Research ArticleNutritional Status of School Going Adolescent Girls in AwashTown Afar Region Ethiopia

Molla Kahssay 1 Lidia Mohamed2 and Abel Gebre 1

1Department of Public Health Samara University Semera Afar Ethiopia2Afar Regional Health Bureau Semera Afar Ethiopia

Correspondence should be addressed to Molla Kahssay mollaka2005gmailcom

Received 2 May 2019 Revised 24 January 2020 Accepted 1 February 2020 Published 21 February 2020

Academic Editor Maria R Gualano

Copyright copy 2020Molla Kahssay et al)is is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Background Adolescence is an essential stage in the human life cycle a transition period between childhood and adulthood that ischaracterized by rapid growth spurt in which nutritional requirement is high Adolescents are risk groups for malnutrition butthey are not part of a target in many intervention strategies Hence this study was aimed at assessing nutritional status ofadolescent girls and its associated factors Methods Institutional based cross-sectional study design was employed amongrandomly selected 348 school going adolescent girls Data were entered into Epi Info and transported to SPSS version 20 forfurther analysis Binary logistic regression analysis was used to identify predicators of nutritional status of adolescent girls at p

value lt005 and 95 confidence level Results )is study revealed that 229 and 882 of school adolescent girls were stuntedand thin respectively Being at early adolescent age (14-15 years) [AOR 14 95 CI (104ndash428)] ownership of phone[AOR 33 95 CI (155ndash702)] and dietary diversity score of lt4 food groups [AOR 22 95 CI (14ndash454)] were some of thepotential predictors of stunting Similarly dietary diversity score of lt4 food groups [AOR 18 95 CI (114ndash438)] and low foodconsumption [AOR 3 95 CI (115ndash790)] were some of the potential predictors of thinness Conclusion and Recommendation)e prevalence of both stunting and thinness is a public health problem in the study area Early adolescent age (10ndash14 years)ownership of phone and dietary diversity score of lt4 food groups were independent predictors of stunting Dietary diversity scoreof lt4 food groups and eating less than usual were independent predictors of thinness An integrated nutritional intervention andhealth related services that meet the needs of adolescent girls in the school community have to be established and strengthenedSince adolescent age is period of growth and development in which growth spurt and nutritional requirement are high ado-lescents should be provided with enough meals and diversified foods

1 Background

Adolescence is a pivotal period of development which rep-resents the age of 10ndash19 years Adolescence is a tap rootgrowth and development life stage which has implications forfuture nutritional status and food consumption habits Ad-olescent girls need to have good quantity and quality nutrientsto cope with this rapid growth and other health risks whichincrease nutritional demand [1] Adolescents account forabout one-fourth of the total worldrsquos population and themajority of them live in developing countries Greater thanone-third (386) of Ethiopian population were found in thisage group making Ethiopia the third country in the world [2]Adolescence is an essential stage in the human life cycle a

transition period between childhood and adulthood that ischaracterized by rapid growth spurt [3 4]

Adolescent girls thus need to be adequately nourished toensure their own optimal growth and maturation inpreparation for their future reproductive capacity duringthis crucial period )e physical and psychosocial changesoccurring during childhood and adolescence make this agegroup more vulnerable to health and nutrition concernscompared to others Because of pubertal growth andmenarche during this period the adolescents are requiringthe highest quantity and quality nutrients Consequently ifthose requirements and quality of nutrients for adolescentsare not met malnutrition happens which influences growthdevelopment and health of adolescents [5 6]

HindawiJournal of Environmental and Public HealthVolume 2020 Article ID 7367139 9 pageshttpsdoiorg10115520207367139

In Africa the prevalence of undernutrition amongadolescents was found to be higher in the eastern part ofthe continent [7 8] In Ethiopia the prevalence of un-dernutrition was found to be high [7 9] Undernutrition isa major public health problem in the majority of Ethiopiancommunities including urban and rural adolescents[10 11] In most developing countries nutrition initiativeshave been focusing on children and women thusneglecting adolescent girls Addressing the nutrition needsof adolescents could be an important step towardsbreaking the vicious cycle of intergenerational malnutri-tion chronic diseases and poverty Malnutrition duringadolescence can have lasting consequences on an ado-lescentrsquos cognitive development resulting in decreasedlearning ability poor concentration and impaired schoolperformance [12]

Malnutrition is associated with significant morbidityand mortality and affects the reproductive outcome inadolescent girls Moreover undernourished adolescentstend to be ultimately malnourished adults give birth tosmall babies and transmit undernutrition to future gen-eration [9] )e health consequences on adolescent girlshave been identified to be high if they are short and un-derweight and transmit malnutrition to next generationbecause of competing growth of mother [13 14] Despitethe emergence of a number of advancements in areas ofhealth and nutrition services in developing countries in-cluding Ethiopia nutritional status of adolescents is not yetcommonly included in health and nutrition surveys and anup-to-date overview of their nutritional status across theworld is not available [15] Within the past few yearsemerging research on adolescent health in sub-SaharanAfrica describes a high prevalence of malnutrition espe-cially among girls [16] Attaining health for all people atevery stage of their life especially for the adolescents the socalled next generation is impossible in the presence ofmalnutrition [12 17 18]

In Ethiopia so far limited studies have been conductedwith regard to adolescent nutrition and there was no similarstudy conducted in pastoral community Hence this studyaimed to assess nutritional status of school going adolescentgirls and its associated factors in Awash town Afar RegionEthiopia

2 Methods

21 Study Area )e study was conducted in Afar RegionEthiopia Afar is located in the eastern part of Ethiopia )eAfar Regional State consists of 9 administrative zones 32woredas and 5 urban administrationstowns )e area ischaracterized by a harsh climate with temperatures up to40degC highly variable average precipitation between 5 and600mm annually and recurrent droughts and floods underthese conditions mobile pastoralist is the dominant type ofland use due to its high adaptive capacity As of 2018 Awashtown has one primary and one secondary and preparatoryschool which are owned by the government

22 Study Period )e study was conducted from January toFebruary 2018

23 Study Design Facility based cross-sectional study wasemployed

24 Source Population All adolescent girls found in allschools of Awash town constituted the source population ofthis study

25 Study Population Adolescent girls attending the se-lected Awash primary secondary and preparatory schoolsconstituted the study population

26 Eligibility Criteria All adolescent girls aged 10 to 19years attending the selected schools during the study periodwere part of the study and adolescent girls with obviousphysical deformities for anthropometric measurements andor who were seriously ill to be interviewed were excludedfrom the study

27 Sample Size Determination )e sample size was de-termined using single population proportion formulaconsidering 95 confidence interval 80 power and 5marginal error with the proportion of adolescents who werestunted being 315 [19]

n zα2( 1113857

2 lowast P(1 minus P)1113872 1113873

d2( )

n (196)2(0315lowast 0685)1113872 1113873

(005)2

n 331

(1)

Adding 5 nonresponse rate the final sample size was348 subjects

28 Sampling Procedures According to Awash Town Edu-cation Bureau report the town had one primary school andone secondary and preparatory school )e total adolescentgirls in the schools were 1252 Elementary secondary andpreparatory school adolescent girls were taken using pop-ulation proportion to size allocation based on the number ofadolescent girls in each school Finally study participantswere selected using a simple random sampling techniquefrom sampling frame that was made from all school registersobtained (Figure 1)

29 Operational Definition of Terms )e definitions ofterms were as follows

Adolescents individuals in the age group of 10ndash19 years

2 Journal of Environmental and Public Health

)inness BMI-for-agelt minus 2 Z scores of the 2007 WHOreferenceStunting height-for-agelt minus 2 Z scores of the 2007WHO referencePoor dietary diversity adolescent girls with dietarydiversity score of lt4 food groupsGood dietary diversity adolescent girls with dietarydiversity score of ge4 food groups

210 Data Collection Process Data was collected using aninterviewer who administered structured questionnairetaking anthropometric measurements (weight height) of thestudy subjects)e questionnaire was adapted from previousstudies after a thorough review of different studies Stadi-ometers with a sliding headpiece attached to digital weightscale were used to measure height and weight respectivelyDuring anthropometric measurements weight was mea-sured to the nearest 01 kg and height to the nearest 01 cm instanding position Periodic calibration of the instrumentswas made by placing standard calibration on the scaleAnthropometric measurements were converted to height-for-age and BMI-for-age Z scores by using AnthroPlussoftware Girls with height-for-age below minus 2 Z scores andBMI-for-age below minus 2 Z scores of the 2007 WHO referencepopulation were classified as stunted and thin respectively(Figures 2ndash6)

211 Data Quality and Control )e English version of thestructured questionnaire was translated into local languageldquoAfarafrdquo and again back-translated to English by anothertranslator to assure the consistency of the questions Datacollectors and supervisors were trained for three days onstandardization of the anthropometric tools All anthropo-metric tools were tested to ensure that each tool produces thesame measure of a standard object To test for accuracy the

scales were checked by placing items of knownweight on themafter every 10 measurements )e scale was regularly checkedand adjusted to zero after eachmeasurement Pretest was donein 5 of the total sample before the actual survey out of thestudy setting to ensure clarity ordering consistency andacceptance of the questionnaire To improve quality of the

252

137

204 211168

122

88

203

136 129172

218

0

10

20

30

40

50

60

70

80

90

100

Own house Ownlivestock

Farm land Television Radio Refrigerator

Perc

ent

NoYes

Figure 2 Household asset possession of school going adolescentgirls Awash town 2018 (n 340)

Simple random sampling

Awash town = one primary andone secondary and preparatory school = total of

1252 adolescent girls

Total elementary school girls = 780Total secondary and preparatory school girls = 132

Elementary school = 216 samplesAwash secondary and preparatory school = 132

samples

348 participants

Proportional allocation of samples

Figure 1 Schematic representation of sampling procedure ofschool adolescent girls Awash town Afar Ethiopia

YesNo

771

229

Stunning

Figure 3 Prevalence of stunting among school going adolescentgirls Awash town 2018 (n 340)

Freq

uenc

y

Severe stunningModerate stunning

Severity of stunning

15ndash19 years

10ndash14 years0

20

40

Severe stunning Moderate stunning108

10ndash14 years15ndash19 years

2733

Figure 4 Prevalence and degree of stunting by age among schoolgoing adolescent girls Awash town 2018 (n 340)

Journal of Environmental and Public Health 3

data data collectors were closely supervised and each com-pleted questionnaire was checked to ascertain that all ques-tions were properly filled and corrected

212 Data Processing andAnalysis After data collection thedata was cleaned coded entered into Epi Info and thenexported to SPSS version 20 for further analysis Anthro-pometric indices were calculated by usingWHOAnthroPlussoftware Descriptive statistics was used to show the prev-alence of stunting and thinness and other sociodemographiccharacteristics All variables having a p value of lt025 in theunivariable analysis were candidates for multivariable lo-gistic regression model In the multivariable analysis vari-ables with p value lt005 were taken as significant predictorsfor stunting and thinness at a 95 confidence interval

213 Ethical Consideration Ethical approval was obtainedfrom Research and Ethics Review Committee at SamaraUniversity Support letter was also obtained from respectiveregional and district education offices as well as from all theselected schools in Awash town After permission was

obtained from school administration the parental consentwas obtained the day prior to the data collection After thewritten consent was obtained from parents of study subjectsassent was obtained by explaining the purpose and theimportance of the study to the adolescent girls with standardassurance of confidentiality

3 Results

31 Sociodemographic and Economic Characteristics of StudyParticipants A total of 340 adolescent girls participated inthe study with response rate of 977 More than half (53)of the study participants were from Awash secondary andpreparatory school Of the total adolescent girls 135 (397)were aged 10ndash14 years (early adolescence) and 205 (607)were in the age category of 15ndash19 years (late adolescence)Regarding religion 162 (476) 122 (359) and 55 (162)of the participants were Muslims Orthodox Christians andProtestants respectively (Table 1)

32 Dietary Intake Characteristics of Study ParticipantsPurchased and own products were source of staple foods for201 (591) and 101 (297) of the study participants Teffwas the most cited staple food for 294 (865) of the studyparticipants whereas wheat was the least listed staple food for20 (59) of the study participants According to studyparticipants 24 hour recall report the number of foodgroups consumed was computed Almost half (49) of thestudy participants had consumed foods from lt4 foodgroups )e mean consumption of diversified food was281plusmn (SD 0501) food groups (Table 2)

33 Life Style and Behavior Characteristics of StudyParticipants One hundred thirty-six (40) of the studyparticipants claimed that they had regular physical activitiesKhat chewing was practiced in 86 (253) of the studysubjects Cigarette smoking and alcohol consumption werepracticed in 2 (06) and 31 (91) of families of studyparticipants respectively Based on self-estimation of bodysize 126 (371) 58 (171) and 99 (291) of the par-ticipants considered themselves as thin medium and veryfat respectively Of the total study participants 85 (25) and47 (138) participants attempted to gain weight and to loseweight respectively

34 Sanitation and Hygiene Characteristics of StudyParticipants All selected schools had latrine but none ofthem had hand washing facilities )e majority of studyparticipants 262 (772) had latrine in their home of whichonly 128 (376) had hand washing facilities )e mostcommon type of latrine was pit latrine without slab 153(45) followed by pit latrine with slab 57 (168) Most ofthe study participants were obtaining water from tap(994) About 13 (45) and 16 (47) of the study subjectsdid not wash their hands before eating food and after usingtoilet respectively

882

YesNo

9118

882

Thinness

882

Figure 5 Prevalence of thinness among school going adolescentgirls Awash town June 2018 (n 340)

Freq

uenc

y

Severity of thinness

SevereModerate

Moderate

15ndash19 years

10ndash14 years0

5

10

15

20

10ndash14 years15ndash19 years

Severe31

1610

Figure 6 Prevalence and degree of thinness by age among schoolgoing adolescent girls Awash town 2018 (n 340)

