Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision-making, intra-household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive (A&T) initiative implemented an intervention to improve complementary feeding practices through father engagement. This study describes household gender roles among A&T participants and how they influence maternal and paternal involvement in complementary feeding. We conducted 16 focus group discussions with mothers and fathers of children aged 6-23 months in urban and rural administrative wards and analysed them using qualitative thematic analysis methods. Most mothers and fathers have traditional roles with fathers as 'providers' and 'supervisors' and mothers as 'caregivers'. Traditional normative roles of fathers limit their involvement in 'hands-on' activities, which support feeding and caring for children. Less traditional normative roles, whereby some mothers contributed to the provision of resources and some fathers contributed to caregiving, were also described by some participants and were more salient in the urban wards.In the rural wards, more fathers expressed resistance to fathers playing less traditional roles. Fathers who participated in caregiving tasks reported respect from their children, strong family relationships and had healthy home environments. Our research findings point to the need for more context-specific approaches that address prevalent gender normative roles in complementary feeding in a variety of settings.

Background Although most health facilities in urban Nigeria are privately-owned, interventions to promote optimal breastfeeding practices in private facilities have not previously been implemented. Objectives We tested the impact of a breastfeeding promotion intervention on early initiation of breastfeeding and exclusive breastfeeding among clients in private facilities in Lagos, Nigeria. Methods The intervention included training for health care providers on the Baby Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging. We used logistic regression models adjusted for clustering to detect differences in a cohort of women (N = 1200) at 10 intervention and 10 comparison facilities interviewed during their third trimester and at 6 and 24 weeks postpartum. Results The intervention significantly increased exclusive breastfed at 6 weeks (83% intervention, 76% comparison, P = 0.02) and 24 weeks (66% intervention, 52% comparison, P < 0.001), but had no impact on early initiation of breastfeeding (35% intervention, 33% comparison, P = 0.65). Among infants who were exclusively breastfed at 6 weeks, the odds of continued exclusive breastfeeding at 24 weeks were higher in the intervention arm than comparison arm (OR 1.6, P = 0.005). Infants had increased odds of being exclusively breastfed at 6 weeks if their mothers discussed breastfeeding with a private health provider (OR 2.3, P < 0.001), received text or WhatsApp messages about breastfeeding (OR 1.7, P = 0.048), or heard breastfeeding radio spots (OR 4.2, P = 0.029). Infants had increased odds of exclusive breastfeeding at 24 weeks if their mothers participated in a WhatsApp breastfeeding support group (OR 1.5, P = 0.040). Conclusions A breastfeeding intervention in private health facilities in Lagos increased exclusive breastfeeding. Implementation of breastfeeding interventions in private facilities could extend the reach of breastfeeding promotion programs in urban Nigeria. ClinicalTrials.gov registration: NCT04835051.

Background Fathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers. Objective To measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers’ and mothers’ complementary feeding knowledge, and fathers’ support for complementary feeding (secondary outcomes). Methods The 12-month intervention in Kaduna State, Nigeria engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child 6-23 months were conducted, and regression models were used to compare results at baseline (N = 497) and endline (N = 495). Results Children's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P<0.001) increased. Fathers’ and mothers’ knowledge of the timing of introduction of different foods and meal frequency improved. Fathers’ support for child feeding by providing money for food increased (79% to 90%, P<0.001). Fathers’ and mothers’ reported intervention exposure was low (11%-26% across types of SBCC). Child feeding outcomes were not associated with fathers’ exposure, but odds of both fish and egg consumption increased significantly with mothers’ exposure to community meetings, religious services, home visits, and TV spots and odds of minimum meal frequency increased significantly with mothers’ exposure to home visits. Conclusions A multipronged SBCC intervention improved complementary feeding practices, fathers’ and mothers’ knowledge of complementary feeding, and fathers’ support for complementary feeding, despite low levels of reported exposure, which may have been influenced by COVID-19 disruptions. Registered with ClinicalTrials.gov (NCT04835662).

Background Evidence about the effects of mothers’ decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relationship between mothers’ decision-making autonomy and the practice of complementary feeding. Objectives This study examined the moderation effect of fathers’ complementary feeding support on the association of mothers’ decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post-hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers’ and fathers’ perspectives of mothers’ autonomy and fathers’ complementary feeding support. Methods Data were from cross-sectional surveys of 495 cohabiting parents of children aged 6–23 months enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation. Kappa statistics and 95% confidence intervals were used to assess the concordance in reported perspectives of the parents. Results The moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥ 2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents’ perspectives of mothers’ autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents’ perspectives of fathers’ complementary feeding support. Conclusions In Nigeria, high levels of fathers’ complementary feeding support strengthen the association of mothers’ decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day. Registered with ClinicalTrials.gov (NCT04835662).

Objectives The majority of health providers in Lagos, Nigeria are private, but few of them offer breastfeeding counseling. From May 2019-April 2020, Alive & Thrive implemented a breastfeeding promotion intervention in collaboration with 10 private health facilities in Lagos. The intervention included implementation of the Baby-Friendly Hospital Initiative, training for providers, and provision of breastfeeding counseling to women in person and on Whatsapp, breastfeeding Whatsapp support groups, and infant and young child feeding (IYCF) counseling materials. The objective of our research was to examine the feasibility of integrating the intervention into routine health services using a mixed-methods process evaluation. Methods We conducted in-depth interviews (IDIs) with 20 health facility leaders and providers, 90 structured observations and exit interviews with women during the 3rd trimester and at 6 weeks postpartum. The IDIs were transcribed and analyzed thematically in Dedoose software (version 8), and the structured observations and exit interviews were summarized as proportions. Results The IDIs indicated that almost all health facility leaders and providers had positive experiences with the intervention. Facilitators included the training received, support from facility leaders, and availability of IYCF counseling materials. Barriers included increased workloads, paperwork, and health providers’ use of personal time for counseling on Whatsapp. Observations and exit interviews suggested that breastfeeding counseling improved over time. Exit interviews also showed that most mothers were very satisfied with services and were very confident they could carry out the breastfeeding advice they had received. Conclusions Provision of breastfeeding counseling and support through private health facilities is feasible, but service delivery challenges must be considered for successful scale-up of the intervention in Nigeria. Funding Sources This research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation Irish Aid, and other donors.