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Nutrition Causal Analysis: usefulness and application

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Anonymous 730

Nutrition and Food Security Officer

Normal user

9 Apr 2015, 07:53

I am considering the use of a nutrition causal analysis to find out more about how malnutrition prevalence remains high, yet mortality is low and the population is receiving 2,100kcal/day and benefitting from a comprehensive set of nutrition treatment programmes. I am looking for useful material and reports on examples of settings where the NCA was used to identify specific contributors or causes of malnutrition and how this informed programming.

Julien Chalimbaud

ACF

Normal user

9 Apr 2015, 08:29

Dear Anonymous
I am working for ACF and we have developped a method for conducted a Nutrition Causal Analysis that we call the Link NCA method. We have also a technical unit that you can contact at linknca@actioncontrelafaim.org to get their support, guidelines, previous studies and other materials.
We will have soon a website (linknca.org) that is not yet active.
Also you can have a look at the last field exchange articles on NCA.
Don't hesitate to send us an email to get field materials
cheers

Mark Myatt

Consultant Epideomiologist

Frequent user

9 Apr 2015, 08:41

I have no experience with the NCA method developed by ACF.

I have done nutrition causal analysis for SAM in a few settings using matched case-control studies. These are cheap, work well, and can be nested in SQUEAC assessments. I think that concentrating on SAM makes sense for several reasons. See:

http://www.ennonline.net/fex/42/causal

http://www.ennonline.net/fex/45/determining

for some background.

Before doing a causal analysis you should consider the data you have. Assuming by "malnutrition" you mean acute malnutrition then with adequate diet you might expect infection to be an important cause but you are also seeing low mortality. This is confusing. If you can trust this information then you might consider if the case-definition you are using is appropriate. In many parts of North Africa and the Horn of Africa the WHZ case-definition will overestimate prevalence considerably because of body shape. Since linear growth is mostly in the limbs a WHZ case-definition in these contexts has a tendency to class the healthiest and best nourished children as malnourished (so you would see high GAM with good nutrition and low mortality). In these settings it makes more sense to use MUAC case-definitions.

I hope this is of some use.

Anonymous 730

Nutrition and Food Security Officer

Normal user

9 Apr 2015, 09:14

Thank you Mark and Julien,

Both responses are very useful. I have written to the email which Julien shared, and I am very much interested by the "causal analysis within a SQUEAC" as it strongly reflects what we are trying to really do as we were debating on whether we could do one or both.I will come back with more questions and would appreciate more links on settings where this was used, if there are any in addition to the ones already shared.

Many thanks.

Mark Myatt

Consultant Epideomiologist

Frequent user

10 Apr 2015, 11:13

I know that the causal analysis within SQUEAC has been done in Sudan (UNICEF) and Chad (IRC). I believe that IRC have done one in Niger. Here is another report (abstract) of the Chad CA.

Mark Myatt

Consultant Epideomiologist

Frequent user

10 Apr 2015, 11:46

Forgot to add ... WVI did a SQUEACy causal analysis linked with a RAM type survey (to calculate population attributable risks from risk ratios and risk prevalences in order to identify priority interventions) last year in Ethiopia.

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