Inclusion criteria: * Child 2-5 years of age (24-59 mo); * Signed informed consent for the child's participation from a parent or guardian; * Planning to remain in the study area for the next 10 months; * Caregiver willing to use study-provided bouillon in household cooking for the next 10 months. Exclusion criteria: * Severe illness warranting immediate hospital referral; * COVID-19 diagnosis or exposure in the previous two weeks \[individual may repeat eligibility assessment after deferral\]; * Presence of morbidity symptoms suggesting COVID-19 infection (fever, \[temperature \> 38°C\], chills/shaking, dry cough, shortness of breath or difficulty breathing, loss of smell or taste within the past 72 hours) \[individual may repeat eligibility assessment after deferral\]; * Mid-upper arm circumference \< 11.5 cm; * Chronic severe medical condition (e.g. malignancy) or congenital anomalies requiring frequent medical attention or potentially interfering with nutritional status. Lactating women Inclusion criteria: * Non-pregnant women of reproductive age (15 - 49 years), currently breastfeeding a child who is 4-18 months of age; * Signed the informed consent form (or in the case of adolescents 15-17 years of age, unmarried and still living with their parents, provide assent from the index participant and consent from a parent or guardian); * Planning to remain in the study area for the next 4 months; * Planning to breastfeed for the next 4 months; * Willing to use study-provided bouillon in household cooking for the next 4 months; * Not planning to become pregnant during the next 4 months. Exclusion criteria: * Pregnancy (determined by self-report); * Severe illness warranting immediate hospital referral; * COVID-19 diagnosis or exposure in the previous two weeks \[individual may repeat eligibility assessment after deferral\]; * Presence of morbidity symptoms suggesting COVID-19 infection (fever\[temperature \> 38°C\], chills/shaking, dry cough, shortness of breath or difficulty breathing, loss of smell or taste within the past 72 hours) \[individual may repeat eligibility assessment after deferral\]; * Chronic severe medical condition (e.g. malignancy) or congenital anomalies requiring frequent medical attention or potentially interfering with nutritional status; * Unable to provide informed consent due to impaired decision-making abilities. Exclusion criteria at screening visit for vitamin A isotope dose (WRA only): Non-pregnant, non-lactating women of reproductive age * Hemoglobin \< 80 g/L at baseline screening visit; * Severe illness warranting immediate hospital referral; * COVID-19 diagnosis or exposure in the previous two weeks \[individual may repeat eligibility assessment after deferral\]; * Presence of morbidity symptoms suggesting COVID-19 infection (fever \[temperature \> 38°C\], chills/shaking, dry cough, shortness of breath or difficulty breathing, loss of smell or taste within the past 72 hours) \[individual may repeat eligibility assessment after deferral\]; * Recent diarrhea \[≥3 liquid or semiliquid stools in 72 hours\]) \[individual may repeat eligibility assessment after deferral\]; * Reported consumption of vitamin A-rich foods (e.g., liver) in the previous 24 hours \[individual may repeat eligibility assessment after deferral\]; * Pregnancy (as ascertained via urine pregnancy test for human chorionic gonadotropin on the day of isotope dosing); * Incomplete consumption of vitamin A isotope dose; * Positive malaria RDT on the day of isotope dosing \[individual may repeat eligibility assessment after deferral\]; * CRP \> 5 mg/L on the day of isotope dosing \[individual may repeat eligibility assessment after deferral\]. Exclusion criteria at baseline visit: Non-pregnant, non-lactating women of reproductive age * Hemoglobin \< 80 g/L; * Severe illness warranting immediate hospital referral; * COVID-19 diagnosis or exposure in the previous two weeks \[individual may repeat eligibility assessment after deferral\]; * Presence of morbidity symptoms suggesting COVID-19 infection (fever \[temperature \> 38°C\], chills/shaking, dry cough, shortness of breath or difficulty breathing, loss of smell or taste within the past 72 hours) \[individual may repeat eligibility assessment after deferral\]; * Pregnancy (determined by self-report). Children 2-5 years of age * Hemoglobin \< 70 g/L; * Severe illness warranting immediate hospital referral; * COVID-19 diagnosis or exposure in the previous two weeks \[individual may repeat eligibility assessment after deferral\]; * Presence of morbidity symptoms suggesting COVID-19 infection (fever \[temperature \> 38°C\], chills/shaking, dry cough, shortness of breath or difficulty breathing, loss of smell or taste within the past 72 hours) \[individual may repeat eligibility assessment after referral\]; * Severe acute malnutrition at baseline (weight-for-height Z-score \< -3 SD or bilateral oedema). Lactating women * Severe illness warranting immediate hospital referral; * COVID-19 diagnosis or exposure in the previous two weeks \[individual may repeat eligibility assessment after deferral\]; * Presence of morbidity symptoms suggesting COVID-19 infection (fever \[temperature \> 38°C\], chills/shaking, dry cough, shortness of breath or difficulty breathing, or loss of taste or smell within the past 72 hours) \[individual may repeat eligibility assessment after deferral\]; * Pregnancy (determined by self-report); * Cessation of lactation, or planning to discontinue breastfeeding in the next three months. Exclusion criteria during course of the intervention: Non-pregnant, non-lactating women of reproductive age * Pregnancy (determined by self-report); * Pregnancy (as ascertained via urine pregnancy test for human chorionic gonadotropin at pre-endline isotope dosing). Lactating women * Cessation of lactation (determined by self-report); * Pregnancy (determined by self-report).