1. 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

5. 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?

6. Methods
0. Designing the NCA
1. Identifying risk factors and pathways
2. Gathering evidence of causality
3. Rating causal factors
4. Validating results

7. 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

8. Gathering Evidence of Causality

10. Labour/Charcoal Livelihood Causal Model

11. Risk factor
Interpretation
during rainy
season
Interpretation
during winter
season
Vulnerable groups
Diarrhoea
Important Risk
Factor
Important Risk
Factor
Risk more prevalent
for populations living
in islands
Diet diversity Minor risk factor
Important Risk
Factor
Children above 24
months are more
sensitive
Rating Causal Factors
Based on field investigation results, the analyst rates each
risk factor…

12. Risk factor
Interpretation
during rainy
season
Interpretation
during winter
season
Confidence Note
Diarrhoea
Important Risk
Factor
Important Risk
Factor
High
Poor Diet diversity Minor risk factor
Important Risk
Factor
Medium
Validating Results
Workshop participants then collectively assign confidence
notes to each factor…

13. Validating Results
… in order to reach a consensus on the priority risk factors
and actions needed to prevent undernutrition in that
context

14. Final Isiolo County Local Causal Model

15. 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

16. 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

17. Why NCA? (1)
Describe the health
issue in the
population studied
Analyse causal
determinants
Propose adapted
interventions
Measure the impact
of interventions
Epidemiological
cycle

18. 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

19. 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)

20. Thank You