Link NCA Chad Case Study Abdi District of the Ouaddaï Region, 2015/2016


International Medical Corps (IMC) has been working on nutrition in Chad, which ranks 185th on the 2014 Human Development Index , since 2004.

A SMART survey conducted in 2014 in the Abdi district (Ouaddai region) in eastern Chad determined that Abdi had some of the highest acute malnutrition rates (wasting) in the Sahel; 13.7% moderate acute malnutrition (MAM) and 4% severe acute malnutrition (SAM) rates were recorded for children under 5 years old.

The experience of IMC in Chad confirmed that the principal factors contributing to malnutrition were linked to structural issues and questions of chronic underdevelopment. There is poor food security in general in the Abdi district. Livelihoods are based on agricultural production of different grains, gardening (which are easily affected by unpredictable rainfalls) and pasturage. The sanitary context is troubling and is particularly connected to reduced access and utilization of the poorly developed healthcare system in the region.

To have a sustainable impact on nutrition insecurity in the region, it was essential for IMC to have an understanding of the principal underlying causes of undernutrition and the local context. IMC decided to implement a Link NCA study, financed by OFDA, to determine the underlying causes and risk factors for undernutrition. After completing the Link NCA study it would be possible to develop appropriate, effective and global program responses, aimed at improving nutrition security in the Abdi district.


To evaluate the causes of undernutrition in Abdi, a mixed method approach was used. The quantitative methodology is designed to objectively evaluate the prevalence of undernutrition and its risk factors, while the qualitative analysis seeks to address questions regarding how or why undernutrition/good nutrition occurs. The two methods are complementary and offer an in-depth, global image of the causes of undernutrition. The information from these multiple sources was then reviewed and triangulated through a participatory process to generate a general consensus on undernutrition causality in the Abdi district.

The Link NCA was conducted over 5 months between September 2015 and January 2016 at the end of the lean season in four phases:

Preparatory Phase

The first step focused on a literature review of existing data sources which was performed by the NCA analyst. There were also preliminary interviews with governmental and non-governmental partners. This was part of the preparatory phase implemented for all potential Link NCAs, to determine the need and feasibility of conducting a Link NCA study.

Developing Nutrition Causal Hypotheses

The next step was to develop hypotheses for the causes of undernutrition in Abdi, with the information gathered from the first phase. These hypotheses were discussed, reworked and validated during a technical workshop in Abeche.

Community Level Data Collection

Qualitative and quantitative studies were carried out in November and December 2015 in order to validate the causal hypotheses and potential risk factors developed during the second phase.

Synthesizing Results and Building Consensus

After the data collection, the hypotheses were ranked according to importance, while paying careful attention to historical variations and vulnerable groups. The results were then presented to the local community and also during a final technical workshop where outcomes were discussed with stakeholders and multisectoral WaSH, health/nutrition and food security experts. A sequential, participatory process was employed to build consensus around the plausible causes of undernutrition.