A total of 114 caregivers participated (Table2).

When referring to RUSF and LNS-MQ, most of the participants named the nutritional supplements by a word in Hausa representing its consistency and appearance, they were primarily described as biskit (biscuit) or labou (groundnut paste).

Giving the children biscuits protected them against certain illnesses like diarrhea, vomiting and fever, RUSF/Cash.

We are very happy with the biskit because it protects our children from malnutrition, LNS-MQ/Cash.

When referring to SC+, consistency, appearance, perceived effects on weight gain and overall nutritional status were also considered. Participants described SC+ as gari, which means flour, but also as garin kwamasso, which means flour for malnutrition, or garin boudous, meaning flour that promotes weight gain, or garin taimako, which means aid flour.

During the distribution and prior to returning home, caregivers were invited to participate in an information session on how to use the nutritional supplements and answer any questions. During the interviews, some of the mothers described deviations in the use of the supplement at the household level. For example, some caregivers reported that they mixed the LNS-MQ into food or drink to prevent vomiting or with hot milk to increase appetite. Some reported that they did not mix the RUSF, as they were instructed.

I added water and give him like a liquid, he accepted to drink it because I noticed that when he eats this compact paste he had to vomit immediately. LNS-MQ.

I give it to my child as it is, I had never mixed it with something else. RUSF.

Regarding SC+ consumption, most frequently, the mode of preparation consisted of cooking it with water, as presented during the information sessions. However, some participants said that they use it moistened for which they covered the flour with hot water, as for preparing local couscous. Other participants indicated consuming the SC+ in dry form i.e. without any preparation. Some participants explained that they prepared it depending on the childrens preferences and some reported adding other ingredients such as oil, onion, peanut meal, salt, or sugar. A participant indicated:

Thats what I do, I buy some oil, some onion and then peanut meal and I mix it with a little salt. SC+.

Different forms of preparing the nutritional supplements emerged.

Consumption and sharing practices.

Divergences in the way in which nutritional supplements are consumed, emerged as a commonality among participants. However, although differences in how the nutritional supplements were given to children emerged, when referring to LNS-MQ and RUSF, most of the participants explained that they complied with the daily dose of one packet, most administered it between meals, in the morning. However, some participants indicated dividing the daily dose into two or three feedings, particularly for the youngest children who were still breastfeeding. A participant said:

When the distribution started, my child was not yet complementary feeding. When I take the packet I divide it in two, I give one portion in the morning, the rest in the evening; but now that he is weaned, he eats a packet by himself. RUSF.

When exploring how LNS-MQ was used, most of the participants indicated that they gave one spoonful in the morning, one spoonful at noon, one spoonful in the afternoon. However, some participants indicated that their children disliked the product, particularly the first few days after introduction. These participants explained that when children disliked the product, they tried to find ways to make their children like it. Hence, finding ways to increase acceptability were the main drivers to find alternative ways to prepare LNS-MQ.

A participant explained:

I mixed it [referring to LNS-MQ] with beans and rice for him at first when I saw that he didnt want to eat it. [ ] but now hes used to it, he eats it without me mixing it into other things. LNS-MQ/Cash.

Most of the participants indicated that color and consistency of prepared SC+ helped them to know if the child would consume it or not. A participant explained,

After preparation, we use it for up to 30 minutes. After this there is a change in color or it may become liquid as water meaning that it then it becomes less concentrated. SC+.

In reference to RUSF, LNS-MQ and SC+ most of the participants reported that when the supplements were introduced to the children for the first time, they were not well accepted, but once they got used to them, they appreciated the products. Referring to SC+, a participant explained:

In the beginning, my child didnt want to eat it. I waited and offered him to try again and again, until he accepted it. Sometimes I buy little cakes and promise to give him after he consumes the porridge. SC+.

From the participants perspective, nutritional supplements seem to be shared primarily with siblings in the household, but also with other family members, neighbors and friends.

In some households, where men had more than one wife, it was common for them to share the products with other children and even with all members of the household. A participant explained:

Honestly, all of the members of the household eat it and some spouses, when you refuse to give them any, they express their displeasure [ ] our wish is to tell you to give us a little more or to give us something else other than gari. SC+.

When referring to LNS-MQ a participant explained:

... when they provide you with labou the others expect, hope that you will share it with them, now if you refuse then trouble starts. LNS-MQ/Cash.

