A Large-Scale Nutrition- and Gender-Sensitive Poultry Market-Based Program Did Not Improve Maternal and Child Diets in Rural Burkina Faso: A Cluster-Randomized Controlled Trial

BACKGROUND: Livestock production interventions can improve consumption of animal-source foods and diet diversity, which may lead to improved micronutrient adequacy. OBJECTIVES: We assessed the effectiveness on maternal and child dietary outcomes of "Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale" (SELEVER), a livestock intervention designed to improve diets in rural Burkina Faso through training and market facilitation to improve poultry production; females' empowerment activities; and nutrition and hygiene behavior change communication. METHODS: For a nonblinded cluster-randomized controlled trial, we randomly assigned 30 communes to SELEVER and 30 communes to control, of which 15 communes served as control for a narrow sample. Fifteen households were randomly selected in 2 villages per commune; of which 12 were included in the narrow sample. In the wide sample, we used analyses of covariance to assess SELEVER's effectiveness on dietary diversity in index children aged 2-4 y at baseline and in their caregivers, and on minimum acceptable diet in their siblings aged 6-23 mo at measurement. In the narrow sample, we used difference-in-difference to assess SELEVER's effectiveness on vitamin A, iron, and zinc prevalence of adequate intakes (PA) and mean PA of 11 micronutrients in index children and caregivers. RESULTS: We enrolled 1767 index children, 1766 caregivers, and 412 siblings aged 6-23 mo at endline in the wide sample, and 1054 caregiver-child dyads in the narrow sample. In the wide sample, exposure to program activities was higher but moderate in SELEVER communities, with limited effects on dietary knowledge and practices and no effects on diet outcomes. The narrow sample showed a negative effect on zinc PA in children (-26 percentage points, P = 0.020), and no effect on other outcomes. CONCLUSIONS: A program focused on improving the productivity of and demand for nutritious foods did not improve micronutrient adequacy. Implementation strategy and bottlenecks may have limited the system transformations needed to produce measurable shifts toward healthier diets. TRIAL REGISTRATION NUMBER: This study was registered at ISCRCTN with registration number ISRCTN16686478 (https://www.isrctn.com/ISRCTN16686478).