4 Journal of Environmental and Public Health

35 Reproductive Characteristics of Study ParticipantsAmong respondents about 232 (682) of them claimed thatthey started menstruating whereas 108 (318) of them didnot start menstruating Of the total respondents 339 (997)had no previous history of utilization of family planningmethods

36 Nutritional Status of Study Participants

361 Stunting )is study revealed that 78 (229) of schooladolescent girls were stunted

3627inness )is study revealed that 30 (882) of schooladolescent girls were thin

37 Factors Associated with Stunting In univariable binarylogistic regression analysis adolescent age adolescent family

size source of food dietary intake of adolescents and familypossession of phone were some of the variables with p valuelt025 and were candidates for multivariable analysis Inmultivariable binary logistic regression analysis being atearly adolescent age (10ndash14 years) ownership of phone andpoor consumption of diversified foods (low DDS) wereindependent predictors of stunting

Adolescents aged 10ndash14 years were 14 times more likelyto be stunted compared to adolescents aged 15ndash19 years(AOR 14 95 CI (104ndash428)) Adolescents from familieswho did not possess phone were about three times morelikely to be stunted compared to their counterparts(AOR 33 95 CI (155ndash702)) Regarding dietary intakeadolescents who had poor consumption of diversified foods(DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454))(Table 3)

Table 1 Sociodemographic and economic characteristics of school going adolescent girls Awash town 2018 (n 340)

Variable Category Frequency

Age 10ndash14 135 39715ndash19 205 603

School grade 1ndash8 160 479ndash12 180 53

Family sizelt 3 42 1244ndash5 94 276gt5 204 600

ReligionMuslim 162 476Orthodox 122 359Protestant 56 165

LivingWith parent 278 818Renting alone 9 26With relatives 53 156

Absence from school in a month ge5 days 43 336lt5 days 85 664

Work other than being student Yes 46 135No 294 865

Table 2 Dietary intake characteristics of school going adolescent girls Awash town 2018 (n 340)

Source of food

Own product 101 297Market purchase 201 591

Gift 6 18Exchange and barter 12 35

Humanitarian food aid 16 47Loan 4 12

Mainly used food staples in the area

Teff 294 865Maize 11 32

Sorghum 15 44Wheat 20 59

Number of hunger episodes in last month

No episodes 15 44One episode 5 15Two episodes 35 103)ree episodes 71 209

Four and above episodes 214 629

Diet diversity Poor (lt4 food groups) 167 49Good (ge4 food groups) 173 51

Journal of Environmental and Public Health 5

38 Factors Associated with 7inness In univariable binarylogistic regression analysis consumption of fruit and veg-etables reducing meal in household and changing feedinghabit were some of the variables with p value lt025 and werecandidates for multivariable analysis In multivariable binarylogistic regression analysis poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness Adolescents who hadpoor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) Ado-lescents who did eat less because of household financialconstraints were three time more likely to be thin than theircounterparts (AOR 3 95 CI (115ndash790)) (Table 4)

4 Discussion

)is study was conducted to determine nutritional statusand associated factors among school adolescent girls inAwash town )e main nutritional problem which affectsadolescents is undernutrition in terms of stunting andthinness )is study revealed a prevalence of thinness andstunting of 882 and 229 respectively )e prevalence ofstunting in this study was comparable with that in a studyconducted in Eastern Arsi Zone which was 202 [20] andnational nutrition survey report of Ethiopia 23 [21] butless than the finding in Amhara Region 315 [19] )epossible reason for this difference in prevalence could be adifference in socioeconomic status However the prevalenceof stunting in this study was greater than studies conductedin Adama city 156 [22] and Adwa town Tigray 122[23] )e possible reason for this variation could be thedifference in the study setting as this study was conducted inurban adolescent girls while the above studies were done inboth urban and rural areas whereby health service utilizationand factors which determine health are quite different

)e prevalence of thinness in this study was 88 )isresult is similar to that in a study conducted in NorthwestEthiopia Gondar town which was 104 [24] )is studyresult is lower than the study results conducted at Amhara136 [19] and rural community of Aseko district EasternArsi Zone and Oromia region 148 [20] )is variationmight be related to the nature of the diet and lifestyle of theindividual or may be attributed to poor socioeconomicconditions in the study settings

Regarding factors associated with stunting this study hasfound that adolescents aged 10ndash14years were 14 times morelikely to be stunted compared to adolescents aged 15ndash19years (AOR 14 95 CI (104ndash428)) )is finding isconsistent with some research findings [9 19] )ose earlyadolescents are at the greatest gain in height as compared tolate adolescents Hence failing to achieve their nutrientneeds for this period will make early adolescents moresusceptible for developing chronic malnutrition

)e findings of this study showed that adolescent girlsfrom families who did not possess phone were about threetimes more likely to be stunted compared to their coun-terparts (AOR 33 95 CI (155ndash702)) Regarding dietaryintake adolescents who had poor consumption of diversifiedfoods (DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454)) )ismight be because dietary diversity is the proxy indicator ofdietary habit and having poor dietary habit can lead tostunting

According to this study finding adolescent girls who dideat less because of household financial constraints were threetimemore likely to be thin than their counterparts (AOR 395 CI (115ndash790)) )is finding is consistent with a studydone in Amhara Region Northwestern Ethiopia [19] )ismight be explained by the fact that failing to achieve nutrientneeds can be manifested by thinness Adolescent girls who

Table 3 Multivariable binary logistic regression analysis for determinants of stunting among school going adolescent girls of Awash town2018 (n 340)

VariablesStunting

COR (95) AOR (95 CI)Yes () No ()

Age10ndash14 37 (474) 98(374) 151(112ndash543) 14(104ndash428)lowast15ndash19 41 (526) 164 (626) 1

Family sizelt 3 persons 7 (90) 35 (134) 14ndash5 persons 18 (231) 76 (290) 118(45ndash309) 131(048ndash357)gt5 persons 53(679) 151(576) 175(74ndash419) 187(075ndash463)

Availability of phoneYes 63 (808) 240 (916) 1 No 15 (192) 22 (84) 256 (127ndash529) 33(155ndash702)lowast

DDSGood 29(372) 144(55) 1 1Poor 49(628) 118(45) 206(123 564) 22(14 454)lowast

Fruits and vegetables intakeYes 39 (500) 90 (344) 191 (115ndash319) 172 (014ndash425)No 39 (500) 172 (656) 1

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

6 Journal of Environmental and Public Health

had poor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) )ismight be explained by the fact that poor dietary diversity isthe proxy indicator of poor dietary habit which can lead tothinness

41Strengthsof theStudy )e strength of this study lies in itsfocus on adolescent girls a group that is presently lackingattention )is study also used primary data source

42 Utility of the Study )e present research has enormoussocial relevance and utility )is study provided informationon the nutrition status of school adolescent girls and sig-nificant predictors of stunting and thinness )is could beused as a baseline data for other researchers and will provideevidence for administrators and policy makers to planprevention strategies for undernutrition among adolescentgirls

43 Limitations of the Study )e primary limitation of thisstudy is that it is cross-sectional Because the exposure and

outcome were assessed simultaneously we cannot claim acausal relationship between the identified predictor variablesand the outcome variable (undernutrition)

5 Conclusion and Recommendation

)e findings of the study have shown that stunting andthinness were high among school adolescent girls One outof four adolescents was stunted Early adolescent age (10ndash14years) ownership of phone and poor consumption of di-versified foods (DDSlt 4 food groups) were independentpredictors of stunting Poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness An integrated nutri-tional intervention and health related services that meet theneeds of adolescent girls in the school community have to beestablished and strengthened Since adolescent age is periodof growth and development in which growth spurt andnutritional requirement are high adolescents should beprovided with enough meals and diversified foods Familiesas well as the whole community have to be aware of nutritionof adolescent girls through health extension workers androutine facilities service

Table 4 Multivariable binary logistic regression analysis for determinants of thinness among school going adolescent girls of Awash town2018 (n 340)

Variables)inness

COR (95) AOR (95 CI)Yes () No ()

Fathersrsquo occupationPastoral 1(33) 12(39) 85(09ndash733) 93(009ndash891)Agro pastoral 3(100) 36(116) 85(22ndash333) 83(017ndash415)Merchant 9(300) 86(277) 1070(41ndash282) 149(047ndash472)Daily laborer 8(267) 84(271) 97(36ndash264) 139(42ndash464)Government employee 9(300) 92(297) 1 1

Mothersrsquo occupationPastoral 2(67) 19(61) 109(16ndash712) 197(023ndash1646)Agro pastoral 1(33) 11(35) 94(08ndash1000) 353(024ndash5254)Merchant 9(300) 93(300) 10(25ndash393) 168(035ndash811)Daily laborer 5(167) 64(206) 81(18ndash357) 234(041ndash1336)Government employee 10(333) 92(297) 112(29ndash435) 423(077ndash231)Housewife 3(100) 31(100) 1 1

Feeding habitAs usual 17(567) 189 (61) 1More than usual 12(40) 81(261) 165 (75ndash361) 177 (072ndash434)Less than usual 1(33) 40(129) 28 (04ndash215) 25 (003ndash201)

Eating less than usualYes 23(767) 157(506) 32(134ndash768) 301(115ndash790) lowastNo 7(233) 153(494) 1

DDSGood 14(47) 159(61) 1 1Poor 16(53) 103(39) 176(122 486) 18(114 438)lowast

Fruit and vegetable consumptionYes 19(633) 110(355) 1No 11(367) 200(645) 032(015ndash069) 028 (011ndash178)

Milk consumptionYes 2(67) 36(116) 1No 28(933) 274(884) 184(042ndash805) 029(006ndash148)

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

Journal of Environmental and Public Health 7

Abbreviations

CSA Central Statistical AgencyDDS Dietary diversity scoreEDHS Ethiopia Demographic and Health SurveyFAO Food and Agriculture OrganizationICRW International Center for Research on WomenNHNES National Health and Nutrition Examination

SurveySPSS Statistical Package for the Social Sciences

Data Availability

All the results of this research were based on the use ofprimary data and the data collection was performed pro-spectively )e datasets supporting the conclusions of thestudy are included in the article Any additional data will beavailable from the corresponding author on reasonablerequest

Ethical Approval

)e study was approved by the Institutional Review Board ofCollage of Medical and Health Sciences Samara UniversityA letter of support was obtained from Awash Town Edu-cation Bureau)e study was conducted in accordance withthe ethical standards of the institutional and national re-search committee and it also adheres to the Declaration ofHelsinki

Consent

After permission was obtained from school administrationthe parental consent was obtained the day prior to the datacollection After the written consent was obtained from theparents of the study subjects assent was obtained byexplaining the purpose and the importance of the study to theadolescent girls with standard assurance of confidentiality

Conflicts of Interest

)e authors have no conflicts of interest regarding thisresearch

Authorsrsquo Contributions

LM has conceived and executed the study carried out theoverall design and performed data collection and statisticalanalysis MK and AG have critically revised the design of thestudy and the data collection techniques and helped in thestatistical analysis MK has drafted the manuscript Allthe authors read and finally approved this manuscript forsubmission

Acknowledgments

)e authors would like to thank all respondents for theirvaluable information)e authors also extend their gratitudeto Afar Regional Education Bureau and Awash Town Ed-ucation Bureau for their support throughout the work

Finally the authors would like to thank all data collectorsand supervisors who have given their precious time to collectthe necessary data

References

[1] UNFPA Adolescent Sexual and Reproductive Health Toolkitfor Humanitarian Setting a Companion to the Inter-AgencyField Manual on Reproductive Health in Humanitarian Set-tings UNFPA New York NY USA September 2009

[2] D Clifton and A Hervish 7e Worldrsquos Youth Data SheetPopulation Reference Bureau Washington DC USA 2013

[3] H Delisle Nutrition in Adolescence Issues and Challenges forthe Health Sector Issues in Adolescent Health and Develop-ment World Health Organization Geneva Switzerland 2005

[4] L Cordeiro S Lamstein Z Mahmud and J Levinson Ad-olescent Malnutrition in Developing Countries a Close Look atthe Problem and at Two National Experiences vol 31pp 6ndash13 WHO Geneva Switzerland 2006

[5] J E Brown and J Stang Nutrition 7rough Life 7e CycleWadsworth Cengage learning Boston MA USA 4th edition2011

[6] CSA Summary and Statistical Report of the 2007 Populationand Housing Census Results Population Size by Age and SexAddis Ababa Ethiopia FDRE Population Cecsus Commis-sion Addis Ababa Ethiopia 2008

[7] Y Mesert J Haidar H Kassa and F Fleming Jr ldquoSocio-economic and demographic factors affecthing body massindex of adolescents students aged 10-19 in ambo (a ruraltown) in Ethiopiardquo International Journal of Biomedical Sci-ence vol 6 no 4 pp 321ndash326 2010

[8] A Prista J A R Maia A Damasceno A Damasceno andG Beunen ldquoAnthropometric indicators of nutritional statusimplications for fitness activity and health in school-agechildren and adolescents from Maputo Mozambiquerdquo 7eAmerican Journal of Clinical Nutrition vol 77 no 4pp 952ndash959 2003

[9] A Mulugeta F Hagos B Stoecker et al ldquoNutritional status ofadolescent girls from rural communities of Tigray NorthernEthiopia Ethiopianrdquo 7e Ethiopian Journal of Health Devel-opment vol 23 no 1 pp 5ndash10 2009

[10] A L Sawaya P A Martins L P Grillo and T T FlorencioldquoLong-term effects of early malnutrition on body weightregulationrdquo Nutrition Reviews vol 62 pp S127ndashS133 2004

