How to analyse the causes of undernutrition in a local context? The LINK NCA

A frequent shortcoming of nutrition programmes is their lack of profound assessments of situation analysis. Instead, routine, large-scale assessments are implemented, providing general analyses that often overlook the specificities of the local contexts and the challenges of vulnerable and marginalized groups, and the unique factors that contribute to their under-nutrition vulnerability.

The Link NCA (“Nutrition Causal Analysis”) method was created with the objective of helping define response strategies for tackling under-nutrition. The Link-NCA project encourages the collaboration of stakeholders to develop local multisectoral response strategies to the issue of undernutrition. It is structured and participatory thanks to the inclusion of a community-level qualitative enquiry. The qualitative enquiry illuminates context-specific and community-defined causes of undernutrition while directly integrating local communities early in the process.

To learn more about this method, check out the website and read through the methodology.

Find below, the Link NCAs that have already been conducted:

– Grand Kanem, Tchad 2012

The NCA was conducted in the context of a food security crisis in the Kanem region of Chad. The survey period took place during a peak period of admission rates for severe acute malnutrition. The results of the study support the following causal pathways of undernutrition: insufficient production of agriculture and livestock, climatic shocks, lack of agricultural training and tools, post-harvest crop destruction by bird and insects, lack of access to water, and insufficient access to markets.

– Tapoa, Burkina Faso 2013

Since 2009, Action Against Hunger has been collecting quantitative data in the province of Tapoa through studies such as the SMART study (nutritional status), the KAP survey (knowledge, attitude and practices) and HEA survey (household economy). In addition, in 2011, a nutrition surveillance system was implemented (monthly data collection from followed households, Listening Post).The results of the Link NCA highlighted that the peak of diarrhoeal diseases before the hunger gap was a really important contributor to the seasonality of wasting in the province.

– Satkhira District, Bangladesh 2014

The NCA was conducted in 4 upazilas in the Satkhira district. ACF-INT has worked in this district since 2011 following the flooding emergency. The immediate causes of undernutrition were found to be inadequate diet and dietary diversity, as well as disease incidence. Through triangulation of data, the following were found to be major risk factors: inappropriate complementary feeding practices, poor initiation and continuation of exclusive breastfeeding, adolescent pregnancies, poor psycho-social and health care for pregnant women including poor food intake, low income opportunities, and poor water and sanitation quality.

Sidama Zone, Ethiopia 2014

ACF conducted a Link-NCA in the maize livelihood belt of Aleto Chucko and Aleta Wondo Districts. Data collection took place in four villages during March and April 2014 at the beginning of the hunger gap. The prevalence of GAM was estimated at 5.6%. The major causal pathways of undernutrition were multi-sectoral and related to child health status, poor health service access and utilization, the WASH environment, economic factors, care practices. The low status of women was found to be a significant underlying factor.

East Hararghe Zone, Ethiopia 2014

The poor nutritional status of children and women has been a serious problem in Ethiopia for many years. Acute and chronic malnutrition are most prevalent, with half of Ethiopian children chronically malnourished and one in ten wasted. East Hararghe (EH) is within the Ethiopian Region of Oromiya. The objective of this study was to provide a greater level of understanding of the possible causes of acute malnutrition of children 6 – 59 months in 3 livelihood zones in two districts / woredas (Fedis and Kersa) of the East Harerghe Zone.

Burhanpur, India 2014

The overall objective of this NCA is to provide a greater level of understanding regarding the possible causes of child undernutrition in the operational ACF-India area of Khaknar block, Bhuranpur district, Madhya Pradesh. In Burhanpur District, ACF is working closely with the National Rural Health Mission (NRHM) and the Integrated Child Development Services (ICDS) at district and village level. Its actions are focusing on the prevention and detection of acute malnutrition, referral of children with severe acute malnutrition (SAM) to nutrition rehabilitation centres (NRCs) and their follow-up with an integrated IYCF approach.

Masbate Province, Philippines 2015

The province of Masbate belongs to the Bicol Region and is known to be one of the most needy provinces of the Philippines with a poverty incidence of 44.2% (NSCB 2012). Child undernutrition remains a major public health issue in the Bicol region with a high rate of underweight, stunting and wasting (respectively 24.6%, 39.8% and 7.4% – NNS 2013). As with the rest of the Philippines, the province is located along the typhoon belt in the Pacific and often impacted by typhoons of medium intensity. Its geographical location also contributes to its susceptibility to sea level rises, storm surges, flooding and drought what is believed to have an impact of farming and fishing livelihoods. In 2014, Acción Contra el Hambre (ACH/ACF) decided to develop actions in the four municipalities of Masbate with the poorest socio-economic indicators (Aroroy, Cawayan, Milagros and Monreal). Being new in the area, ACH implemented a Link NCA in those four municipalities to gather information regarding malnutrition mechanisms and, therefore, to be able to tackle the root causes of undernutrition. The study took place from September 2014 to January 2015.