The welfare impacts of buffer stock operations in agriculture in Ghana

This dissertation examines the impacts of buffer stock operations in Ghana, as a market intervention policy in a failing market environment to guarantee that market prices only move within a desired price band by publicly announcing floor and ceiling prices to control price movement. The dissertation aims to contribute insights into how public buffer stockholding operations, targeted at smallholder farmers in a developing world setting, impacts its actors, focusing on welfare. The dissertation contributes in four ways; first testing the efficacy of buffer stocks operations, second analysing the effect of output support on smallholder farmers income, thirdly develop a new measure to measure the impact of buffer stock intervention on food security by means of the nutrient- content household dietary diversity index, and finally, investigate the effect of buffer stocks on the well-being of smallholder farmers. The results demonstrates that buffer stocks operation is still a viable policy option for governments in developing countries to stabilize commodity prices. Beyond stabilizing commodity prices, buffer stock operations intervention improves household food and nutrition security and is a poverty reduction instrument for rural communities in low-income countries. Most importantly, buffer stock operations in agriculture improve the objective and subjective wellbeing of smallholder farmers

Buffer Stock Operations and Well-Being:The Case of Smallholder Farmers in Ghana

This study investigates the possible causal relationship between buffer stock operations in Ghanaian agriculture and the well-being of smallholder farmers in a developing world setting. We analyze the differences in the objective and subjective well-being of smallholder farmers who do or do not participate in a buffer stock price stabilization policy initiative, using self-reported assessments of 507 farmers. We adopt a two-stage least square instrumental variable estimation to account for possible endogeneity. Our results provide evidence that participation in buffer stock operations improves the objective and subjective well-being of smallholder farmers by 20% and 15%, respectively. Also, with estimated coefficient of 1.033, we find a significant and robust relationship between objective well-being and subjective well-being among smallholder farmers. This relationship implies that improving objective well-being enhances the subjective well-being of the farmers. We also find that the activities of intermediaries decrease both the objective and subjective well-being of farmers. This study demonstrates that economic, social, and environmental aspects of agricultural life could constitute priorities for public policy in improving well-being, given their strong correlation with the well-being of farmers. Based on the results of this study, we provide a better understanding, which may aid policy-makers, that public buffer stockholding operations policy is a viable tool for improving the well-being of smallholder farmers in a developing country

Near vision spectacle coverage and barriers to near vision correction among adults in the Cape Coast Metropolis of Ghana

Purpose: To determine the near vision spectacle coverage and barriers to obtaining near vision correction among adults aged 35 years and older in the Cape Coast Metropolis of Ghana.Methods: A population-based cross-sectional study design was adopted and 500 out of 576 participants aged 35 years and older were examined from 12 randomly selected clusters in Cape Coast, Ghana. All participants underwent a comprehensive eye examination which included: distance and near visual acuities measurements and external and internal ocular health assessments. Distance and near refractions were performed using subjective refraction technique. Information on participants’ demographics, near vision correction status, near visual needs and barriers to acquiring near vision correction were obtained through a questionnaire administered as part of the study.Results: The mean age of participants was 52.3±10.3 years of whom 280 (56%) were females and 220 (44%) were males. The near vision spectacle coverage was 25%, 33% “met need” for near vision correction in the presbyopic population, and 64% unmet need in the entire study population. After controlling for other variables, age (5th and 6th decades) and educational level were associated with “met need” for near vision correction (OR=2.7 (1.55-4.68), p =0.00, and OR=2.36 (1.18-4.72), p=0.02 respectively). Among those who needed but did not have near vision correction, 64 (26%) did not feel the need for correction, 55 (22%) stated that they were unaware of available interventions, and 53 (21%) found the cost of near vision correction prohibitive.Conclusion: There was a low near vision spectacle coverage in this population which suggests the need for strategies on health education and promotion to address the lack of awareness of spectacle need and cost of services.Keywords: Presbyopia, near vision, spectacle coverage, unmet needs, Ghan

Near vision spectacle coverage and barriers to near vision correction among adults in the Cape Coast Metropolis of Ghana.

