Does ownership of improved dairy cow breeds improve child nutrition? A pathway analysis for Uganda

Evidence on Milk Consumption and Production Linkages from Rural Bihar, India

Background

Milk is an important source of protein for many Indian households. However, milk intake is very low. Hence, it is necessary to examine production-consumption linkages of milk within the paradigm of accessibility, availability, and affordability.

Objectives

This study examined linkages between milk consumption and production, accounting for sales and factors associated with production investments in rural Bihar, a major milk-producing state of India with very poor nutritional status.

Methods

A panel of households from the Gaya and Nalanda districts of Bihar were surveyed: the first round in July and August 2019 (n = 2026 households) and the second round from December 2019 to January 2020 (n = 2001 households). Data were collected on household consumption, production, and sale of milk, as well as other foods. The study examines the consumption-production linkage of milk and the association of dietary diversity with consumption from own production, with households as the unit of analysis. Ordinary least square regression analysis of average monthly household milk consumption was used to identify factors associated with milk consumption, particularly milk production.

Results

The median (Quartile 1, Quartile 3) per capita milk consumption per day was 83.3 (41.6, 166.6) mL in the milk-consuming households. Average monthly household milk consumption in liters was higher in milk-producing households [β: 7.1; 95% confidence interval (CI): 6.1, 8.1] than households relying on market purchases. Household milk consumption was higher in the third tertile of milk production than the first tertile of production (β: 14.3 L/wk; 95% CI: 12.1, 17.2) and lower in the highest tertile of household sale quantity (β: -8.8 L/wk in tertile 3, 95% CI: -12.7, -5) than the first tertile of household sale quantity of milk.

Conclusions

The study provides evidence that consumption of milk in rural households is associated with own production such that households with higher production consume more. However, sale preferences restrict the quantity of milk consumed in milk-producing households.

The glass of milk half-empty? Dairy development and nutrition in low and middle income countries

Dairy products have an exceptionally rich nutrient profile and have long been promoted in high income countries to redress child malnutrition. But given all this potential, and the high burden of undernutrition in low- and middle-income countries (LMICs), why isn't dairy consumption more actively promoted in the developing world? In this review we focus on a broadly defined concept of "dairy development" to include production, trade, marketing, regulation, and demand stimulation. We address three key questions. First, how strong is the evidence on the importance of dairy production and consumption for improving nutrition among young children in LMICs? Second, which regions have the lowest consumption of dairy products? Third, what are the supply- and demand-side challenges that prevent LMICs from expanding dairy consumption? We argue that although more nutrition- and consumer-oriented dairy development interventions have tremendous potential to redress undernutrition in LMICs, the pathways for achieving this development are highly context-specific: LMICs with significant agroecological potential for dairy production primarily require institutional solutions for the complex marketing challenges in perishable milk value chains; lower potential LMICs require consumer-oriented trade and industrial approaches to the sector's development. And all dairy strategies require a stronger focus on cross-cutting issues of nutrition education and demand creation, food safety and quality, gender and inclusiveness, and environmental sustainability and resilience. We conclude our review by emphasizing important areas for research and policy expansion.

Associations between livestock keeping, morbidity and nutritional status of children and women in low- and middle-income countries: a systematic review

Livestock keeping can positively influence the nutritional status of populations and households through increased consumption of animal-source foods (ASF) and other indirect pathways, but can also adversely affect health by increasing the risk of diseases. We conducted a systematic review synthesising the current state of knowledge on the associations among livestock keeping, infectious disease and the nutritional status of children under 5 years and women of reproductive age in low- and lower-middle-income countries (LMICs). A comprehensive search of 12 electronic databases and grey literature sources published from 1991 to the end of December 2020 was conducted. Investigations exploring relationships between livestock keeping and risk of infectious disease transmission and nutritional status were selected using pre-defined inclusion criteria. After screening and filtering of 34,402 unique references, 176 references were included in the final synthesis. Most (160/176, 90.1%) of the references included in the final synthesis were from sub-Saharan Africa (SSA) and Asia. About two out of every five (42%) studies reviewed showed that livestock production is associated with improved height-for-age Z scores (HAZ) and weight-for-length/height Z scores (WHZ), while close to a third (30.7%) with improved weight-for-age Z scores (WAZ). Similarly, livestock production showed a positive or neutral relationship with women's nutritional status in almost all the references that reported on the topic. Conversely, four-fifths (66/81, 79.5%) of the references reporting on infection and morbidity outcomes indicated that livestock keeping is linked to a wide range of infectious disease outcomes, which are spread primarily through water, food and insects. In conclusion, in many LMIC settings, livestock production is associated with better nutritional outcomes but also a higher risk of disease transmission or morbidity among women and children.This review was prospectively registered on PROSPERO 2020 [CRD42020193622].

