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 factor

Interpretation

during rainy

season

Interpretation

during winter

season

Vulnerable 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 factor

Interpretation

during rainy

season

Interpretation

during winter

season

Confidence Note

DiarrhoeaImportant Risk

Factor

Important Risk

FactorHigh

Poor Diet diversity Minor risk factorImportant Risk

FactorMedium

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

NCA RESEARCH PROJECT

NCA METHOD

v1

End 2010

Field Tests

ZIMBABWE

BANGLADESH

2011

NCA METHOD

v2

2012

Field Tests

BURKINA-

FASO

End

2012

Internal

Validation +

Externally

Peer-

Reviewed2013

Guideline

s

End

2013

NCA Research Team

J. 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