Animal Source Food Social and Behavior Change Communication Intervention Among Girinka Livestock Transfer Beneficiaries in Rwanda: A Cluster Randomized Evaluation

Abstract

A social and behavior change communication intervention designed to promote consumption of cow’s milk among families that received a cow from a government livestock transfer program increased mothers’ knowledge and awareness of milk consumption. Although intervention exposure was associated with increased frequency of children’s cow’s milk intake, it did not lead to increased consumption or dietary diversity.

Abstract

Key Findings

• A social and behavior change communication (SBCC) intervention was associated with increased odds of children consuming cow’s milk 2 or more times per week.

• For approximately half of the children, frequency of cow’s milk consumption was limited by inadequate household milk production or sale of the milk produced.

• SBCC did not influence the percentage of households that kept or sold their milk, demonstrating that SBCC alone is not enough to change nutrition outcomes in households with poor food security.

Key Implications

• Community health workers successfully implemented the intervention and the SBCC messages have been incorporated into the recently revised national CHW counseling cards.

• SBCC for this target population should be implemented for a longer period and tailored to discuss financial management and dietary choices with a limited budget. Accompanying training or other activities to assist households that receive cows are needed to ensure adequate cow’s milk production for home consumption.

• High levels of severe food insecurity in this population may have limited the potential of the SBCC to improve dietary diversity and more substantially improve frequency of cow’s milk consumption.

ABSTRACT

Animal source foods (ASFs), including cow’s milk, contain essential nutrients and contribute to a healthy diet, but frequency of intake is low among children in low- and middle-income countries. We hypothesized that an ASF social and behavior change communication (SBCC) intervention implemented by community health workers (CHWs) would increase child milk consumption and dietary diversity in households that received a cow from the Government of Rwanda’s Girinka livestock transfer program. We tested the 9-month SBCC intervention among children aged 12–29 months at baseline in administrative cells randomly assigned to the intervention or control. Most mothers in the intervention group were exposed to CHWs’ home visits (90.7%) or community-level activities (82.8%). At endline, more mothers in the intervention group compared with the control group knew that cow’s milk was an ASF (90.1% vs. 81.7%, P=.03) and could be introduced to children at 12 months (41.7% vs. 18.7%, P<.001). More mothers in the intervention group compared with the control group knew they should feed their children ASFs (76.2% vs. 62.1%, P=.01) and give them 1 cup of cow’s milk per day (20.6% vs. 7.8%, P<.001). Children’s consumption of fresh cow’s milk 2 or more times per week increased in the intervention group, although not significantly (8.0 percentage points, P=.17); minimum dietary diversity was unchanged. Children in the intervention group had increased odds of consuming cow’s milk 2 or more times per week if their mothers recalled hearing that children should drink 1 cup of cow’s milk per day during a CHW’s home visit [odds ratio (OR) 2.1, 95% confidence interval (CI) (1.1, 3.9)] or a community activity [OR 2.0, 95% CI (1.2, 3.5)]. Approximately half of the children had no milk during the past week because their households produced too little or sold what was produced. In poor households receiving a livestock transfer, strategies to further tailor SBCC and increase cow’s milk production may be needed to achieve larger increases in children’s frequency of milk consumption.