Feasibility of a milk matters initiative to enhance milk intake in children over six months of age in Somalia

Results

Livelihoods and their management: Pastoralists relied on livestock production as their main source of income. One third (32.7%) of pastoralist and all (100%) agro-pastoralist households reported that they had land access; 44% of urban population respondents reported that they had some land, albeit in places far from where they were settled. Of the sampled households, 72.4% had goats, 41.2 % had cows, 44.6% had camels and 23.8% had sheep. Results showed seasonal variability, with greater herd sizes in wet compared to dry seasons (23% difference), and greater availability of fodder in the wet season (60.3%) compared to dry (42.9%). Livestock management was found to be a male responsibility, while decisions on milk use were predominantly made by females in consultation with males, as reported in 75% of the surveyed households. In total, 64.2% of women were responsible for milk handling, storage and transportation to selling points. Pastoralists migrated with their herds (mainly cows and camels) during drought or seasonal stresses, leaving goats behind for milking purposes (75.9%).

Milk consumption: Across all three livelihood groups, consumption of milk is high during the high production season and low during the low production; hence production of milk is the main barrier to milk consumption and utilisation, as reflected in Figure 1. During the wet season (Gu), milk consumption was higher and milk provided a major source of income. Households consumed 41.8% and 27.8% of produced milk in wet and dry (Jilal) seasons respectively. More than half (52.3%) of pastoralists had milk surplus during the wet season, consumed by children under five years in 80% of households. In 71.2% of the households, milk was added to vegetables, potatoes, water or tea before feeding children. In households with no livestock, an average of 0.56 litres was purchased daily in wet seasons, of which 0.38 litres was consumed by children aged 6-59 months (68%), compared to 0.5 litres of milk purchased daily by households with no livestock in the dry season (no significant difference between volume of milk bought between the two seasons (P=0.547). Figure 1 compares patterns of milk utilisation between each of the three groups (pastoralists, agro-pastoralists and urban dwellers) in both regions.

Figure 1: Milk utilisation in the household 24 hours before the survey

Milk availability and management: Low milk availability was perceived to contribute to the poor nutrition status of children in 27.7% of households across the livelihoods. Communities generally perceive the benefits of animal milk in the prevention of malnutrition. Knowledge on optimal breastfeeding and complementary feeding was low (37.7% and 33.1% respectively). In 47.3% of households, milk was boiled for consumption and traditional methods such as cold-water storage (28.6%), repeated boiling (56%), fermentation and mixing with traditional herbs were used to preserve unconsumed milk. Restricted access to markets, insecurity, seasonal floods, limited marketing skills, poor storage facilities and seasonal availability were factors limiting milk markets. Most small-scale traders were women (97.6%). Only 4.9% of the milk traders were engaged in milk production. In Hiran region a lack of companies processing and preserving milk was cited as a problem. Other than fermentation (35.1%), there were no other known milk products in the region, showing a limitation in value addition.

Key learning points

Livelihoods and their management

Results show good acceptability of milk among young children in pastoral and agro-pastoral communities and the use of milk to enhance household revenue; therefore investing in increased milk production and processing capabilities to ensure milk availability beyond the production season has the potential to increase milk consumption among young children and enhance household income. Advocacy is needed to reinforce multi-sector engagement – agriculture, water, sanitation and hygiene, health and nutrition – to enhance milk production and processing. Results show a clear preference for goats among pastoralists for both milk and meat, due to their relative affordability, taste of the meat and tolerance to drought and disease. Domestically, goats are also considered easier to keep at home by women due to their smaller size. Future programmes should therefore focus livestock investments on goats.

Women are the main decision-makers on milk utilisation in households; there is therefore great potential to mobilise women’s groups for the improvement of milk production and enhanced nutrition status among children. While the focus is on women, engagement of the men in the programme is required to provide supportive roles for sustainability. The mobilisation of community groups, including men, for fodder management, water management, rangeland and environment management is essential.

Milk production

The high consumption of milk in Gu is attributed to high milk production in the households, low prices of milk and limited markets due to over-production. Milk production should be maximised during dry seasons and milk preservation should be maximised during wet seasons to support continuity of use. Possible basic interventions could include fodder and water management, support to quality veterinary services, and promotion of appropriate nutrition and IYCF practices. Pilot and scale-up should focus on pastoral and agro-pastoral communities, where incidence of livestock ownership is high and traditional practices recognise the importance of milk in enhancing nutrition among children. Further research is needed to determine the impact of the milk consumption on nutrition status.

Milk consumption by households and children

Milk is perceived to be an important food in the prevention of malnutrition in children and is used to enrich complementary foods for infants. Behaviour change communication (BCC) is needed that focuses on sustained production and milk consumption across the seasons, alongside the promotion of optimal complementary feeding. The availability of milk in the households does not seem to influence breastfeeding patterns among mothers; rather breastfeeding is influenced by socio-cultural practices. The feasibility study did not provide information on milk consumption specifically among children aged 6-23 months and monitoring of milk intake for this category should be considered.

Milk availability and management

The study noted poor hygiene practices in milk handling and preservation. Improving hygiene and safety practices should be prioritised, alongside other water and sanitation-related interventions, such as establishing water catchment dams and underground tanks for water harvesting and developing boreholes at strategic points to boosting milk production. Such interventions will help tackle some of the underlying causes of malnutrition. Investment is also needed in the surveillance of milk availability, including monitoring; analysis of supply, market availability and price could also contribute to enhancing decisions about milk management.

Conclusion

Focusing on milk production and processing during the wet season are effective strategies to address food access and improve child nutrition intake in pastoral and agro-pastoral communities of Somalia. Key boosters to enhance milk production at household level are availability of pasture, land, water, animal breeds and veterinary services (see Box 1). The processing and optimisation of milk product availability beyond production time is also important and outlines the importance of food systems (supply of and demand for milk products) to enhance child nutrition intake and status in agro-pastoral areas, complemented by quality nutrition education on utilisation.

To maximise impact, milk matters interventions should aim to enhance milk production and processing during the wet season and should focus on building the capacity of communities in milk handling, increased production and preservation. Quality BCC strategies related to IYCF should also be implemented in conjunction. The expected benefits go beyond nutrition to include improved livestock production systems, improved access to income and improved community resilience.

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