Presentation by Emmanuel Muunda and Silvia Alonso at the 16th International Symposium of Veterinary Epidemiology and Economics, Halifax, Canada, 12 August 2022.

1. Better lives through livestock
Milk safety and child nutrition: Impacts of
the MoreMilk project’s training scheme for
informal dairy vendors
Emmanuel Muunda and Silvia Alonso
International Livestock Research Institute
22nd International Symposium of Veterinary Epidemiology and Economics (ISVEE 22)
Halifax, Canada, 5–12 August 2022

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MoreMilk: making the most of milk

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MoreMilk: making the most of milk

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The MoreMilk project
• A cluster randomized control trial
• Target population: Informal dairy
vendors (raw milk sellers) and their
customers
• Intervention: training, certification and
marketing scheme for dairy vendors
• Peri-urban areas in Kenya (Nairobi,
Eldoret)
• 4.6M; Donors: Bill & Melinda Gates
Foundation, UK Aid, CGIAR donors

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Primary outcomes
 Food safety outcome:
Microbiological quality:
Total bacterial counts in milk sold
by vendors
 Nutrition outcome:
Mean dietary adequacy of protein,
calcium and vitamin B12 (3 key
milk nutrients) in children 12–48
months at baseline

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Secondary outcomes
 Enterobacteriaceae counts in milk at
selling
 Milk handling knowledge and
practices
 Business revenue
 Women-vendor empowerment

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Why an RCT?
• We wanted unquestionable evidence to engage the politicized policy
and decision-making environment.
• Better approach for causality inference
• We had designed ‘light touch’ intervention that needed testing.
• We had some evidence on effect on food safety, but none on nutrition.
• Donor interest

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Challenges encountered
 Level of compliance to procedure:
 Trainings not fully attended
 Seasonality driving high market turnover = attrition
 Participants’ fatigue
 Controls motivation
 Life goes on! Many things can affect the implementation, the
participants, the intervention, the outcomes…
 Management of expectations

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Want to conduct a RCT in an informal food market?
Design
 Labour-intensive!
Logistics
 Informal markets are sensitive to time and seasons – plan
Attrition
 Keep engaging control groups
 Expectations – misunderstandings
Consider process evaluation (PE): RCT addresses the
counterfactual; PE ‘audits’ the implementation

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Acknowledgements: MoreMilk project
Funders Project partners

11. THANK YOU