EVALUATING THE IMPACT OF POULTRY INTERVENTIONS ON MATERNAL AND CHILD NUTRITION OUTCOMES IN THE LUANGWA VALLEY, ZAMBIA A Dissertation Presented to the Faculty of the Graduate School of Cornell University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy by Sarah Elise Dumas December 2017 © 2017 Sarah Elise Dumas EVALUATING THE IMPACT OF POULTRY INTERVENTIONS ON MATERNAL AND CHILD NUTRITION OUTCOMES IN THE LUANGWA VALLEY, ZAMBIA Sarah Elise Dumas, Ph.D. Cornell University 2017 Worldwide, approximately 156 million children under five are stunted because of chronic undernutrition. Animal source foods (ASF) can improve children’s dietary quality, micronutrient intake, and nutrition outcomes, but ASF are often inaccessible and unaffordable for the most vulnerable children. Livestock interventions can increase the accessibility of ASF in remote, low-income communities, but evidence that they effectively improve child nutrition remains inconclusive. We therefore aimed to examine the association between household livestock ownership and child nutrition outcomes and evaluate the impact of two targeted poultry interventions in rural communities in the Luangwa Valley, Zambia. First, we utilized multiple data sources to assess the impact of interventions addressing health and management constraints in the existing “village chicken” production system. Our analyses revealed that the interventions resulted in improved flock sizes and profits, but had no impact on household consumption of chickens or eggs, because farmers preferred to sell chickens. Then, in a large cross-sectional survey, we similarly found that owning livestock managed in traditional systems was not associated with improved dietary or nutrition outcomes among children. Building off these studies, we implemented a novel, market-based intervention supporting egg production centers (EPCs) in 24 communities. Using mixed methods, we found that, despite programmatic challenges, the EPCs could be adequately productive and profitable, widely acceptable to participants, and practical to implement in most rural communities in the Luangwa Valley. Finally, in an impact evaluation, we found that the EPC program successfully increased the acquisition and consumption of eggs by households, women, and young children in participating communities. In this dissertation, we took a comprehensive and stepwise approach, utilizing conceptual frameworks and program impact pathways to identify and test underlying assumptions and intermediate outcomes on the hypothesized pathway from livestock to child nutrition. We suggest that the novel EPC program could function as one component of an integrated nutrition intervention to enhance access to, and consumption of, high-quality ASF in vulnerable households. Our results contribute to the growing evidence that livestock can enhance child nutrition and point to a new approach for livestock interventions and evaluations that focuses on impact at the community-level. BIOGRAPHICAL SKETCH Originally from Portland, Oregon, Sarah Elise Dumas completed her undergraduate degree in biology (pre-medical track) at Pomona College in Claremont, California where she received distinction for her senior thesis on the role of the FoxO transcription factor in controlling lifespan in the Hydra vulgaris . Through extensive coursework in political science, Sarah became interested in the important roles of public policy and food systems in ensuring human health, and, with the aim of dedicating herself to achieving optimal health and wellbeing for the greatest number of people, she decided to pursue a career in public health. Sarah studied mixed animal medicine at Cornell University College of Veterinary Medicine, where she was introduced to the concept of “One Health” – the framework that recognizes that human health is intricately linked to the health of the environment and the animals around them. During veterinary school, she worked extensively in Kenya and Zambia (with International Livestock Research Institute and Community Markets for Conservation, respectively) on projects that aimed to improve rural livelihoods and reduce natural resource degradation through the sustainable development of smallholder livestock systems. Sarah was awarded the Leonard Pearson Veterinary Prize for academic and professional leadership upon her graduation from Cornell in 2012 and practiced farm animal medicine and surgery for a year in the University of Illinois’ Rural Animal Health Management program. Sarah returned to Cornell University in Fall 2013 to pursue her PhD in Comparative Biomedical Sciences, with a focus on epidemiology and nutrition, to develop research and practices skills relevant to public health, including design, implementation, and evaluation