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The supports necessary for the LinkNCA method


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Indicator Guide

Pathways guide

Overview of the methodology

The Link NCA is a mixed method for analysing the multi-causality of under-nutrition, as a starting point for improving the relevance and effectiveness of nutrition security programming in a given context. It uses participatory approaches to build a consensus amongst communities, local stakeholders and technical experts on major factors of undernutrition in the zone of study and the best solutions to address them.


The Link NCA is a flexible method that can be adapted to a variety of contexts and operational objectives. Until today, the Link NCA method has been conducted on 3 continents, in both rural and urban settings, volatile post-conflicts settings, as well as in refugee camps. With the recent optimisation of the quantitative component, Link NCA allows to study potential differences in causal mechanisms of wasting, stunting, underweight and anaemia.


The full process lasts 4-5 months, but the method is sequenced so the timeframe can be downsized or expanded, depending on circumstances and available resources. This usually includes approximately 3 weeks for the preparatory phase, 5 weeks for the qualitative data collection, 4 weeks for the quantitative data collection and 7-8 weeks for the data analysis and triangulation, presented in a form of final report. Approximately 40% of work can be done remotely.

Key steps

The Link NCA study consists of five key phases:

  • Preparatory phase includes a formulation of study’s objectives, mobilisation of resources and a recruitment of a study team.
  • Identification of hypothesized risk factors consists of an in-depth literature review and a consultation of stakeholders with the objective to identify risk factors likely to have an impact on the incidence of malnutrition in the zone of study. This phase is sealed with an initial technical workshop, during which hypothesized risk factors are validated for field testing.
  • Qualitative inquiry covers a 4-week in-depth qualitative research in distinct locations, qualitatively representative of different population segments living in the study zone. This translates into approximately 50 focus group discussions using a variety of participatory exercises and tools to stimulate these exchanges. After the qualitative inquiry, a study team has a complex understanding of community’s key concerns related to study questions as well as their priorities for programmatic solutions.
  • Quantitative survey combines the anthropometric survey following the SMART methodology and a Risk Factor Survey. The population-based sample of approximately 500-600 households allows to establish reliable prevalence figures for selected indicators as well as to study statistical associations between child’s nutritional status and these indicators. Together with inputs from the qualitative inquiry, this data allows to design local pathways of undernutrition, highlighting potential different differences between various nutritional outcomes.
  • Synthesis of results consists of a triangulation of all data collected over the course of study and a successive categorisation of risk factors based on their likely contribution to the incidence of malnutrition in the zone of study. This phase is sealed with a final technical workshop, during which all available evidence is reviewed and recommendations for future programming are outlined.

  • Resources needed

    The price of the whole Link NCA depends on the research protocol and local prices in a country, in which it is implemented. On average, it can cost approximately €90,000. The price includes all costs related to the data collection for both the qualitative and quantitative components, including the technical support to analysts in order to ensure the highest quality of the study.


    The key output of the Link NCA exercise is a final report, detailing risk factors relative to the zone of study, supported by both the qualitative and quantitative evidence. In addition, following a consultation with communities and technical experts, the Link NCA final report also outlines and prioritises recommendations for future programming. It is highly recommended to follow this analysis process with a design of the action plan and/or project proposal based on the Link NCA study findings in order to translate the research into meaningful interventions.


    The Link NCA study is a study of local causes of undernutrition and it is therefore most effective at a smaller scale, i.e. at the level of a (health) district. Larger zones can be considered, however, previous experience has shown that Link NCA studies covering larger zones, such as regions, yield less meaningful results unless they are replicated for each distinctive zone separately.


    Q: How is Link NCA different from other nutrition assessments or surveys, such as KAP, SQUEAC, SMART?

    A: The main objective of the Link NCA study is to identify and categorise risk factors of undernutrition in a given context. Very simply, it attempts to answer a question: “What is likely causing undernutrition in a study area?” On the other hand, SMART survey estimate the prevalence of undernutrition and therefore answer a question: “What percentage of children suffer from malnutrition” while coverage surveys, such as SQUEAC, estimate what percentage of children suffering from malnutrition are receiving treatment. Each assessment plays an important role in the project cycle of nutrition programmes around the world and should be used appropriately.


    Q: Is Link NCA always a mixed method study?

    A: Yes, Link NCA method relies both on qualitative and quantitative data. An absence of either of these influences our capacity to answer research questions usually covered by the Link NCA methodology. Prior to the launch of the Link NCA study, the Link NCA Technical Unit guides the commissioning organisation in a proper framing of the study, considering the availability of existing grey literature and/or datasets.


    Q: Does Link NCA focus only on wasting?

    A: The Link NCA study was primarily developed for studying causal mechanisms of wasting. However, we are currently adapting the methodology to also cover stunting and anaemia. Therefore, the Link NCA study in your study zone can cover one or all nutrition outcomes, depending on your needs.


    Q: When a Link NCA needs to be conducted?

    A: The Link NCA is a contextual analysis tool and therefore should be conducted at the beginning of the project cycle so that the learnings generated by the study are transformed into programmatic interventions. There are possibilities of conducting a Link NCA study at other stages of the project cycle too under a condition that its recommendations can be transformed into an actionable plan or project once the study is complete.


    Q: Can I use a Link NCA study to estimate people’s needs during an emergency?

    A: The Link NCA is not an emergency tool and should not be used in such circumstances. The Link NCA study can take at least 5 months and therefore the context, in which it is conducted, should be relatively stable.


    Q: Can I extrapolate the Link NCA findings to other areas where my organisation works?

    A: The Link NCA is a study of local causes of malnutrition and its findings are only relevant for studied populations. In other words, its findings should not be extrapolated to other areas without a proper analysis of a similitude between the zones and an estimation of the likelihood that the findings could apply.


    Q: Can I be trained on the Link NCA methodology?

    A: Interested individuals and/or organisations can be trained on the Link NCA methodology at different levels – from rapid overviews to in-depth trainings for Link NCA analysts. However, please note that the Link NCA Technical Unit does not organise mass training sessions on the methodology (for now) and only responds to commissioning organisation’s requests. The Link NCA analysts are only trained when their participation in the study has been confirmed.

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