Presentation by Silvia Alonso at the Agriculture, Nutrition and Health (ANH) Academy Week, Lilongwe, Malawi, 27 June 2023.

1. Better lives through livestock
Milk safety and child nutrition impacts of a training,
certification and marketing Scheme for informal dairy vendors
in Kenya: The MoreMilk project
Silvia Alonso
Principal Scientist - Epidemiologist, MoreMilk project PI
Animal and Human Health Program, ILRI
ANH Academy Week, Lilongwe, Malawi
27 July 2023

2. MOREMILK
PROJECT
Making the
most of milk

3. 3
FOOD SAFETY
OUTCOME - Total bacterial count in milk at the
vendor business
NUTRITION
OUTCOME – dietary adequacy of protein, Ca, and
vitamin B12 for children 12–48 months
PRIMARY OUTCOMES

4. 4
Intervention – 3 components
1. TRAINING (15 hrs) on milk handling and business skills

5. 5
Intervention – 3 components
1. TRAINING (15 hrs) on milk handling
and business skills
2. VISITS TO VENDORS reporting lab results

6. 6
Intervention – 3 components
1. TRAINING (15 hrs) on milk handling
and business skills
2. VISITS TO VENDORS reporting lab
results
3. MILK MARKETING CAMPAIGN

7. 7
Cluster Randomized Control Trial
ENDLINE
Oct/Nov 2022
TRAINING
Vendors
recruited
(n=283)
TRAINING
BASELINE
Oct/Nov 2021
CENSUS
≤ 10HHs /
vendor
(n=1014)
VISIT 1 VISIT 2
MARKETING CAMPAIGN

8. 8
Intervention effect – FOOD SAFETY OUTCOME
Baseline mean ± SEa Endline mean ± SEa Impact estimates β ± SE
Control Treatment Control Treatment Model 1 Model 2 Model 3
unadjusted adjusted adjusted
Ln Total Bacterial Count in
milk 13.79 ± 0.54 14.23 ± 0.48 13.46 ± 0.6 13.14 ± 0.54 -0.33 ± 0.8 -0.44 ± 0.81 -0.46 ± 0.86
Ln Total Enterobacteria
Count in milk 11.62 ± 0.56 11.88 ± 0.56 10.87 ± 0.63 10.84 ± 0.55 -0.03 ± 0.83 -0.08 ± 0.85 -0.11 ± 0.9
• Microbiological quality of milk affected by
earlier steps in the supply chain
• Failure to sustain effect overtime
• Capital investments needed
• Other secondary outcomes to be analysed

9. 9
Intervention effect – NUTRITION OUTCOME
• Increase of 40–50ml/d of milk intake in
treatment group compared to control
• No difference in diet adequacy on calcium,
protein and vitamin B12
• No difference in child acute diarrhoea incidence
Baseline mean ± SEa Endline mean ± SEa Impact estimates β ± SE
Control Treatment Control Treatment Model 1 Model 2 Model 3
unadjusted adjusted adjusted
Ln mean adeq ratio
(incl. breastmilk intake) 0.95 ± 0.03 0.95 ± 0.03 0.89 ± 0.03 0.97 ± 0.03 0.09 ± 0.05 0.07 ± 0.04 0.07 ± 0.04
Milk intake mL/d - all
milk types 313.47 ± 11.63 308.82 ± 11.79 323.15 ± 12.10 371.20 ± 12.16 48.05 ± 17.16** 43.82 ± 15.53** 40.24 ± 15.39**
Child acute diarrhea, % 11.75 ± 1.57 12.26 ± 1.59 5.80 ± 1.21 5.90 ± 1.22 0.09 ± 1.71 0.38 ± 1.71 0.09 ± 1.71

10. The intervention should consider:
• Complementing the intervention
with actions along the value chain.
• Access to credit - change of
practices will require investments
• Expand milk marketing strategy
(diets?)
• A design that suits a sector where
there is a large turnover of
businesses

11. THANK YOU