Cow Milk Production, Milk Consumption, and Production Constraints in Ethiopia: A Systematic Review

Cow Milk Production, Milk Consumption, and Production Constraints in Ethiopia: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Cow Milk Production, Milk Consumption, and Production Constraints in Ethiopia: A Systematic Review Fana Shiferaw This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5892534/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Child malnutrition is a major public health issue in Ethiopia, contributing significantly to child morbidity and mortality. Understanding the factors influencing child milk consumption and dairy cattle productivity is critical for addressing malnutrition. Objective : This systematic review aims to identify the factors affecting dairy cattle productivity and child milk consumption in Ethiopia and to evaluate the constraints limiting milk production and its impact on child nutrition. Methods : In accordance withPRISMA guidelines, a comprehensive literature search was conducted across multiple databases. Studies examining child milk consumption, dairy cattle productivity, and their relationship with child nutrition outcomes were included. Data were extracted and synthesized to highlight key determinants, constraints, and strategies for improvement. Results : Evidence indicates a positive correlation between dairy production and child nutritional outcomes. For example, increased milk consumption improves height-for-age Z scores by 0.52 SD and reduces stunting by 11.3%. The keydeterminants of child milk consumption include household income, family size, the education level of the food budget manager, and milk product prices. However, low dairy productivity in Ethiopia is attributed to feed scarcity, land limitations, high feed costs, inadequate veterinary services, genetic limitations, and inefficient artificial insemination practices. Conclusion : Addressing the constraints on dairy cattle productivity is crucial for improving milk availability and enhancing child nutrition. This review provides insights for policymakers and stakeholders in the design of interventions that promote child milk consumption and mitigate malnutrition in Ethiopia. Animal Science Milk consumption Ethiopia Malnutrition Milk production Figures Figure 1 1. Introduction Child malnutrition remains a significant public health concern in developing countries and is a leading cause of illness and mortality among children. Children under the age of five are particularly vulnerable to malnutrition(Yirga et al. 2019 ). In Ethiopia, for example, approximately 57% of child mortality is under the age of five years, which is related to malnutrition(Girma and Genebo 2002). In Ethiopia alone, 4.25% of children are chronically malnourished (Ethiopia Service Provision Assessment 2023 ). According to the findings of Mekonnen et al. ( 2023 ), there were 4.98 deaths for every 1,000 child-months observed in the study. In addition to causing morbidity and mortality, malnutrition leads to stunting and wasting, which are relatively prevalent in Ethiopia(Raru et al. 2022 ). Therefore, to address this issue and improve children's nutritional status, measures should be implemented to increase animal productivity, ensuring a better supply of high-quality animal protein (Headey 2023 ; Scherbaum and Srour 2018). However, child nutrition can also be influenced by factors such as parental education, household income, family size, low milk production, and the type of agricultural activities practiced (Headey et al. 2024; Ijaiya, Anjorin, and Uthman 2024 ; Sahiledengle et al. 2022). In low- and middle-income countries, dairy production and consumption are strongly linked to reduced stunting risk(Headey et al. 2024). In a similar vein, (Namulondo and Bashaasha 2024) concluded that household milk production and milk purchasing work together to increase child milk consumption. Nevertheless, in Ethiopia, dairy cattle produce only a small volume of milk(Fufa, van der Lee, and Mengistu 2024). Addressing this issue, along with the constraints on child milk consumption mentioned above, requires identifying the primary barriers and implementing effective measures for improvement. Therefore, this review aims to address these gaps by examining the factors limiting dairy cattle productivity and child milk consumption. 2. Materials and methods This systematic review explores cow milk production, child milk consumption, and constraints on milk production in Ethiopia. This finding underscores the importance of improving milk production and ensuring equitable access to milk for households, particularly those with young children. The review concludes by emphasizing the need for coordinated efforts among policymakers, researchers, and stakeholders to implement sustainable solutions for a healthier future. 2.1. Literature selection criteria The selection of articles for this review was guided by specific inclusion and exclusion criteria as follows: 2.2.1. Inclusion criteria Studies published in peer-reviewed journals, theses, conference proceedings, or authoritative reports. Research addressing Cow Milk Production, Milk Consumption, and Production Constraints in Ethiopia. Publications available in English or translated into English. 2.1.2. Exclusion criteria Articles focusing on milk from other species. Studies not involving children under five years of age or households with children. Studies conducted outside of Ethiopia. Research published before 2002. 