[11] S Nandy M Irving D Gordon S V Subramanian andG D Smith ldquoPoverty child undernutrition andwhich is similarto the pattern morbidity new evidence from Indianrdquo Bulletin ofthe World Health Organization vol 83 pp 210ndash216 2005

[12] California Department of Public Health California Nutritionand Physical Activity Guideline for Adolescent Child andAdolescent Health Division California Department of PublicHealth Sacramento CA USA 2012

[13] H Delisle V Chandra-Mouli and B Bruno Should Ado-lescents Be Specifically Targeted for Nutrition in DevelopingCountries To Address Which Problems and How WorldHealth OrganizationInternational Nutrition Foundation forDeveloping Countries Geneva Switzerland 2000

[14] United nation standing committee of nutrition 6th Report onthe World Nutrition Situation UNSCN Paris France 2009

[15] R Uauy J Kain V Mericq J Rojas and C CorvalanldquoNutrition child growth and chronic disease preventionrdquoAnnals of Medicine vol 40 no 1 pp 11ndash20 2008

8 Journal of Environmental and Public Health

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9

)inness BMI-for-agelt minus 2 Z scores of the 2007 WHOreferenceStunting height-for-agelt minus 2 Z scores of the 2007WHO referencePoor dietary diversity adolescent girls with dietarydiversity score of lt4 food groupsGood dietary diversity adolescent girls with dietarydiversity score of ge4 food groups

210 Data Collection Process Data was collected using aninterviewer who administered structured questionnairetaking anthropometric measurements (weight height) of thestudy subjects)e questionnaire was adapted from previousstudies after a thorough review of different studies Stadi-ometers with a sliding headpiece attached to digital weightscale were used to measure height and weight respectivelyDuring anthropometric measurements weight was mea-sured to the nearest 01 kg and height to the nearest 01 cm instanding position Periodic calibration of the instrumentswas made by placing standard calibration on the scaleAnthropometric measurements were converted to height-for-age and BMI-for-age Z scores by using AnthroPlussoftware Girls with height-for-age below minus 2 Z scores andBMI-for-age below minus 2 Z scores of the 2007 WHO referencepopulation were classified as stunted and thin respectively(Figures 2ndash6)

211 Data Quality and Control )e English version of thestructured questionnaire was translated into local languageldquoAfarafrdquo and again back-translated to English by anothertranslator to assure the consistency of the questions Datacollectors and supervisors were trained for three days onstandardization of the anthropometric tools All anthropo-metric tools were tested to ensure that each tool produces thesame measure of a standard object To test for accuracy the

scales were checked by placing items of knownweight on themafter every 10 measurements )e scale was regularly checkedand adjusted to zero after eachmeasurement Pretest was donein 5 of the total sample before the actual survey out of thestudy setting to ensure clarity ordering consistency andacceptance of the questionnaire To improve quality of the

252

137

204 211168

122

88

203

136 129172

218

0

10

20

30

40

50

60

70

80

90

100

Own house Ownlivestock

Farm land Television Radio Refrigerator

Perc

ent

NoYes

Figure 2 Household asset possession of school going adolescentgirls Awash town 2018 (n 340)

Simple random sampling

Awash town = one primary andone secondary and preparatory school = total of

1252 adolescent girls

Total elementary school girls = 780Total secondary and preparatory school girls = 132

Elementary school = 216 samplesAwash secondary and preparatory school = 132

samples

348 participants

Proportional allocation of samples

Figure 1 Schematic representation of sampling procedure ofschool adolescent girls Awash town Afar Ethiopia

YesNo

771

229

Stunning

Figure 3 Prevalence of stunting among school going adolescentgirls Awash town 2018 (n 340)

Freq

uenc

y

Severe stunningModerate stunning

Severity of stunning

15ndash19 years

10ndash14 years0

20

40

Severe stunning Moderate stunning108

10ndash14 years15ndash19 years

2733

Figure 4 Prevalence and degree of stunting by age among schoolgoing adolescent girls Awash town 2018 (n 340)

Journal of Environmental and Public Health 3

data data collectors were closely supervised and each com-pleted questionnaire was checked to ascertain that all ques-tions were properly filled and corrected

212 Data Processing andAnalysis After data collection thedata was cleaned coded entered into Epi Info and thenexported to SPSS version 20 for further analysis Anthro-pometric indices were calculated by usingWHOAnthroPlussoftware Descriptive statistics was used to show the prev-alence of stunting and thinness and other sociodemographiccharacteristics All variables having a p value of lt025 in theunivariable analysis were candidates for multivariable lo-gistic regression model In the multivariable analysis vari-ables with p value lt005 were taken as significant predictorsfor stunting and thinness at a 95 confidence interval

213 Ethical Consideration Ethical approval was obtainedfrom Research and Ethics Review Committee at SamaraUniversity Support letter was also obtained from respectiveregional and district education offices as well as from all theselected schools in Awash town After permission was

obtained from school administration the parental consentwas obtained the day prior to the data collection After thewritten consent was obtained from parents of study subjectsassent was obtained by explaining the purpose and theimportance of the study to the adolescent girls with standardassurance of confidentiality

3 Results

31 Sociodemographic and Economic Characteristics of StudyParticipants A total of 340 adolescent girls participated inthe study with response rate of 977 More than half (53)of the study participants were from Awash secondary andpreparatory school Of the total adolescent girls 135 (397)were aged 10ndash14 years (early adolescence) and 205 (607)were in the age category of 15ndash19 years (late adolescence)Regarding religion 162 (476) 122 (359) and 55 (162)of the participants were Muslims Orthodox Christians andProtestants respectively (Table 1)

32 Dietary Intake Characteristics of Study ParticipantsPurchased and own products were source of staple foods for201 (591) and 101 (297) of the study participants Teffwas the most cited staple food for 294 (865) of the studyparticipants whereas wheat was the least listed staple food for20 (59) of the study participants According to studyparticipants 24 hour recall report the number of foodgroups consumed was computed Almost half (49) of thestudy participants had consumed foods from lt4 foodgroups )e mean consumption of diversified food was281plusmn (SD 0501) food groups (Table 2)

33 Life Style and Behavior Characteristics of StudyParticipants One hundred thirty-six (40) of the studyparticipants claimed that they had regular physical activitiesKhat chewing was practiced in 86 (253) of the studysubjects Cigarette smoking and alcohol consumption werepracticed in 2 (06) and 31 (91) of families of studyparticipants respectively Based on self-estimation of bodysize 126 (371) 58 (171) and 99 (291) of the par-ticipants considered themselves as thin medium and veryfat respectively Of the total study participants 85 (25) and47 (138) participants attempted to gain weight and to loseweight respectively

34 Sanitation and Hygiene Characteristics of StudyParticipants All selected schools had latrine but none ofthem had hand washing facilities )e majority of studyparticipants 262 (772) had latrine in their home of whichonly 128 (376) had hand washing facilities )e mostcommon type of latrine was pit latrine without slab 153(45) followed by pit latrine with slab 57 (168) Most ofthe study participants were obtaining water from tap(994) About 13 (45) and 16 (47) of the study subjectsdid not wash their hands before eating food and after usingtoilet respectively

882

YesNo

9118

882

Thinness

882

Figure 5 Prevalence of thinness among school going adolescentgirls Awash town June 2018 (n 340)

Freq

uenc

y

Severity of thinness

SevereModerate

Moderate

15ndash19 years

10ndash14 years0

5

10

15

20

10ndash14 years15ndash19 years

Severe31

1610

Figure 6 Prevalence and degree of thinness by age among schoolgoing adolescent girls Awash town 2018 (n 340)

4 Journal of Environmental and Public Health

35 Reproductive Characteristics of Study ParticipantsAmong respondents about 232 (682) of them claimed thatthey started menstruating whereas 108 (318) of them didnot start menstruating Of the total respondents 339 (997)had no previous history of utilization of family planningmethods

36 Nutritional Status of Study Participants

361 Stunting )is study revealed that 78 (229) of schooladolescent girls were stunted

3627inness )is study revealed that 30 (882) of schooladolescent girls were thin

37 Factors Associated with Stunting In univariable binarylogistic regression analysis adolescent age adolescent family

size source of food dietary intake of adolescents and familypossession of phone were some of the variables with p valuelt025 and were candidates for multivariable analysis Inmultivariable binary logistic regression analysis being atearly adolescent age (10ndash14 years) ownership of phone andpoor consumption of diversified foods (low DDS) wereindependent predictors of stunting

Adolescents aged 10ndash14 years were 14 times more likelyto be stunted compared to adolescents aged 15ndash19 years(AOR 14 95 CI (104ndash428)) Adolescents from familieswho did not possess phone were about three times morelikely to be stunted compared to their counterparts(AOR 33 95 CI (155ndash702)) Regarding dietary intakeadolescents who had poor consumption of diversified foods(DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454))(Table 3)

Table 1 Sociodemographic and economic characteristics of school going adolescent girls Awash town 2018 (n 340)

Variable Category Frequency

Age 10ndash14 135 39715ndash19 205 603

School grade 1ndash8 160 479ndash12 180 53

Family sizelt 3 42 1244ndash5 94 276gt5 204 600

ReligionMuslim 162 476Orthodox 122 359Protestant 56 165

LivingWith parent 278 818Renting alone 9 26With relatives 53 156

Absence from school in a month ge5 days 43 336lt5 days 85 664

Work other than being student Yes 46 135No 294 865

Table 2 Dietary intake characteristics of school going adolescent girls Awash town 2018 (n 340)

Source of food

Own product 101 297Market purchase 201 591

Gift 6 18Exchange and barter 12 35

Humanitarian food aid 16 47Loan 4 12

Mainly used food staples in the area

Teff 294 865Maize 11 32

Sorghum 15 44Wheat 20 59

Number of hunger episodes in last month

No episodes 15 44One episode 5 15Two episodes 35 103)ree episodes 71 209

Four and above episodes 214 629

Diet diversity Poor (lt4 food groups) 167 49Good (ge4 food groups) 173 51

Journal of Environmental and Public Health 5

38 Factors Associated with 7inness In univariable binarylogistic regression analysis consumption of fruit and veg-etables reducing meal in household and changing feedinghabit were some of the variables with p value lt025 and werecandidates for multivariable analysis In multivariable binarylogistic regression analysis poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness Adolescents who hadpoor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) Ado-lescents who did eat less because of household financialconstraints were three time more likely to be thin than theircounterparts (AOR 3 95 CI (115ndash790)) (Table 4)

4 Discussion

)is study was conducted to determine nutritional statusand associated factors among school adolescent girls inAwash town )e main nutritional problem which affectsadolescents is undernutrition in terms of stunting andthinness )is study revealed a prevalence of thinness andstunting of 882 and 229 respectively )e prevalence ofstunting in this study was comparable with that in a studyconducted in Eastern Arsi Zone which was 202 [20] andnational nutrition survey report of Ethiopia 23 [21] butless than the finding in Amhara Region 315 [19] )epossible reason for this difference in prevalence could be adifference in socioeconomic status However the prevalenceof stunting in this study was greater than studies conductedin Adama city 156 [22] and Adwa town Tigray 122[23] )e possible reason for this variation could be thedifference in the study setting as this study was conducted inurban adolescent girls while the above studies were done inboth urban and rural areas whereby health service utilizationand factors which determine health are quite different

)e prevalence of thinness in this study was 88 )isresult is similar to that in a study conducted in NorthwestEthiopia Gondar town which was 104 [24] )is studyresult is lower than the study results conducted at Amhara136 [19] and rural community of Aseko district EasternArsi Zone and Oromia region 148 [20] )is variationmight be related to the nature of the diet and lifestyle of theindividual or may be attributed to poor socioeconomicconditions in the study settings

Regarding factors associated with stunting this study hasfound that adolescents aged 10ndash14years were 14 times morelikely to be stunted compared to adolescents aged 15ndash19years (AOR 14 95 CI (104ndash428)) )is finding isconsistent with some research findings [9 19] )ose earlyadolescents are at the greatest gain in height as compared tolate adolescents Hence failing to achieve their nutrientneeds for this period will make early adolescents moresusceptible for developing chronic malnutrition

)e findings of this study showed that adolescent girlsfrom families who did not possess phone were about threetimes more likely to be stunted compared to their coun-terparts (AOR 33 95 CI (155ndash702)) Regarding dietaryintake adolescents who had poor consumption of diversifiedfoods (DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454)) )ismight be because dietary diversity is the proxy indicator ofdietary habit and having poor dietary habit can lead tostunting

According to this study finding adolescent girls who dideat less because of household financial constraints were threetimemore likely to be thin than their counterparts (AOR 395 CI (115ndash790)) )is finding is consistent with a studydone in Amhara Region Northwestern Ethiopia [19] )ismight be explained by the fact that failing to achieve nutrientneeds can be manifested by thinness Adolescent girls who

Table 3 Multivariable binary logistic regression analysis for determinants of stunting among school going adolescent girls of Awash town2018 (n 340)

VariablesStunting

COR (95) AOR (95 CI)Yes () No ()

Age10ndash14 37 (474) 98(374) 151(112ndash543) 14(104ndash428)lowast15ndash19 41 (526) 164 (626) 1

Family sizelt 3 persons 7 (90) 35 (134) 14ndash5 persons 18 (231) 76 (290) 118(45ndash309) 131(048ndash357)gt5 persons 53(679) 151(576) 175(74ndash419) 187(075ndash463)

Availability of phoneYes 63 (808) 240 (916) 1 No 15 (192) 22 (84) 256 (127ndash529) 33(155ndash702)lowast

DDSGood 29(372) 144(55) 1 1Poor 49(628) 118(45) 206(123 564) 22(14 454)lowast

Fruits and vegetables intakeYes 39 (500) 90 (344) 191 (115ndash319) 172 (014ndash425)No 39 (500) 172 (656) 1

