Action Against Hunger in Madagascar is implementing a 4-year project funded by the European Union, aiming to reduce the poverty of rural populations in 5 communes of the district of Bekily and 3 communes of the district of Betroka. The project known by the abbreviation “AFAFI Sud” aims to improve the nutritional security of households in 8 communes of the intervention zone and to increase their resilience to climatic hazards. The realization of the Link NCA study helped to better understand the multi-sectoral risk factors of undernutrition and to strengthen programmatic responses.

Out of 20 risk factors likely to have impact on the incidence of undernutrition in the study zone, four (4) factors were identified as having a major impact, namely the low access to income, poor resilience capacities, short birthspacing and inadequate accessibility, availability and quality of water at the household level.

Statistical analyses between the nutritional status of children and household risk factors allowed to differentiate between the causal mechanisms of wasting, stunting and underweight. The indicators related to household income sources were strongly represented in all three pathways. The pathway of wasting and stunting also presented strong evidence for coping strategies, although these strategies do not appear to have a real influence on underweight. In the health sector, wasting appears to be most influenced by the access and use of health services while their importance decreases for stunting and underweight. Women's nutritional status is a protective factor against wasting and underweight.