2.2. Search strategy A comprehensive literature search was conducted using the following key terms: child milk consumption, cow milk production, constraints of child milk consumption, and constraints of cow milk production. Filters were applied to restrict the results to studies published between 2002 and 2024, ensuring the inclusion of the most recent and relevant research. 2.3. Study Selection The study selection process adhered to the PRISMA guidelines, starting with the screening of titles and abstracts, followed by a full-text review of relevant studies, as detailed in Additional File1. Studies were included if they met the established inclusion criteria. Data extraction was conducted independently by the author to minimize bias and ensure consistency. 2.4. Assessment of Study Quality Each included study was assessed for methodological rigor via a set of predefined criteria. These criteria included the clarity of reporting on outcomes related to child cow milk consumption, cow milk production, constraints on child cow milk consumption, and constraints on cow milk production, as well as the experimental design (preferably randomized controlled trials). Only studies that met these criteria for relevance and methodological quality were included. However, sample size data were not consistently available or applicable for all studies. 2.5. Potential biases and limitations Several potential biases were considered in the study selection and analysis: Publication Bias : There may be a tendency for studies with positive or significant results to be more likely published, whereas negative or inconclusive studies may be underrepresented. To mitigate this, studies with varying results were included, and gray literature (e.g., theses, reports) was reviewed when available. Language Bias : Only studies published in English or translated into English were included. This could exclude relevant studies published in other languages, although English-language publications predominated in this field. Geographical Bias : Most of the studies retrieved were from Ethiopia, but studies from other countries around the world were also included. This may limit the generalizability of the findings to other regions. Selection bias : The studies included focused primarily on child milk consumption and constraints, cow milk production, and cow milk production constraints. This focus could limit the generalizability of the findings. Confirmation Bias : The authors' expectations regarding cow milk production, child milk consumption, and production constraints in Ethiopia may have led to the selective inclusion of studies that support this hypothesis. To minimize bias, studies with neutral or conflicting findings were also considered, provided that they met the quality criteria. 2.6. Data Synthesis and Analysis Data synthesis was performed by extracting key information on cow milk production, child milk consumption, and production constraints in Ethiopia. Given the variability in experimental design and reporting formats across the included studies, a qualitative synthesis approach was employed. 2.7. Statistical analysis Owing to the qualitative nature of the data, formal statistical analysis could not be conducted. However, a trend analysis was performed to identify patterns across studies. Variations in the data were observed, particularly regarding the constraints on child milk consumption. 2.8. Availability of Materials and Data The data supporting the results of this review are available from the corresponding author upon reasonable request. No primary datasets were collected as part of this systematic review; data were extracted from existing published studies. 2.9 Ethical approval As this is a systematic review of existing studies, no ethical approval was required for this study. 2.10. PRISMA flow diagram 3. Cow Milk Production and Milk Consumption Cow milk production and child milk consumption are positively correlated (Choudhury and Headey 2018; Namulondo and Bashaasha 2024). A study by Choudhury and Headey (2018) revealed that household dairy production increases height-for-age Z scores by 0.52 standard deviations during the critical growth window of 6–23 months. Similarly, Mehrab Bakhtiar and Hoddinott (2023) demonstrated that dairy cow ownership is positively associated with height-for-age Z scores, increasing them by 0.13 standard deviations and reducing stunting by 11.3 percentage points. Therefore, dairy cow ownership and milk production play significant roles in ensuring household child nutrition(Choudhury and Headey 2018). 3.1. Child Milk Consumption in Ethiopia In sub-Saharan Africa, the proportion of nonbreastfed children aged 6--23 months meeting the minimum milk feeding frequency is low. In Ethiopia, approximately 4.4 billion litters of fresh milk were produced in 2018, with 3.08 billion litters (70%) designated for human consumption. Among these, 57% were consumed by rural households, whereas 43% were processed and distributed through supply chains. However, per capita annual dairy consumption is only 11% of the recommended level of dairy consumption by the World Health Organization(Farrell 2021). A study conducted in the Adea Woreda of Debre Zeit reported that the consumption level of milk and milk products was very low, at only 11.2 g LME (Livestock Milk Equivalent) per head per day, even compared with other African countries(Melesse and Beyene 2009). The likelihood of meeting this requirement increases with higher