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

6 Journal of Environmental and Public Health

had poor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) )ismight be explained by the fact that poor dietary diversity isthe proxy indicator of poor dietary habit which can lead tothinness

41Strengthsof theStudy )e strength of this study lies in itsfocus on adolescent girls a group that is presently lackingattention )is study also used primary data source

42 Utility of the Study )e present research has enormoussocial relevance and utility )is study provided informationon the nutrition status of school adolescent girls and sig-nificant predictors of stunting and thinness )is could beused as a baseline data for other researchers and will provideevidence for administrators and policy makers to planprevention strategies for undernutrition among adolescentgirls

43 Limitations of the Study )e primary limitation of thisstudy is that it is cross-sectional Because the exposure and

outcome were assessed simultaneously we cannot claim acausal relationship between the identified predictor variablesand the outcome variable (undernutrition)

5 Conclusion and Recommendation

)e findings of the study have shown that stunting andthinness were high among school adolescent girls One outof four adolescents was stunted Early adolescent age (10ndash14years) ownership of phone and poor consumption of di-versified foods (DDSlt 4 food groups) were independentpredictors of stunting Poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness An integrated nutri-tional intervention and health related services that meet theneeds of adolescent girls in the school community have to beestablished and strengthened Since adolescent age is periodof growth and development in which growth spurt andnutritional requirement are high adolescents should beprovided with enough meals and diversified foods Familiesas well as the whole community have to be aware of nutritionof adolescent girls through health extension workers androutine facilities service

Table 4 Multivariable binary logistic regression analysis for determinants of thinness among school going adolescent girls of Awash town2018 (n 340)

Variables)inness

COR (95) AOR (95 CI)Yes () No ()

Fathersrsquo occupationPastoral 1(33) 12(39) 85(09ndash733) 93(009ndash891)Agro pastoral 3(100) 36(116) 85(22ndash333) 83(017ndash415)Merchant 9(300) 86(277) 1070(41ndash282) 149(047ndash472)Daily laborer 8(267) 84(271) 97(36ndash264) 139(42ndash464)Government employee 9(300) 92(297) 1 1

Mothersrsquo occupationPastoral 2(67) 19(61) 109(16ndash712) 197(023ndash1646)Agro pastoral 1(33) 11(35) 94(08ndash1000) 353(024ndash5254)Merchant 9(300) 93(300) 10(25ndash393) 168(035ndash811)Daily laborer 5(167) 64(206) 81(18ndash357) 234(041ndash1336)Government employee 10(333) 92(297) 112(29ndash435) 423(077ndash231)Housewife 3(100) 31(100) 1 1

Feeding habitAs usual 17(567) 189 (61) 1More than usual 12(40) 81(261) 165 (75ndash361) 177 (072ndash434)Less than usual 1(33) 40(129) 28 (04ndash215) 25 (003ndash201)

Eating less than usualYes 23(767) 157(506) 32(134ndash768) 301(115ndash790) lowastNo 7(233) 153(494) 1

DDSGood 14(47) 159(61) 1 1Poor 16(53) 103(39) 176(122 486) 18(114 438)lowast

Fruit and vegetable consumptionYes 19(633) 110(355) 1No 11(367) 200(645) 032(015ndash069) 028 (011ndash178)

Milk consumptionYes 2(67) 36(116) 1No 28(933) 274(884) 184(042ndash805) 029(006ndash148)

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

Journal of Environmental and Public Health 7

Abbreviations

CSA Central Statistical AgencyDDS Dietary diversity scoreEDHS Ethiopia Demographic and Health SurveyFAO Food and Agriculture OrganizationICRW International Center for Research on WomenNHNES National Health and Nutrition Examination

SurveySPSS Statistical Package for the Social Sciences

Data Availability

All the results of this research were based on the use ofprimary data and the data collection was performed pro-spectively )e datasets supporting the conclusions of thestudy are included in the article Any additional data will beavailable from the corresponding author on reasonablerequest

Ethical Approval

)e study was approved by the Institutional Review Board ofCollage of Medical and Health Sciences Samara UniversityA letter of support was obtained from Awash Town Edu-cation Bureau)e study was conducted in accordance withthe ethical standards of the institutional and national re-search committee and it also adheres to the Declaration ofHelsinki

Consent

After permission was obtained from school administrationthe parental consent was obtained the day prior to the datacollection After the written consent was obtained from theparents of the study subjects assent was obtained byexplaining the purpose and the importance of the study to theadolescent girls with standard assurance of confidentiality

Conflicts of Interest

)e authors have no conflicts of interest regarding thisresearch

Authorsrsquo Contributions

LM has conceived and executed the study carried out theoverall design and performed data collection and statisticalanalysis MK and AG have critically revised the design of thestudy and the data collection techniques and helped in thestatistical analysis MK has drafted the manuscript Allthe authors read and finally approved this manuscript forsubmission

Acknowledgments

)e authors would like to thank all respondents for theirvaluable information)e authors also extend their gratitudeto Afar Regional Education Bureau and Awash Town Ed-ucation Bureau for their support throughout the work

Finally the authors would like to thank all data collectorsand supervisors who have given their precious time to collectthe necessary data

References

[1] UNFPA Adolescent Sexual and Reproductive Health Toolkitfor Humanitarian Setting a Companion to the Inter-AgencyField Manual on Reproductive Health in Humanitarian Set-tings UNFPA New York NY USA September 2009

[2] D Clifton and A Hervish 7e Worldrsquos Youth Data SheetPopulation Reference Bureau Washington DC USA 2013

[3] H Delisle Nutrition in Adolescence Issues and Challenges forthe Health Sector Issues in Adolescent Health and Develop-ment World Health Organization Geneva Switzerland 2005

[4] L Cordeiro S Lamstein Z Mahmud and J Levinson Ad-olescent Malnutrition in Developing Countries a Close Look atthe Problem and at Two National Experiences vol 31pp 6ndash13 WHO Geneva Switzerland 2006

[5] J E Brown and J Stang Nutrition 7rough Life 7e CycleWadsworth Cengage learning Boston MA USA 4th edition2011

[6] CSA Summary and Statistical Report of the 2007 Populationand Housing Census Results Population Size by Age and SexAddis Ababa Ethiopia FDRE Population Cecsus Commis-sion Addis Ababa Ethiopia 2008

[7] Y Mesert J Haidar H Kassa and F Fleming Jr ldquoSocio-economic and demographic factors affecthing body massindex of adolescents students aged 10-19 in ambo (a ruraltown) in Ethiopiardquo International Journal of Biomedical Sci-ence vol 6 no 4 pp 321ndash326 2010

[8] A Prista J A R Maia A Damasceno A Damasceno andG Beunen ldquoAnthropometric indicators of nutritional statusimplications for fitness activity and health in school-agechildren and adolescents from Maputo Mozambiquerdquo 7eAmerican Journal of Clinical Nutrition vol 77 no 4pp 952ndash959 2003

[9] A Mulugeta F Hagos B Stoecker et al ldquoNutritional status ofadolescent girls from rural communities of Tigray NorthernEthiopia Ethiopianrdquo 7e Ethiopian Journal of Health Devel-opment vol 23 no 1 pp 5ndash10 2009

[10] A L Sawaya P A Martins L P Grillo and T T FlorencioldquoLong-term effects of early malnutrition on body weightregulationrdquo Nutrition Reviews vol 62 pp S127ndashS133 2004

[11] S Nandy M Irving D Gordon S V Subramanian andG D Smith ldquoPoverty child undernutrition andwhich is similarto the pattern morbidity new evidence from Indianrdquo Bulletin ofthe World Health Organization vol 83 pp 210ndash216 2005

[12] California Department of Public Health California Nutritionand Physical Activity Guideline for Adolescent Child andAdolescent Health Division California Department of PublicHealth Sacramento CA USA 2012

[13] H Delisle V Chandra-Mouli and B Bruno Should Ado-lescents Be Specifically Targeted for Nutrition in DevelopingCountries To Address Which Problems and How WorldHealth OrganizationInternational Nutrition Foundation forDeveloping Countries Geneva Switzerland 2000

[14] United nation standing committee of nutrition 6th Report onthe World Nutrition Situation UNSCN Paris France 2009

[15] R Uauy J Kain V Mericq J Rojas and C CorvalanldquoNutrition child growth and chronic disease preventionrdquoAnnals of Medicine vol 40 no 1 pp 11ndash20 2008

8 Journal of Environmental and Public Health

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9

data data collectors were closely supervised and each com-pleted questionnaire was checked to ascertain that all ques-tions were properly filled and corrected

212 Data Processing andAnalysis After data collection thedata was cleaned coded entered into Epi Info and thenexported to SPSS version 20 for further analysis Anthro-pometric indices were calculated by usingWHOAnthroPlussoftware Descriptive statistics was used to show the prev-alence of stunting and thinness and other sociodemographiccharacteristics All variables having a p value of lt025 in theunivariable analysis were candidates for multivariable lo-gistic regression model In the multivariable analysis vari-ables with p value lt005 were taken as significant predictorsfor stunting and thinness at a 95 confidence interval

213 Ethical Consideration Ethical approval was obtainedfrom Research and Ethics Review Committee at SamaraUniversity Support letter was also obtained from respectiveregional and district education offices as well as from all theselected schools in Awash town After permission was

obtained from school administration the parental consentwas obtained the day prior to the data collection After thewritten consent was obtained from parents of study subjectsassent was obtained by explaining the purpose and theimportance of the study to the adolescent girls with standardassurance of confidentiality

3 Results

31 Sociodemographic and Economic Characteristics of StudyParticipants A total of 340 adolescent girls participated inthe study with response rate of 977 More than half (53)of the study participants were from Awash secondary andpreparatory school Of the total adolescent girls 135 (397)were aged 10ndash14 years (early adolescence) and 205 (607)were in the age category of 15ndash19 years (late adolescence)Regarding religion 162 (476) 122 (359) and 55 (162)of the participants were Muslims Orthodox Christians andProtestants respectively (Table 1)

32 Dietary Intake Characteristics of Study ParticipantsPurchased and own products were source of staple foods for201 (591) and 101 (297) of the study participants Teffwas the most cited staple food for 294 (865) of the studyparticipants whereas wheat was the least listed staple food for20 (59) of the study participants According to studyparticipants 24 hour recall report the number of foodgroups consumed was computed Almost half (49) of thestudy participants had consumed foods from lt4 foodgroups )e mean consumption of diversified food was281plusmn (SD 0501) food groups (Table 2)

33 Life Style and Behavior Characteristics of StudyParticipants One hundred thirty-six (40) of the studyparticipants claimed that they had regular physical activitiesKhat chewing was practiced in 86 (253) of the studysubjects Cigarette smoking and alcohol consumption werepracticed in 2 (06) and 31 (91) of families of studyparticipants respectively Based on self-estimation of bodysize 126 (371) 58 (171) and 99 (291) of the par-ticipants considered themselves as thin medium and veryfat respectively Of the total study participants 85 (25) and47 (138) participants attempted to gain weight and to loseweight respectively

34 Sanitation and Hygiene Characteristics of StudyParticipants All selected schools had latrine but none ofthem had hand washing facilities )e majority of studyparticipants 262 (772) had latrine in their home of whichonly 128 (376) had hand washing facilities )e mostcommon type of latrine was pit latrine without slab 153(45) followed by pit latrine with slab 57 (168) Most ofthe study participants were obtaining water from tap(994) About 13 (45) and 16 (47) of the study subjectsdid not wash their hands before eating food and after usingtoilet respectively

882

YesNo

9118

882

Thinness

882

Figure 5 Prevalence of thinness among school going adolescentgirls Awash town June 2018 (n 340)

Freq

uenc

y

Severity of thinness

SevereModerate

Moderate

15ndash19 years

10ndash14 years0

5

10

15

20

10ndash14 years15ndash19 years

Severe31

1610

Figure 6 Prevalence and degree of thinness by age among schoolgoing adolescent girls Awash town 2018 (n 340)

4 Journal of Environmental and Public Health

35 Reproductive Characteristics of Study ParticipantsAmong respondents about 232 (682) of them claimed thatthey started menstruating whereas 108 (318) of them didnot start menstruating Of the total respondents 339 (997)had no previous history of utilization of family planningmethods

36 Nutritional Status of Study Participants

361 Stunting )is study revealed that 78 (229) of schooladolescent girls were stunted

3627inness )is study revealed that 30 (882) of schooladolescent girls were thin

37 Factors Associated with Stunting In univariable binarylogistic regression analysis adolescent age adolescent family

size source of food dietary intake of adolescents and familypossession of phone were some of the variables with p valuelt025 and were candidates for multivariable analysis Inmultivariable binary logistic regression analysis being atearly adolescent age (10ndash14 years) ownership of phone andpoor consumption of diversified foods (low DDS) wereindependent predictors of stunting

Adolescents aged 10ndash14 years were 14 times more likelyto be stunted compared to adolescents aged 15ndash19 years(AOR 14 95 CI (104ndash428)) Adolescents from familieswho did not possess phone were about three times morelikely to be stunted compared to their counterparts(AOR 33 95 CI (155ndash702)) Regarding dietary intakeadolescents who had poor consumption of diversified foods(DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454))(Table 3)

Table 1 Sociodemographic and economic characteristics of school going adolescent girls Awash town 2018 (n 340)

Variable Category Frequency

Age 10ndash14 135 39715ndash19 205 603

School grade 1ndash8 160 479ndash12 180 53

Family sizelt 3 42 1244ndash5 94 276gt5 204 600

ReligionMuslim 162 476Orthodox 122 359Protestant 56 165

LivingWith parent 278 818Renting alone 9 26With relatives 53 156

Absence from school in a month ge5 days 43 336lt5 days 85 664

Work other than being student Yes 46 135No 294 865

Table 2 Dietary intake characteristics of school going adolescent girls Awash town 2018 (n 340)

