Bovine milk has shown a positive association with child growth rates, but access in Hyderabad, India, is variable and milk-borne hazards are of concern. The aim of this study was to investigate how milk value chains (VCs) in urban Hyderabad influence microbiological and toxicological milk safety and their intersection with child stunting. A mixed-methods approach was used, encompassing a thematic reflexive analysis of qualitative interviews conducted with 12 VC key informants and risk-based sampling of 42 milk, 24 animal feed and 20 water samples that were subjected to microbiological and aflatoxin testing. Key themes identified were financial instability, trust-based processes, milk safety concerns and power imbalances in the VCs. The microbiological analysis showed contamination in unpasteurized milk at various nodes, with high levels of total colony count, faecal coliforms, Staphylococcus aureus and yeast/mould, while water used in the VCs also showed microbial contamination. A total of 67% of dairy feed samples tested positive for total aflatoxins; all of them were within Indian regulatory limits. Opportunities for safer and more nutritious milk that could help to reduce child stunting include improved food safety practices, enhanced awareness of milk-borne hazards, institutional accountability and increased agency of VC actors. This article is part of the theme issue 'Biological, biomedical and environmental drivers of stunting'.
Häsler et al. (Thu,) studied this question.