education levels, unemployment, media exposure, higher wealth status, being unmarried, childbirth in a health facility, receiving postnatal care (PNC), being 6 to 8 months old, and residing in urban areas (Mekonen et al. 2024). Cow milk consumption in Ethiopia is significantly correlated with household income, family size, education level of the food budget manager (FBM), age of the FBM, household location, dairy cattle ownership, monthly expenditure on dairy products, average daily milk production per household, and the price of milk products(Melesse and Beyene 2009). On the other hand, an investigation by (Teklehaymanot 2015) indicated that significant risk factors for malnutrition in Ethiopia include the child's age, the educational level of both parents, the mother's occupation, the source of cow milk, the sex of the respondent and the child, child vaccination status, marital status, commonly consumed cereals, and the frequency of soap use. Generally, the consumption of animal-source foods depends on socioeconomic status and women's empowerment, as measured by household food security, livestock ownership, household income, and maternal educational status(Daba et al. 2024). Among the various constraints on child milk consumption, low milk production and the type of agricultural activities are the primary limitations(Headey et al. 2024). Therefore, addressing these issues promotes increased child milk consumption and helps overcome malnutrition. 3.2. Constraints on milk production in Ethiopia In Ethiopia, despite the large number of dairy cattle, their productivity remains low due to various factors, including high feed costs, land and space limitations, poor feed quality and availability, and inadequate extension and veterinary services(Dekebo and Kebede 2023). Similarly, (Abebe and Korato 2022) highlighted that, despite the significant cattle population and an established dairy industry, productivity remains low due to challenges such as diseases, feed scarcity, limited and inefficient artificial insemination (AI), inadequate veterinary services, infectious diseases, environmental factors, and shortages of both feed and land. The study by (Bekele et al. 2023) underscores the importance of breed as a major constraint in milk production, illustrating how genetic composition affects productivity. The study suggests that a greater proportion of exotic breeds is more suitable for the liquid milk market, as milk prices are usually determined by volume. On the other hand, crossbred cows with 50% exotic genes produce less milk but have a higher fat content. Furthermore, the study conducted by (Hailemariam, Tezera, and Engidashet 2022) indicated that feed shortages, limited access to improved dairy heifers, and the high purchasing cost of these heifers were the two most pressing constraints on dairy production in the Dilla Zuriya district, Gedeo Zone, Ethiopia. Addressing these constraints through improved management practices, genetic selection, and better access to veterinary and extension services is crucial for increasing milk productivity, increasing child milk consumption, and fostering the overall growth of Ethiopia's dairy industry. 4. Conclusion Child milk consumption in Ethiopia is intricately linked to dairy cattle productivity and influenced by various socioeconomic and demographic factors, including household income, family size, education level of food budget managers, and milk product prices. Despite the significant potential of Ethiopia's dairy sector, milk production remains constrained by challenges such as feed scarcity, land limitations, high feed costs, inadequate veterinary services, genetic limitations, and inefficient artificial insemination practices. Addressing these constraints is essential for improving milk productivity, which, in turn, can increase child milk consumption and contribute to reducing malnutrition. Strategies such as improved feed management, access to quality veterinary and extension services, genetic enhancements, and investments in efficient dairy practices are crucial for overcoming these barriers. Ultimately, enhancing milk production and promoting equitable access to milk for households, particularly those with young children, is a pivotal step in improving child nutrition outcomes and reducing the burden of malnutrition in Ethiopia. This comprehensive review highlights the need for coordinated efforts from policymakers, researchers, and stakeholders to implement sustainable solutions for a healthier future. Declarations Acknowledgements: I would like to express my deepest gratitude to my father, Dr. Shiferaw, my mother, Mrs. Tiruwork, my little brother, Architect Million, and my beloved son, Kidus. Your unwavering support, encouragement, and love have been my greatest strength throughout this journey. This work would not have been possible without you. Thank you from the bottom of my heart. Author Contributions: Conceptualization, F.S.; methodology, F.S.; validation, F.S.; formal analysis, F.S.; investigation, F.S.; resources, F.S.; data curation, F.S.; writing: original draft preparation, F.S.; writing: review and editing, F.S. I confirm that I independently carried out all aspects of the study and approved the final manuscript. Funding: The author received no external funding for this work. Availability of data and materials: Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. Ethics approval : Not applicable. Consent to Publish Declaration: Not applicable. Consent to Participate declaration: Not applicable. Competing interests : The authors declare that they have no competing interests. References Abebe M, Korato T (2022) Review on Opportunities and Constraints of Dairy Production in Ethiopia . Vol. 10 Bekele R, Taye M, Abebe G, and Selam Meseret (2023) Genetic and Non-Genetic Factors Affecting Test Day Milk Yield and Milk Composition Traits in Crossbred Dairy Cattle in Ethiopia. Veterinary Integr Sci 21(3):717–733. 