Public health nutrition research often begins with statistics. For me, this study began with people—specifically, mothers and children I met during my internship as a Nutrition Officer at the Nutrition Department of the Ministry of Health in Ebonyi State, Nigeria.

During this period, the department was collaborating with Helen Keller International to implement a programme called Transforming Lives Through Nutrition. One of the core components involved the administration of Ready-to-Use Therapeutic Food (RUTF) for children under five suffering from severe acute malnutrition. Day after day, I witnessed the remarkable short-term recovery these children made once they were enrolled in the programme.

But alongside this progress came an unsettling question that would eventually give birth to this research.

I found myself asking: What happens to these mothers and children if the programme folds up tomorrow? Because USAID programme at the time, conversations were already emerging about funding uncertainties. What if Transforming Lives Through Nutrition also disappears, what safety net remains? More importantly, do mothers have the practical means—not just the knowledge—to sustain good nutrition using locally available foods?

These questions stayed with me and became the foundation of our study: Nutrition knowledge, dietary diversity, and household food security among mothers of under-five children in Abakaliki, Ebonyi State, Nigeria.

From Observation to Research Question

Nutrition advocacy has made significant strides in Nigeria. Mothers are increasingly exposed to messages about exclusive breastfeeding, complementary feeding, and child care through health facilities and community campaigns. Indeed, much of the published literature focuses on what mothers know.

However, during my field experience, a troubling pattern was evident. Many mothers could correctly describe recommended feeding practices, yet still presented with malnourished children. This contradiction forced us to rethink a central assumption in nutrition programming: knowledge automatically leads to action.

Our study was designed not to dismiss nutrition education, but to interrogate its limits.

What We Found: A Knowledge–Implementation Gap

The findings were striking. An overwhelming majority of mothers demonstrated adequate nutrition knowledge. They understood exclusive breastfeeding, the importance of continued feeding during illness, and the basics of child nutrition. On paper, this looked like success.

Yet beneath this encouraging surface lay a harsher reality.

More than two-thirds of households were severely food insecure. Dietary diversity among women was suboptimal, with limited consumption of nutrient-dense foods such as eggs, dark green leafy vegetables, and dairy products. In practical terms, mothers knew what their children should eat—but often could not afford it, access it, or prioritize it within complex household dynamics.

This exposed a critical truth: knowledge without the means to implement it produces the same outcome as no knowledge at all—continued child malnutrition.

Why Implementation Fails

Our interactions with mothers revealed that poor implementation was not due to negligence or indifference. Instead, it was shaped by structural and social constraints:

Poverty and food access: Many households relied on monotonous staple diets, not by choice but by necessity.

Household decision-making: Mothers often lacked autonomy over food purchases and distribution.

Cultural practices: Persistent beliefs around herbal remedies and breastfeeding during pregnancy continued to influence behaviour.

Programme dependency: Emergency nutrition interventions saved lives but were not always paired with sustainable, food-based solutions.

In essence, mothers were being asked to practice “ideal nutrition” in non-ideal circumstances.

Why This Matters for Public Health

This research reinforces an uncomfortable but necessary message for public health nutrition: information alone does not change outcomes in contexts of deprivation.

Nutrition education remains vital, but it must be embedded within broader systems that address food security, livelihoods, gender dynamics, and access to diverse local foods. Without this, we risk placing responsibility on mothers for outcomes largely determined by structural conditions beyond their control.

Our findings align with global nutrition priorities, including the Sustainable Development Goal 2 (Zero Hunger), which emphasizes not only knowledge, but access, availability, and utilization of nutritious food.

Looking Forward: Rethinking Future Interventions

Future research and programming must shift focus from whether mothers know to why mothers cannot act on what they know. This includes:

Investigating barriers to translating knowledge into practice

Integrating nutrition education with food-based livelihood support

Promoting locally available, affordable dietary solutions

Designing culturally sensitive, community-led behaviour change strategies

Evaluating sustainability beyond donor-funded interventions

Only by addressing these dimensions together can nutrition knowledge become truly transformative.

A Personal Reflection

This study is deeply personal to me. It represents a transition from observing problems in the field to systematically documenting them, with the hope of influencing policy and practice. The mothers I met were not lacking in awareness—they were navigating constraints with resilience and dignity.

If this work contributes even modestly to reframing how we design nutrition interventions—away from knowledge alone and toward implementation-focused solutions—then it has achieved its purpose.

Because in public health nutrition, the real measure of success is not what people know, but what they are realistically able to do.

https://doi.org/10.1186/s12982-025-01310-1