Household dairy production, dairy intake, and anthropometric outcomes in rural Bangladesh

We assess whether ownership of dairy cows is associated with a greater likelihood of consuming dairy products and with child anthropometric status in rural Bangladesh. Consistent with the assumption of imperfectly functioning markets for dairy products, ownership of dairy cows increases the likelihood that a child 6-59 months consumes milk by 7.7 percentage points with no difference in this association between boys and girls. This association nearly doubles in magnitude when we consider households that own a dairy cow that produced milk in the last year. This result is robust to the controls we use and the way in which we measure dairy cow ownership. Even when we saturate our model with child, maternal, household, wealth, as well as village fixed effects, we retain an association between dairy cow ownership and height-for-age z scores (HAZ) that is meaningful in magnitude - 0.13 standard deviations - and statistically significant at the one percent level. For children in the 12-23.9 month age group, ownership of a dairy cow is associated with a 0.37 SD increase in HAZ and a reduction of 11.3 percentage points in stunting. There is no statistically significant association with weight-for-height or wasting. These associations do not differ between boys and girls.

The impact of livestock interventions on nutritional outcomes of children younger than 5 years old and women in Africa: a systematic review and meta-analysis

Background

Nutrition-sensitive livestock interventions have the potential to improve the nutrition of communities that are dependent on livestock for their livelihoods by increasing the availability and access to animal-source foods. These interventions can also boost household income, improving purchasing power for other foods, as well as enhance determinants of health. However, there is a lack of synthesized empirical evidence of the impact and effect of livestock interventions on diets and human nutritional status in Africa.

Objective

To review evidence of the effectiveness of nutrition-sensitive livestock interventions in improving diets and nutritional status in children younger than 5 years old and in pregnant and lactating women.

Methods

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of published studies reporting on the effect of livestock interventions on maternal and child nutrition in Africa. Data were extracted, synthesized, and summarized qualitatively. Key outcomes were presented in summary tables alongside a narrative summary. Estimation of pooled effects was undertaken for experimental studies with nutritional outcomes of consumption of animal-source foods (ASFs) and minimum dietary diversity (MDD). Fixed effects regression models and pooled effect sizes were computed and reported as odds ratios (ORs) together with their 95% confidence intervals (CI).

Results

After the screening, 29 research papers were included in the review, and of these, only 4 were included in the meta-analysis. We found that nutrition-sensitive livestock interventions have a significant positive impact on the consumption of ASFs for children < 5 years (OR = 5.39; 95% CI: 4.43-6.56) and on the likelihood of meeting minimum dietary diversity (OR = 1.89; 95% CI: 1.51-2.37). Additionally, the impact of livestock interventions on stunting, wasting, and being underweight varied depending on the type of intervention and duration of the program/intervention implementation. Therefore, because of this heterogeneity in reporting metrics, the pooled estimates could not be computed.

Conclusion

Nutrition-sensitive livestock interventions showed a positive effect in increasing the consumption of ASFs, leading to improved dietary diversity. However, the quality of the evidence is low, and therefore, more randomized controlled studies with consistent and similar reporting metrics are needed to increase the evidence base on how nutrition-sensitive livestock interventions affect child growth outcomes.

Growth in milk consumption and reductions in child stunting: Historical evidence from cross-country panel data

Agricultural and food policies are increasingly being tasked with doing more to improve the nutritional status of low-income populations, especially reductions in child stunting. Which specific food sectors warrant additional policy attention is less clear, although a growing body of research argues that increased animal-sourced food consumption in general, and increased dairy consumption specifically, can significantly reduce the risks of stunting, as well as deficiencies in micronutrients and high quality protein. However, experimental research on dairy's impacts on child growth in developing countries is very limited, and non-experimental evidence is confined to cross-sectional surveys. In this study we adopt a more macro lens by using a cross-country panel to show that increases in milk consumption over time are associated with large reductions in child stunting even after controlling for important confounding factors. Countries with high rates of stunting should therefore consider nutrition-sensitive strategies to increase dairy consumption among young children through both supply- and demand-side interventions.