Source of food

Own product 101 297Market purchase 201 591

Gift 6 18Exchange and barter 12 35

Humanitarian food aid 16 47Loan 4 12

Mainly used food staples in the area

Teff 294 865Maize 11 32

Sorghum 15 44Wheat 20 59

Number of hunger episodes in last month

No episodes 15 44One episode 5 15Two episodes 35 103)ree episodes 71 209

Four and above episodes 214 629

Diet diversity Poor (lt4 food groups) 167 49Good (ge4 food groups) 173 51

Journal of Environmental and Public Health 5

38 Factors Associated with 7inness In univariable binarylogistic regression analysis consumption of fruit and veg-etables reducing meal in household and changing feedinghabit were some of the variables with p value lt025 and werecandidates for multivariable analysis In multivariable binarylogistic regression analysis poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness Adolescents who hadpoor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) Ado-lescents who did eat less because of household financialconstraints were three time more likely to be thin than theircounterparts (AOR 3 95 CI (115ndash790)) (Table 4)

4 Discussion

)is study was conducted to determine nutritional statusand associated factors among school adolescent girls inAwash town )e main nutritional problem which affectsadolescents is undernutrition in terms of stunting andthinness )is study revealed a prevalence of thinness andstunting of 882 and 229 respectively )e prevalence ofstunting in this study was comparable with that in a studyconducted in Eastern Arsi Zone which was 202 [20] andnational nutrition survey report of Ethiopia 23 [21] butless than the finding in Amhara Region 315 [19] )epossible reason for this difference in prevalence could be adifference in socioeconomic status However the prevalenceof stunting in this study was greater than studies conductedin Adama city 156 [22] and Adwa town Tigray 122[23] )e possible reason for this variation could be thedifference in the study setting as this study was conducted inurban adolescent girls while the above studies were done inboth urban and rural areas whereby health service utilizationand factors which determine health are quite different

)e prevalence of thinness in this study was 88 )isresult is similar to that in a study conducted in NorthwestEthiopia Gondar town which was 104 [24] )is studyresult is lower than the study results conducted at Amhara136 [19] and rural community of Aseko district EasternArsi Zone and Oromia region 148 [20] )is variationmight be related to the nature of the diet and lifestyle of theindividual or may be attributed to poor socioeconomicconditions in the study settings

Regarding factors associated with stunting this study hasfound that adolescents aged 10ndash14years were 14 times morelikely to be stunted compared to adolescents aged 15ndash19years (AOR 14 95 CI (104ndash428)) )is finding isconsistent with some research findings [9 19] )ose earlyadolescents are at the greatest gain in height as compared tolate adolescents Hence failing to achieve their nutrientneeds for this period will make early adolescents moresusceptible for developing chronic malnutrition

)e findings of this study showed that adolescent girlsfrom families who did not possess phone were about threetimes more likely to be stunted compared to their coun-terparts (AOR 33 95 CI (155ndash702)) Regarding dietaryintake adolescents who had poor consumption of diversifiedfoods (DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454)) )ismight be because dietary diversity is the proxy indicator ofdietary habit and having poor dietary habit can lead tostunting

According to this study finding adolescent girls who dideat less because of household financial constraints were threetimemore likely to be thin than their counterparts (AOR 395 CI (115ndash790)) )is finding is consistent with a studydone in Amhara Region Northwestern Ethiopia [19] )ismight be explained by the fact that failing to achieve nutrientneeds can be manifested by thinness Adolescent girls who

Table 3 Multivariable binary logistic regression analysis for determinants of stunting among school going adolescent girls of Awash town2018 (n 340)

VariablesStunting

COR (95) AOR (95 CI)Yes () No ()

Age10ndash14 37 (474) 98(374) 151(112ndash543) 14(104ndash428)lowast15ndash19 41 (526) 164 (626) 1

Family sizelt 3 persons 7 (90) 35 (134) 14ndash5 persons 18 (231) 76 (290) 118(45ndash309) 131(048ndash357)gt5 persons 53(679) 151(576) 175(74ndash419) 187(075ndash463)

Availability of phoneYes 63 (808) 240 (916) 1 No 15 (192) 22 (84) 256 (127ndash529) 33(155ndash702)lowast

DDSGood 29(372) 144(55) 1 1Poor 49(628) 118(45) 206(123 564) 22(14 454)lowast

Fruits and vegetables intakeYes 39 (500) 90 (344) 191 (115ndash319) 172 (014ndash425)No 39 (500) 172 (656) 1

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

6 Journal of Environmental and Public Health

had poor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) )ismight be explained by the fact that poor dietary diversity isthe proxy indicator of poor dietary habit which can lead tothinness

41Strengthsof theStudy )e strength of this study lies in itsfocus on adolescent girls a group that is presently lackingattention )is study also used primary data source

42 Utility of the Study )e present research has enormoussocial relevance and utility )is study provided informationon the nutrition status of school adolescent girls and sig-nificant predictors of stunting and thinness )is could beused as a baseline data for other researchers and will provideevidence for administrators and policy makers to planprevention strategies for undernutrition among adolescentgirls

43 Limitations of the Study )e primary limitation of thisstudy is that it is cross-sectional Because the exposure and

outcome were assessed simultaneously we cannot claim acausal relationship between the identified predictor variablesand the outcome variable (undernutrition)

5 Conclusion and Recommendation

)e findings of the study have shown that stunting andthinness were high among school adolescent girls One outof four adolescents was stunted Early adolescent age (10ndash14years) ownership of phone and poor consumption of di-versified foods (DDSlt 4 food groups) were independentpredictors of stunting Poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness An integrated nutri-tional intervention and health related services that meet theneeds of adolescent girls in the school community have to beestablished and strengthened Since adolescent age is periodof growth and development in which growth spurt andnutritional requirement are high adolescents should beprovided with enough meals and diversified foods Familiesas well as the whole community have to be aware of nutritionof adolescent girls through health extension workers androutine facilities service

Table 4 Multivariable binary logistic regression analysis for determinants of thinness among school going adolescent girls of Awash town2018 (n 340)

Variables)inness

COR (95) AOR (95 CI)Yes () No ()

Fathersrsquo occupationPastoral 1(33) 12(39) 85(09ndash733) 93(009ndash891)Agro pastoral 3(100) 36(116) 85(22ndash333) 83(017ndash415)Merchant 9(300) 86(277) 1070(41ndash282) 149(047ndash472)Daily laborer 8(267) 84(271) 97(36ndash264) 139(42ndash464)Government employee 9(300) 92(297) 1 1

Mothersrsquo occupationPastoral 2(67) 19(61) 109(16ndash712) 197(023ndash1646)Agro pastoral 1(33) 11(35) 94(08ndash1000) 353(024ndash5254)Merchant 9(300) 93(300) 10(25ndash393) 168(035ndash811)Daily laborer 5(167) 64(206) 81(18ndash357) 234(041ndash1336)Government employee 10(333) 92(297) 112(29ndash435) 423(077ndash231)Housewife 3(100) 31(100) 1 1

Feeding habitAs usual 17(567) 189 (61) 1More than usual 12(40) 81(261) 165 (75ndash361) 177 (072ndash434)Less than usual 1(33) 40(129) 28 (04ndash215) 25 (003ndash201)

Eating less than usualYes 23(767) 157(506) 32(134ndash768) 301(115ndash790) lowastNo 7(233) 153(494) 1

DDSGood 14(47) 159(61) 1 1Poor 16(53) 103(39) 176(122 486) 18(114 438)lowast

Fruit and vegetable consumptionYes 19(633) 110(355) 1No 11(367) 200(645) 032(015ndash069) 028 (011ndash178)

Milk consumptionYes 2(67) 36(116) 1No 28(933) 274(884) 184(042ndash805) 029(006ndash148)

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

Journal of Environmental and Public Health 7

Abbreviations

CSA Central Statistical AgencyDDS Dietary diversity scoreEDHS Ethiopia Demographic and Health SurveyFAO Food and Agriculture OrganizationICRW International Center for Research on WomenNHNES National Health and Nutrition Examination

SurveySPSS Statistical Package for the Social Sciences

Data Availability

All the results of this research were based on the use ofprimary data and the data collection was performed pro-spectively )e datasets supporting the conclusions of thestudy are included in the article Any additional data will beavailable from the corresponding author on reasonablerequest

Ethical Approval

)e study was approved by the Institutional Review Board ofCollage of Medical and Health Sciences Samara UniversityA letter of support was obtained from Awash Town Edu-cation Bureau)e study was conducted in accordance withthe ethical standards of the institutional and national re-search committee and it also adheres to the Declaration ofHelsinki

Consent

After permission was obtained from school administrationthe parental consent was obtained the day prior to the datacollection After the written consent was obtained from theparents of the study subjects assent was obtained byexplaining the purpose and the importance of the study to theadolescent girls with standard assurance of confidentiality

Conflicts of Interest

)e authors have no conflicts of interest regarding thisresearch

Authorsrsquo Contributions

LM has conceived and executed the study carried out theoverall design and performed data collection and statisticalanalysis MK and AG have critically revised the design of thestudy and the data collection techniques and helped in thestatistical analysis MK has drafted the manuscript Allthe authors read and finally approved this manuscript forsubmission

Acknowledgments

)e authors would like to thank all respondents for theirvaluable information)e authors also extend their gratitudeto Afar Regional Education Bureau and Awash Town Ed-ucation Bureau for their support throughout the work

Finally the authors would like to thank all data collectorsand supervisors who have given their precious time to collectthe necessary data

References

[1] UNFPA Adolescent Sexual and Reproductive Health Toolkitfor Humanitarian Setting a Companion to the Inter-AgencyField Manual on Reproductive Health in Humanitarian Set-tings UNFPA New York NY USA September 2009

[2] D Clifton and A Hervish 7e Worldrsquos Youth Data SheetPopulation Reference Bureau Washington DC USA 2013

[3] H Delisle Nutrition in Adolescence Issues and Challenges forthe Health Sector Issues in Adolescent Health and Develop-ment World Health Organization Geneva Switzerland 2005

[4] L Cordeiro S Lamstein Z Mahmud and J Levinson Ad-olescent Malnutrition in Developing Countries a Close Look atthe Problem and at Two National Experiences vol 31pp 6ndash13 WHO Geneva Switzerland 2006

[5] J E Brown and J Stang Nutrition 7rough Life 7e CycleWadsworth Cengage learning Boston MA USA 4th edition2011

[6] CSA Summary and Statistical Report of the 2007 Populationand Housing Census Results Population Size by Age and SexAddis Ababa Ethiopia FDRE Population Cecsus Commis-sion Addis Ababa Ethiopia 2008

[7] Y Mesert J Haidar H Kassa and F Fleming Jr ldquoSocio-economic and demographic factors affecthing body massindex of adolescents students aged 10-19 in ambo (a ruraltown) in Ethiopiardquo International Journal of Biomedical Sci-ence vol 6 no 4 pp 321ndash326 2010

[8] A Prista J A R Maia A Damasceno A Damasceno andG Beunen ldquoAnthropometric indicators of nutritional statusimplications for fitness activity and health in school-agechildren and adolescents from Maputo Mozambiquerdquo 7eAmerican Journal of Clinical Nutrition vol 77 no 4pp 952ndash959 2003

[9] A Mulugeta F Hagos B Stoecker et al ldquoNutritional status ofadolescent girls from rural communities of Tigray NorthernEthiopia Ethiopianrdquo 7e Ethiopian Journal of Health Devel-opment vol 23 no 1 pp 5ndash10 2009

[10] A L Sawaya P A Martins L P Grillo and T T FlorencioldquoLong-term effects of early malnutrition on body weightregulationrdquo Nutrition Reviews vol 62 pp S127ndashS133 2004

[11] S Nandy M Irving D Gordon S V Subramanian andG D Smith ldquoPoverty child undernutrition andwhich is similarto the pattern morbidity new evidence from Indianrdquo Bulletin ofthe World Health Organization vol 83 pp 210ndash216 2005

[12] California Department of Public Health California Nutritionand Physical Activity Guideline for Adolescent Child andAdolescent Health Division California Department of PublicHealth Sacramento CA USA 2012

[13] H Delisle V Chandra-Mouli and B Bruno Should Ado-lescents Be Specifically Targeted for Nutrition in DevelopingCountries To Address Which Problems and How WorldHealth OrganizationInternational Nutrition Foundation forDeveloping Countries Geneva Switzerland 2000

[14] United nation standing committee of nutrition 6th Report onthe World Nutrition Situation UNSCN Paris France 2009

[15] R Uauy J Kain V Mericq J Rojas and C CorvalanldquoNutrition child growth and chronic disease preventionrdquoAnnals of Medicine vol 40 no 1 pp 11ndash20 2008

8 Journal of Environmental and Public Health

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9

35 Reproductive Characteristics of Study ParticipantsAmong respondents about 232 (682) of them claimed thatthey started menstruating whereas 108 (318) of them didnot start menstruating Of the total respondents 339 (997)had no previous history of utilization of family planningmethods

36 Nutritional Status of Study Participants

361 Stunting )is study revealed that 78 (229) of schooladolescent girls were stunted

3627inness )is study revealed that 30 (882) of schooladolescent girls were thin

37 Factors Associated with Stunting In univariable binarylogistic regression analysis adolescent age adolescent family

size source of food dietary intake of adolescents and familypossession of phone were some of the variables with p valuelt025 and were candidates for multivariable analysis Inmultivariable binary logistic regression analysis being atearly adolescent age (10ndash14 years) ownership of phone andpoor consumption of diversified foods (low DDS) wereindependent predictors of stunting

