Clinical trial NCT04608656: Livestock for Health Project
Official title: Livestock Programming for Nutritional Improvements in Pregnant, Lactating Mothers and Children Under Five Years of Age in Marsabit County, Kenya
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Malnutrition
Keywords: Children under five years
Pregnant and Lactating women
Livestock feeds
Nutrition counselling
Undernutrition
Pastoralism
Kenya
Lead sponsor: Washington State University
Sponsor class: OTHER
Collaborators: name: Food and Agriculture Organization of the United Nations
name: UNICEF
First posted: 2020-10-29
Enrollment: 1734
Sex: ALL
Minimum age (years): 6
Maximum age (years): 60
Standard ages: CHILD
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: FACTORIAL
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.
Primary purpose: PREVENTION

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Household inclusion criteria

Only households meeting the following study criteria will be recruited:

* Presence of a mother (lactating or non-lactating) and child 3 years and below
* Ownership of livestock with 1-6 tropical livestock units
* Household consent to participate in the study o Including willingness to have 1-2 tropical livestock units (1-2 cattle or camel, 10-20 sheep/ goats) at household

Exclusion Criteria:

* Households excluded in the study will have the following criteria:

  * Households that do not consent to participate in the study
  * Households unwilling to adhere to the study protocol including feeding instructions and retaining the study animals at the household for milk access

Primary outcomes:
measure: Household milk yield (litres/week)
timeFrame: 24 months
measure: Milk consumption (amount and frequency) by children < 5 years and pregnant and lactating women
timeFrame: 24 months
measure: Undernutrition (wasting, stunting and underweight)
timeFrame: 24 months
measure: Cost-effectiveness ratio of (changes in total cost of interventions by arm )/(Changes in acute malnutrition (WHZ) by arm)
timeFrame: 24 months
Secondary outcomes:
Other outcomes:
Locations:
city: Nairobi
country: Kenya
facility: Washington State University
Study officials:
affiliation: Washington State University, Paul G Allen School for Global Animal Health
name: Thumbi Mwangi, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Washington State University - Global Health Kenya
name: Josphat M Muema, PhD(c)
role: STUDY_DIRECTOR
affiliation: Washington State University - Global Health Kenya
name: Mutono Nyamai, PhD(c)
role: STUDY_DIRECTOR
affiliation: Washington State University, Paul G Allen School for Global Animal Health
name: Guy Palmer, PhD
role: STUDY_CHAIR
References: