Undernutrition and Associated Factors among Adolescent Girls in Damot Sore District, Southern Ethiopia

Stunting and Underweight among Adolescent Girls of Indigenous Communities in Telangana, India: A Cross-Sectional Study

India's indigenous groups remain vulnerable to malnutrition, despite economic progress, reflecting the reliance on traditional agriculture and the problems of poverty and inadequate education and sanitation. This mixed-methods study analyzed the incidence, causes and determinants of chronic malnutrition, measured through stunting, thinness and underweight among adolescent indigenous girls in Telangana. Using 2017 data on 695 girls aged 11-18 years from 2542 households, the analysis showed that 13% had normal nutritional status, while 87% were stunted, underweight or thin. Early adolescents (11-14 years) had higher underweight prevalence (24.4%), while late adolescents (15-18 years) showed greater stunting (30%). Regressions identified key influencing factors. Higher education levels of heads of households and the girls themselves alongside household toilet access significantly improved nutritional status and reduced stunting and underweight. The sociocultural emphasis on starchy staple-based diets and early marriage also impacted outcomes. Tackling this crisis requires mainstreaming nutrition across development agendas via comprehensive policies, education, communication and community participation. Further research can guide context-specific solutions. But, evidence-based investments in indigenous education, livelihoods, sanitation and women's empowerment are the first steps. Nutrition-sensitive development is indispensable for indigenous groups to fully participate in and benefit from India's progress.

Feasibility and impact of school-based nutrition education interventions on the diets of adolescent girls in Ethiopia: a non-masked, cluster-randomised, controlled trial

BACKGROUND

Adolescence is a critical period of physical and psychological development, especially for girls, because poor nutrition can affect their wellbeing as well as that of their children. We aimed to assess the feasibility and impact of a package of nutrition education interventions delivered through public primary schools on the diets of adolescent girls in Ethiopia.

METHODS

In this non-masked, cluster-randomised, controlled trial, primary schools (clusters) in the Southern Nations, Nationalities, and People's Region and Somali region of Ethiopia were randomly allocated to the intervention group (nutrition information provided during flag ceremonies, classroom lessons, school club meetings, peer group mentoring, BMI measurement and counselling, and parent-teacher meetings) or the control group (standard academic curriculum on health and nutrition) by use of computer-generated pseudo-random numbers. Duration of the school-based interventions was 4 months, and the key messages were related to dietary diversity (eating a variety of foods), energy adequacy (eating breakfast and healthy snacks), and healthy food choices (avoiding junk foods). Adolescent girls were eligible for participation if aged 10-14 years and enrolled in grades 4-8 in a study school. Data were collected with two independent cross-sectional surveys: baseline before the start of implementation and endline 1·5 years later. The primary outcome of impact was dietary diversity score, defined as the number of food groups (out of ten) consumed over the previous 24 h using a list-based method, and minimum dietary diversity, defined as the proportion of girls who consumed foods from at least five of the ten food groups, in the intention-to-treat population. We also assessed intervention exposure as a measure of feasibility. We estimated intervention effects using linear regression models for mean differences at endline, with SEs clustered at the school level, and controlled for adolescent age, region, household food security, and wealth. The trial is registered with ClinicalTrials.Gov, NCT04121559, and is complete.

FINDINGS

27 primary schools were randomly allocated to the intervention group and 27 to the control group. Between March 22 and April 29, 2021, 536 adolescent girls participated in the endline survey (270 in the intervention group and 266 in the control group), with median age of 13·3 years (IQR 12·1-14·0). At endline, the dietary diversity score was 5·37 (SD 1·66) food groups in the intervention group and 3·98 (1·43) food groups in the control group (adjusted mean difference 1·33, 95% CI 0·90-1·75, p<0·0001). Increased minimum dietary diversity was also associated with the intervention (182 [67%] of 270 in the intervention group vs 76 [29%] of 266 in the control group; adjusted odds ratio 5·37 [95% CI 3·04-9·50], p<0·0001). 256 (95%) of 270 adolescent girls in the intervention group were exposed to at least one of the five in-school intervention components.