Adolescents aged 10ndash14 years were 14 times more likelyto be stunted compared to adolescents aged 15ndash19 years(AOR 14 95 CI (104ndash428)) Adolescents from familieswho did not possess phone were about three times morelikely to be stunted compared to their counterparts(AOR 33 95 CI (155ndash702)) Regarding dietary intakeadolescents who had poor consumption of diversified foods(DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454))(Table 3)

Table 1 Sociodemographic and economic characteristics of school going adolescent girls Awash town 2018 (n 340)

Variable Category Frequency

Age 10ndash14 135 39715ndash19 205 603

School grade 1ndash8 160 479ndash12 180 53

Family sizelt 3 42 1244ndash5 94 276gt5 204 600

ReligionMuslim 162 476Orthodox 122 359Protestant 56 165

LivingWith parent 278 818Renting alone 9 26With relatives 53 156

Absence from school in a month ge5 days 43 336lt5 days 85 664

Work other than being student Yes 46 135No 294 865

Table 2 Dietary intake characteristics of school going adolescent girls Awash town 2018 (n 340)

Source of food

Own product 101 297Market purchase 201 591

Gift 6 18Exchange and barter 12 35

Humanitarian food aid 16 47Loan 4 12

Mainly used food staples in the area

Teff 294 865Maize 11 32

Sorghum 15 44Wheat 20 59

Number of hunger episodes in last month

No episodes 15 44One episode 5 15Two episodes 35 103)ree episodes 71 209

Four and above episodes 214 629

Diet diversity Poor (lt4 food groups) 167 49Good (ge4 food groups) 173 51

Journal of Environmental and Public Health 5

38 Factors Associated with 7inness In univariable binarylogistic regression analysis consumption of fruit and veg-etables reducing meal in household and changing feedinghabit were some of the variables with p value lt025 and werecandidates for multivariable analysis In multivariable binarylogistic regression analysis poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness Adolescents who hadpoor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) Ado-lescents who did eat less because of household financialconstraints were three time more likely to be thin than theircounterparts (AOR 3 95 CI (115ndash790)) (Table 4)

4 Discussion

)is study was conducted to determine nutritional statusand associated factors among school adolescent girls inAwash town )e main nutritional problem which affectsadolescents is undernutrition in terms of stunting andthinness )is study revealed a prevalence of thinness andstunting of 882 and 229 respectively )e prevalence ofstunting in this study was comparable with that in a studyconducted in Eastern Arsi Zone which was 202 [20] andnational nutrition survey report of Ethiopia 23 [21] butless than the finding in Amhara Region 315 [19] )epossible reason for this difference in prevalence could be adifference in socioeconomic status However the prevalenceof stunting in this study was greater than studies conductedin Adama city 156 [22] and Adwa town Tigray 122[23] )e possible reason for this variation could be thedifference in the study setting as this study was conducted inurban adolescent girls while the above studies were done inboth urban and rural areas whereby health service utilizationand factors which determine health are quite different

)e prevalence of thinness in this study was 88 )isresult is similar to that in a study conducted in NorthwestEthiopia Gondar town which was 104 [24] )is studyresult is lower than the study results conducted at Amhara136 [19] and rural community of Aseko district EasternArsi Zone and Oromia region 148 [20] )is variationmight be related to the nature of the diet and lifestyle of theindividual or may be attributed to poor socioeconomicconditions in the study settings

Regarding factors associated with stunting this study hasfound that adolescents aged 10ndash14years were 14 times morelikely to be stunted compared to adolescents aged 15ndash19years (AOR 14 95 CI (104ndash428)) )is finding isconsistent with some research findings [9 19] )ose earlyadolescents are at the greatest gain in height as compared tolate adolescents Hence failing to achieve their nutrientneeds for this period will make early adolescents moresusceptible for developing chronic malnutrition

)e findings of this study showed that adolescent girlsfrom families who did not possess phone were about threetimes more likely to be stunted compared to their coun-terparts (AOR 33 95 CI (155ndash702)) Regarding dietaryintake adolescents who had poor consumption of diversifiedfoods (DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454)) )ismight be because dietary diversity is the proxy indicator ofdietary habit and having poor dietary habit can lead tostunting

According to this study finding adolescent girls who dideat less because of household financial constraints were threetimemore likely to be thin than their counterparts (AOR 395 CI (115ndash790)) )is finding is consistent with a studydone in Amhara Region Northwestern Ethiopia [19] )ismight be explained by the fact that failing to achieve nutrientneeds can be manifested by thinness Adolescent girls who

Table 3 Multivariable binary logistic regression analysis for determinants of stunting among school going adolescent girls of Awash town2018 (n 340)

VariablesStunting

COR (95) AOR (95 CI)Yes () No ()

Age10ndash14 37 (474) 98(374) 151(112ndash543) 14(104ndash428)lowast15ndash19 41 (526) 164 (626) 1

Family sizelt 3 persons 7 (90) 35 (134) 14ndash5 persons 18 (231) 76 (290) 118(45ndash309) 131(048ndash357)gt5 persons 53(679) 151(576) 175(74ndash419) 187(075ndash463)

Availability of phoneYes 63 (808) 240 (916) 1 No 15 (192) 22 (84) 256 (127ndash529) 33(155ndash702)lowast

DDSGood 29(372) 144(55) 1 1Poor 49(628) 118(45) 206(123 564) 22(14 454)lowast

Fruits and vegetables intakeYes 39 (500) 90 (344) 191 (115ndash319) 172 (014ndash425)No 39 (500) 172 (656) 1

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

6 Journal of Environmental and Public Health

had poor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) )ismight be explained by the fact that poor dietary diversity isthe proxy indicator of poor dietary habit which can lead tothinness

41Strengthsof theStudy )e strength of this study lies in itsfocus on adolescent girls a group that is presently lackingattention )is study also used primary data source

42 Utility of the Study )e present research has enormoussocial relevance and utility )is study provided informationon the nutrition status of school adolescent girls and sig-nificant predictors of stunting and thinness )is could beused as a baseline data for other researchers and will provideevidence for administrators and policy makers to planprevention strategies for undernutrition among adolescentgirls

43 Limitations of the Study )e primary limitation of thisstudy is that it is cross-sectional Because the exposure and

outcome were assessed simultaneously we cannot claim acausal relationship between the identified predictor variablesand the outcome variable (undernutrition)

5 Conclusion and Recommendation

)e findings of the study have shown that stunting andthinness were high among school adolescent girls One outof four adolescents was stunted Early adolescent age (10ndash14years) ownership of phone and poor consumption of di-versified foods (DDSlt 4 food groups) were independentpredictors of stunting Poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness An integrated nutri-tional intervention and health related services that meet theneeds of adolescent girls in the school community have to beestablished and strengthened Since adolescent age is periodof growth and development in which growth spurt andnutritional requirement are high adolescents should beprovided with enough meals and diversified foods Familiesas well as the whole community have to be aware of nutritionof adolescent girls through health extension workers androutine facilities service

Table 4 Multivariable binary logistic regression analysis for determinants of thinness among school going adolescent girls of Awash town2018 (n 340)

Variables)inness

COR (95) AOR (95 CI)Yes () No ()

Fathersrsquo occupationPastoral 1(33) 12(39) 85(09ndash733) 93(009ndash891)Agro pastoral 3(100) 36(116) 85(22ndash333) 83(017ndash415)Merchant 9(300) 86(277) 1070(41ndash282) 149(047ndash472)Daily laborer 8(267) 84(271) 97(36ndash264) 139(42ndash464)Government employee 9(300) 92(297) 1 1

Mothersrsquo occupationPastoral 2(67) 19(61) 109(16ndash712) 197(023ndash1646)Agro pastoral 1(33) 11(35) 94(08ndash1000) 353(024ndash5254)Merchant 9(300) 93(300) 10(25ndash393) 168(035ndash811)Daily laborer 5(167) 64(206) 81(18ndash357) 234(041ndash1336)Government employee 10(333) 92(297) 112(29ndash435) 423(077ndash231)Housewife 3(100) 31(100) 1 1

Feeding habitAs usual 17(567) 189 (61) 1More than usual 12(40) 81(261) 165 (75ndash361) 177 (072ndash434)Less than usual 1(33) 40(129) 28 (04ndash215) 25 (003ndash201)

Eating less than usualYes 23(767) 157(506) 32(134ndash768) 301(115ndash790) lowastNo 7(233) 153(494) 1

DDSGood 14(47) 159(61) 1 1Poor 16(53) 103(39) 176(122 486) 18(114 438)lowast

Fruit and vegetable consumptionYes 19(633) 110(355) 1No 11(367) 200(645) 032(015ndash069) 028 (011ndash178)

Milk consumptionYes 2(67) 36(116) 1No 28(933) 274(884) 184(042ndash805) 029(006ndash148)

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

Journal of Environmental and Public Health 7

Abbreviations

CSA Central Statistical AgencyDDS Dietary diversity scoreEDHS Ethiopia Demographic and Health SurveyFAO Food and Agriculture OrganizationICRW International Center for Research on WomenNHNES National Health and Nutrition Examination

SurveySPSS Statistical Package for the Social Sciences

Data Availability

All the results of this research were based on the use ofprimary data and the data collection was performed pro-spectively )e datasets supporting the conclusions of thestudy are included in the article Any additional data will beavailable from the corresponding author on reasonablerequest

Ethical Approval

)e study was approved by the Institutional Review Board ofCollage of Medical and Health Sciences Samara UniversityA letter of support was obtained from Awash Town Edu-cation Bureau)e study was conducted in accordance withthe ethical standards of the institutional and national re-search committee and it also adheres to the Declaration ofHelsinki

Consent

After permission was obtained from school administrationthe parental consent was obtained the day prior to the datacollection After the written consent was obtained from theparents of the study subjects assent was obtained byexplaining the purpose and the importance of the study to theadolescent girls with standard assurance of confidentiality

Conflicts of Interest

)e authors have no conflicts of interest regarding thisresearch

Authorsrsquo Contributions

LM has conceived and executed the study carried out theoverall design and performed data collection and statisticalanalysis MK and AG have critically revised the design of thestudy and the data collection techniques and helped in thestatistical analysis MK has drafted the manuscript Allthe authors read and finally approved this manuscript forsubmission

Acknowledgments

)e authors would like to thank all respondents for theirvaluable information)e authors also extend their gratitudeto Afar Regional Education Bureau and Awash Town Ed-ucation Bureau for their support throughout the work

Finally the authors would like to thank all data collectorsand supervisors who have given their precious time to collectthe necessary data

References

[1] UNFPA Adolescent Sexual and Reproductive Health Toolkitfor Humanitarian Setting a Companion to the Inter-AgencyField Manual on Reproductive Health in Humanitarian Set-tings UNFPA New York NY USA September 2009

[2] D Clifton and A Hervish 7e Worldrsquos Youth Data SheetPopulation Reference Bureau Washington DC USA 2013

[3] H Delisle Nutrition in Adolescence Issues and Challenges forthe Health Sector Issues in Adolescent Health and Develop-ment World Health Organization Geneva Switzerland 2005

[4] L Cordeiro S Lamstein Z Mahmud and J Levinson Ad-olescent Malnutrition in Developing Countries a Close Look atthe Problem and at Two National Experiences vol 31pp 6ndash13 WHO Geneva Switzerland 2006

[5] J E Brown and J Stang Nutrition 7rough Life 7e CycleWadsworth Cengage learning Boston MA USA 4th edition2011

[6] CSA Summary and Statistical Report of the 2007 Populationand Housing Census Results Population Size by Age and SexAddis Ababa Ethiopia FDRE Population Cecsus Commis-sion Addis Ababa Ethiopia 2008

[7] Y Mesert J Haidar H Kassa and F Fleming Jr ldquoSocio-economic and demographic factors affecthing body massindex of adolescents students aged 10-19 in ambo (a ruraltown) in Ethiopiardquo International Journal of Biomedical Sci-ence vol 6 no 4 pp 321ndash326 2010

[8] A Prista J A R Maia A Damasceno A Damasceno andG Beunen ldquoAnthropometric indicators of nutritional statusimplications for fitness activity and health in school-agechildren and adolescents from Maputo Mozambiquerdquo 7eAmerican Journal of Clinical Nutrition vol 77 no 4pp 952ndash959 2003

[9] A Mulugeta F Hagos B Stoecker et al ldquoNutritional status ofadolescent girls from rural communities of Tigray NorthernEthiopia Ethiopianrdquo 7e Ethiopian Journal of Health Devel-opment vol 23 no 1 pp 5ndash10 2009

[10] A L Sawaya P A Martins L P Grillo and T T FlorencioldquoLong-term effects of early malnutrition on body weightregulationrdquo Nutrition Reviews vol 62 pp S127ndashS133 2004

[11] S Nandy M Irving D Gordon S V Subramanian andG D Smith ldquoPoverty child undernutrition andwhich is similarto the pattern morbidity new evidence from Indianrdquo Bulletin ofthe World Health Organization vol 83 pp 210ndash216 2005

[12] California Department of Public Health California Nutritionand Physical Activity Guideline for Adolescent Child andAdolescent Health Division California Department of PublicHealth Sacramento CA USA 2012

[13] H Delisle V Chandra-Mouli and B Bruno Should Ado-lescents Be Specifically Targeted for Nutrition in DevelopingCountries To Address Which Problems and How WorldHealth OrganizationInternational Nutrition Foundation forDeveloping Countries Geneva Switzerland 2000

[14] United nation standing committee of nutrition 6th Report onthe World Nutrition Situation UNSCN Paris France 2009