of nutrition-sensitive strategies to support livestock development in vulnerable communities. iii For Sarrah iv ACKNOWLEDGEMENTS I am grateful to the members of my special committee for their support and guidance. Alex Travis has served as my mentor since the fall of 2008, my first year in veterinary school, when he took me on as a summer research student and sent me to Zambia through Cornell’s Expanding Horizons program. Whereas most Expanding Horizons projects are completed in a single 2-3 month trip, Alex encouraged me to continue my research in Zambia throughout veterinary school, and his dedication and enthusiasm to the project inspired me to return to Cornell for my doctoral studies to continue working on it. As an adviser and mentor, Dr. Travis has been patient and supportive, challenging me to improve myself, develop my strengths, and explore new opportunities. I have no doubt that he is truly committed to the advancement of my career and development of my knowledge and skills, and I am truly indebted to him for his vision, encouragement, and advice throughout the years. Becky Stoltzfus and Sera Young generously invited me into their respective research groups, and the relationships I built and knowledge I gained in those meetings were instrumental to my development as a researcher. I sincerely value the time I spent in those meetings, learning, sharing, and getting insightful feedback from Becky, Sera, and the amazing group of graduate students, staff, and colleagues they work with. Sera also challenged me to develop qualitative research skills, then gave me the perfect balance of independence and support to design a small substudy within her project in Kenya exploring the perceived role of gender on livestock ownership, investments, and benefits among female smallholder livestock keepers. Yrjö Gröhn was generous with his time and was always willing to share his deep knowledge of epidemiological methods and provide guidance and feedback on my work. v This research would not have been possible without the incredible support of my friends and colleagues in Zambia, including: Luke Lungu, Nathan Mulmabya, Kelvin Kasongo, Smith Kapeya, Whiteson Daka, Joel Ngumayo, Mary Tembo, Moses Njobvu, Major Lungu, and Isaac Mbuzi at COMACO; Joseph Mumba and Peter Ng’ona at CARE Zambia; and the doctors, nurses, and staff of the Masumba Rural Health Centre. I am especially indebted to Dale Lewis, founder and President of COMACO, for believing in this project and dedicating the time, staff, and resources to help make it a reality. Thank you also to my field research staff: Ruth Ngoma, Chiefundo Jere, Matthews Mwanza, Margaret Zulu, Jannet Mwanza, Lucky Ulaya, Jonathan Jumbe Mwale, Obed Mulambya, Riston Mbewe, Vidah Phiri, Anderson Chulu, Mostafa Makawa, Samuel Kasaro, Suwilo Mulambya, Zagwa Zulu, Noah Tembo, Janet Ndashe, Brenda Tembo, Zondwase Ziba, and Augustine “Tobias” Banda. I am fortunate to have worked with such an enthusiastic, dedicated, and thoughtful team of young researchers. Thank you to Senior Chief Nsefu, late Chief Jumbe, Chief Mnkhanya, and Chief Mwanya for graciously allowing me to work within their communities. Of course, I am incredibly grateful for the members of the egg producer groups and our research participants for their time, patience, and interest in this project. I have relied heavily on the resources at Cornell. I am very grateful to Benjamin Lucio- Martinez, Jarra Jagne, Karel “Ton” Schat, and Ricardo de Matos for their many lessons on poultry medicine and production. The amazing statisticians at the Cornell Statistical Consulting Unit, in particular Françoise Vermeylen, Kevin Packard, and Stephen Parry guided me through the complex statistical analyses presented here and answered my many questions with patience. I am grateful for the administrative support at the College of Veterinary Medicine and the Baker Institute, who helped me to navigate the logistics of conducting research across continents, including: Arla Hourigan and Cindy Grey at the Office of Graduate Education at the College of vi Veterinary Medicine; Grants and Contracts Officers Kimberly Hayes, Teresa Griffin, and Bonnie Coffin; Cathy Lee and Vonda Royce at the Accounting Service Center at the College of Veterinary Medicine; and Jacque Nelson-Harrington of the Travis Lab. Thank you also to Dave Lin, Director of Graduate Studies in the field of Comparative Biomedical Sciences, for his support and patience as I explored research questions far outside of what is “typical” for the field. Undergraduate researchers Abena Maranga, Emily Martey, Josephine Hong, Lea Kassa, Paige Killelea, Lauren Blacker, and Elise Pajak all directly or indirectly contributed to this work. Special thanks to Roseanne Schuster, Stephanie