Purpose: To determine the near vision spectacle coverage and barriers to obtaining near vision correction among adults aged 35 years and older in the Cape Coast Metropolis of Ghana. Methods: A population-based cross-sectional study design was adopted and 500 out of 576 participants aged 35 years and older were examined from 12 randomly selected clusters in Cape Coast, Ghana. All participants underwent a comprehensive eye examination which included: distance and near visual acuities measurements and external and internal ocular health assessments. Distance and near refractions were performed using subjective refraction technique. Information on participants\u2019 demographics, near vision correction status, near visual needs and barriers to acquiring near vision correction were obtained through a questionnaire administered as part of the study. Results: The mean age of participants was 52.3\ub110.3 years of whom 280 (56%) were females and 220 (44%) were males. The near vision spectacle coverage was 25%, 33% \u201cmet need\u201d for near vision correction in the presbyopic population, and 64% unmet need in the entire study population. After controlling for other variables, age (5th and 6th decades) and educational level were associated with \u201cmet need\u201d for near vision correction (OR=2.7 (1.55-4.68), p =0.00, and OR=2.36 (1.18-4.72), p=0.02 respectively). Among those who needed but did not have near vision correction, 64 (26%) did not feel the need for correction, 55 (22%) stated that they were unaware of available interventions, and 53 (21%) found the cost of near vision correction prohibitive. Conclusion: There was a low near vision spectacle coverage in this population which suggests the need for strategies on health education and promotion to address the lack of awareness of spectacle need and cost of services

Economic costs of fever to households in the middle belt of Ghana.

BACKGROUND: Malaria is one of the main health problems in the sub-Saharan Africa accounting for approximately 198 million morbidity and close to 600,000 mortality cases. Households incur out-of-pocket expenditure for treatment and lose income as a result of not being able to work or care for family members. The main objective of this survey was to assess the economic cost of treating malaria and/or fever with the new ACT to households in the Kintampo districts of Ghana where a health and demographic surveillance systems (KHDSS) are set up to document population dynamics. METHODS: The study was a cross-sectional survey conducted from October 2009 to July 2011 using community members' accessed using KHDSS population in the Kintampo area. An estimated sample size of 4226 was randomly selected from the active members of the KHDSS. A structured questionnaire was administered to the selected populates who reported of fever within the last 2 weeks prior to the visit. Data was collected on treatment-seeking behaviour, direct and indirect costs of malaria from the patient perspective. RESULTS: Of the 4226 households selected, 947 households with 1222 household members had fever out of which 92 % sought treatment outside home; 55 % of these were females. 31.6 % of these patients sought care from chemical shops. A mean amount of GHS 4.2 (US$2.76) and GHS 18.0 (US$11.84) were incurred by households as direct and indirect cost respectively. On average a household incurred a total cost of GHS 22.2 (US$14.61) per patient per episode. Total economic cost was lowest for those in the highest quintile and highest for those in the middle quintile. CONCLUSION: The total cost of treating fever/malaria episode is relatively high in the study area considering the poverty levels in Ghana. The NHIS has positively influenced health-seeking behaviours and reduced the financial burden of seeking care for those that are insured

Community perceptions of malaria and malaria treatment behaviour in a rural district of Ghana: implications for artemisinin combination therapy