[15] R Uauy J Kain V Mericq J Rojas and C CorvalanldquoNutrition child growth and chronic disease preventionrdquoAnnals of Medicine vol 40 no 1 pp 11ndash20 2008

8 Journal of Environmental and Public Health

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9

38 Factors Associated with 7inness In univariable binarylogistic regression analysis consumption of fruit and veg-etables reducing meal in household and changing feedinghabit were some of the variables with p value lt025 and werecandidates for multivariable analysis In multivariable binarylogistic regression analysis poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness Adolescents who hadpoor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) Ado-lescents who did eat less because of household financialconstraints were three time more likely to be thin than theircounterparts (AOR 3 95 CI (115ndash790)) (Table 4)

4 Discussion

)is study was conducted to determine nutritional statusand associated factors among school adolescent girls inAwash town )e main nutritional problem which affectsadolescents is undernutrition in terms of stunting andthinness )is study revealed a prevalence of thinness andstunting of 882 and 229 respectively )e prevalence ofstunting in this study was comparable with that in a studyconducted in Eastern Arsi Zone which was 202 [20] andnational nutrition survey report of Ethiopia 23 [21] butless than the finding in Amhara Region 315 [19] )epossible reason for this difference in prevalence could be adifference in socioeconomic status However the prevalenceof stunting in this study was greater than studies conductedin Adama city 156 [22] and Adwa town Tigray 122[23] )e possible reason for this variation could be thedifference in the study setting as this study was conducted inurban adolescent girls while the above studies were done inboth urban and rural areas whereby health service utilizationand factors which determine health are quite different

)e prevalence of thinness in this study was 88 )isresult is similar to that in a study conducted in NorthwestEthiopia Gondar town which was 104 [24] )is studyresult is lower than the study results conducted at Amhara136 [19] and rural community of Aseko district EasternArsi Zone and Oromia region 148 [20] )is variationmight be related to the nature of the diet and lifestyle of theindividual or may be attributed to poor socioeconomicconditions in the study settings

Regarding factors associated with stunting this study hasfound that adolescents aged 10ndash14years were 14 times morelikely to be stunted compared to adolescents aged 15ndash19years (AOR 14 95 CI (104ndash428)) )is finding isconsistent with some research findings [9 19] )ose earlyadolescents are at the greatest gain in height as compared tolate adolescents Hence failing to achieve their nutrientneeds for this period will make early adolescents moresusceptible for developing chronic malnutrition

)e findings of this study showed that adolescent girlsfrom families who did not possess phone were about threetimes more likely to be stunted compared to their coun-terparts (AOR 33 95 CI (155ndash702)) Regarding dietaryintake adolescents who had poor consumption of diversifiedfoods (DDSlt 4 food groups) were 22 times more likely to bestunted compared to those who had good consumption(DDSge 4 food groups) (AOR 22 95 CI (14ndash454)) )ismight be because dietary diversity is the proxy indicator ofdietary habit and having poor dietary habit can lead tostunting

According to this study finding adolescent girls who dideat less because of household financial constraints were threetimemore likely to be thin than their counterparts (AOR 395 CI (115ndash790)) )is finding is consistent with a studydone in Amhara Region Northwestern Ethiopia [19] )ismight be explained by the fact that failing to achieve nutrientneeds can be manifested by thinness Adolescent girls who

Table 3 Multivariable binary logistic regression analysis for determinants of stunting among school going adolescent girls of Awash town2018 (n 340)

VariablesStunting

COR (95) AOR (95 CI)Yes () No ()

Age10ndash14 37 (474) 98(374) 151(112ndash543) 14(104ndash428)lowast15ndash19 41 (526) 164 (626) 1

Family sizelt 3 persons 7 (90) 35 (134) 14ndash5 persons 18 (231) 76 (290) 118(45ndash309) 131(048ndash357)gt5 persons 53(679) 151(576) 175(74ndash419) 187(075ndash463)

Availability of phoneYes 63 (808) 240 (916) 1 No 15 (192) 22 (84) 256 (127ndash529) 33(155ndash702)lowast

DDSGood 29(372) 144(55) 1 1Poor 49(628) 118(45) 206(123 564) 22(14 454)lowast

Fruits and vegetables intakeYes 39 (500) 90 (344) 191 (115ndash319) 172 (014ndash425)No 39 (500) 172 (656) 1

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

6 Journal of Environmental and Public Health

had poor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) )ismight be explained by the fact that poor dietary diversity isthe proxy indicator of poor dietary habit which can lead tothinness

41Strengthsof theStudy )e strength of this study lies in itsfocus on adolescent girls a group that is presently lackingattention )is study also used primary data source

42 Utility of the Study )e present research has enormoussocial relevance and utility )is study provided informationon the nutrition status of school adolescent girls and sig-nificant predictors of stunting and thinness )is could beused as a baseline data for other researchers and will provideevidence for administrators and policy makers to planprevention strategies for undernutrition among adolescentgirls

43 Limitations of the Study )e primary limitation of thisstudy is that it is cross-sectional Because the exposure and

outcome were assessed simultaneously we cannot claim acausal relationship between the identified predictor variablesand the outcome variable (undernutrition)

5 Conclusion and Recommendation

)e findings of the study have shown that stunting andthinness were high among school adolescent girls One outof four adolescents was stunted Early adolescent age (10ndash14years) ownership of phone and poor consumption of di-versified foods (DDSlt 4 food groups) were independentpredictors of stunting Poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness An integrated nutri-tional intervention and health related services that meet theneeds of adolescent girls in the school community have to beestablished and strengthened Since adolescent age is periodof growth and development in which growth spurt andnutritional requirement are high adolescents should beprovided with enough meals and diversified foods Familiesas well as the whole community have to be aware of nutritionof adolescent girls through health extension workers androutine facilities service

Table 4 Multivariable binary logistic regression analysis for determinants of thinness among school going adolescent girls of Awash town2018 (n 340)

Variables)inness

COR (95) AOR (95 CI)Yes () No ()

Fathersrsquo occupationPastoral 1(33) 12(39) 85(09ndash733) 93(009ndash891)Agro pastoral 3(100) 36(116) 85(22ndash333) 83(017ndash415)Merchant 9(300) 86(277) 1070(41ndash282) 149(047ndash472)Daily laborer 8(267) 84(271) 97(36ndash264) 139(42ndash464)Government employee 9(300) 92(297) 1 1

Mothersrsquo occupationPastoral 2(67) 19(61) 109(16ndash712) 197(023ndash1646)Agro pastoral 1(33) 11(35) 94(08ndash1000) 353(024ndash5254)Merchant 9(300) 93(300) 10(25ndash393) 168(035ndash811)Daily laborer 5(167) 64(206) 81(18ndash357) 234(041ndash1336)Government employee 10(333) 92(297) 112(29ndash435) 423(077ndash231)Housewife 3(100) 31(100) 1 1

Feeding habitAs usual 17(567) 189 (61) 1More than usual 12(40) 81(261) 165 (75ndash361) 177 (072ndash434)Less than usual 1(33) 40(129) 28 (04ndash215) 25 (003ndash201)

Eating less than usualYes 23(767) 157(506) 32(134ndash768) 301(115ndash790) lowastNo 7(233) 153(494) 1

DDSGood 14(47) 159(61) 1 1Poor 16(53) 103(39) 176(122 486) 18(114 438)lowast

Fruit and vegetable consumptionYes 19(633) 110(355) 1No 11(367) 200(645) 032(015ndash069) 028 (011ndash178)

Milk consumptionYes 2(67) 36(116) 1No 28(933) 274(884) 184(042ndash805) 029(006ndash148)

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

Journal of Environmental and Public Health 7

Abbreviations

CSA Central Statistical AgencyDDS Dietary diversity scoreEDHS Ethiopia Demographic and Health SurveyFAO Food and Agriculture OrganizationICRW International Center for Research on WomenNHNES National Health and Nutrition Examination

SurveySPSS Statistical Package for the Social Sciences

Data Availability

All the results of this research were based on the use ofprimary data and the data collection was performed pro-spectively )e datasets supporting the conclusions of thestudy are included in the article Any additional data will beavailable from the corresponding author on reasonablerequest

Ethical Approval

)e study was approved by the Institutional Review Board ofCollage of Medical and Health Sciences Samara UniversityA letter of support was obtained from Awash Town Edu-cation Bureau)e study was conducted in accordance withthe ethical standards of the institutional and national re-search committee and it also adheres to the Declaration ofHelsinki

Consent

After permission was obtained from school administrationthe parental consent was obtained the day prior to the datacollection After the written consent was obtained from theparents of the study subjects assent was obtained byexplaining the purpose and the importance of the study to theadolescent girls with standard assurance of confidentiality

Conflicts of Interest

)e authors have no conflicts of interest regarding thisresearch

Authorsrsquo Contributions

LM has conceived and executed the study carried out theoverall design and performed data collection and statisticalanalysis MK and AG have critically revised the design of thestudy and the data collection techniques and helped in thestatistical analysis MK has drafted the manuscript Allthe authors read and finally approved this manuscript forsubmission

Acknowledgments

)e authors would like to thank all respondents for theirvaluable information)e authors also extend their gratitudeto Afar Regional Education Bureau and Awash Town Ed-ucation Bureau for their support throughout the work

Finally the authors would like to thank all data collectorsand supervisors who have given their precious time to collectthe necessary data

References

[1] UNFPA Adolescent Sexual and Reproductive Health Toolkitfor Humanitarian Setting a Companion to the Inter-AgencyField Manual on Reproductive Health in Humanitarian Set-tings UNFPA New York NY USA September 2009

[2] D Clifton and A Hervish 7e Worldrsquos Youth Data SheetPopulation Reference Bureau Washington DC USA 2013

[3] H Delisle Nutrition in Adolescence Issues and Challenges forthe Health Sector Issues in Adolescent Health and Develop-ment World Health Organization Geneva Switzerland 2005

[4] L Cordeiro S Lamstein Z Mahmud and J Levinson Ad-olescent Malnutrition in Developing Countries a Close Look atthe Problem and at Two National Experiences vol 31pp 6ndash13 WHO Geneva Switzerland 2006

[5] J E Brown and J Stang Nutrition 7rough Life 7e CycleWadsworth Cengage learning Boston MA USA 4th edition2011

[6] CSA Summary and Statistical Report of the 2007 Populationand Housing Census Results Population Size by Age and SexAddis Ababa Ethiopia FDRE Population Cecsus Commis-sion Addis Ababa Ethiopia 2008

[7] Y Mesert J Haidar H Kassa and F Fleming Jr ldquoSocio-economic and demographic factors affecthing body massindex of adolescents students aged 10-19 in ambo (a ruraltown) in Ethiopiardquo International Journal of Biomedical Sci-ence vol 6 no 4 pp 321ndash326 2010

[8] A Prista J A R Maia A Damasceno A Damasceno andG Beunen ldquoAnthropometric indicators of nutritional statusimplications for fitness activity and health in school-agechildren and adolescents from Maputo Mozambiquerdquo 7eAmerican Journal of Clinical Nutrition vol 77 no 4pp 952ndash959 2003

[9] A Mulugeta F Hagos B Stoecker et al ldquoNutritional status ofadolescent girls from rural communities of Tigray NorthernEthiopia Ethiopianrdquo 7e Ethiopian Journal of Health Devel-opment vol 23 no 1 pp 5ndash10 2009

[10] A L Sawaya P A Martins L P Grillo and T T FlorencioldquoLong-term effects of early malnutrition on body weightregulationrdquo Nutrition Reviews vol 62 pp S127ndashS133 2004

[11] S Nandy M Irving D Gordon S V Subramanian andG D Smith ldquoPoverty child undernutrition andwhich is similarto the pattern morbidity new evidence from Indianrdquo Bulletin ofthe World Health Organization vol 83 pp 210ndash216 2005

[12] California Department of Public Health California Nutritionand Physical Activity Guideline for Adolescent Child andAdolescent Health Division California Department of PublicHealth Sacramento CA USA 2012

[13] H Delisle V Chandra-Mouli and B Bruno Should Ado-lescents Be Specifically Targeted for Nutrition in DevelopingCountries To Address Which Problems and How WorldHealth OrganizationInternational Nutrition Foundation forDeveloping Countries Geneva Switzerland 2000

[14] United nation standing committee of nutrition 6th Report onthe World Nutrition Situation UNSCN Paris France 2009

[15] R Uauy J Kain V Mericq J Rojas and C CorvalanldquoNutrition child growth and chronic disease preventionrdquoAnnals of Medicine vol 40 no 1 pp 11ndash20 2008

8 Journal of Environmental and Public Health

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9

had poor consumption of diversified foods (DDSlt 4 foodgroups) were 18 times more likely to be thin compared totheir counterparts (AOR 18 95 CI (114ndash438)) )ismight be explained by the fact that poor dietary diversity isthe proxy indicator of poor dietary habit which can lead tothinness

41Strengthsof theStudy )e strength of this study lies in itsfocus on adolescent girls a group that is presently lackingattention )is study also used primary data source

42 Utility of the Study )e present research has enormoussocial relevance and utility )is study provided informationon the nutrition status of school adolescent girls and sig-nificant predictors of stunting and thinness )is could beused as a baseline data for other researchers and will provideevidence for administrators and policy makers to planprevention strategies for undernutrition among adolescentgirls

43 Limitations of the Study )e primary limitation of thisstudy is that it is cross-sectional Because the exposure and

outcome were assessed simultaneously we cannot claim acausal relationship between the identified predictor variablesand the outcome variable (undernutrition)