The effect of extreme weather events on child nutrition and health

This study traces the causal effects of extreme weather events on nutritional and health outcomes among rural children in Uganda using four waves of individual child survey data (2009–2014). A simultaneous regression model was applied for causal inference while also accounting for households’ adaptive responses. The study finds the evidence of a significant negative relationship between extreme weather events and availability of calories and nutrients for children. In particular, droughts reduced calorie, protein and zinc supply, and overall diet diversity by 67%, 37%, 28% and 30%, respectively. We further traced the effects of this reduced calorie and nutrient availability on child health indicators. A 10% decrease in zinc supply decreased height-for-age z-scores (HAZ) by around 0.139 - 0.164 standard deviations (SD), and increased probability of stunting ranging from 3.1 to 3.5 percentage points. Both boys and girls HAZ and stunting rates were sensitive to nutrient inadequacies. Different coping and adaptation strategies significantly influenced rural households’ ability to safeguard children’s nutrition and health against the effects of extreme weather. The findings of this study provide specific insights for building ex-ante resilience against extreme weather events, particularly when compared to ex-post, unsustainable, and often costlier relief actions.

Do smallholder farmers belong to the same adopter category? An assessment of smallholder farmers innovation adopter categories in Ghana

More often than not, good innovations introduced to farmers failed to be adopted or diffused among them, simply because the complexities and the variations in farmers' innovation adoption are not well explore. This study aims to analyse the innovation adopter categories that smallholder farmers belong to in Ghana and how their socioeconomic attributes influence their innovativeness. A survey was employed to gather information from smallholder farmers in Ghana. The data obtained from the survey were analysed using the SPSS version 22 and the Individual Innovativeness (II) scales. The hypotheses were tested using the Logistic regression model. The results indicated a large number (36.6%) of the smallholder farmers belong to the late majority of the innovation adopter category. Also, more than three-quarters of the farmers were classified as low innovators. Factors such as farmer education and gender were found to be insignificant to their innovativeness, while other prominent factors were significant to farmers' innovativeness. The study also made a novel revelation on Roger's innovation adopter categorisation values. The study concluded that smallholder farmers in the study area do not belong to a homogenous innovation adopter category. Also, educated farmers without income are less innovative. It was therefore recommended that stakeholders introducing new technologies to smallholder farmers should develop attractive marketing packages combined with videos and pictures to educate farmers on the new products, to speed up adoption.

Dairy Animal Ownership and Household Milk Production Associated with Better Child and Family Diet in Rural Nepal during the COVID-19 Pandemic

The economic and health crises related to the COVID-19 pandemic raised considerable concern about child and family diet, especially among small-holder farming households in low- and middle-income countries (LMIC). In rural Nepal, 309 families (including 368 children aged 6−66 months) were enrolled pre-COVID-19 in a prospective study of a nutrition education intervention and family milk consumption. The intervention could not be implemented due to COVID-19; however, child and family diet was assessed in three household surveys (one before and two during the pandemic). Over time, after adjusting for child and household factors, child and family diet quality declined (reduced diet diversity, consumption of milk and animal-source-foods (ASF)). However, in dairy-animal-owning (vs. non-dairy-animal-owning) households, both children and family were more likely to consume milk (aOR respectively 2.88× (p < 0.05), 5.81× (p < 0.001)). Similarly, in households producing >3.5 L/d milk (vs. ≤3.5 L/d), children and family members were more likely to consume milk (respectively 7.45× and 11.88× (both p < 0.001)). Thus, the overall decline in child and family diet quality, especially related to milk consumption, was buffered independently by household ownership of ≥1 dairy animals (cow or buffalo) and by milk production >3.5 L/day. A better understanding of these protective factors might facilitate the development of interventions to promote resilience in future crises.

