Understanding intrahousehold factors prior to infant and young child feeding (IYCF) programming with micronutrient powder (MNP) in northern Nigeria

Objective We conducted formative research to develop a culturally‐appropriate and effective integrated nutrition program with MNP. In doing so, we aimed to describe household meal preparation and eating behaviors. We also sought to describe typical IYCF practices in comparison to national guidelines and for consideration during program implementation. Methods This study was part of larger formative research designed to have a series of iterative and participatory phases using a triangulation of methods. For this component, ethnographic data collection occurred in 3 areas of each Kebbi and Adamawa. First, in‐depth interviews were conducted among community leaders ( n = 18), religious leaders ( n = 15), health workers ( n = 30), and caregivers ( n = 36). Then , a home‐feeding trial was conducted with 144 households that were provided MNP over two, four‐week phases. 48 children were enrolled into each age stratum (6 – 11 mo; 12 – 17 mo; 18 – 23 mo). In phase 1, we conducted full‐day (12‐hour) observations with a sample of households using MNP ( n = 24). In phase 2, the same households ( n = 18) were observed a second time. Additional interviews to clarify or explain findings from the observations were conducted after the trial ( n = 27). Textual data from interviews and observations were inductively analyzed using a team‐based coding approach with Dedoose software. Results The top IYCF‐related challenges in these settings stem from varying seasonal agricultural yields, causing food access difficulties getting nutrient‐rich young child foods, such as groundnuts and soya. Caregivers explain that coping mechanisms include reducing the quantity of young child meals per day or serving only un‐fortified, cereal‐based porridges. Observations revealed predictable household meal patterns: men eating alone or with other men; women eating alone or with other women; children eating with children of similar age and/or gender; in‐laws eating alone; and the child 6 – 12 mo. eating with her primary caregiver or, in cases when the child is older than 12 mo. eating with children 2 – 5 years, as a way to learn eating behaviors. Food sharing is a core cultural value and manifests as shared plate eating in households, as well as food bartering between households. The top foods consumed by children 6 – 23 mo. were breast milk and cereal‐based staples, either kunu (cereal‐based, watery or semi‐solid porridge) or tuwo (boiled and cereal‐based, solid staple food). There were very few leafy green vegetables consumed across observations and, other than powdered milk, no animal‐sources such as liver, eggs, or fish. Iron‐rich foods were missing from the diets of young children who were observed. We compared IYCF practices to national guidelines and found that 94.1% (6 – 11 mo.), 83.3% (12 – 17 mo.), and 53.8% (18 – 23 mo.) of children practiced continued breastfeeding. However, just 5.8% of children observed were fed fortified porridge with groundnuts/soya; 52.9% were fed foods other than breast milk or porridge; and 0.0% were fed any animal‐source foods. Finally, observations revealed that only 4.8% (2/42) of children 6 – 23 mo. had their hands washed prior to feeding/eating episodes. Conclusions The interdependent cultural context and food sharing values may offer challenges to ensuring MNP is consumed by only the beneficiary child during programming. While MNP is efficacious to reduce anemia, it still requires substantial formative work and careful consideration to inform program design. Support or Funding Information European Union