10.12982/VIS.2023.052 Choudhury S, Headey DD (2018) Household Dairy Production and Child Growth: Evidence from Bangladesh. Econ Hum Biol 30:150–161. 10.1016/j.ehb.2018.07.001 Daba A, Kabeta M, Murimi K, Abegaz (2024) and Dejene Hailu. Animal Source Food Consumption Practice and Factors Associated among Infant and Young Children from Selected Rural Districts in Ethiopia: A Cross-Sectional Study. PLoS ONE 19(7 July). 10.1371/journal.pone.0306648 Dekebo D, and Isayas Asefa Kebede (2023) Review on Dairy Cattle Production in Ethiopia: Review Article. Mathews J Veterinary Sci 7(4). 10.30654/mjvs.10028 Ethiopia Service Provision Assessment (2023) Ethiopia Service Provision Assessment 2021-22 Final Report . Addis Ababa Farrell J (2021) Dairy in Ethiopia. Application of the Supply Chain Analysis for Nutrition (SCAN) Tool . Geneva. 10.36072/bp.7 Fufa A, Jabessa, Jan, van der Lee, Mengistu A (2024) Risk Coping Strategies of Typical and Entrepreneurial Smallholder Dairy Farmers in Ethiopia. NJAS: Impact Agricultural Life Sci 96(1). 10.1080/27685241.2024.2335375 Girma W, Timotiows, Genebo (2002) Determinants of the Nutritional Status of Mothers and Children in Ethiopia . Addis Ababa Hailemariam E, Tezera T, and Haile. Engidashet (2022) Husbandry Practices and Constraints of Smallholder Dairy Production in Dilla Zuriya District, Gedeo Zone, Ethiopia. Heliyon 8(3). 10.1016/j.heliyon.2022.e09151 Headey D (2023) Can Dairy Help Solve the Malnutrition Crisis in Developing Countries? An Economic Analysis. Anim Front 13(1):7–16. 10.1093/af/vfac083 Headey DD, Alderman H, John Hoddinott, and Sudha Narayanan (2024) The Glass of Milk Half-Empty? Dairy Development and Nutrition in Low and Middle Income Countries. Food Policy 122 Ijaiya MA, Anjorin S, Uthman OA (2024) Income and Education Disparities in Childhood Malnutrition: A Multi-Country Decomposition Analysis. BMC Public Health 24(1):2882. 10.1186/s12889-024-20378-z Mehrab Bakhtiar M, and John Hoddinott (2023) Household Dairy Production, Dairy Intake, and Anthropometric Outcomes in Rural Bangladesh. Food Policy 121. 10.1016/j.foodpol.2023.102567 Mekonen E, Getaneh BS, Workneh MS, Ali AT, Gonete Tewodros Getaneh Alemu, Tadesse Tarik Tamir, Berhan Tekeba, Masresha Asmare Techane, Mulugeta Wassie, Alemneh Tadesse Kassie, and Alebachew Ferede Zegeye. 2024. Minimum Milk Feeding Frequency and Its Associated Factors among Non-Breastfed Children Aged 6–23 Months in Sub-Saharan Africa: A Multilevel Analysis of the Recent Demographic and Health Survey Data. BMC Public Health 24(1). 10.1186/s12889-024-19275-2 Mekonnen E, Arega M, Belay DM, Birhanu D, Tesfaw T, Ayele H (2023) and Keralem Anteneh Bishaw. Time to Death and Its Predictors among Under-Five Children on Antiretroviral Treatment in Public Hospitals of Addis Ababa, Addis Ababa, Ethiopia, a Retrospective Follow up Study. PLoS ONE 18(7 July). 10.1371/journal.pone.0288475 Melesse K (2009) and Fekadu Beyene. Consumption Pattern of Milk and Milk Products in Ada’a Woreda, East Shoa Zone, Central Ethiopia . Vol. 21 Namulondo R, and Bernard Bashaasha (2024) Household Milk Production, Milk Purchase and Child Nutrition: Panel Data Evidence from Rural Uganda. Afr J Agricultural Resource Econ 19(1):19–34. 10.53936/afjare.2024.19(1).2 Raru T, Beshir GM, Ayana BT, Merga B, Negash A, Deressa A, Birhanu FA, Hassen, and Kedir Teji Roba (2022) Magnitude of Under-Nutrition among under Five Children in Ethiopia Based on 2019 Mini-Ethiopia Demographic and Health Survey: Generalized Linear Mixed Model (GLMM). BMC Nutr 8(1). 10.1186/s40795-022-00598-5 Sahiledengle B, Mwanri L, Petrucka P, Kumie A, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Teferu Z Debebe Wordofa, Kenbon Seyoum, Degefa Gomora, Getahun Negash, and Kingsley Emwinyore Agho. 2022. Determinants of Undernutrition among Young Children in Ethiopia. Sci Rep 12(1). 10.1038/s41598-022-25160-y Scherbaum V, Leila Srour M (2018) Milk Products in the Dietary Management of Childhood Undernutrition - A Historical Review. Nutr Res Rev 31(1):71–84 Teklehaymanot A (2015) SCHOOL OF CHEMICAL AND FOOD PROCESS ENGINEERING Master Program. Applied Human Nutrition NUTRITIONAL STATUS OF CHILDREN 2–5 YEARS OLD, ITS RELATION WITH COW MILK CONSUMPTION AND OTHER ASSOCIATED FACTORS IN KILTEAWLAELO DISTRICT EASTERN ZONE TIGRAY, ETHIOPIA. KILTEAWLAELO DISTRICT EASTERN ZONE TIGRAY, ETHIOPIA Yirga A, Argaw HG, Mwambi DG, Ayele, Sileshi Fanta M (2019) Factors Affecting Child Malnutrition in Ethiopia. Afr Health Sci 19(2):1897–1909. 