INTERPRETATION

Integrating nutrition interventions into primary schools in Ethiopia was feasible and increased dietary diversity incrementally among adolescent girls, but could be limited in changing other food choice behaviours, such as junk food consumption, based on nutrition education alone.

FUNDING

Bill & Melinda Gates Foundation.

The prevalence of undernutrition among students attending traditional Ethiopian orthodox Tewahedo church schools in northwest Ethiopia

Background

Undernutrition is a major public health concern affecting the health, growth, development, and academic performance of adolescents studying in school. During this crucial period, dietary patterns have a vital impact on lifetime nutritional status and health. The problem of undernutrition among particular groups of adolescents attending traditional schools has not previously been studied. Therefore, this study aimed to assess the prevalence of undernutrition and associated factors among adolescents aged 10-19 years attending Orthodox Church schools in northwest Ethiopia.

Methods

An institution-based, cross-sectional study design was employed, with data collected from March 1 to 30, 2021. A simple random sampling technique was used to recruit a total of 848 male attendees of traditional schools. Data were collected via an interviewer-administered semi-structured questionnaire. The nutritional status of participants was assessed using anthropometric measurements. The WHO Anthroplus software was used for analysis. Both bivariable and multivariable logistic regression analyses were conducted to identify the factors associated with nutritional status. The degree of association between the independent variables and the dependent variable was assessed using odds ratios, reported with 95% confidence intervals, and a threshold of p ≤ 0.05.

Results

The prevalence of undernutrition was found to be 61.3% [95% CI: 58.1, 64.6]. The likelihood of developing undernutrition was elevated among those adolescents who were following the traditional school levels of dikuna (AOR = 4.3, 95% CI = 1.3, 13.6), kinne (AOR = 4.5, 95% CI = 1.4, 14.6), aquaquame (AOR = 9.9, 95% CI = 2.5, 39.88), tirguame (AOR = 6.4, 95% CI = 1.6, 25.6), and among those whose mothers had no formal education [AOR = 3.7, 95% CI: 1.2, 12.8]. In contrast, those adolescents who always washed their hands after a toilet visit had lower odds of undernutrition than their counterparts [AOR = 0.7, 95%CI: 0.5, 0.98].

Conclusion

More than three out of five participating male adolescents were undernourished. Thus, to improve the nutritional status of adolescents studying in traditional church schools, extensive health education for these adolescents is essential. Moreover, the establishment of well-resourced traditional religious school, equipped for the provision of an adequate, diversified diet, is important. Developing the habit of handwashing after visiting the toilet and before and after food preparation is also recommended for adolescent students.

Prevalence and correlates of stunting and thinness among adolescent students in Lideta subcity, Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

To determine the prevalence of stunting and thinness and associated factors among adolescents attending public schools in Lideta subcity, Addis Ababa, Ethiopia, in 2021.

DESIGN

Cross-sectional.

SETTING

Public schools in Lideta subcity, Addis Ababa, Ethiopia.

ELIGIBILITY

Adolescents from grades 5-12 in public schools and students whose parents gave consent for participation.

DATA ANALYSIS

Bivariate and multivariable logistic regression analyses were used to examine the association between the independent variables and stunting and thinness. Using a 95% CI and adjusted OR (AOR), factors with a p value of less than 0.05 were determined to have a significant association.

OUTCOME MEASURES

The prevalence of stunting and thinness, as well as the factors associated with stunting and thinness, were secondary outcomes.

RESULTS

The overall prevalence of stunting and thinness was 7.2% (95% CI: 5.3% to 9.3%) and 9% (95% CI: 6.8% to 11.4%), respectively. Stunting was associated with a larger family size (AOR=3.76; 95% CI: 1.58 to 8.94), low dietary diversity (AOR=2.87; 95% CI: 1.44 to 5.74), food insecurity (AOR=2.81; 95% CI: 1.38 to 5.71) and a lower wealth index (AOR=3.34; 95% CI: 1.51 to 7.41). On the other hand, thinness was associated with maternal education in those who were unable to read and write (AOR=2.5; 95% CI: 1.97 to 8.11), inadequate dietary diversity (AOR=4.81; 95% CI: 2.55 to 9.07) and larger family size (AOR=2.46; 95% CI: 1.14 to 5.29).

