The Nutrition causal analysis conducted by ACF with support from DFID started in January 2017 in Nangere LGA, Yobe state, Northeastern Nigeria and ended in May with a technical workshop consiting of stakeholders from MDAs, INGOs, National and Local NGOs on Monday 8^th and Tuesday 9^th May 2017 to:

-          Evaluate the preliminary Link NCA results

-          Evaluate the preliminary Link NCA recommendation

-          Improve the quality of Link NCA result and recommendation 

 The following hypothesised risk factorsfrom the UNICEF framework of malnutrition causality were considered and rated by experts in the preliminary workshop:

Technical experts individually rated the 22 original causal hypotheses from 1 (hypothesis believed to contribute marginally to under-nutrition) to 5 (hypothesis believed to be a major contributor to under-nutrition).

Hypotheses 1, 11, 21, 22, were mostly considered as major hypotheses and hypotheses 8 and 18 as minor hypotheses by the technical experts. Original hypotheses mainly got a high confidence note, with an average rating score of 4.56.

CLASSICAL DESIGN

1. Designing the NCA

2. Identify causal hypothesis at stake.

3. Participatory ranking of hypothesis.

4. Validation of results.

BACKGROUND OF STUDY

Nangere Local Government Area (LGA) is one of the 17 LGAs located in Yobe State. Nangere LGA borders Positikum LGA to the East, Fune LGA to the North East, Jakusko to the North, Bauchi State to the West and Fika LGA to the South. The LGA has an estimated population of 151,344 persons1 spread over a geographical area of 1,183km². The LGA has a total of 11Wards (Chukuriwa, Dawasa, Kukuri, Watinani, Dudduye, New Nangere, Tikau, Dazigau, Chilariye, Degubi and Langawa Darin) with headquarters located in Sabon Gari Nanger (Sabon Garin). There are a total of 461 villages in Nangere LGA. The main crop and livestock markets is also located in Potiskum and Dawasa markets. 

Globally, over 35% of under-five deaths are attributed to child undernutrition. The North East region of Nigeria has the highest acute malnutrition caseloads in the country. The national nutrition and health survey conducted in 20152 revealed Global Acute Malnutrition(GAM) and Severe Acute Malnutrition(SAM) prevalence(WHZ<-2SD) among children less than five years in Yobe State was at 10.9% and 2.0% respectively.

The SMART-AAH survey findings revealed prevalence of Global Acute Malnutrition (GAM) and Severe Acute Malnutrition (SAM) based on Weight for Height Z-scores (WHZ<-2SD and/or oedema) among children aged (6-59 months) in the surveyed areas of Nangere LGA was 14.6% (11.4-18.6 95% CI)and 2.6% ( 1.5- 4.4 95% CI) respectively.

The prevalence of stunting and underweight among children aged (6-59 months) was at 68.3% (63.0-73.2 95% CI) and 51.6% (46.0-57.1 95% CI) respectively. The prevalence of Stunting and underweight were above WHO thresholds13.The prevalence of stunting indicates that more than one in every two children were exposed to undesirable consequences of stunted growth and retardation.

METHODOLOGY

The sample size of the quantitative survey was design following the NCA methodology. A preliminary sample was designed with ENA, and then the final sample size was design according to the target population by household to be surveyed for the main indicators.

The risk factors survey used a random cluster sampling method and clusters were selected with ENA accordingly to the Proportion Population Size (PPS).

The selection of households was done following a two-stage or a three-stage cluster sampling method accordingly to the size of the cluster.

Size of the household was recorded for each family visited. The NCA being exclusive, only families with at least one child under 59 months were fully interviewed. Sample size targeted was 530 households within 30 clusters.

Among these 30 clusters, 5 were randomly selected for the qualitative survey. They were selected with a random selection formula in Excel. Due to security issues and bad weather conditions, only one cluster was visited for the qualitative enquiry. The population of the cluster was homogeneous and representative of the studied area and quality findings were gathered. However, the study presents some important limitations and the results are not representative of other areas or of other communities.

The RFS questionnaire was divided in six sections with different targets: household level, child 0-23, child 0-59, main caregiver, anthropometric measurement of 6-59 months children and observation part.

29 core indicators, 17 optional indicators and 11 local indicators were used to design the questionnaires. These indicators were chosen from the Link NCA indicators guidelines. Unfortunately, some of those data were not collected or do not meet quality criteria and could not be used.

FGD methodology and life story interviews were used for the qualitative component. One week was spent in each village. FGDs topics were “understanding of malnutrition-perception of good nutrition”, “health status”, “FSL status”, “WASH situation and main issues”, “Care practices behaviours” and “Protection”.

FGDs welcomed mothers and grandmothers of children less than 59 months in different group sessions. Some other FGD was organised in each village with fathers and grandfathers of children less than 59 months.

Interviews were done with key informants and mothers of undernourished children.

A seasonal and historical calendar was design for each villages and communities participated to rating exercises of the main hypothesis.

The Link NCA is based on the triangulation between scientific literature, quantitative data and NCA qualitative findings. Following the final technical workshop, the Link NCA report will be finalized.

These hypothesised risked factors were rated by participants in the final technical workshop:

Risk factors: confidence note and rating

 RECOMMENDATIONS

BACKGROUND RECOMMENDATIONS

FOOD SECURITY

Support farming and gardening:

Support raising:

Support women business

PROPOSITION