Exploring the feeding practices of mothers of under-five children and how household members influence exclusive breastfeeding in Jigawa State, Nigeria - A qualitative study.

Child nutrition interventions in low-income settings are variably effective as strategies often focus on primary caregivers, with less attention given to other household members. This study explored the influence of household members on exclusive breastfeeding and the feeding practices of mothers of under-five children in Jigawa State, Northern Nigeria. As part of a cluster randomised controlled trial in Jigawa State, we conducted an ethnographic process evaluation. Households were selected from six administrative wards (3 intervention and 3 control) in the Kiyawa local government area, and 90 women were recruited for the ethnography. In-depth life history interviews were conducted at three time points alongside monthly informal household visits. For this study, 36 women, who reported breastfeeding within the last 2 years, were included. Data were analysed using a reflexive thematic approach. Participant accounts identified that breastfeeding practices in the first six months varied from exclusive breastfeeding to mixed practices combining breastmilk with traditional practices centring on symbolic, nutritional and religious roles of water. Crucially, we found that decision-making around feeding practices includes wider networks of household members, involving in-laws/older family members, co-wives and neighbours who support childcare efforts. Our findings suggest that a more comprehensive and inclusive approach is needed to tackle suboptimal breastfeeding in this setting. Information needs to target entire communities to create enabling environments for exclusive breastfeeding.