a. Rational for NCA research
Action Contre la Faim would like to develop a standardized method for analyzing the causes of malnutrition, as a starting point for improving the relevance and effectiveness of the organization’s programming in a given context. The Nutrition Causal Analysis is also intended to be useful as platform for informing the broader stakeholder response and for ensuring that this response reflects an appropriate contextualized understanding of malnutrition’s complex multi-causality.
While there are a number of documented approaches for conducting NCAs, the results of these NCAs are typically constrained in three main ways. First, they often yield only a static picture of the causes of malnutrition. Rarely the methods examine the interaction among various risk factors, or take into account feedback loops and dynamic process, such as seasonality or changes in caring practices at different stages of child growth. The second limitation of most NCAs as currently conducted is that they fail to prioritize causes, rendering the results less actionable and operationally useful. A third issue with NCAs is that they often focused on a single type of malnutrition (eg. stunting vs. wasting), rather than considering the different etiologies of different malnutrition outcomes, and how these causes may vary by age.
Though this is a demanding set of criteria, ACF has risen to meet this challenge by investing in the development of a standardized method for Nutrition Causal Analysis that can incorporate the elements describe above and be applied across the various contexts in which it works. ACF has enlisted Mrs Jennifer Coates at TUFTS University to advise the responsible of NCA study in Zimbabwe in developing the protocol for the standardized method in collaboration with the MOHCW and provide guidance during the field work and analysis of the findings.
b. Rationale for NCA study in the country
Over the past two decades (1990-2010), Zimbabwe underwent a number of economic and political challenges including economic decline (hyper inflation, high unemployment, decrease in GDP, shortage of basic supplies) exacerbated by repeated poor harvests, increase of political instability, combined with demographic changes such as internal population displacement, loss of livelihoods and emigration of a significant proportion of the skilled labour in the country. In this same period, Zimbabwe experienced climate changes consequences (drought, erratic agro-ecological conditions), epidemic outbreaks (cholera, measles) with a persistent high level of HIV/AIDS prevalence (13.7% in 2009) having a large and multi sector impact.
Last January 2010, a National Nutrition Survey has been conducted. The results revealed a high prevalence of stunting (33.8%) with a low prevalence of acute malnutrition (2.1%). Unexpected trends showed a significant increase of stunting prevalence from 21% in the 1994 ZDHS, 22% in 1995, 28% in 2005-06 to 33.8% in 2010 with the proportion of infants with low birth weight remained above 10%.
All over the world, stunting is known as responsible of around 20% of all the mortality of children younger than 5 years of age and long term cognitive deficit, poorer performance in school, fewer years of completing schooling, and lower adult economic productivity.
In opposite way, the prevalence of acute malnutrition has decreased from 6.4% in 2005-2006 to 2.1% in 2010.
In Zimbabwe, list of potential causes of malnutrition have been highlighted but evidences are few. To guide the development of appropriate recommendations to address malnutrition problem, we conducted NCA study in one District to establish statistical evidences and ranking the risk factors or group of risk factors of malnutrition.
c. Rational for NCA study for ACF
ACF mission opened in September 2002 with initial programmes focusing on short term nutrition, water and sanitation fields. From 2006, ACF combined targeted interventions with a short-term impact (rehabilitation of water points, vegetable gardens, seeds and tools distribution) with mid-term agricultural and water facility interventions. The strategy was further refined to aim at enhancing sustainable livelihoods through a coherent range of food security, WASH and nutrition focused interventions for food insecure vulnerable households. Simultaneously, the emergency response and preparedness capacity were developed in longer term projects. Considering high HIV prevalence, ACF has started in 2008 efforts to improve HIV mainstreaming.
Internally, the NCA study represented a great opportunity for ACF Zimbabwe to reorient and fine in tune its programme in country. Existing links between nutrition, food security, water and sanitation programmes needed to be strengthen and supported by evidences justifying each aspect of the intervention. In a more external point of view, the NCA study was going to facilitate ACF recognition among partners as technical key player having skills to conduct such research and being a potential partner for coming study in country.