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Link Nca Nutrition Causal Analysis Karamoja, Mid-Northern and West Nile Sub-Regions, Uganda

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LINK NCA NUTRITION CAUSAL ANALYSIS KARAMOJA, MID-NORTHERN AND WEST NILE SUB-REGIONS, UGANDA a b LINK NCA NUTRITION CAUSAL ANALYSIS KARAMOJA, MID-NORTHERN AND WEST NILE SUB-REGIONS, UGANDA Office of the Prime Minister Kampala, Uganda UNICEF Uganda Kampala, Uganda Action Against Hunger, Uganda Kampala, Uganda June 2020 i The publication is a part of the EU-UNICEF Joint Nutrition Action under the Development Initiative for Northern Uganda (DINU) of the United Nations Children Fund (UNICEF). Required citation: Office of the Prime Minister (OPM), UNICEF Uganda and Action Against Hunger (AAH) Uganda. 2020. Link Nutrition Causal Analysis for Karamoja, Mid-Northern and West Nile Sub-Regions, Uganda. Kampala, Uganda This work is a product of the staff of Action Against Hunger Uganda with external technical contributions from Action Against Hunger US/HEARO and AAH UK. Funding for the survey was provided by the European Union (EU) and UNICEF. The study was done under the overall supervision of the Office of the Prime Minister (OPM) of the Government of Uganda. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of Head Office of Action Against Hunger or the other countries where they operate. Much as the authors guarantee the accuracy of the qualitative data included in this work, we do not guarantee the accuracy of the quantitative data. The work may be reproduced, in whole or in part, for non-commercial purposes as long as full attribution is given. Any queries on this work should be addressed to: The Country Director, Action Against Hunger, Uganda Office Embassy Plaza, off Nsambya-Kabalagala road. Additional material relating to this report can be found on the website (www.linknca.org). Additional information about the 2019 FSNA may be obtained from the Strategic Coordination and Implementation (SCI), Office of the Prime Minister, Kampala, Uganda Additional information about the 2019 FSNA may be obtained from the UNICEF Uganda Country Office, George Street, PO Box 7047, Kampala, Uganda COVER PHOTOGRAPH Guy Calaf for Action Against Hunger. ii ACKNOWLEDGEMENTS The Link NCA Nutrition Causal Analysis in Northern Uganda was conducted between August and December 2019, with nancial contribution from the EU and UNICEF. The study was conducted by a Link NCA Analyst - Brian Musaga, with support from Deputy Analysts Erinest Bumba, Florence Akot, Mary Amony, Harriet Itiakorit and Simpson Kamugisha; as well as a statistician, Brenda Ayuge, under the supervision of the study’s focal points, Claire Mazin (AAH Uganda Country Director), Margaret Nagawa (AAH Uganda Nutrition Manager) and Imelda Awino (AAH Regional Nutrition Advisor). Lenka Blanarova (AAH Link NCA Technical Advisor, UK) and Grace Heymseld (AAH USA) provided technical guidance and support. The Link NCA team wishes to express their thanks to all those who have contributed to this study and/or facilitated its development, in particular: • Mr Joses Tyeza and Ms Maureen Bakunzi at the Ofce of the Prime Minister for providing leadership and ensuring coordination for the study; • Sumit Karn, Nutrition Specialist and Cecilia De Bustos, Nutrition Manager at the UNICEF Uganda Ofce, for providing technical oversight for the study and ensuring coordination between AAH Uganda, UNICEF and Ofce of the Prime Minister. We are grateful for your guidance that saw the study progress; • Nelly Birungi, Nutrition Specialist and Paska Aluba, Nutrition Ofcer at the UNICEF Uganda Ofce for providing support in facilitating the coordination and management of study; • To all the technical experts who attended the initial and nal Link NCA technical workshops, including the entire team of technical advisors and project managers at Action Against Hun- ger, Uganda, representatives of partner organisations, such as DINU Staff, UNICEF staff, and all other Government and Non-Government Organisations; • To all residents of sampled and/or randomly visited localities for their hospitality and genuine collaboration. Special thanks to the qualitative teams for their efforts in trying conditions. We are grateful for your patience, trustworthiness and professionalism; • To local authorities for their tireless dedication in the ght against undernutrition and their unwavering support over the course of the study; • Ms. Claire Mazin, AAH Uganda, we would not have gone this far without your timely admin- istrative guidance and ensuring that all the necessary resources were always availed to the team. Finally, we would also like to thank the Link NCA Technical Unit, Action Against Hunger, UK, in particular Lenka Blanarova for her constant availability, technical guidance at all stages and encouragement. Your unwavering understanding