10.4314/ahs.v19i2.13 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5892534","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":406460297,"identity":"0e4bbc49-5f4d-4382-b76e-118f58fccfcd","order_by":0,"name":"Fana Shiferaw","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBAC9gYwZcEIpnkMEuRA9IEHeLTwHABTEowNbBAtxmAtCcRrYUhIBFuHVwv72YOfeSokZPvl2x9+eFOQlj4/7PBDoC12croNOLTw5CVL85yRMJ7ZxmMsOccgJ3fj7TQDoJZkY7MD2LXYM+QYSOe2SSRuOMbDIM1jUJG7cXYCSMuBxG04tPDwvzH+DdKy/xj7499ALemGs9M/4NcikWMGsYWNwQxoS06CvHQOAVsk3phZ/wH6ZcaxHDPLOQZphhukcwoOJBjg9gsPf47xzRkVNrL9zccf33jzJ1lefnb65g8fKuzkcGnBBAZglQbEKgcB+QZSVI+CUTAKRsFIAABoUF7i4nNCZgAAAABJRU5ErkJggg==","orcid":"","institution":"BAHIR DAR UNIVERSITY, COLLEGE OF MEDICINE AND HEALTH SCIENCES","correspondingAuthor":true,"prefix":"","firstName":"Fana","middleName":"","lastName":"Shiferaw","suffix":""}],"badges":[],"createdAt":"2025-01-24 05:18:17","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5892534/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5892534/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74999089,"identity":"686ac667-6ecc-4548-bdd3-89cbb03a9956","added_by":"auto","created_at":"2025-01-29 09:25:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":68186,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5892534/v1/113e1c2c36cf4eb97d2fa10b.png"},{"id":75000616,"identity":"6fed5840-ccfd-42c7-a2ad-c3b29468b37b","added_by":"auto","created_at":"2025-01-29 09:41:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":598185,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5892534/v1/339c2561-52f2-4ae0-ae10-e832ced18b56.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCow Milk Production, Milk Consumption, and Production Constraints in Ethiopia: A Systematic Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eChild malnutrition remains a significant public health concern in developing countries and is a leading cause of illness and mortality among children. Children under the age of five are particularly vulnerable to malnutrition(Yirga et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In Ethiopia, for example, approximately 57% of child mortality is under the age of five years, which is related to malnutrition(Girma and Genebo 2002).\u003c/p\u003e \u003cp\u003eIn Ethiopia alone, 4.25% of children are chronically malnourished (Ethiopia Service Provision Assessment \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). According to the findings of Mekonnen et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), there were 4.98 deaths for every 1,000 child-months observed in the study. In addition to causing morbidity and mortality, malnutrition leads to stunting and wasting, which are relatively prevalent in Ethiopia(Raru et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, to address this issue and improve children's nutritional status, measures should be implemented to increase animal productivity, ensuring a better supply of high-quality animal protein (Headey \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Scherbaum and Srour 2018).\u003c/p\u003e \u003cp\u003eHowever, child nutrition can also be influenced by factors such as parental education, household income, family size, low milk production, and the type of agricultural activities practiced (Headey et al. 2024; Ijaiya, Anjorin, and Uthman \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sahiledengle et al. 2022). In low- and middle-income countries, dairy production and consumption are strongly linked to reduced stunting risk(Headey et al. 2024). In a similar vein, (Namulondo and Bashaasha 2024) concluded that household milk production and milk purchasing work together to increase child milk consumption. Nevertheless, in Ethiopia, dairy cattle produce only a small volume of milk(Fufa, van der Lee, and Mengistu 2024). Addressing this issue, along with the constraints on child milk consumption mentioned above, requires identifying the primary barriers and implementing effective measures for improvement.\u003c/p\u003e \u003cp\u003eTherefore, this review aims to address these gaps by examining the factors limiting dairy cattle productivity and child milk consumption.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003eThis systematic review explores cow milk production, child milk consumption, and constraints on milk production in Ethiopia. This finding underscores the importance of improving milk production and ensuring equitable access to milk for households, particularly those with young children. The review concludes by emphasizing the need for coordinated efforts among policymakers, researchers, and stakeholders to implement sustainable solutions for a healthier future.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Literature selection criteria\u003c/h2\u003e \u003cp\u003eThe selection of articles for this review was guided by specific inclusion and exclusion criteria as follows:\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1. Inclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies published in peer-reviewed journals, theses, conference proceedings, or authoritative reports.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eResearch addressing Cow Milk Production, Milk Consumption, and Production Constraints in Ethiopia.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePublications available in English or translated into English.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2. Exclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eArticles focusing on milk from other species.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies not involving children under five years of age or households with children.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies conducted outside of Ethiopia.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eResearch published before 2002.