“Upon admission to the ward, they (twins) looked tiny to the point that they could not even grab the nipples to suck breasts. All their bones were visible and looked very weak,” said Emmanuel Sodiga, an FHI 360 health worker.
Mrs. Zulai Mohammed, a mother of four, gave birth to the twins under poor economic and environmental conditions. It is well known that the long-term armed conflict in northern Nigeria has disrupted the livelihood, health, nutrition, education, and social protection of individuals.

As a result, Zulai faced insufficient breast milk production and a lack of adequate knowledge about IYCF, which negatively impacted the nutritional status of her twins. This was further worsened by underlying infections in the children.

The four weeks old twins, namely Hassan Auwalu (male) and Hussaina Auwalu (female), all presented with fever, cough, and visible signs of wasting, such as visible ribs and prominent zygomatic bones.

“Life became difficult after we were displaced some years ago”, Mrs. Zulai recounted. “The situation even worsened after the delivery of these children as I needed more food, but my husband was not able to provide because he doesn’t have a good job. Because of my hunger, I couldn’t get enough breast milk to breastfeed my children. Hence, I used sachet powdered milk as I could not afford infant formula”. Notably, the sachet of powdered milk is not designed for children under 12 months. However, Zulai fed her 4 weeks old babies with it. This resulted in low weight, as Hassan was 1.4 kg, while Hussaina was 1.3 kg. The mother was also assessed on proper breastfeeding practices, and it revealed that there was poor attachment, poor position, and poor hygiene practices.

The twins and their mother were admitted and treated according to national guidelines. To stimulate re-lactation, F100 diluted (DF100) was administered using the Supplemental Sucking Technique (SST), while oral antibiotics treated underlying infections causing fever. The mother received comprehensive care, including nutrition, hygiene education, breastfeeding guidance, and psychosocial counseling.

By April 22, 2024, both twins had gained sufficient weight—Hassan increased from 1.3 kg to 2.2 kg, and Hussaina from 1.4 kg to 2.2 kg. With successful re-lactation and improved health, they were discharged. The mother’s mental and physical health also showed significant improvement.