When safety competes with nutrition: maternal dietary diversity and coping strategies in conflict-affected Sokoto State, Nigeria

Abstract

Maternal dietary diversity is a critical indicator of micronutrient adequacy, yet it remains severely compromised in conflict-affected settings. In north-western Nigeria, persistent insecurity disrupts food systems, livelihoods, and market access, exacerbating maternal nutritional vulnerability. This study examines the determinants of maternal dietary diversity among pregnant and lactating women in conflict-affected areas of Sokoto State. A convergent mixed-methods design was employed. Quantitative data were collected from 768 women using structured questionnaires incorporating a 24-hour recall to compute the Maternal Dietary Diversity Score (MDDS). Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were conducted to identify predictors of adequate dietary diversity (≥ 5 food groups). Qualitative data from in-depth interviews and focus group discussions were analysed thematically to contextualise statistical findings. Dietary diversity was markedly low, with 70.0% consuming fewer than five food groups. Bivariate analysis revealed significant associations between dietary diversity and location (χ²=59.81, p < 0.05), education (χ²=182.37, p < 0.05), employment (χ²=68.11, p < 0.05), and household role (χ²=187.82, p < 0.05). Multivariable regression showed that duration of displacement significantly increased the likelihood of adequate dietary diversity: 6–12 months (AOR = 1.82; 95% CI: 1.01–3.28), 1–2 years (AOR = 2.35; 95% CI: 1.37–4.03), and ≥ 2 years (AOR = 3.10; 95% CI: 1.85–5.20). Women in Sabon-Birni were more likely to achieve adequate dietary diversity than those in Illela (AOR = 1.85; 95% CI: 1.02–3.35). Similarly, IDPs (AOR = 1.92; 95% CI: 1.12–3.29) and refugees (AOR = 3.10; 95% CI: 1.58–6.08) had higher odds compared to host communities. Conversely, households with changing income were significantly less likely to achieve adequate dietary diversity (AOR = 0.10; 95% CI: 0.04–0.24). Qualitative findings revealed coping strategies including maternal self-deprivation, reliance on monotonous diets, and constrained market access due to insecurity. Maternal dietary diversity in conflict settings is shaped by structural determinants including displacement, location, and economic instability. Interventions must integrate nutrition support with livelihood recovery, market stabilization, and security-sensitive programming.