of the Link NCA methodology, coupled with the vast experience in conducting Link NCA studies, was very crucial in all the guidance provided. This study would not have been possible without the exceptional work and commitment of all those involved. Thank you all. iii ABBREVIATIONS AAH Action Against Hunger ACF Action Contre La Faim ANC Ante-Natal Care CAFH Concerned Action For Health DINU Development Initiative for Northern Uganda DLG District Local Government ECD Early Childhood Development FGD Focus Group Discussion FSNA Food Security and Nutrition Assessment HEARO Horn and Eastern Africa Regional Ofce IGA Income Generating Activity IPC Integrated Food security Phase Classication GSU Global Support Unit ITN Insecticide Treated Net Link NCA Link Nutrition Causal Analysis MAAIF Ministry of Agriculture, Animal Industry and Fisheries MDD Minimum Dietary Diversity MoH Ministry of Health MWE Ministry of Water and Environment NCA Nutrition Causal Analysis NGO Non-Governmental Organisation NMS National Medical Stores OPM Ofce of the Prime Minister of Uganda RUTF Ready-to-Use Therapeutic Food SBCC Social and Behaviour Change Communication SSI Semi-structured Interview SMART Standardized Monitoring and Assessment of Relief and Transitions TBA Traditional Birth Attendant UNICEF United Nations Children Fund VHT Village Health Teams VSLA Village Savings and Loan Associations WASH Water, Sanitation and Hygiene WFP United Nations World Food Programme iv TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................................................................................................................. iii ABBREVIATIONS .............................................................................................................................................iv LIST OF FIGURES .......................................................................................................................................... viii LIST OF TABLES ..............................................................................................................................................ix LIST OF PICTURES ...........................................................................................................................................x EXECUTIVE SUMMARY ....................................................................................................................................1 KEY FINDINGS ..................................................................................................................................................2 OVERARCHING CAUSAL PATHWAY FOR UNDERNUTRITION (WASTING AND STUNTING) AND ANAEMIA ...........................................................................................................................................................3 DOMINANT PATHWAY RECOMMENDATIONS.................................................................................................4 COMPLEMENTARY PATHWAY RECOMMENDATIONS ....................................................................................4 INTRODUCTION................................................................................................................................................6 KARAMOJA REGION ........................................................................................................................................8 MID-NORTH REGION .......................................................................................................................................9 WEST NILE REGION .......................................................................................................................................11 OBJECTIVES OF THE STUDY ........................................................................................................................13 METHODOLOGY .............................................................................................................................................14 KEY STAGES ...................................................................................................................................................15 PREPARATORY PHASE (JUNE - JULY 2019) ................................................................................................15 IDENTIFICATION OF HYPOTHESISED RISK FACTORS AND CAUSAL PATHWAYS (AUGUST 2019) ...........15 SECONDARY QUANTITATIVE DATA ANALYSIS (AUGUST – NOVEMBER 2019) ...........................................16 PRIMARY QUALITATIVE DATA COLLECTION (SEPTEMBER – OCTOBER 2019) ..........................................16 SYNTHESIS OF RESULTS AND BUILDING TECHNICAL CONSENSUS (OCTOBER – NOVEMBER 2019) ..16 QUANTITATIVE DATA ......................................................................................................................................17
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