A cluster randomised controlled trial evaluated an integrated livestock management intervention in pastoral and agro-pastoral communities in Chad. The study randomised 76 villages, with 821 children from 521 households assessed at the dry-season peak. The intervention combined livestock feed supplementation, household-level zoonotic risk mitigation, and nutrition counselling, compared to a control group receiving no intervention. The primary outcome was the prevalence of global acute malnutrition (GAM) and severe acute malnutrition (SAM).
At the dry-season peak, GAM prevalence was 22.2% in intervention villages versus 47.4% in control villages (adjusted OR 0.29, 95% CI 0.18-0.49; p<0.001). SAM prevalence was 4.4% in intervention villages versus 19.4% in controls (adjusted OR 0.17, 95% CI 0.08-0.37; p<0.001). The intervention also significantly increased daily household milk availability by 588 mL (p<0.001) and child milk consumption by 102 mL per day (p=0.008).
Secondary outcomes showed the intervention was associated with substantially lower self-reported diarrhoeal disease (aOR 0.21, 95% CI 0.10-0.44) and acute respiratory infection (aOR 0.22, 95% CI 0.11-0.46). The study did not report specific safety or tolerability data for the intervention components. Key limitations include reliance on self-reported health outcomes, potential for social desirability bias, and the specific context of pastoral communities in Chad, which may limit generalisability to other settings.
For practice, this trial provides evidence that a multi-component, livestock-focused intervention can improve child nutrition and health indicators in a challenging, resource-limited environment. The benefit-cost ratio was assessed but not reported in the provided results. Clinicians working in similar pastoralist contexts may consider the value of integrated approaches that address both livestock health and household nutrition.
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Background: Child acute malnutrition remains persistently above emergency thresholds in Chad's Sahelian drylands, with a predictable, but rarely recognized, dry season peak linked to declining pasture and livestock productivity, reduced milk availability and heightened exposure to zoonotic infections. Humanitarian responses remain largely reactive and treatment-focused, with limited evidence on preventive strategies that address drivers embedded in local livelihood systems. We evaluated the effectiveness and return on investment (ROI) of an integrated livestock management intervention designed to prevent the dry-season peak of child acute malnutrition in pastoral and agro-pastoral communities in Chad. Methods: We conducted a cluster-randomised controlled trial in Kanem and Barh-El-Gazel provinces, Chad. Seventy-six villages were randomised (1:1) to intervention or control. Eligible households had at least one child aged 6-59 months and access to milking livestock during the dry season. The intervention (December 2024-June 2025) combined livestock feed supplementation to sustain milk production near households during the dry season, household-level zoonotic risk mitigation, and nutrition counselling. Primary outcomes were the prevalence of global acute malnutrition (GAM) and severe acute malnutrition (SAM) at the dry-season peak (May 2025), assessed in a prespecified random subsample of 52 clusters. All 76 clusters were assessed post-peak (July 2025). Analyses followed an intention-to-treat approach using mixed-effects models. A societal ROI analysis was conducted over six months with projections to 24 months. Findings: At the dry-season peak, 821 children 6-59 months from 521 households were assessed across 52 villages. GAM prevalence was 22.2% in intervention villages versus 47.4% in controls (adjusted OR 0.29 [95% CI 0.18-0.49]; p<0.001), and SAM prevalence was 4.4% versus 19.4% (adjusted OR 0.17 [0.08-0.37]; p<0.001). Intervention households had higher daily milk availability (+588 mL per household; p<0.001), and children consumed more milk (+102 mL per day; p=0.008). Odds of self-reported diarrhoeal disease and acute respiratory infection were substantially lower among children in intervention villages (aOR 0.21 [0.10-0.44] and 0.22 [0.11-0.46], respectively). Post-peak, women's dietary diversity increased (aOR 3.68 [1.90-7.13]), alongside reduced workload, lower household food insecurity and distress livestock sales, improved livestock condition, and a benefit-cost ratio of 5.40 at six months, rising to 16.40 at 24 months. Interpretation: Protecting livestock productivity and sustaining children's access to milk while reducing zoonotic exposure during the pastoral lean season effectively prevents seasonal peaks of child acute malnutrition. This integrated anticipatory action and One Health livelihood-based approach offers a scalable, dignifying, high-return lifesaving preventive model for pastoral and agro-pastoral humanitarian settings.
