Milk safety and child nutrition: Impacts of the MoreMilk project’s training scheme for informal dairy vendors

Objective
In Kenya, like most developing countries, majority rely on informal milk markets to meet their dairy
needs. In those markets, there are food safety concerns that elicit interventions ranging from policy
change to research, aimed at improving the food safety in the value chain. The MoreMilk project employs
cRCT study design to estimate the impact of an intervention on improving food safety on informal
dairy markets and promoting increased dairy intake by children.
Methods
MoreMilk intervention is a two-arm cluster-randomized control trial. Study clusters were randomly
assigned to: Treatment arm (Training, certification, and marketing scheme for vendors); Control arm:
Delayed intervention. A baseline survey was conducted and an endline survey will be done for each
arm after 12 months targeting same vendors and households. The unit of randomization is a cluster
of 1-4 vendors and the households consuming milk from those vendors. The study aims at
measuring the effect of the intervention on two primary outcomes: microbiological quality of milk sold
by vendors, measured as total bacterial counts (TBC) per mL of milk, and mean dietary adequacy of
protein, Ca, and vitamin B12. The vendor surveys include questionnaire modules on operations, milk
handling practices, and business performance. The household surveys assess milk and food
expenditure, milk handling and consumption practices, and a 24hr dietary recall for an index child.
Impact
A nutrition-sensitive approach to a market-based intervention could potentially increase the
consumption of safe, nutritious foods leading to better health outcomes for children. MoreMilk
intervention is envisaged to reduce TBC in the milk of the vendors offered the intervention compared
to a control group. It also envisages increasing the mean adequacy of three micronutrients (calcium,
protein and vitamin B12) in the households buying milk from a vendor offered the intervention
compared to households buying milk from control group vendors.