Farm-level production diversity and child and adolescent nutrition in rural sub-Saharan Africa: a multicountry, longitudinal study

BACKGROUND

Child malnutrition remains widespread in sub-Saharan Africa, especially in rural areas where many households are involved in subsistence farming. Increasing farm-level production diversity (FPD) is often considered a useful strategy to improve child diets and nutrition, but the empirical evidence is mixed. Most studies have investigated associations between FPD and dietary diversity. We therefore aimed to analyse associations between FPD and child and adolescent nutritional status.

METHODS

In this multicountry, longitudinal study, we used representative panel data from four countries in sub-Saharan Africa (Ethiopia, Malawi, Tanzania, and Uganda) to test the hypothesis that higher FPD is positively associated with child and adolescent nutritional status. The data were from the Living Standards Measurement Study-Integrated Surveys on Agriculture collected between 2008 and 2019. We included data from all children and adolescents aged 0-18 years with available anthropometric data who were living in households involved in farming activities for home consumption, market sales, or both. FPD was measured in terms of the number of different crop and livestock species and food groups produced on each farm. Child and adolescent nutritional status was measured in terms of height-for-age Z scores (HAZ). We estimated panel data regression models with correlated random effects to control for confounding factors and time-invariant unobserved heterogeneity.

FINDINGS

The total sample size included 50 689 child and adolescent observations. In combined models, with data from all countries included, we found one additional species produced on the farm (crop and livestock combined) was associated with a mean 0·015 SD greater child or adolescent HAZ (p<0·0001). The role of FPD tended to decrease with better market access (in more remote locations mean 0·020 SD [p<0·0001] and in less remote locations mean 0·008 SD [p=0·091]). In individual-country models, the effects were smaller and statistically insignificant in three of the four countries. Livestock diversity had larger positive associations with HAZ than crop diversity (livestock diversity effect on HAZ mean 0·085 SD [p<0·0001] and crop diversity effect on HAZ mean 0·007 SD [p=0·080]). In Tanzania and Uganda, higher crop diversity was negatively associated with child and adolescent HAZ.

INTERPRETATION

Our findings suggest that further farm-level diversification is not a suitable general strategy to improve child and adolescent nutrition but might be useful in some situations. Livestock production seems to be conducive for improving child and adolescent nutrition on average. Context-specific approaches need to be developed.

FUNDING

None.

Association of Livestock Ownership and Household Dietary Quality: Results from a Cross-Sectional Survey from Rural India

Studies from India and several eastern African countries found that the impact of dairy animal ownership on household nutrition varied greatly, depending on the socio-geographic context. The purpose of this study was to examine the association between livestock ownership and household dietary quality in rural Kolar district, India. We collected data from a household survey in four study villages (n = all 195 households of the four villages) of Kolar district, applying a cross-sectional design. Kendall's rank correlation coefficient was employed to determine the correlation between milk consumption and other dietary variables. Multivariable logistic regression was used to describe the relationship between dairy animal ownership and household milk consumption. Households owning dairy animals more often had access to irrigation (58.3% vs. 25.2%) and were less often woman-headed (2.4% vs. 22.5%). Household milk consumption was significantly correlated with consumption of vegetable variety, egg, and meat (all p-values < 0.05). After adjusting for multiple confounders, the odds ratio of milk consumption between dairy animal-owning households as compared to other households was 2.11 (95% confidence interval 0.85, 5.45). While dairy animal ownership was found to be associated with improved dietary quality, larger households were in a better position to adopt dairy animals, which, in turn, might contribute to better household nutrition.

Sustained intake of animal-sourced foods is associated with less stunting in young children

The value of animal-sourced foods (ASFs) in providing key nutrients, particularly for child growth and where diets are of low quality, is understood mainly from cross-sectional assessment of current consumption. Longitudinal panel data from Nepal, Bangladesh and Uganda were used here to assess associations among previous (lagged) and contemporaneous ASF intake with linear growth of children aged 6-24 months. Lagged ASF consumption was significantly correlated with a 10% decline in stunting in Nepali children who consumed any ASF in the previous year, while current intake was associated with a 9% decline in stunting in Uganda. Previous consumption of two or more ASFs showed a stronger association, ranging from a 10% decline in stunting in Bangladesh to a 16% decline in Nepal. This novel lagged analysis emphasizes the need for regular and appropriate levels of ASF intake by young children to support healthy growth in resource-constrained settings.

