Factors associated with milk rejection, self-reported profitability, raw milk consumption and zoonotic disease awareness among smallholder dairy farmers in southern Malawi

Background Smallholder dairy farming produces more than 60% of Malawi's milk, most of which is marketed through cooperative Milk Bulking Groups (MBGs). Milk rejection at MBGs can reduce farmer income, while raw milk consumption may increase the risk of exposure to milk-borne zoonotic pathogens. This study investigated factors associated with milk rejection, self-reported milk-sale profitability, household raw milk consumption, and awareness of milk-borne zoonotic disease transmission among smallholder dairy farmers in southern Malawi. Methods A cross-sectional survey using a multistage sampling design was conducted among 300 farmers from 29 MBGs in Blantyre, Thyolo, and Chiradzulu districts. Data were collected using a structured questionnaire and analysed using descriptive statistics, logistic regression, cumulative link mixed models (CLMMs), and mixed-effects logistic regression in R (version 4.5.1). Results An interval of >6 h between milking and MBG delivery was associated with higher odds of milk rejection (OR adj = 2.39, 95% CI: 1.06–5.82; p = 0.043), whereas farmers in Blantyre had lower odds of rejection than those in Thyolo. An interval of 3–6 h was associated with lower odds of being in a higher self-reported profitability category (OR adj = 0.22, 95% CI: 0.06–0.77; p = 0.018), while higher daily milk yield was associated with greater odds of higher profitability (OR adj = 1.04, 95% CI: 1.01–1.08; p = 0.013). Household raw milk consumption was less likely among older farmers, those with secondary education, and those whose milk had never been rejected. Awareness of milk-borne zoonotic disease transmission was higher among male farmers (OR adj = 2.49, 95% CI: 1.40–4.43; p = 0.002) but lower among farmers whose milk had never been rejected. Conclusions An interval of more than 6 h between milking and MBG delivery was associated with milk rejection, whereas the 3–6-h interval, but not the interval exceeding 6 h, was associated with lower self-reported profitability. Higher daily milk yield was associated with greater self-reported profitability. Household raw milk consumption and awareness of milk-borne zoonotic disease transmission varied according to farmer characteristics and previous milk rejection. The findings support interventions to reduce delays in milk delivery, improve access to effective cooling, and strengthen inclusive education on safe milk handling and milk-borne zoonotic risks.