Action Against Hunger in Sierra Leone is implementing a 3-year programme in 3 chiefdoms of Bonthe district. Funded by Irish Aid, the programme focuses on the multisectoral community-led approach to improve nutrition, which includes Integrated Management of Acute Malnutrition and nutrition education components, while Food Security and Livelihoods, Water, Sanitation and Hygiene and Mental Health and Psychosocial Support interventions also form an integral part of the programme. The main objective of this Link NCA was to understand causal mechanisms of undernutrition, notably stunting, in order to strengthen AAH's programmatic response.

Out of 20 risk factors likely to have an impact on the prevalence of undernutrition in the study zone, 2 were identified as major, namely limited access to health services and low access to income sources. Other notable risk factors included low female autonomy/decision-making powers, low social support, low coping strategies and women’s heavy workload. Statistical analyses between the nutritional status of children and household risk factors allowed to differentiate between the causal mechanisms of wasting, stunting, underweight and anaemia. Limited access to income sources and limited access and use of health services with varying evidence can be observed across pathways for wasting, stunting, underweight and concurrent wasting and stunting. Low social support for women and heavy women’s workload can be observed in pathways for wasting but evidence is missing in others.