<p>Abstract</p> <p>Background</p> <p>Artesunate-amodiaquine (AS-AQ) was introduced in Ghana as the first line drug for treatment of uncomplicated malaria in 2004. We report the perceptions of malaria and malaria treatment behaviour, the community awareness of and perceptions about AS-AQ two years after the introduction of this ACT treatment for malaria.</p> <p>Methods</p> <p>Two surveys were conducted; a cross-sectional survey of 729 randomly selected household heads (urban-362, rural-367) and 282 women with children < 5 years (urban-121, rural-161) was conducted in 2006. A district wide survey was conducted in 2007 to assess awareness of AS-AQ. These were complemented with twenty-eight focus group discussions (FGDs) and 16 key informant interviews (KII) among community members and major stakeholders in the health care delivery services. All nine (9) health facilities and five (5) purposively selected drug stores were audited in order to identify commonly used anti-malarials in the study area at the time of the survey.</p> <p>Results</p> <p>Majority of respondents ( > 75%) in the sampled survey mentioned mosquito bites as the cause of malaria. Other causes mentioned include environmental factors (e.g. dirty surroundings) and standing in the sun. Close to 60% of the household heads and 40% of the care-givers interviewed did not know about AS-AQ. The community respondents who knew about and had ever taken AS-AQ perceived it to be a good drug; although they mentioned they had experienced some side effects including headaches and body weakness. Co-blistered AS-AQ was available in all the government health facilities in the study area. Different formulations of ACTs were however found in urban chemical shops but not in rural chemical stores where monotherapy antimalarials were predominant.</p> <p>Conclusion</p> <p>The knowledge of fever as a symptom of malaria is high among the study population. The awareness of AS-AQ therapy and its side-effect was low in the study area. Community education and sensitization, targeting all categories of the population, has to be intensified to ensure an efficient implementation process.</p

Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana

properly cited. Purpose. The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods. A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including 2 , independent -test, and ANOVA were done. A value ≤ 0.05 was considered statistically significant. Results. Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bell&apos;s palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm 3 . The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders ( = 2.5, = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders ( = 2.8, = 0.006). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders. Background Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) which affects all body organs either directly or by opportunistic infections, and the eye is not spared. AIDS indicates advanced HIV disease in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive There is a huge dearth of information in Ghana on ocular related findings in HIV patients. Reports from other societies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The purpose of this study was to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods Study Site. The study was carried out at the Antiretroviral Therapy (ART) Specialist Clinic of the Cape Coast Teaching Hospital in Ghana. The Cape Coast Teaching Hospital, one of the five teaching hospitals in Ghana, provides health services to people in the central and western regions and parts of Ashanti and eastern regions. It also has the mandate of training doctors and other medical staff. Study Design and Participants. The study employed a descriptive cross-sectional design. Sample size was determined based on the expression , where is the minimum sample size, is the standard normal deviation, usually set at 1.96 which corresponds to the 95% confidence interval, is the proportion in the target population estimated to have the infection (1.4% for the central region), and is the degree of accuracy desired, usually set at 5%. Consequently, a sample size of 30 was calculated. This was adjusted to 200 participants to account for attrition rate and inefficiencies associated with the sampling method. A systematic sampling method was used to recruit clinically diagnosed HIV patients, who attended the ART Specialist Clinic between January and May 2016. Based on the average daily attendance at the clinic and a determined sampling interval of three (3), the first participant was chosen by randomly selecting a number between one and three. Every third patient from the first participant was then recruited into the study. In all, 320 patients were examined within the period. Out of them, 295 patients had complete medical data and they were included in the analysis. Patients who had comorbidities such as diabetes, hypertension, and sickle cell disease were excluded from the study. Ethical Considerations. The study was conducted in accordance with the Helsinki Declaration on Research Regarding Human Subjects. Ethical clearance (ID number UCCIRB/CHAS/2015/090) was obtained from the Institutional Review Board of the University of Cape Coast. The rationale of the study was comprehensively explained to all participants after which consent forms were issued to them to sign, including local language versions which were read out to illiterate subjects who consented with a thumbprint prior to investigation. For participants below 18 years of age whose assent was sought, their parents/guardians signed the consent forms on their behalf. The participants were assured of confidentiality and safety at all times. They were also reminded of the voluntary nature of the study which granted them the right to withdraw at any point. Data Collection. The method of data collection consisted of semistructured questionnaires, laboratory investigation, medical profiles, and ophthalmic examination. Every consenting patient was assigned a specific study code. A trained investigator interviewed and filled the questionnaires for all the participants. Information obtained from the questionnaires included age, gender, occupation, religion, marital status, level of education, and duration of infection from the time of diagnosis. The patient&apos;s HIV related medical information such as the World Health Organization (WHO) clinical stage of the disease, whether the participant was on ART or not, and duration of ART usage was recorded. Blood Sample Collection and Analysis . About 3 mL of venous blood was collected from each participant and HIV biomarkers CD4 counts and viral loads were determined. Two CD4 counts were obtained for this study: nadir CD4 counts (the lowest CD4 count ever recorded) and the current CD4 counts (CD4 counts at the time of the study). It was important to evaluate both the nadir and the current CD4 counts in this study to appreciate the effect of antiretroviral therapy on CD4 and to ascertain the stage at which some HIV related ocular disorders actually occurred. Ophthalmic Examination. Ophthalmic examination was conducted by experienced eye care personnel. Presenting Distance Visual Acuity (PDVA) measurements followed by slit lamp biomicroscopy and dilated funduscopy were performed on all participants. Pinhole acuity was performed to rule out refractive error as the cause of reduced vision. Dilated fundus examination was performed with 2.5% phenylephrine ophthalmic solution. Two drops of the phenylephrine were administered at an interval of 5 minutes followed by one hour of waiting to ensure maximum papillary dilation. Journal of Ophthalmology 3 Ophthalmoscopy was then performed on each participant. Ophthalmic examination forms were correspondingly labeled for each participant. Categories of visual impairment (VI) were determined based on the International Classification of Diseases, where &quot;low vision&quot; is defined as presenting visual acuity &lt; 6/18 in the better eye Statistical Analysis. The data collected were entered into SPSS for Windows, version 21.0.1. The analysis involved the use of frequency distribution tables. Chi-square ( 2 ) test was used to determine the associations between categorical variables. Fisher&apos;s exact test was used where counts were less than 5. Independent -test and analysis of variance (ANOVA) were performed to compare the mean values of HIV biomarkers (CD4 counts and viral loads) between participants who had HIV related visual disorders and those who did not. A value ≤ 0.05 was considered statistically significant. Results A total of 320 patients were examined within the period, out of whom 