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Enhancing Food Production, Gender Equity & Nutritional Security in a Changing World
International Food Security Dialogue 2014
Nutrition Causal Analysis in Isiolo County, Kenya:
results of a pilot methodology
Research Questions What is the prevalence and severity of wasting in Isiolo
County?
Does the prevalence and severity of wasting in Isiolo county vary geographically or by characteristics such as livelihood, religion, clan?
What is the prevalence of known risk factors for undernutrition in Isiolo County?
What are the causal ‘pathways of undernutrition’ by which children become wasted?
How has wasting amongst children less than five years of age and its causes changed a) over time due to historical trends, b) seasonally due to cyclical trends, c) due to recent shocks if any?
Which risk factors are most prevalent in this population?
Which sets of risk factors and pathways are likely to be the most modifiable by stakeholders within a given context?
What type of action can be taken in response to these findings?
Methods
0. Designing the NCA
1. Identifying risk factors and pathways
2. Gathering evidence of causality
3. Rating causal factors
4. Validating results
Identifying Risk Factors
E. Inadequate access to milk and animal products during dry seasons (inc. extended dry)
F. Poor storage of food, seeds, grains, livestock in home
G. Poor land/livestock management and productivity
2. POOR MATERNAL AND CHILD HEALTH
A. Early pregnancies and inadequate birth spacing B. High childhood morbidity C. Immunisation is not 100% covered in U5 and PLW D. Poor access to health/nutrition programs due to insecurity and nomadic movement E. Poor operational HC coverage F. HC staff providing inadequate health and care practices G. Stigma attached to malnutrition or admission to program H. Poor perception/identification of disease and management I. Health problems are often referred to a traditional healer first
Gathering Evidence of Causality
Labour/Charcoal Livelihood Causal Model
Risk factorInterpretation during rainy
season
Interpretation during winter
seasonVulnerable groups
DiarrhoeaImportant Risk Factor
Important Risk Factor
Risk more prevalent for populations living in islands
Diet diversity Minor risk factorImportant Risk Factor
Children above 24 months are more sensitive
Rating Causal Factors
Based on field investigation results, the analyst rates each risk factor…
Risk factorInterpretation during rainy
season
Interpretation during winter
seasonConfidence Note
DiarrhoeaImportant Risk Factor
Important Risk Factor
High
Poor Diet diversity Minor risk factorImportant Risk Factor
Medium
Validating Results
Workshop participants then collectively assign confidence notes to each factor…
Validating Results
… in order to reach a consensus on the priority risk factors and actions needed to prevent undernutrition in that context
Final Isiolo County Local Causal Model
Final Agreed Risk Factors
No. RISK FACTORS Confidence Note*
2B High childhood morbidity (malaria, diarrhoea, ARI) affecting malnutrition in U5 children
High
3B Inadequate quantity and diversity of age-specific foods High
4B Access to safe water for household use (bathing, cooking, drinking, cleaning) High
5F Distance to access water is taking a large proportion of women’s time and duties High
5G Pregnant and lactating women are working hard High
1A Inadequate access to food High
1D Poor or fluctuating stability (conflict, diseases, migration, inflation, market prices, unfavourable climatic conditions)
High
1E Inadequate access to milk and animal products during dry seasons High
4C Inadequate coverage of latrines High
1B Poor availability of foods High
5D Caregivers spending inadequate time with the U5 child both psychosocially and nutritionally
High
4A Access to water for livelihood use (animals, farming) High
Major Causal Factors found in Isiolo
High child morbidity
Inadequate access to safe water
Poor access to age-specific foods, including milk in the dry season
Recurrent drought :o is splitting families o increasing women’s workload and o affecting maternal health and care of young
children
Why NCA? (1)
Describe the health issue in the population studied
Analyse causal determinants
Propose adapted interventions
Measure the impact of interventions
Epidemiological cycle
weak
NCA RESEARCH PROJECT
NCA METHOD v1
End 2010
Field TestsZIMBABWEBANGLADE
SH2011
NCA METHOD
v2
2012
Field TestsBURKINA-
FASO
End
2012
Internal Validation
+ Externally
Peer-Reviewed2013
Guidelines
End
2013
NCA Research TeamJ. Coates
H. Young
Y. Martin-Prével
K. Ogden
S. Jaspars
H.Deret; J.Morel; A.D. Israel; J.Eyrard; M.Aït-Aïssa; M.Calo; C.Bizouerne; E.Dominguez; N.Guibert; L.Boucher-Castel…
External Peers: C.Dufour (FAO) and A.Dhur (ICRC)
Thank You