CONCLUSION

Adolescent stunting and thinness were common in Addis Ababa's public schools. Family size, dietary diversity and food security were the main factors associated with both thinness and stunting. Therefore, to solve the problem of adolescent stunting and thinness, the administration of Addis Ababa city should prioritise minimising food insecurity while boosting productivity to enhance adolescent nutritional diversity. Moreover, nutritional education should be strengthened by healthcare providers working at public schools as well as health extension workers.

Nutritional Status and Associated Factors Among School Adolescent Girls in North Shoa Zone, Amhara Region, Ethiopia: A Cross-Sectional Study

Background

Adolescents are the most affected group and the group that is least studied when it comes to malnutrition, which is one of the most important public health concerns in underdeveloped countries, including Ethiopia. Therefore, the goal of this study was to assess nutritional status and related factors among teenage females who are in school.

Materials and Methods

From October 1 to October 25, 2018, 645 young girls in school participated in an institution-based cross-sectional study. Girls in their teen years from the school were selected using a simple random sample method. Anthropometric tests and in-person interviews were used to collect the data. An odds ratio with 95% confidence intervals (CIs) and a p-value under 0.05 were used to declare a statistical association.

Results

This study found that 12.3% and 9.6% of school adolescent girls were stunted and thin, respectively. Being a rural resident (adjusted odd ratio [AOR]: 1.85, 95% CI: 1.05-3.28) and inadequate dietary diversity score (AOR: 3.02, 95% CI: 1.06-4.60) were significant predictors of stunting. School adolescent girls from merchant father were 71% less likely to develop stunting compared with government employee father. Late adolescent age (AOR: 2.27, 95% CI: 1.28-4.02) and family size ≥5 (AOR: 1.98, 95% CI: 1.05-3.75) were significant predictors of thinness.

Conclusions

Stunting and thinness were the major public health problems among school adolescent girls in the study area. Being a rural resident and inadequate dietary diversity increases the risk of stunting. However, being late adolescent girl and large family size were risk factors for thinness. There was a need for a school-based instruction program that concentrated on a varied diet and methods of encouraging the adolescent girls' appetites.

Stunting and thinness in school-attending adolescents in Addis Ababa

BACKGROUND

Adolescent population Global Diet Quality Score (GDQS) is uncommon in low-income settings. Though Global Diet Quality Score is a good measure of dietary diversity, it has not been used in assessing nutritional outcomes among adolescents. Therefore, the aim of this study is to assess school-attending adolescents stunting and thinness status and associations with global diet quality scores in Addis Ababa.

METHODS

A school-based cross-sectional study was conducted among school-attending adolescents in the age group of 10-14 years in urban settings in Ethiopia. A multi-stage stratified random sampling procedure was used to select schools and students. A total of 1200 adolescents were included in the study. Binary and Multinomial logistic regression analyses were used to determine the predictors of stunting and thinness respectively.

RESULTS

The proportion of school-attending adolescents stunting was 8.17% (95% CI: 6.74%,9.85%) and their thinness status 12.66% (95% CI: 10.89%, 14.67%). The overall mean GDQS food groups for Seven days period consumed were 19.99 + 2.81 SD. Male adolescents were 1.95 times more likely to be stunted compared to female adolescents (1.95; 95%CI: 1.11,3.39). Frequent consumption of low-fat dairy increased the risk of thinness, while frequent consumption of citrus fruits and white root tubers decreased the risk of school-attending adolescents' thinness.

CONCLUSION

The proportion of thin or stunted adolescents attending school was high still, about 1 in 10. Stunting and thinness have no association with the overall GDQS. Nutritional interventions need to consider frequent consumption of citrus fruits, low-fat dairy, and white roots and tubers in school adolescents' nutritional programs. Further studies should validate the GDQS for stunting and thinness of school adolescents.