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Search strategy\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was conducted using the following key terms: child milk consumption, cow milk production, constraints of child milk consumption, and constraints of cow milk production. Filters were applied to restrict the results to studies published between 2002 and 2024, ensuring the inclusion of the most recent and relevant research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Study Selection\u003c/h2\u003e \u003cp\u003eThe study selection process adhered to the PRISMA guidelines, starting with the screening of titles and abstracts, followed by a full-text review of relevant studies, as detailed in Additional File1. Studies were included if they met the established inclusion criteria. Data extraction was conducted independently by the author to minimize bias and ensure consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Assessment of Study Quality\u003c/h2\u003e \u003cp\u003eEach included study was assessed for methodological rigor via a set of predefined criteria. These criteria included the clarity of reporting on outcomes related to child cow milk consumption, cow milk production, constraints on child cow milk consumption, and constraints on cow milk production, as well as the experimental design (preferably randomized controlled trials). Only studies that met these criteria for relevance and methodological quality were included. However, sample size data were not consistently available or applicable for all studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Potential biases and limitations\u003c/h2\u003e \u003cp\u003eSeveral potential biases were considered in the study selection and analysis:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePublication Bias\u003c/b\u003e: There may be a tendency for studies with positive or significant results to be more likely published, whereas negative or inconclusive studies may be underrepresented. To mitigate this, studies with varying results were included, and gray literature (e.g., theses, reports) was reviewed when available.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLanguage Bias\u003c/b\u003e: Only studies published in English or translated into English were included. This could exclude relevant studies published in other languages, although English-language publications predominated in this field.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eGeographical Bias\u003c/b\u003e: Most of the studies retrieved were from Ethiopia, but studies from other countries around the world were also included. This may limit the generalizability of the findings to other regions.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSelection bias\u003c/b\u003e: The studies included focused primarily on child milk consumption and constraints, cow milk production, and cow milk production constraints. This focus could limit the generalizability of the findings.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eConfirmation Bias\u003c/b\u003e: The authors' expectations regarding cow milk production, child milk consumption, and production constraints in Ethiopia may have led to the selective inclusion of studies that support this hypothesis. To minimize bias, studies with neutral or conflicting findings were also considered, provided that they met the quality criteria.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Data Synthesis and Analysis\u003c/h2\u003e \u003cp\u003eData synthesis was performed by extracting key information on cow milk production, child milk consumption, and production constraints in Ethiopia. Given the variability in experimental design and reporting formats across the included studies, a qualitative synthesis approach was employed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.7. Statistical analysis\u003c/h2\u003e \u003cp\u003eOwing to the qualitative nature of the data, formal statistical analysis could not be conducted. However, a trend analysis was performed to identify patterns across studies. Variations in the data were observed, particularly regarding the constraints on child milk consumption.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.8. Availability of Materials and Data\u003c/h2\u003e \u003cp\u003eThe data supporting the results of this review are available from the corresponding author upon reasonable request. No primary datasets were collected as part of this systematic review; data were extracted from existing published studies.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u0026nbsp;2.9 Ethical approval\u003c/p\u003e\n\u003cp\u003eAs this is a systematic review of existing studies, no ethical approval was required for this study.\u003c/p\u003e\u003cp\u003e2.10. PRISMA flow diagram\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"3.\tCow Milk Production and Milk Consumption","content":"\u003cp\u003eCow milk production and child milk consumption are positively correlated (Choudhury and Headey 2018; Namulondo and Bashaasha 2024). A study by Choudhury and Headey (2018) revealed that household dairy production increases height-for-age Z scores by 0.52 standard deviations during the critical growth window of 6\u0026ndash;23 months. Similarly, Mehrab Bakhtiar and Hoddinott (2023)\u0026nbsp;demonstrated that dairy cow ownership is positively associated with height-for-age Z scores, increasing them by 0.13 standard deviations and reducing stunting by 11.3 percentage points. Therefore, dairy cow ownership and milk production play significant roles in ensuring household child nutrition(Choudhury and Headey 2018).