Training and food marketing in the informal dairy sector increase child milk intake in Kenya

The informal food sector is the primary source of affordable food for households in Sub-Saharan Africa. Often operating at the margins of regulation, food safety in the informal sector is a constant concern to authorities. Unsafe food causes more than one-hundred million episodes of foodborne illness and close to 200,000 deaths each year in Africa where investments in food safety are disproportionally low compared to the magnitude of its health burden. Despite the paramount role that informal food markets have in people’s access to healthy diets limited research has been done on the potential of market-focused interventions to improve both food safety and nutrition outcomes. Here we show the results of a two-arm cluster randomized control trial conducted to assess how a market intervention targeted to food vendors in the informal sector impacts various nutrition and milk safety outcomes. The intervention was a training and marketing scheme designed to improve milk safety and vendor revenues and increase milk consumption by children 12–48 months old in consumer households. After the intervention, children in households in the treatment arm consumed an additional 40ml of milk per day. The intervention did not have an impact on milk bacterial load, dietary adequacy or any of the other study outcomes. This study demonstrates that market interventions can be powerful channels for nutrition-related behaviour change communication. The absence of an impact on the bacteriological quality of milk suggests that efforts to improve food safety need to involve the entire food value chain, from farm to shelf. This study deepens our understanding of how market interventions can be used to leverage informal markets in low- and middle-income countries for better nutrition and food safety.