Some women also indicated sharing the supplements with close family members who lived in the same compound and/or had many children to feed. However, although sharing was frequently reported, many participants indicated keeping most of the ration for the children for whom the nutritional supplement was indicated. When referring to SC+, a participant explained:

Yes of course his brothers [of the target child] like gari, I give them a little raw gari but not the same amount as the target child and I only do it to get them out of the way because they are big. SC+.

This practice was also found among participants who received LNS. A participant indicated:

I have other children and once I get back to the house, after I have given half a pot to my co-wife, I give half a pot to my own children; I keep the remaining three pots for the target child and that covers about two weeks. LNS-MQ/Cash (During the distribution, the participants received four pots of LNS-MQ per child per month).

RUSF, LNS-MQ and SC+ were shared. Most of the participants indicated that they need to take care of their children and please them equally. Feeding them with nutritional supplements, or any other food, was one way of taking care of children and to please them.

Some participants indicated:

We make certain gestures out of obligation without wanting to when a parent comes to your house to tell you: today my child hasnt even had a bite to eat; and so you are obligated to give them some flour, SC+.

...you put some [referring to SC+] in a quart scoop and you bring it to your mother so she can cook it for your brothers, SC+.

I take two packets that I hide for my daughter and the rest I give to neighbors, in-laws and my parents, SC+/Cash (During the distribution, the participants received four bags of 1.5kg per child per month).

Among some breastfeeding mothers, eating one of the three supplements was perceived to help them to produce more breast milk and was an important motivating factor for consuming the supplements themselves. A breastfeeding mother indicated:

Ive noticed that it increases milk supply [ ] I often mix the gari with oil to eat and it gives me milk, SC+/Cash.

The stock lasts for three weeks because us mothers eat some from time to time to guarantee our milk supply, LNS-MQ/Cash.

Only a few participants indicated that they did not share RUSF or LNS-MQ. The perception that it would not have the expected effects on the children who needed the supplement was the main reason that prevented them from sharing the products. They also indicated that the amount of supplements distributed monthly covered the entire period between two distributions, thus the product was only consumed by the target child. A participant explained:

For me, in principle I tell myself that the complete contents of the packet must be eaten by the child each day, but if I share it with a child that was not targeted I know deep inside that the product will not work because it was not eaten by the intended child only, so thats why I never share it with other children. RUSF/Cash.

Perception of the impact of supplementary foods.

Nutritional supplements were often described to be a special kind of food that improves health, intelligence, physical appearance and protects children from diseases. After using the supplements for 5months, the benefits described from nutritional supplements included childrens weight gain, physical strength, beauty, intelligence and health maintenance.

Independently of the type of nutritional supplement, after participants gave the products to their children for a 5-month period, the children were described as, more healthy, more active, doing well, smoother, brighter, more handsome, more plump, and stronger.

I am happy because giving the gari means that I dont have to shuttle back and forth between my house and the CSI [health center] anymore, he doesnt have diarrhea, he doesnt vomit, he has gained weight and he has become active. SC+/ Food ration.

The nutritional supplements were presented by some participants as a special kind of food, which can provide protection from disease. Other caregivers compared the nutritional supplements to vitamins or even to medicine. When referring to SC+ participants indicated:

Its a food but it is mixed with a strong medicine that makes the child stop being malnourished, SC+.

In my opinion, it [referring to LNS-MQ] is an enriched product that you give to children to protect them from diseases, improve their appetite, and the child gets better quickly. LNS-MQ/Cash.

Furthermore, some mothers who fed their children with RUSF indicated that feeding their children with the biskit give them independence because children become satiated and they asked for food less often. A participant explained:

Really, the biskit, in addition to protecting our children from illness, has become a means of independence for the mothers, because as soon as you offer them a biskit, they eat it right away, they drink some water and go play, thanks to the biscuit there are no more complaints from children clinging to their mothers skirts. RUSF/Cash.

Nutritional supplements are also perceived as an additional financial support to the household. The nutritional supplements were described as a financial impact on households by guaranteeing food for their children. Participants indicated:

...thanks to the gari the womens expenses have been reduced because as soon as the child is full he doesnt demand anything else to eat, SC+.

The financial impact was also described in terms of decreasing expenses for medical costs because children were sick less often. A participant explained:

I can say that husbands are satisfied because they said that thanks to the flour, they dont pay medical costs anymore because the children have stopped being sick all the time. SC+.

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Intrahousehold management and use of nutritional supplements during the hunger gap in Maradi region, Niger: a qualitative study - BMC Blogs Network