\u003c/p\u003e\n\u003cp\u003e3.1. Child Milk Consumption in Ethiopia\u003c/p\u003e\n\u003cp\u003eIn sub-Saharan Africa, the proportion of nonbreastfed children aged 6--23 months meeting the minimum milk feeding frequency is low. In Ethiopia, approximately 4.4 billion litters of fresh milk were produced in 2018, with 3.08 billion litters (70%) designated for human consumption. Among these, 57% were consumed by rural households, whereas 43% were processed and distributed through supply chains. However, per capita annual dairy consumption is only 11% of the recommended level of dairy consumption by the World Health Organization(Farrell 2021).\u0026nbsp;A\u0026nbsp;study conducted in the Adea Woreda of Debre Zeit\u0026nbsp;reported\u0026nbsp;that the consumption level of milk and milk products was very low, at only 11.2 g LME (Livestock Milk Equivalent) per head per day, even compared\u0026nbsp;with\u0026nbsp;other African countries(Melesse and Beyene 2009).\u003c/p\u003e\n\u003cp\u003eThe likelihood of meeting this requirement increases with higher education levels, unemployment, media exposure, higher wealth status, being unmarried, childbirth in a health facility, receiving postnatal care (PNC), being 6 to 8 months old, and residing in urban areas (Mekonen et al. 2024).\u003c/p\u003e\n\u003cp\u003eCow milk consumption in Ethiopia is significantly correlated with household income, family size, education level of the food budget manager (FBM), age of the FBM, household location, dairy cattle ownership, monthly expenditure on dairy products, average daily milk production per household, and the price of milk products(Melesse and Beyene 2009). On the other hand, an investigation by (Teklehaymanot 2015) indicated that significant risk factors for malnutrition in Ethiopia include the child\u0026apos;s age, the educational level of both parents, the mother\u0026apos;s occupation, the source of cow milk, the sex of the respondent and the child, child vaccination status, marital status, commonly consumed cereals, and the frequency of soap use.\u003c/p\u003e\n\u003cp\u003eGenerally, the consumption of animal-source foods depends on socioeconomic status and women\u0026apos;s empowerment, as measured by household food security, livestock ownership, household income, and maternal educational status(Daba et al. 2024). Among the various constraints on child milk consumption, low milk production and the type of agricultural activities are the primary limitations(Headey et al. 2024). Therefore, addressing these issues promotes\u0026nbsp;increased\u0026nbsp;child milk consumption and helps overcome malnutrition.\u003c/p\u003e\n\u003cp\u003e3.2. Constraints on milk production in Ethiopia\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, despite the large number of dairy cattle, their productivity remains low due to various factors, including high feed costs, land and space limitations, poor feed quality and availability, and inadequate extension and veterinary services(Dekebo and Kebede 2023). Similarly,\u0026nbsp;(Abebe and Korato 2022)\u0026nbsp;highlighted that, despite the significant cattle population and an established dairy industry, productivity remains low due to challenges such as diseases, feed scarcity, limited and inefficient artificial insemination (AI), inadequate veterinary services, infectious diseases, environmental factors, and shortages of both feed and land.\u003c/p\u003e\n\u003cp\u003eThe study by (Bekele et al. 2023) underscores the importance of breed as a major constraint in milk production, illustrating how genetic composition affects productivity. The study suggests that a greater proportion of exotic breeds is more suitable for the liquid milk market, as milk prices are usually determined by volume. On the other hand, crossbred cows with 50% exotic genes produce less milk but have a higher fat content. Furthermore, the study conducted by (Hailemariam, Tezera, and Engidashet 2022) indicated that feed shortages, limited access to improved dairy heifers, and the high purchasing cost of these heifers were the two most pressing constraints on dairy production in the Dilla Zuriya district, Gedeo Zone, Ethiopia. Addressing these constraints through improved management practices, genetic selection, and better access to veterinary and extension services is crucial for increasing milk productivity, increasing child milk consumption, and fostering the overall growth of Ethiopia\u0026apos;s dairy industry.\u003c/p\u003e"},{"header":"4.\tConclusion","content":"\u003cp\u003eChild milk consumption in Ethiopia is intricately linked to dairy cattle productivity and influenced by various socioeconomic and demographic factors, including household income, family size, education level of food budget managers, and milk product prices. Despite the significant potential of Ethiopia\u0026apos;s dairy sector, milk production remains constrained by challenges such as feed scarcity, land limitations, high feed costs, inadequate veterinary services, genetic limitations, and inefficient artificial insemination practices.\u003c/p\u003e\n\u003cp\u003eAddressing these constraints is essential for improving milk productivity, which, in turn, can increase child milk consumption and contribute to reducing malnutrition. Strategies such as improved feed management, access to quality veterinary and extension services, genetic enhancements, and investments in efficient dairy practices are crucial for overcoming these barriers.