Multilevel analysis of undernutrition and associated factors among adolescent girls and young women in Ethiopia

Background

The consequences of undernutrition have serious implication for the health and future reproductive periods of adolescent girls and young women aged 15–24 years. Inspite of this, they are neglected age groups and there is limited information about the nutritional status of this age group in Ethiopia. Therefore, estimating the extent and associated factors of undernutrition among adolescent girls and young women in a national context using multilevel analysis is essential.

Methods

Secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016. A total sample weight of 5362 adolescent girls and young women was included in this study. A multilevel mixed-effect binary logistic regression model with cluster-level random effects was fitted to determine the associated factors of undernutrition among adolescent girls and young women in Ethiopia. Finally, the odds ratios along with the 95% confidence interval was generated to determine the individual and community level factors of undernutrition. A p-value less than 0.05 was declared as the level of statistical significance.

Results

Overall, 25.6% (95%CI: 24.5–26.9) of adolescent girls and young women were undernourished. Statistically significant individual level factors includes adolescent girls and young women aged 15–19 years (AOR: 1.53, 95%CI: 1.32–1.77), individual media exposure (AOR: 0.82, 95%CI: 0.69–0.97), and unprotected drinking water source (AOR: 1.24, 95%CI: 1.04–1.48). Whereas, Southern Nations, Nationalities, and Peoples' Region (AOR: 0.33, 95%CI: 0.13–0.83) and rural residence (AOR: 1.69, 95%CI: 1.24–2.32), were community level factors for adolescent girls and young women undernutrition.

Conclusion

One quarter of the Ethiopian adolescent girls and young women were undernourished. Therefore, the Ethiopian government should better engage this age group in different aspects of the food system. To improve nutritional status, public health interventions such as increased media exposure for rural residents and interventions that improve access to protected water sources will be critical.

Magnitude and Determinants of Under-Nutrition Among Late Adolescent Girls in East Africa: Evidence From Demographic and Health Surveys (2010-2016)

Background

Adolescent girls are vulnerable to undernutrition owing to their increased nutrition demand for growth and development, including sexual development and maturation. Despite its public health importance, undernutrition among late adolescent girls has received little attention in health and nutrition policies. Although undernutrition in adolescent girls has been investigated, most of the previous study reports were based on small sample sizes and limited geographic settings. Therefore, we aimed to estimate the prevalence and determinants of undernutrition among late adolescent girls in East Africa.

Methods

Secondary data analysis was conducted among 10 East African countries using the most recent Demographic and Health Survey (DHS) reports. A total of 21,779 adolescent girls aged 15-19 years were included in this study. Descriptive statistics were conducted to describe the study population. The binary logistic regression model was fitted to identify the determinants of undernutrition among late adolescent girls. Variables with a p-value of <0.05 in the multivariate analysis were identified as statistically significant determinants of undernutrition.

Results

The overall magnitude of undernutrition among late adolescent girls in East Africa was 16.50% (95% CI: 16.00-17.00), whereas the overall magnitude of obesity among late adolescent girls in East Africa was 2.41% (95% CI: 2.21-2.62). In the final model of the multivariate analysis, adolescent girls aged 18-19 years [adjusted odds ratio (AOR) = 0.55; 95% CI: 0.51-0.60], having secondary education (AOR = 0.79; 95% CI: 0.68-0.93), being from a rich wealth index family (AOR = 0.63; 95% CI: 0.56-0.69), and being from a medium wealth index family (AOR = 0.80; 95% CI: 0.72-0.89) were negatively and statistically associated with undernutrition. Likewise, having more than seven household members (AOR = 1.36; 95% CI: 1.10-1.67), walking more than 30 min to a water source (AOR = 1.10; 95% CI: 1.01-1.20), and living in Ethiopia (AOR = 1.75; 95% CI: 1.51-2.03) were positive determinants of undernutrition among late adolescent girls.

Conclusion

In this study, undernutrition in late adolescent girls remains a considerable public health problem in East Africa. Age group, educational status, marital status, family wealth index, family size, time taken to reach a water source, media exposure, and country of resident were significant determinants of undernutrition. Therefore, devising strategies that improve the socioeconomic status of households and/or adolescents would help to reduce the risks of undernutrition in late adolescents.

