Milk safety and child nutrition impacts of the MoreMilk training, certification and marketing scheme for informal dairy vendors: a cluster-randomized controlled trial in Eldoret, Kenya

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Poster by Silvia Alonso, Emmanuel Muunda, Moira Donahue Angel, Emily Kilonzi, Giordano Palloni, Gideon Kiarie, Paula Dominguez-Salas, Delia Grace and Jef L. Leroy presented at the Micronutrient Forum 6th Global Conference, The Hague, Netherlands, 16 October 2023.

Impact
Vendors
70
Female (%)
103
Milk sold/wk
(median, liter)
24
Age of
business
(median, mo)
Milk safety and child nutrition impacts of theMoreMilk training,
certificationand marketing scheme for informal dairy vendors: a
cluster-randomized controlled trial in Eldoret, Kenya
Silvia Alonso, Emmanuel Muunda, Moira Donahue Angel, Emily Kilonzi, Giordano Palloni, Gideon
Kiarie, Paula Dominguez-Salas, Delia Grace, Jef L Leroy
Baseline
mean ± SE
Endline
mean ± SE
Impact
β ± SE
Control Treatment Control Treatment
Ln total bacterial count 13.79 ± 0.54 14.23 ± 0.48 13.46 ± 0.6 13.14 ± 0.54 -0.33 ± 0.8
Ln total enterobacteria
count
11.62 ± 0.56 11.88 ± 0.56 10.87 ± 0.63 10.84 ± 0.55 -0.03 ± 0.83
Milk safety (vendors)
Baseline
mean ± SE
Endline
mean ± SE
Impact
β ± SE
Control Treatment Control Treatment
Mean adequacy ratio
(protein, vit B12, Ca)
2.53 ± 1.03 2.53 ± 1.03 2.39 ± 1.03 2.61 ± 1.03 7% ± 4%
Milk intake, mL/d 313 ± 12 309 ± 12 323 ± 12 371 ± 12 40 ± 15*
Child acute diarrhea, %
(past 2 weeks)
11.75 ± 1.57 12.26 ± 1.59 5.80 ± 1.21 5.90 ± 1.22 0.08 ± 1.71
Mean probability of
adequacy
0.93 ± 0.00 0.94 ± 0.00 0.96 ± 0.00 0.97 ± 0.00 0.01 ± 0.00*
Nutrition (children 2-5 y in customer households)
Intervention
The intervention, targeted to
informal milk vendors in Eldoret,
Kenya, had 3 components:
Training (15 h)
on milk
handling and
safety, and
business skills
Microbiological
testing of milk
and reporting
of lab results to
vendors
Milk marketing
campaign at
vendor shops
Study population
Households
4.4
Household
size
12-48
Child age
baseline (mo)
64
moderately/
severely food
insecure (%)
Key findings
Lack of observable effect on food safety might be due to…
• Microbiological quality of milk compromised earlier in the supply chain
• Failure to sustain effect overtime
Milk intake in children increased…
… not at the expense of mean probability of micronutrient adequacy
The MoreMilk intervention led to improvements in self-reported practices
and outcomes (process evaluation)
• Increased milk testing for quality
• Stronger negotiation with suppliers
• Better communication with customers around attributes of milk
• Increased sales
Contact: s.alonso@cgiar.org; j.leroy@cgiar.org
Evaluation design
Follow-up survey:
households &
vendors
Oct-Nov 2022
Vendors
recruited
(n=283)
Baseline survey:
households &
vendors
Oct-Nov 2021
census
Up to 10
households per
vendor recruited
(n=954)
milk testing
& reporting
milk marketing campaign
training
Random
allocation
(clusters of
vendors)
training
milk testing
& reporting
intervention
control
Motivation
• Informal vendors are the primary source of milk for most households in Kenya.
• Informally traded milk is often unsafe and prone to adulteration.
• Professionalizing the informal sector holds promise to improve milk safety, but
the effectiveness has not been evaluated.

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Milk safety and child nutrition impacts of the MoreMilk training, certification and marketing scheme for informal dairy vendors: a cluster-randomized controlled trial in Eldoret, Kenya

1. Impact Vendors 70 Female (%) 103 Milk sold/wk (median, liter) 24 Age of business (median, mo) Milk safety and child nutrition impacts of theMoreMilk training, certificationand marketing scheme for informal dairy vendors: a cluster-randomized controlled trial in Eldoret, Kenya Silvia Alonso, Emmanuel Muunda, Moira Donahue Angel, Emily Kilonzi, Giordano Palloni, Gideon Kiarie, Paula Dominguez-Salas, Delia Grace, Jef L Leroy Baseline mean ± SE Endline mean ± SE Impact β ± SE Control Treatment Control Treatment Ln total bacterial count 13.79 ± 0.54 14.23 ± 0.48 13.46 ± 0.6 13.14 ± 0.54 -0.33 ± 0.8 Ln total enterobacteria count 11.62 ± 0.56 11.88 ± 0.56 10.87 ± 0.63 10.84 ± 0.55 -0.03 ± 0.83 Milk safety (vendors) Baseline mean ± SE Endline mean ± SE Impact β ± SE Control Treatment Control Treatment Mean adequacy ratio (protein, vit B12, Ca) 2.53 ± 1.03 2.53 ± 1.03 2.39 ± 1.03 2.61 ± 1.03 7% ± 4% Milk intake, mL/d 313 ± 12 309 ± 12 323 ± 12 371 ± 12 40 ± 15* Child acute diarrhea, % (past 2 weeks) 11.75 ± 1.57 12.26 ± 1.59 5.80 ± 1.21 5.90 ± 1.22 0.08 ± 1.71 Mean probability of adequacy 0.93 ± 0.00 0.94 ± 0.00 0.96 ± 0.00 0.97 ± 0.00 0.01 ± 0.00* Nutrition (children 2-5 y in customer households) Intervention The intervention, targeted to informal milk vendors in Eldoret, Kenya, had 3 components: Training (15 h) on milk handling and safety, and business skills Microbiological testing of milk and reporting of lab results to vendors Milk marketing campaign at vendor shops Study population Households 4.4 Household size 12-48 Child age baseline (mo) 64 moderately/ severely food insecure (%) Key findings Lack of observable effect on food safety might be due to… • Microbiological quality of milk compromised earlier in the supply chain • Failure to sustain effect overtime Milk intake in children increased… … not at the expense of mean probability of micronutrient adequacy The MoreMilk intervention led to improvements in self-reported practices and outcomes (process evaluation) • Increased milk testing for quality • Stronger negotiation with suppliers • Better communication with customers around attributes of milk • Increased sales Contact: s.alonso@cgiar.org; j.leroy@cgiar.org Evaluation design Follow-up survey: households & vendors Oct-Nov 2022 Vendors recruited (n=283) Baseline survey: households & vendors Oct-Nov 2021 census Up to 10 households per vendor recruited (n=954) milk testing & reporting milk marketing campaign training Random allocation (clusters of vendors) training milk testing & reporting intervention control Motivation • Informal vendors are the primary source of milk for most households in Kenya. • Informally traded milk is often unsafe and prone to adulteration. • Professionalizing the informal sector holds promise to improve milk safety, but the effectiveness has not been evaluated.

Milk safety and child nutrition impacts of the MoreMilk training, certification and marketing scheme for informal dairy vendors: a cluster-randomized controlled trial in Eldoret, Kenya

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Milk safety and child nutrition impacts of the MoreMilk training, certification and marketing scheme for informal dairy vendors: a cluster-randomized controlled trial in Eldoret, Kenya