\u003c/p\u003e\n\u003cp\u003eUltimately, enhancing milk production and promoting equitable access to milk for households, particularly those with young children, is a pivotal step in improving child nutrition outcomes and reducing the burden of malnutrition in Ethiopia. This comprehensive review highlights the need for coordinated efforts from policymakers, researchers, and stakeholders to implement sustainable solutions for a healthier future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eI would like to express my deepest gratitude to my father, Dr. Shiferaw, my mother, Mrs. Tiruwork, my little brother, Architect Million, and my beloved son, Kidus. Your unwavering support, encouragement, and love have been my greatest strength throughout this journey. This work would not have been possible without you. Thank you from the bottom of my heart.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conceptualization, F.S.; methodology, F.S.; validation, F.S.; formal analysis, F.S.; investigation, F.S.; resources, F.S.; data curation, F.S.; writing: original draft preparation, F.S.; writing: review and editing, F.S. I confirm that I independently carried out all aspects of the study and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The author received no external funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish Declaration:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbebe M, Korato T (2022) \u003cem\u003eReview on Opportunities and Constraints of Dairy Production in Ethiopia\u003c/em\u003e. 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Sci Rep 12(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-022-25160-y\u003c/span\u003e\u003cspan address=\"10.1038/s41598-022-25160-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScherbaum V, Leila Srour M (2018) Milk Products in the Dietary Management of Childhood Undernutrition - A Historical Review. Nutr Res Rev 31(1):71\u0026ndash;84\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeklehaymanot A (2015) SCHOOL OF CHEMICAL AND FOOD PROCESS ENGINEERING Master Program. Applied Human Nutrition NUTRITIONAL STATUS OF CHILDREN 2\u0026ndash;5 YEARS OLD, ITS RELATION WITH COW MILK CONSUMPTION AND OTHER ASSOCIATED FACTORS IN KILTEAWLAELO DISTRICT EASTERN ZONE TIGRAY, ETHIOPIA. KILTEAWLAELO DISTRICT EASTERN ZONE TIGRAY, ETHIOPIA\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYirga A, Argaw HG, Mwambi DG, Ayele, Sileshi Fanta M (2019) Factors Affecting Child Malnutrition in Ethiopia. Afr Health Sci 19(2):1897\u0026ndash;1909. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4314/ahs.v19i2.13\u003c/span\u003e\u003cspan address=\"10.4314/ahs.v19i2.13\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Milk consumption, Ethiopia, Malnutrition, Milk production","lastPublishedDoi":"10.21203/rs.3.rs-5892534/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5892534/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Child malnutrition is a major public health issue in Ethiopia, contributing significantly to child morbidity and mortality. Understanding the factors influencing child milk consumption and dairy cattle productivity is critical for addressing malnutrition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: This systematic review aims to identify the factors affecting dairy cattle productivity and child milk consumption in Ethiopia and to evaluate the constraints limiting milk production and its impact on child nutrition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: In accordance withPRISMA guidelines, a comprehensive literature search was conducted across multiple databases. Studies examining child milk consumption, dairy cattle productivity, and their relationship with child nutrition outcomes were included. Data were extracted and synthesized to highlight key determinants, constraints, and strategies for improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Evidence indicates a positive correlation between dairy production and child nutritional outcomes. For example, increased milk consumption improves height-for-age Z scores by 0.52 SD and reduces stunting by 11.3%. The keydeterminants of child milk consumption include household income, family size, the education level of the food budget manager, and milk product prices. However, low dairy productivity in Ethiopia is attributed to feed scarcity, land limitations, high feed costs, inadequate veterinary services, genetic limitations, and inefficient artificial insemination practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Addressing the constraints on dairy cattle productivity is crucial for improving milk availability and enhancing child nutrition. This review provides insights for policymakers and stakeholders in the design of interventions that promote child milk consumption and mitigate malnutrition in Ethiopia.\u003c/p\u003e","manuscriptTitle":"Cow Milk Production, Milk Consumption, and Production Constraints in Ethiopia: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-29 09:25:24","doi":"10.21203/rs.3.rs-5892534/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e76610bd-942f-4076-b109-588ae732599d","owner":[],"postedDate":"January 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":43345169,"name":"Animal Science"}],"tags":[],"updatedAt":"2025-01-29T09:25:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-29 09:25:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5892534","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5892534","identity":"rs-5892534","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}