295 had complete medical data and were included in the analysis. They comprised 78 (26.4%) males and 217 (73.6%) females. Their ages ranged from 10 to 83 years with mean age of 45.3 years (SD: ±11.6). According to the WHO criteria on HIV classification, majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three, one, and four that had 68 (23.1%), 62 (21%), and 3 (1%) participants, respectively. Two hundred and five (69.5%) of the participants were on antiretroviral therapy while the remaining 90 (30.5%) were not on therapy. The mean age of participants on ART was 45.9 (SD: ±11.64) years while those not on ART had a mean age of 43.8 (SD: ±11.46) years. There was no statistically significant difference between the mean ages of participants on ART and those without therapy ( = 1.4, = 0.14). The mean current CD4 count of participants on ART was lower (786.5 cells/mm 3 ) than of participants not on ART (863.8 cells/mm 3 ). This difference was, however, not significant ( = 1.3, = 0.20). Similarly, there was no significant difference between the mean viral load counts for participants on ART and those not on ART ( = 1.1, = 0.28). Majority of the participants (150, 50.8%) had normal vision of VA 6/6. One hundred and sixteen (39.3%) had mild visual impairment (VA 6/9-6/18). Twenty-nine (9.8%) of the participants had low vision (VA &lt; 6/18) out of whom 19 (65.5%) were on antiretroviral therapy. Five (17.2%) of the 29 participants were in the first clinical stage of the disease whereas 19 (65.5%) and 5 (17.2%) were in stages two and three, respectively. Low vision occurrence was lower in the ART group (9.8%) than in the non-ART group (11.1%). However, there was no significant association between low vision and ART status ( 2 = 0.24, = 0.62). Out of the 295 participants who took part in the study, 17 (5.8%) had HIV related ocular disorders of whom three were bilateral cases (making 20 eyes in all). Of these 17 participants, 4 (23.5%) were males and the remaining 13 (76.5%) were females. There was no significant association between manifestation of ocular disorders and sociodemographic factors such as gender ( = 1.00), age ( = 0.60), occupation ( = 0.38), and duration of infection from the time of diagnosis ( = 0.81). There was also no significant difference between the mean ages of patients who manifested ocular disorders and those who did not ( = 0.2, = 0.80). The most prevalent HIV related ocular disorder in this study was retinal microvasculopathy (10, 58.8%). The mean CD4 count for participants with this disorder was 142 cells/mm 3 with a mean viral load of 20,308 copies/mL. Herpes zoster ophthalmicus and Toxoplasma retinochoroiditis each accounted for 2 (11.8%) of the ocular disorders found. Participants who had HZO recorded a mean CD4 count of 269 cells/mm 3 and mean viral load of 38,090 copies/mL. Cytomegalovirus retinitis was responsible for only 1 (5.9%) case and it occurred in a participant with a CD4 count of 136 cells/mm 3 and the highest viral load count of 1,474,676 copies/mL. Neuroophthalmic disorders found were Bell&apos;s (hemifacial) palsy and optic neuritis, each accounting for (1, 5.9%) of the cases. Participants who had HIV related ocular disorders had significantly lower mean values of nadir CD4 counts (172 cells/mm 3 ) when compared to those who did not have ocular disorders (309 cells/mm 3 ) ( = 0.012). This mean CD4 count (172 cells/mm 3 ) indicates that the patients who manifested HIV related ocular disorders had severe immune suppression (i.e., CD4 &lt; 250 cells/mm 3 ). Also, patients who manifested HIV related ocular disorders recorded significantly higher mean values of viral load copies as compared to their counterparts who did not manifest ocular disorders ( = 0.006). However, no significant association was found between ocular disorders and current CD4 counts ( = 0.10). Non-HIV related ocular conditions such as nonneurological blepharoptosis, pingueculae, pterygia, conjunctivitis, cataract, and glaucoma suspects were also found in the study population. Majority (11, 64.7%) of the participants who had 4 Journal of Ophthalmology HIV related ocular disorders were at stage two of the disease while 4 and 2 were at stages one and three, respectively. There was, however, no association between ocular manifestation and clinical stage of the disease ( 2 = 1.213, = 0.724). Again, no association was found between ART usage and ocular manifestation ( 2 = 0.110, = 1.000). Discussion Previous studies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The current study sought to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. The 5.8% prevalence of HIV related ocular disorders in the present study was lower than in a recently published study from the Ashanti region of Ghana where the authors reported ocular complications in 48% The finding of 9.8% low vision in this study was higher than the 3.1% reported by Abokyi et al. [20] also in the Cape Coast Metropolis in Ghana. HIV retinal microvasculopathy being the most common HIV related ocular manifestation is consistent with the recent report from the Ashanti region, Ghana Herpes zoster ophthalmicus as the second most common ocular disorder was comparable with reported cases from Nigeria and Cameroon The finding on CMV retinitis is consistent with that in Ethiopia Conclusion Consistent with other findings, our study suggests that ocular manifestations in HIV patients are heightened by reduced CD4 counts and corresponding higher viral load copies. Particularly, CMV retinitis was associated with extremely high viral load copies though it was very rare. Ethical Approval Ethical clearance with certificate ID UCCIRB/CHAS/2015/ 090 was obtained from the Institutional Review Board of the University of Cape Coast. Consent Participants and guardians provided informed consent by thumbprinting or signatures after freely agreeing to participate. Competing Interests The authors declare that they have no competing interests. Authors&apos; Contributions Emmanuel Kwasi Abu, Samuel Abokyi, Richard Kobina Dadzie Ephraim, and Daniel Afedo conceived the study idea and participated in its design and data analysis and in the manuscript preparation. Emmanuel Kwasi Abu, Samuel Abokyi, Dorcas Obiri-Yeboah, Daniel Afedo, and Samuel Bert Boadi-Kusi participated in the clinical examination of patients and in the data analysis and were also involved in reviewing the manuscript. Richard Kobina Dadzie Ephraim and Lawrence Duah Agyeman conducted the laboratory analysis of the samples. All authors read and approved the final manuscript