Prevalence of Undernutrition and Its Associated Factors Among Lactating Women in the Shebedino District, Sidama Regional State, Ethiopia

Background: Ensuring the nutritional status of lactating women is crucial to prevent maternal morbidity and mortality in poor countries like Ethiopia. Hence, this study aimed to assess the prevalence of undernutrition and its associated factors among lactating women in Shebedino district, Sidama Regional State, Ethiopia.

Methods: A community-based cross-sectional study was conducted among randomly selected 612 lactating women from February to March 2020. Data were collected by using an interviewer-administered, structured, and pretested questionnaire. Also, physical measurements (weight, height, and body mass index) were measured by using standardized and calibrated instruments. Data entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Descriptive statistics, bivariable, and multivariable logistic regression analysis were done. A P-value of ≤.05 was used to consider the statistical significance.

Result: The prevalence of undernutrition was 25.9% (95% CI: 22.5, 29.5). Having polygamous husband (AOR = 3.47, 95% CI: 1.13, 10.68), belonged to households with less than 5 members (AOR = 1.81, 95% CI: 1.16, 2.83), abortion history in the last 6 months (AOR = 3.09, 95% CI: 1.73, 5.51), poor household wealth status (AOR = 3.85, 95% CI: 1.89, 7.81), and medium wealth status (AOR = 2.07, 95% CI: 1.06, 4.03) were factors positively associated with undernutrition.

Conclusion: Undernutrition among lactating women was high in the study area. Attention should be given to the economic status of the women, family planning services, abortion prevention, and habits of marrying more than 1 wife (polygamy).

Magnitude of Stunting and Associated Factors among Adolescent Students in Legehida District, Northeast Ethiopia

BACKGROUND

Undernutrition including stunting particularly at an adolescent stage was not emphasized by various intervention strategies in the Ethiopian context. Assessing the magnitude and potential risk factors of undernutrition is thus helpful for policymakers to design appropriate intervention strategies. Hence, this study was aimed at assessing the magnitude of stunting and associated factors among adolescent students in Legehida district, Northeast Ethiopia.

METHODS

A school-based cross-sectional study was conducted among 424 adolescent students from February 15th to March 15th, 2018. A stratified sampling followed by a simple random sampling technique was used to select the study participants. A pretested, structured, and self-administered questionnaire was used to collect the required data. Height was measured by using a portable stadiometer and the height-for-age (HFA) z-score was calculated as an indicator of stunting. SPSS version 25 and WHO AnthroPlus software were applied to analyze the data. A multivariable logistic regression analysis was performed to identify factors associated with adolescent stunting. Statistical significance was determined at a p value of <0.05 and association was described by using an odds ratio at a 95% confidence interval.

RESULTS

A total of 406 adolescent students (with a response rate of 95.7%) participated in the study. The magnitude of stunting among adolescent students in this study was 24.9% (95% CI: 24.6%-35.3%).

CONCLUSIONS

Stunting among adolescent students was significantly associated with being male [AOR = 2.1; 95% CI: 1.73-5.90], meal frequency (<3/day) [AOR = 4.6; 95% CI: 2.61-8.24], infrequent handwashing practice [AOR = 3.6; 95% CI: 1.30-9.40], absence of latrine facility (AOR = 5.51; 95% CI: 3.03-9.9), and consumption of unsafe water [AOR = 2.8; 95% CI: 1.35-6.19]. Hence, conducting routine nutrition screenings and assessments, promotion of proper food intake, and emphasis on nutrition education and counseling are needed to be strengthened.

Associated factors and socio-economic inequality in the prevalence of thinness and stunting among adolescent boys and girls in Uttar Pradesh and Bihar, India

Background

Despite economic growth observed in developing countries, under-nutrition still continues to be a major health problem. Undernutrition in adolescence can disrupt normal growth and puberty development and may have long-term impact. Therefore, it is important to study the undernutrition among adolescents. This study aimed to assess the prevalence and the associated factors of stunting, thinness and the coexistence of both (stunting and thinness) among the adolescent belonging to Uttar Pradesh and Bihar, India.