Food value chain interventions and nutritional outcomes: a review of evidence and recommendations for future assessments

Food value chains (FVC) have become an important framework for the assessment of interventions to improve nutritional outcomes during the past decade, and recent literature indicates considerable agreement about FVC importance and potential impact pathways. Despite the usefulness of the FVC framework, the majority of studies reviewed provide only conceptual models or descriptive analyses of linkages with nutrition, limiting their usefulness for quantitative assessment of intervention impacts. Fewer than five studies of 113 reviewed measure the impacts of FVC interventions on nutritional outcomes or provide study protocols for that purpose. In addition to randomized controlled trials, comparative analysis and systems modeling methods will provide relevant evidence about the effectiveness of FVCs for improvement of nutrition.

Livestock ownership and anaemia in Sub-Saharan African households

OBJECTIVE

To determine the association between livestock ownership and Hb concentration of women of child-bearing age (WCBA) and preschool-aged children in Sub-Saharan Africa (SSA).

DESIGN

A prospective analysis of publicly available cross-sectional data, using linear and logistic regressions controlling for potential confounders.

SETTING

Twenty-eight countries in SSA.

PARTICIPANTS

162 305 WCBA and 118 607 children aged 6-59 months.

RESULTS

More than half of WCBA (62·5 %) and children (58 %) belonged to households that owned livestock. The average altitude-adjusted blood Hb concentration for WCBA and children was 12.23 and 10·24 g/dL, respectively. In adjusted models, higher number of livestock owned was associated with lower Hb concentration for children but not for WCBA. The magnitude of the association for children was small, with one additional unit of livestock owned reducing Hb concentration by 0·001 g/dL. Higher numbers of cattle, cows and bulls, sheep, and goats were associated with lower Hb concentration for both groups. The number of certain categories of livestock owned was associated with the consumption of relevant foods by children. There was no association between the consumption of animal-source foods and Hb concentration or between livestock ownership and diarrhoeal diseases or fever among children.

CONCLUSIONS

Livestock ownership in SSA had a net negative association with the Hb concentration of children and no association with that of WCBA. The results highlight the need for research aimed at clarifying the mechanisms linking livestock ownership and nutritional status, and identifying entry points for leveraging livestock ownership to improve the health of women and children in SSA.

A biocultural examination of home food production and child growth in highland Peru

OBJECTIVES

Chronic malnutrition remains a persistent global health issue. This mixed methods investigation in rural Peru examines the role of home food production (HFP) in reducing child malnutrition by testing the following hypotheses: (a) higher HFP will be associated with higher infant z-scores than those with less HFP and (b) infants with higher HFP will exhibit improved longitudinal growth outcomes across 6 months.

METHODS

Ethnographic methods include semi-structured interviews and participant observation. A household survey and anthropometric data were collected twice, from 86 infants under of 24 months old. A HFP index (HFI) was generated based on reports of animals for meat consumption, eggs, milk, and agricultural products for home consumption. Kruskal-Wallis tests were used to examine patterns of HFI and infant anthropometrics. Multivariate regressions were used to examine the relationships between HFP and infant height for age (HAZ), weight for age (WAZ), and triceps skinfold for age (TSAZ) in both rounds and 6-month change between rounds (6MΔ).

RESULTS

There were no relationships between HFI and infant z-scores in round one, however, HFI was significantly positively related to HAZ (B = 0.091, P < .039) in round two and with 6MΔ in HAZ (B = 0.09, P < .047). HFI did not predict WAZ or TSAZ in either round.

CONCLUSIONS

HFP represents an important influence of infant growth in Nuñoa, likely through nutritional improvement due to increased availability of animal-sourced foods and through contribution to household economy and maternal empowerment.

