Determinants of Maternal Malnutrition and Child Health in Balanga LGA, Gombe State, Nigeria: A Qualitative Study

Abstract

Maternal malnutrition remains a key driver of adverse birth outcomes in sub-Saharan Africa, yet contextual evidence on multi-level determinants in north-eastern Nigeria is scarce. This study explored how socio-cultural, environmental, and health-system factors shape maternal nutrition and child health in Balanga Local Government Area (LGA), Gombe State. An exploratory qualitative design underpinned by interpretive phenomenology was employed. Two focus-group discussions (n = 20), five in-depth interviews, and twelve key-informant interviews were conducted among pregnant women, health workers and governance actors. Data were analysed thematically using NVivo 14 and triangulated across sources. Carbohydrate dominance (97% consumed tuwo daily) was reinforced by cultural prohibitions: 70% avoided eggs due to “theft destiny” beliefs. The 2019 Balanga Dam collapse reduced irrigated area from 11 000 ha to ess-than 2 000 ha, raised dried-fish prices by 180% and cut dietary diversity from 28% to 18%. Antenatal care attendance averaged 2.9 visits; 64% of facilities lacked haemoglobinometry. Participants attributed low birth-weight, stunting and delayed vaccination to “weak blood” from maternal undernutrition. Maternal malnutrition in Balanga LGA is produced by intersecting cultural taboos, agronomic shock and health-system challenges. An integrated package of point-of-care diagnostics, conditional e-vouchers and irrigation rehabilitation could avert maternal and child death caused by low birth weight and maternal malnutrition. The findings can be adapted by other Sub-Saharan African countries experiencing similar environmental instability and gendered food allocation.