Methods

The study utilized data from Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey, which was conducted in two Indian states Uttar Pradesh and Bihar, in 2016 by Population Council under the guidance of Ministry of Health and Family Welfare, Government of India. Utilizing information on 20,594 adolescents aged 10–19 years (adolescent boys-5,969 and adolescent girls-14,625), the study examined three outcome variables, i.e., thinness, stunting, and co-existence of both. The study used descriptive and bivariate analysis. Furthermore, the study examined income-related inequality in stunting and thinness through concentration index. At last, the study used Wagstaff decomposition analysis to decompose the concentration index.

Results

The prevalence of thinness was higher among adolescent boys as compared to girls (25.8 per cent vs. 13.1 per cent). However, stunting was more prevalent among girls (25.6 per cent) than in boys (39.3 per cent). The odds of stunting were higher among late adolescents [Boys- OR:1.79; CI: 1.39, 2.30] and [Girls- OR: 2.25; CI: 1.90,2.67], uneducated adolescents [Boys- OR:2.90; CI: 1.67, 5.05] and [Girls- OR: 1.82; CI: 1.44,2.30], and poorest adolescents [Boys- OR:2.54; CI: 1.80, 3.58] and [Girls- OR: 1.79; CI: 1.38,2.32]. Similarly age, educational status, working status and wealth index were significantly associated with thinness among adolescent boys and girls. Media exposure [Boys- OR: 11.8% and Girls- 58.1%] and Wealth index [Boys: 80.1% and Girls: 66.2%] contributed significantly to the inequality in the prevalence of thinness among adolescents. Similarly, wealth index [Boys: 85.2% and Girls: 84.1%] was the only significant contributor to the inequality in the prevalence of stunting among adolescents.

Conclusion

The study provides an understanding that stunting and thinness is a significant public health concern among adolescents, and there is a need to tackle the issue comprehensively. By tackling the issue comprehensively, we mean that the state government of Uttar Pradesh and Bihar shall screen, assess, and monitor the nutritional status of adolescent boys and girls. The interventions shall focus towards both boys as well as girl adolescents, and particular emphasis should be given to adolescents who belonged to poor households. Also, efforts should be taken by stakeholders to increase family wealth status.

Underweight and Associated Factors Among Teenage Adolescent Girls in Resource-poor Settings: A Cross-sectional Study

Background and Purpose

Understanding the undernutrition status of teenage adolescent girls living in urban slums and its associated factors is meaningful to formulate customized health strategies. This study aimed to determine the prevalence of being underweight and associated factors among teenage adolescent girls in urban slums.

Materials and Methods

In this cross-sectional study, we enrolled a total of 418 teenage adolescent girls from five of 210 urban slums of Varanasi district, Uttar Pradesh, India employing two-stage probability sampling for the selection of households and subjects, between September 2016 and July 2017. The study of underwight subjects was assessed with BMI for age using standard criteria. Factors associated with being underweight were determined by multivariable logistic regression analysis.

Results

Of 418 study subjects, 49.76% (208/418) were underweight. Results revealed that sociodemographic factors such as teenage adolescent girls who were from SC/ST (schedule caste/schedule tribe) caste/ethnicity (adjusted odds ratio (AOR)=2.02, 95%CI: 1.00–4.23), subjects whose father’s education level was primary or lower (AOR=1.87, 95%CI: 1.12–3.11), and number of people in the family >4 (AOR=2.18, 95%CI: 1.18–4.03) were associated with being underweight. Likewise, dietary behavior-related factors such as vegetarian (AOR=2.21, 95%CI: 1.25–3.92), and <3 meals per day (AOR=2.36, 95%CI: 1.40–3.98) than their counterparts were associated with being underweight. In addition, teenage adolescent girls from food-insecure households (AOR=3.33, 95%CI: 2.01–5.51) were more likely to be underweight than those from food-secure households.

Conclusion

The higher burden of underweight among teenage adolescent girls in Indian urban slums needs to be addressed through specific public health interventions such as by improving education, providing education regarding dietary behavior, and having access to sufficient, safe, and nutritious foods.