Livestock for Health Project
Condition: Malnutrition
MeSH terms: Malnutrition
Study type: Interventional

Summary: 
      Children 5 years and below, and pregnant/lactating women in pastoralist communities suffer a
      high burden of acute malnutrition. Improving the health and productivity of animals can
      reduce the risk malnutrition during the dry periods. The aim of this study is to assess how
      providing livestock with feeds during critical dry periods can improve household milk
      availability, consumption and risk of malnutrition in pregnant and lactating mothers, and
      children 5 years and below.

      The study will be a cluster randomized control trial conducted in Marsabit County and will
      involve a total of 1800 households that own livestock and have children 5 years and below.
      The households will be divided into three groups and each group will have a total of 600
      households. Group one, will receive livestock feed enough to maintain 2-3 milking animals
      during the critical dry period. The second group will receive similar livestock feed but will
      also receive education and counselling on human nutrition. The third group will be the
      control arm and will not receive any of the two interventions.

      The study will aim to estimate how these interventions impact stunting and underweight in
      children and weight gain for pregnant women by collecting data on middle upper arm
      circumference, height, weight, and weight-gain during pregnancy every three months in a year.
      In addition, data on food consumption patterns such as number of meals taken, type/diversity
      of foods consumed including animal source foods, frequency of times and quantity of specific
      foods consumed) on at least 6-weekly basis will be collected. To further understand this
      problem the investigators will collect human illness data including on fever, diarrhoea, and
      respiratory syndromes among study participants during the regular visits. Socio-economic data
      including household demographics, incomes, expenditures, asset accumulation, gender roles,
      and workload and time allocation will be collected quarterly. Biological samples will be
      collected (venous blood and mother's milk) at recruitment, six months and 12 months.
      Screening for infections such as brucellosis, micronutrient and mycotoxin analysis will be
      conducted on the biological samples in order account for infections or conditions that could
      have an impact on nutritional status of study participants. The study will also assess which
      of the interventions provide value for money given that resources are scarce.
    

Detailed description: 
      Background: In households heavily dependent on livestock, declining availability of forage is
      associated with decreased consumption of animal source foods such as milk and meat, and
      consequently decline in child nutritional status. Populations living in Kenya's Arid and
      Semi-Arid Lands(ASALs) are predominantly pastoral, heavily dependent on livestock and
      practice seasonal mobility to access livestock pasture and water. Livestock interventions
      that maintain or improve health and productivity of animals have been postulated as important
      for reducing the risk of malnutrition during critical drought periods.

      Objectives: Here the investigators implement a cluster randomized control study trial to
      determine the effect of providing livestock feed, livestock feed and nutritional education
      and counselling during critical dry periods on household milk availability and consumption,
      and the risk of malnutrition in pregnant and lactating mothers, and children 5 years and
      below.

      Methods: A total of 1800 households owning livestock and with children 3 years and below in
      Marsabit County will be enrolled into three equal groups (arms) of 600 households each. Each
      household and participant will be followed for 18 months. Households in Arm 1 will receive
      livestock feed enough to maintain 2-3 milking animals during the critical dry period. Arm 2
      will receive similar livestock feed and human nutritional education and counselling. Arm 3
      (control arm) will not have any of the two interventions. Primary outcome measures will be
      child anthropometric indicators (height-for-age, weight-for-age and middle upper arm
      circumference) and maternal anthropometric measures (middle upper arm circumference, height,
      weight, weight-gain during pregnancy) collected quarterly. Data on a 24-hour recall of diet
      (number of meals taken, type/diversity of foods consumed including animal source foods,
      frequency of times and quantity of specific foods consumed) will be collected every 6 weeks.
      To control for additional factors that would influence nutritional status, the investigators
      will collect human health syndromic data (fever, diarrhoea, respiratory syndromes) and
      livestock health data every six weeks and socio-economic data quarterly including household
      demographics, incomes, expenditures, asset accumulation, gender roles, workload and time
      allocation. To control for exposure to infections such as brucellosis in humans and animals
      and for micronutrient and mycotoxin analysis, biological samples (venous blood of mother and
      child), animal biological samples (blood and milk) and household drinking water will be
      collected at recruitment, 6 months and at 12 months. The study will test the
      cost-effectiveness of livestock interventions and nutritional counselling in prevention of
      malnutrition and its health consequences, compared to treatment of malnutrition. Cost data
      associated with each study arm will be tracked to provide estimates of resources required to
      scale up for implementation. Results from this study will form the basis for monitoring
      efficiency and effectiveness of interventions aimed at reducing seasonal spikes in levels of
      acute malnutrition in children under five years and pregnant and lactating women in
      pastoralist communities.

      Study duration: Each study household and participant is followed for a period of 24 months
      from the time of enrolment into the study.
    

Intervention name(s): Provision of livestock feeds; Nutrition counselling
Intervention type(s): Other; Other
Intervention description(s): Households will receive livestock feeds (ranch cubes) for the select lactating animals during the dry season; Households will receive livestock feeds (ranch cubes) for the select lactating animals and will also be enrolled in to a nutrition counselling programme
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: The study households will be assigned one of three study arms:
i) Intervention arm 1: Livestock feed only.
Households in villages assigned to intervention arm 1 will receive a pre-defined amount of livestock feed to maintain two tropical livestock units for a total of 60 days during the dry season (when animals would be moved away in search of pastures).
ii) Intervention arm 2: 1.Provision of Livestock feed, 2. Nutritional counselling
Households recruited into intervention arm two will receive livestock feeds and will be enrolled in a nutritional education and counselling program.
iii) Control arm
The households recruited under this arm will receive none of the two study interventions. These households will receive identical assessment and data collection like other study households in the study.
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Children under five years; Pregnant and Lactating women; Livestock feeds; Nutrition counselling; Undernutrition; Pastoralism; Kenya