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Link NCA is almost 10 years old! How has it evolved?


© Sebastien Dujindam
After field tests in Zimbabwe, Bangladesh and Burkina Faso, the first version of Link NCA guidelines was developed in 2013 and officially published in early 2015. Since then, the guidelines underwent a revamp in 2018, although they were not widely disseminated.

The latest revision of Chapter 5 of the guidelines on quantitative survey was conducted in collaboration with the GNC Technical Alliance in 2021. This revision underwent a thorough validation process by technical experts with an experience in public health quantitative research, statistics and epidemiology. The revised chapter includes detailed instructions on how to conduct regression analyses, which now constitute the essence of the Link NCA quantitative component. The chapter is accompanied by an electronic questionnaire in English and French, which includes a complete set of indicators used during a Link NCA quantitative survey. The indicators were thoroughly reviewed by experts from respective sectors before their integration in the questionnaire.

A revision of Chapter 6 of the guidelines on qualitative inquiry is currently underway. The revised chapter will build on key advancements and lessons learnt in the Link NCA qualitative inquiry since 2018. It will be accompanied by a complete set of interview guides and visual tools, which have become a staple during exchanges with communities. It will also provide guidance on quality assurance during all stages of the process to ensure the compliance with qualitative research standards.

The formal revision of other chapters will follow while the process is constantly being improved based on lessons learnt from each study. The other key developments of the Link NCA methodology include:

*methodological adaptation to all forms of undernutrition. While Link NCA was originally designed to analyse and categorise risk factors of wasting, it has been expanding to cover stunting, concurrent wasting and stunting, underweight and anaemia, depending on context, availability of data and partner’s needs. The adaptation to other forms of undernutrition allows for a more holistic analysis of nutritional status of the studied population, possibly differentiating between distinct risk factors and causal mechanisms for each of these forms;

*rigorous literature review. All available secondary data in a given context is organised for each risk factor individually, which then allows for a transparent categorisation of risk factors during a triangulation process. The output of the literature review now constitutes one of the key deliverables of the Link NCA study and has proven to be greatly beneficial for programme design teams. To facilitate the process and allow for a greater comparability across studies, it is recommended to use a standardised set of hypothesised risk factors based on UNICEF conceptual framework and associated indicators allowing to categorise these risk factors consistently across studies;

*greater integration of historical/seasonal variations of risk factors in qualitative and quantitative components of the study, which favours the identification of potential “triggers” of the deterioration of a nutritional status of a child. The importance of seasonality and shocks, which households or caregivers face, gave rise to the development of qualitative data collection tools, such as “1000 days’ timeline”, comparative study of malnourished children vis-à-vis their non-malnourished siblings, or meal composition before and after a key event. During the exchanges, communities are encouraged to reflect beyond their present situation and identify moments, which forced them to adapt former, often optimal, behaviours. While primary quantitative data collection and/or secondary quantitative data analyses might be of a cross-sectional, i.e. “snapshot in time”, nature, a use of multiple datasets is greatly recommended to offer a longitudinal feel to the analyses, as was the case during a Link NCA study in Dollow Settlements for Internally Displaced Population in Somalia.

*enhanced flexibility of the use of different Link NCA components. Link NCA is principally a mixed method, which relies on a triangulation of qualitative and quantitative data sources. However, it is often not possible to conduct the study in its full form and therefore adaptations are necessary. Each Link NCA component is important in its own right and can be conducted separately, if needed, but the standalone application comes with its limitations, which vary depending on which component is used. Therefore, while it is recommended to strive for a mixed approach, the Link NCA Technical Unit can advise if such approach is not feasible and adapt the methodology to partner’s objectives.

*more transparent final report structure. Link NCA reports can be intimidating to read as they are often longer than 100 pages, dictated by the sheer volume of data that Link NCA Analysts need to consider in the process. Considering that technical experts seem to prefer a detailed presentation of data, notably qualitative findings, it is unlikely that final reports could be considerably shorter. However, the new final report structure, organised by risk factors, proposes a clear distinction between different data sources, displaying therefore all available evidence in a transparent manner and allowing a reader to evaluate the categorisation of risk factors based on different elements. These are then triangulated in the “Conclusions”, where a pathway based on community perceptions of undernutrition is complemented by the quantitative evidence. The final reports are often accompanied by executive summaries or information briefs for advocacy purposes.

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