Link NCA Final Report January 2015 February 2016 Dari-Suf-Bala District, Samangan Province Afghanistan Lysette Boucher - Castel, Link NCA Expert Acknowledgments The Link NCA survey in DSB is the result of many collaborations. During the different phases of the process, the ACF office in Kabul, the ACF Mazar el Sharif Base and Paris worked together from January to June, 2015. We are firstly grateful to all families (530) that welcomed data collectors into their homes and all villagers (mothers and fathers) of Sarwalang Miana in the district of DSB, Samangan province in Afghanistan. The NCA study was conducted under difficult conditions. It has been made possible through the support of the ACF team in Mazar. We are grateful to Mr. Brian Hansen, field coordinator of ACF-Mazar for his support in ensuring proper security measures for the fieldwork teams, and to all Afghan administrative and logistic managers that were always concerned about our organizational needs throughout the duration of the NCA work, in particular during the two months of data collection in the district of DSB. In the field, at the Bazar Stocka base, we wish to express our gratitude to twenty-eight data collectors who visited families in 30 villages in the DSB district. We cannot name them all but we thank in particular Mr. Jalil Ahmad, who held very seriously his role of assistant and allowed us to have access to the population of the village of Sarwalang Miana throughout the qualitative survey, the two translators who were also very good focus group sessions facilitators, Fatima Shinwari and Amanullah Shams . The teams received valuable support from the district Governor and all CDC members in the villages of DSB, who should be thanked for their hospitality and patience. Finally, we are grateful to Mr. Victor Mallelah who supervised the Risk Factor and SMART Surveys. His involvement in the study went above and beyond expectations. Bringing this study to completion in all its methodological dimensions (questionnaires, statistics, and methodology, commented reading drafts) was possible thanks to the NCA team in Paris, which has always accompanied us even when we were far away. Our thanks go to Madame Blanche Mattern. Also, we thank Maryline Cittadini and Karl Lellouche, our focal points for Link NCA in Afghanistan and Paris. Finally, on a personal note, I would like to thank a close friend, the sociologist Michalis Lianos, who read with care and perspicacity all the pages of the report during the summer of 2015. Foreword The Link NCA report for the District DSB of Samangan Province - Afghanistan is presented in two parts: the first part presents the Link NCA process and its implementation in the district of DSB. The second part presents the findings of data collection in DSB and a preliminary rating of hypothesized risk factors. Part I, presents the analysis of secondary data, the work of the first workshop held in Kabul in February 2015, all conceptual preparations (pathway and hypothesized risk factors) and technical tools (sample data management) in view of conducting three surveys: SMART, RFS (household questionnaire) and qualitative investigation. The limitations of the survey are presented in this section. In an annex to part I, we present the causal model of the workshop in February 2015, and a copy of the household questionnaire for the SMART and the RFS survey. Part II focuses on the analysis of quantitative and qualitative data and a proposal on hypotheses that were discussed in the context of this survey. In an annex to Part II, the reader can find the list of all results (mean or proportion) for all indicators measured in the chapter discussing the findings of the investigation. p. 2 Table of Contents Acknowledgments ................................................................................................................................................... 2 Foreword ................................................................................................................................................................... 2 Table of Contents .................................................................................................................................................... 3 List of Charts and Figures ....................................................................................................................................... 5 List of Tables ............................................................................................................................................................. 7 List of Maps and Boxes ........................................................................................................................................... 9 Glossary ................................................................................................................................................................... 10 Introduction ............................................................................................................................................................ 12 Part I. The Link NCA Process in DSB, Samangan Province ............................................................................... 17 1. Why Conduct a Link NCA in the Dari Suf Bala district? ............................................................................ 17 1.1. Contextual Information of Dari Suf Area (Dari Suf Bala and Dari Suf Payeen Districts) ............... 18 1.2. Prevalence of Acute Malnutrition - Wasting- in the Samangan Province...................................... 22 1.3. Prevalence of Chronic Malnutrition –Stunting- ................................................................................. 23 1.4. Objectives of Link NCA Survey in DSB ................................................................................................ 24 2. NCA Survey in DSB ........................................................................................................................................... 25 2.1. Description of Core Indicators and Hypothesized Risk Factors for Afghanistan, Samangan Province and the DSB district ............................................................................................................................... 27 2.1.1. Description of Causal Pathway for DSB, Samangan Province, Afghanistan….…………………....33 2.1.2. Description of Nutrition Vulnerable Groups in the District of DSB, Samangan Province, Afghanistan……… ............................................................................................................................ …41 2.2. Stakeholder Workshop in Afghanistan for the Link NCA Study in Samangan Province .............. 42 2.2.1. Work Group Brainstorming on Causal Under-Nutrition Models ..................................... 43 2.2.2. Multi-Sectorial Groups Identify Vulnerable Groups ........................................................... 47 2.2.3. Consensus on the Hypotheses (Risk Factors) ..................................................................... 48 2.2.4. Rating the “expert opinion” of the Working Group Participants ..................................... 49 2.2.5. Outputs of the Workshop: A List of Hypothesized Risk Factors, and Hypothesized Pathways: A List of Nutrition-Vulnerable Groups, and a Rating of Each Hypothesis by Experts ................. 50 2.3. Field Data Collection ............................................................................................................................. 51 2.3.1. Data Collection Methods ................................................................................................. 53 2.3.2. Quantitative Survey (RFS & SMART) .............................................................................. 57 2.3.3. Qualitative Survey ............................................................................................................. 64 p. 3 2.4. Data Management and Analysis .......................................................................................................... 70 2.5. Ethical Considerations During the Survey .......................................................................................... 73 2.6. Limitations of Link NCA in DSB ............................................................................................................ 73 Part II. Results and Preliminary Hypothesized Risk Factors for Link NCA Study in DSB, Samangan Province................................................................................................................................................................... 75 1. Descriptive Findings Link NCA Study in DSB ............................................................................................. 75 1.1. Targeted Populations of the Link NCA Study .................................................................................... 75 1.1.1. For the Quantitative Survey ............................................................................................. 75 1.1.2. For the Qualitative Survey ............................................................................................... 76 1.2. Results from the Link NCA Study by Sector ....................................................................................... 76 1.2.1. Under-Nutrition ................................................................................................................ 77 1.2.2. Food Security and Livelihoods .......................................................................................