Paucity of Nutrition Guidelines and Nutrient Quality of Meals Served to Kenyan Boarding High School Students

Adequate nutrition is vital for the optimal growth, development, and general well-being of adolescents. A lack of nutritional guidelines for school meals poses a major challenge in the provision of nutritious meals to students in Kenyan boarding high schools. The aim of the study was to investigate the nutrient quality and portion sizes of meals served to students and the adequacy of the meals in meeting students’ health requirements. A cross-sectional study was carried out among 50 catering or kitchen managers of 50 high schools in Kenya. Data were obtained through researcher-assisted questionnaires. It was established that menus were simplistic in nature, lacked variety, and were repetitive. With regard to nutrients, menus offered to students were excessively highin dietary fiber, containing three or five times more than the recommended daily intake. In most cases, students were underfed on nutrients such as carbohydrates, vitamin A, folic acid, potassium, calcium, proteins, and vitamins B1–12, resulting in low energy provision. It is concluded that a majority ofthe Kenyan high schools studied do not provide nutritionally adequate meals. The government of Kenya should have nutrition guidelines to ensure that schools provide diets with high foodand nutrient quality to students.

Does caste determine farmer access to quality information?

This paper explores the social inclusiveness of agricultural extension services in India. We estimate the probability and frequency of farmers’ access to extension services and resulting changes in crop income across different caste groups. The literature suggests that caste-based social segregation manifests in various spheres of life, and perpetuates economic inequality and oppression. An econometric analysis of nationally-representative data from rural India verifies this with respect to the agricultural sector. Farmers belonging to the socially-marginalized castes are found to have a lower chance of accessing the public extension services, primarily due to their inferior resource-endowment status. Contacting extension agents at least once increased the average annual crop income by about 12 thousand Indian rupees per household, which is equivalent to 36% of the annual crop income of those without access to extension services. There exists significant impact heterogeneity. Farmers from the socially-marginalized castes hardly benefited from accessing the extension services. Based on these observations, we have developed a number of policy recommendations that could improve the social inclusiveness of agricultural development strategies in rural India.

Household dairy production and child growth: Evidence from Bangladesh

Research from richer countries finds that dairy consumption has strong positive associations with linear growth in children, but surprisingly little evidence exists for developing countries where diets are far less diversified. One exception is a recent economics literature using the notion of incomplete markets to estimate the impacts of cattle ownership on children's milk consumption and growth outcomes in Eastern Africa. In addition to external validity concerns, an obvious internal validity concern is that dairy producers may systematically differ from non-dairy households, particularly in terms of latent wealth or nutritional knowledge. We re-examine these concerns by applying a novel double difference model to data from rural Bangladesh, a country with relatively low levels of milk consumption and high rates of stunting. We exploit the fact that a cow's lactation cycles provide an exogenous source of variation in household milk supply, which allows us to distinguish between a control group of households that do not own cows, a treatment group that own cows that have produced milk, and a placebo group of cow-owning households that have not produced milk in the past 12 months. We find that household dairy production increases height-for-age Z scores by 0.52 standard deviations in the critical 6-23 month growth window, though in the first year of life we find that household dairy supply is associated with a 21.7 point decline in the rate of breastfeeding. The results therefore suggest that increasing access to dairy products can be extremely beneficial to children's nutrition, but may need to be accompanied by efforts to improve nutritional knowledge and appropriate breastfeeding practices.

Nutrition education, farm production diversity, and commercialization on household and individual dietary diversity in Zimbabwe

Background

Nutrition education is crucial for improved nutrition outcomes. However, there are no studies to the best of our knowledge that have jointly analysed the roles of nutrition education, farm production diversity and commercialization on household, women and child dietary diversity.

Objective

This article jointly analyses the role of nutrition education, farm production diversity and commercialization on household, women and children dietary diversity in Zimbabwe. In addition, we analyze separately the roles of crop and livestock diversity and individual agricultural practices on dietary diversity.

Design

Data were collected from 2,815 households randomly selected in eight districts. Negative binomial regression was used for model estimations.

Results

Nutrition education increased household, women, and child dietary diversity by 3, 9 and 24%, respectively. Farm production diversity had a strong and positive association with household and women dietary diversity. Crop diversification led to a 4 and 5% increase in household and women dietary diversity, respectively. Furthermore, livestock diversification and market participation were positively associated with household, women, and children dietary diversity. The cultivation of pulses and fruits increased household, women, and children dietary diversity. Vegetable production and goat rearing increased household and women dietary diversity.

Conclusions

Nutrition education and improving access to markets are promising strategies to improve dietary diversity at both household and individual level. Results demonstrate the value of promoting nutrition education; farm production diversity; small livestock; pulses, vegetables and fruits; crop-livestock integration; and market access for improved nutrition.