Family Planning Awareness, Perceptions and Practice among Community Members in the Kintampo Districts of Ghana

Family planning is known to prevent maternal deaths, but some social norms, limited supplies and inconsistent use makes this difficult to achieve in most low- and middle-income countries. In spite of the high fertility levels in most sub-Saharan African countries and the potential economic benefits of family planning, its patronage remains very low in the sub-region. This study was with the objective of identifying the levels of awareness, utilization, access to and perceptions about family planning and contraception. A cross-sectional study design was used for the study, with data collected from multiple sources using both quantitative and qualitative approaches. Relevant findings included a marked disconnect between family planning/contraceptive knowledge and use. The pills and injectables were the most frequently used, but females in the study population poorly patronised emergency contraception. Supplies of most family planning methods were found to be health facility based, requiring clients to have to necessarily go there for services. Some respondents harboured perceptions that family planning was the responsibility of females alone and that it fuelled promiscuity among female users. Recommendations made include ensuring that health facilities had adequate staff and expertise to provide facility-based family planning services and also to disabuse the minds of community members of the negative perceptions towards family planning

Provider compliance to artemisinin-based combination therapy at primary health care facilities in the middle belt of Ghana.

BACKGROUND: In 2004, Ghana implemented the artemisinin-based combination therapy (ACT) policy. Health worker (HW) adherence to the national malaria guidelines on case-management with ACT for children below 5 years of age and older patients presenting at health facilities (HF) for primary illness consultations was evaluated 5 years post-ACT policy change. METHODS: Cross-sectional surveys were conducted from 2010 to 2011 at HFs that provide curative care as part of outpatient activities in two districts located in the middle belt of Ghana to coincide with the periods of low and high malaria transmission seasons. A review of patient medical records, HW interviews, HF inventories and finger-pricked blood obtained for independent malaria microscopy were used to assess HW practices on malaria case-management. RESULTS: Data from 130 HW interviews, 769 patient medical records at 20 HFs over 75 survey days were individually linked and evaluated. The majority of consultations were performed at health centres/clinics (68.3 %) by medical assistants (28.6 %) and nurse aids (23.5 %). About 68.4 % of HWs had received ACT-specific training and 51.9 %, supervisory visits in the preceding 6 months. Despite the availability of malaria diagnostic test at most HFs (94 %), only 39.8 % (241) out of 605 (78.7 %) patients who reported fever were investigated for malaria. Treatment with ACT in line with the guidelines was 66.7 %; higher in <5 children compared to patients ≥5 years old. Judged against reference microscopy, only 44.8 % (107/239) of ACT prescriptions that conformed to the guidelines were "truly malaria". Multivariate logistic regression analysis showed that HW were significantly more likely to comply with the guidelines if treatment were by low cadre of health staff, were for children below 5 years of age, and malaria test was performed. CONCLUSION: Although the majority of patients presenting with malaria received treatment according to the national malaria guidelines, there were widespread inappropriate treatment with ACT. Compliance with the guidelines on ACT use was low, 5 years post-ACT policy change. The Ghana NMCP needs to strengthen HW capacity on malaria case-management through regular training supported by effective laboratory quality control measures

The impact of agricultural marketing program on farm investment: Evidence from Ghana

This study investigates the impact of agricultural marketing program on smallholder investment behavior. The study is based on cross-sectional household data from a survey of 507 smallholder maize farmers from rural communities in Ghana. The study employed propensity score matching (PSM) to estimate the average treatment effect of the marketing program on farmers' investment behavior. The results show that smallholder farmers' participation in buffer stock marketing program is influenced positively by gender, transportation cost and access to extension service and negatively by marital status among others. Overall, the results show that the buffer stock marketing program has positive impacts on smallholder farmers' investment behavior of increasing input usage, farm expansion and yield smallholder farmers. However, the highest impact is on farm expansion. The results of the study reveal that the marketing program stimulates investment in farm size expansion more than in inputs usage. To derive the most impact from the program, a possible review of the program could look at strategy of focusing on the implementation of the program in rural areas rather than in peri-urban areas where land access is more constrained. This study contributes to a better understanding of f farmers' investment behavior of input usage and farm expansion. This knowledge could help policymakers and development organizations shape future interventions for increased uptake