Structural Determinants of Chronic Undernutrition Among Children Under Five in Conflict-Affected Communities of North East Nigeria: A Grounded Theory Study

Chronic undernutrition in children under five years remains catastrophically high in conflict-affected communities of North East Nigeria, particularly in Borno, Adamawa, and Yobe states where years of armed conflict have decimated food production systems, healthcare infrastructure, and social support networks. While surface-level associations between conflict and undernutrition are well documented, the deep structural mechanisms through which conflict generates and perpetuates chronic undernutrition in this context are poorly theorised. This thesis develops a grounded theory of the structural determinants of chronic undernutrition in conflict-affected communities of North East Nigeria. The study was conducted in eight internally displaced persons camps and three host communities across Borno and Adamawa states over twenty-two months of fieldwork. Data were generated through 64 in-depth interviews with caregivers, 24 key informant interviews with humanitarian actors and community leaders, 12 focus group discussions, and participant observation of food acquisition and feeding practices. Constant comparative analysis following the Straussian grounded theory tradition was applied. The substantive theory developed identifies a four-tier structural mechanism: conflict-induced livelihood collapse, displacement-driven dietary homogenisation, humanitarian food system dependency with quality limitations, and intergenerational transmission of nutritional vulnerability through maternal malnutrition. The theory specifically foregrounds gender dynamics and access to cash as critical mediating mechanisms not adequately captured in existing structural models. The emergent framework contributes original theoretical insights for the design of nutrition-sensitive humanitarian responses in North East Nigeria. Keywords: chronic undernutrition, structural determinants, conflict, grounded theory, North East Nigeria.