5 Conclusion and Recommendation

)e findings of the study have shown that stunting andthinness were high among school adolescent girls One outof four adolescents was stunted Early adolescent age (10ndash14years) ownership of phone and poor consumption of di-versified foods (DDSlt 4 food groups) were independentpredictors of stunting Poor consumption of diversifiedfoods (DDSlt 4 food groups) and eating less than usual wereindependent predictors of thinness An integrated nutri-tional intervention and health related services that meet theneeds of adolescent girls in the school community have to beestablished and strengthened Since adolescent age is periodof growth and development in which growth spurt andnutritional requirement are high adolescents should beprovided with enough meals and diversified foods Familiesas well as the whole community have to be aware of nutritionof adolescent girls through health extension workers androutine facilities service

Table 4 Multivariable binary logistic regression analysis for determinants of thinness among school going adolescent girls of Awash town2018 (n 340)

Variables)inness

COR (95) AOR (95 CI)Yes () No ()

Fathersrsquo occupationPastoral 1(33) 12(39) 85(09ndash733) 93(009ndash891)Agro pastoral 3(100) 36(116) 85(22ndash333) 83(017ndash415)Merchant 9(300) 86(277) 1070(41ndash282) 149(047ndash472)Daily laborer 8(267) 84(271) 97(36ndash264) 139(42ndash464)Government employee 9(300) 92(297) 1 1

Mothersrsquo occupationPastoral 2(67) 19(61) 109(16ndash712) 197(023ndash1646)Agro pastoral 1(33) 11(35) 94(08ndash1000) 353(024ndash5254)Merchant 9(300) 93(300) 10(25ndash393) 168(035ndash811)Daily laborer 5(167) 64(206) 81(18ndash357) 234(041ndash1336)Government employee 10(333) 92(297) 112(29ndash435) 423(077ndash231)Housewife 3(100) 31(100) 1 1

Feeding habitAs usual 17(567) 189 (61) 1More than usual 12(40) 81(261) 165 (75ndash361) 177 (072ndash434)Less than usual 1(33) 40(129) 28 (04ndash215) 25 (003ndash201)

Eating less than usualYes 23(767) 157(506) 32(134ndash768) 301(115ndash790) lowastNo 7(233) 153(494) 1

DDSGood 14(47) 159(61) 1 1Poor 16(53) 103(39) 176(122 486) 18(114 438)lowast

Fruit and vegetable consumptionYes 19(633) 110(355) 1No 11(367) 200(645) 032(015ndash069) 028 (011ndash178)

Milk consumptionYes 2(67) 36(116) 1No 28(933) 274(884) 184(042ndash805) 029(006ndash148)

COR crude odds ratio AOR adjusted odds ratio CI confidence interval lowastsignificant at plt 005

Journal of Environmental and Public Health 7

Abbreviations

CSA Central Statistical AgencyDDS Dietary diversity scoreEDHS Ethiopia Demographic and Health SurveyFAO Food and Agriculture OrganizationICRW International Center for Research on WomenNHNES National Health and Nutrition Examination

SurveySPSS Statistical Package for the Social Sciences

Data Availability

All the results of this research were based on the use ofprimary data and the data collection was performed pro-spectively )e datasets supporting the conclusions of thestudy are included in the article Any additional data will beavailable from the corresponding author on reasonablerequest

Ethical Approval

)e study was approved by the Institutional Review Board ofCollage of Medical and Health Sciences Samara UniversityA letter of support was obtained from Awash Town Edu-cation Bureau)e study was conducted in accordance withthe ethical standards of the institutional and national re-search committee and it also adheres to the Declaration ofHelsinki

Consent

After permission was obtained from school administrationthe parental consent was obtained the day prior to the datacollection After the written consent was obtained from theparents of the study subjects assent was obtained byexplaining the purpose and the importance of the study to theadolescent girls with standard assurance of confidentiality

Conflicts of Interest

)e authors have no conflicts of interest regarding thisresearch

Authorsrsquo Contributions

LM has conceived and executed the study carried out theoverall design and performed data collection and statisticalanalysis MK and AG have critically revised the design of thestudy and the data collection techniques and helped in thestatistical analysis MK has drafted the manuscript Allthe authors read and finally approved this manuscript forsubmission

Acknowledgments

)e authors would like to thank all respondents for theirvaluable information)e authors also extend their gratitudeto Afar Regional Education Bureau and Awash Town Ed-ucation Bureau for their support throughout the work

Finally the authors would like to thank all data collectorsand supervisors who have given their precious time to collectthe necessary data

References

[1] UNFPA Adolescent Sexual and Reproductive Health Toolkitfor Humanitarian Setting a Companion to the Inter-AgencyField Manual on Reproductive Health in Humanitarian Set-tings UNFPA New York NY USA September 2009

[2] D Clifton and A Hervish 7e Worldrsquos Youth Data SheetPopulation Reference Bureau Washington DC USA 2013

[3] H Delisle Nutrition in Adolescence Issues and Challenges forthe Health Sector Issues in Adolescent Health and Develop-ment World Health Organization Geneva Switzerland 2005

[4] L Cordeiro S Lamstein Z Mahmud and J Levinson Ad-olescent Malnutrition in Developing Countries a Close Look atthe Problem and at Two National Experiences vol 31pp 6ndash13 WHO Geneva Switzerland 2006

[5] J E Brown and J Stang Nutrition 7rough Life 7e CycleWadsworth Cengage learning Boston MA USA 4th edition2011

[6] CSA Summary and Statistical Report of the 2007 Populationand Housing Census Results Population Size by Age and SexAddis Ababa Ethiopia FDRE Population Cecsus Commis-sion Addis Ababa Ethiopia 2008

[7] Y Mesert J Haidar H Kassa and F Fleming Jr ldquoSocio-economic and demographic factors affecthing body massindex of adolescents students aged 10-19 in ambo (a ruraltown) in Ethiopiardquo International Journal of Biomedical Sci-ence vol 6 no 4 pp 321ndash326 2010

[8] A Prista J A R Maia A Damasceno A Damasceno andG Beunen ldquoAnthropometric indicators of nutritional statusimplications for fitness activity and health in school-agechildren and adolescents from Maputo Mozambiquerdquo 7eAmerican Journal of Clinical Nutrition vol 77 no 4pp 952ndash959 2003

[9] A Mulugeta F Hagos B Stoecker et al ldquoNutritional status ofadolescent girls from rural communities of Tigray NorthernEthiopia Ethiopianrdquo 7e Ethiopian Journal of Health Devel-opment vol 23 no 1 pp 5ndash10 2009

[10] A L Sawaya P A Martins L P Grillo and T T FlorencioldquoLong-term effects of early malnutrition on body weightregulationrdquo Nutrition Reviews vol 62 pp S127ndashS133 2004

[11] S Nandy M Irving D Gordon S V Subramanian andG D Smith ldquoPoverty child undernutrition andwhich is similarto the pattern morbidity new evidence from Indianrdquo Bulletin ofthe World Health Organization vol 83 pp 210ndash216 2005

[12] California Department of Public Health California Nutritionand Physical Activity Guideline for Adolescent Child andAdolescent Health Division California Department of PublicHealth Sacramento CA USA 2012

[13] H Delisle V Chandra-Mouli and B Bruno Should Ado-lescents Be Specifically Targeted for Nutrition in DevelopingCountries To Address Which Problems and How WorldHealth OrganizationInternational Nutrition Foundation forDeveloping Countries Geneva Switzerland 2000

[14] United nation standing committee of nutrition 6th Report onthe World Nutrition Situation UNSCN Paris France 2009

[15] R Uauy J Kain V Mericq J Rojas and C CorvalanldquoNutrition child growth and chronic disease preventionrdquoAnnals of Medicine vol 40 no 1 pp 11ndash20 2008

8 Journal of Environmental and Public Health

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9

Abbreviations

CSA Central Statistical AgencyDDS Dietary diversity scoreEDHS Ethiopia Demographic and Health SurveyFAO Food and Agriculture OrganizationICRW International Center for Research on WomenNHNES National Health and Nutrition Examination

SurveySPSS Statistical Package for the Social Sciences

Data Availability

All the results of this research were based on the use ofprimary data and the data collection was performed pro-spectively )e datasets supporting the conclusions of thestudy are included in the article Any additional data will beavailable from the corresponding author on reasonablerequest

Ethical Approval

)e study was approved by the Institutional Review Board ofCollage of Medical and Health Sciences Samara UniversityA letter of support was obtained from Awash Town Edu-cation Bureau)e study was conducted in accordance withthe ethical standards of the institutional and national re-search committee and it also adheres to the Declaration ofHelsinki

Consent

After permission was obtained from school administrationthe parental consent was obtained the day prior to the datacollection After the written consent was obtained from theparents of the study subjects assent was obtained byexplaining the purpose and the importance of the study to theadolescent girls with standard assurance of confidentiality

Conflicts of Interest

)e authors have no conflicts of interest regarding thisresearch

Authorsrsquo Contributions

LM has conceived and executed the study carried out theoverall design and performed data collection and statisticalanalysis MK and AG have critically revised the design of thestudy and the data collection techniques and helped in thestatistical analysis MK has drafted the manuscript Allthe authors read and finally approved this manuscript forsubmission

Acknowledgments

)e authors would like to thank all respondents for theirvaluable information)e authors also extend their gratitudeto Afar Regional Education Bureau and Awash Town Ed-ucation Bureau for their support throughout the work

Finally the authors would like to thank all data collectorsand supervisors who have given their precious time to collectthe necessary data

References

[1] UNFPA Adolescent Sexual and Reproductive Health Toolkitfor Humanitarian Setting a Companion to the Inter-AgencyField Manual on Reproductive Health in Humanitarian Set-tings UNFPA New York NY USA September 2009

[2] D Clifton and A Hervish 7e Worldrsquos Youth Data SheetPopulation Reference Bureau Washington DC USA 2013

[3] H Delisle Nutrition in Adolescence Issues and Challenges forthe Health Sector Issues in Adolescent Health and Develop-ment World Health Organization Geneva Switzerland 2005

[4] L Cordeiro S Lamstein Z Mahmud and J Levinson Ad-olescent Malnutrition in Developing Countries a Close Look atthe Problem and at Two National Experiences vol 31pp 6ndash13 WHO Geneva Switzerland 2006

[5] J E Brown and J Stang Nutrition 7rough Life 7e CycleWadsworth Cengage learning Boston MA USA 4th edition2011

[6] CSA Summary and Statistical Report of the 2007 Populationand Housing Census Results Population Size by Age and SexAddis Ababa Ethiopia FDRE Population Cecsus Commis-sion Addis Ababa Ethiopia 2008

[7] Y Mesert J Haidar H Kassa and F Fleming Jr ldquoSocio-economic and demographic factors affecthing body massindex of adolescents students aged 10-19 in ambo (a ruraltown) in Ethiopiardquo International Journal of Biomedical Sci-ence vol 6 no 4 pp 321ndash326 2010

[8] A Prista J A R Maia A Damasceno A Damasceno andG Beunen ldquoAnthropometric indicators of nutritional statusimplications for fitness activity and health in school-agechildren and adolescents from Maputo Mozambiquerdquo 7eAmerican Journal of Clinical Nutrition vol 77 no 4pp 952ndash959 2003

[9] A Mulugeta F Hagos B Stoecker et al ldquoNutritional status ofadolescent girls from rural communities of Tigray NorthernEthiopia Ethiopianrdquo 7e Ethiopian Journal of Health Devel-opment vol 23 no 1 pp 5ndash10 2009

[10] A L Sawaya P A Martins L P Grillo and T T FlorencioldquoLong-term effects of early malnutrition on body weightregulationrdquo Nutrition Reviews vol 62 pp S127ndashS133 2004

[11] S Nandy M Irving D Gordon S V Subramanian andG D Smith ldquoPoverty child undernutrition andwhich is similarto the pattern morbidity new evidence from Indianrdquo Bulletin ofthe World Health Organization vol 83 pp 210ndash216 2005

[12] California Department of Public Health California Nutritionand Physical Activity Guideline for Adolescent Child andAdolescent Health Division California Department of PublicHealth Sacramento CA USA 2012

[13] H Delisle V Chandra-Mouli and B Bruno Should Ado-lescents Be Specifically Targeted for Nutrition in DevelopingCountries To Address Which Problems and How WorldHealth OrganizationInternational Nutrition Foundation forDeveloping Countries Geneva Switzerland 2000

[14] United nation standing committee of nutrition 6th Report onthe World Nutrition Situation UNSCN Paris France 2009

[15] R Uauy J Kain V Mericq J Rojas and C CorvalanldquoNutrition child growth and chronic disease preventionrdquoAnnals of Medicine vol 40 no 1 pp 11ndash20 2008

8 Journal of Environmental and Public Health

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9

[16] C HadleyD Lindstrom et al ldquoGender bias in the food in-security experience of Ethiopian adolescentsrdquo Social Science ampMedicine vol 66 no 2 pp 427ndash438 2008

[17] E L Kennedy Interactive Learning Exchange ExploringStrategies to Reach and Work with Adolescents Health Nu-trition and Population (HNP) Discussion Paper World bankWashington DC USA 2004

[18] S Roy N S Barman J Mondal and J Sen ldquoPrevalence ofstunting and thinness among adolescent girls belonging to therajbanshi population of West Bengal Indiardquo Journal of NepalPaediatric Society vol 36 no 2 pp 147ndash155 2016

[19] M M Wassie A A Gete M E Yesuf G D Alene A Belayand T Moges ldquoPredictors of nutritional status of Ethiopianadolescent girls a community based cross sectional studyrdquoBMC Nutrition vol 1 p 20 2015

[20] Y Yemaneh G Abel W Niguse et al ldquoUnder nutrition andits associated factors among adolescent girls in rural com-munity of Aseko district Eastern Arsi Zone Oromia regionEastern Ethiopia 2017rdquo International Journal of ClinicalObstetrics and Gynecology vol 1 no 2 pp 17ndash26 2017

[21] EHNRI (Ethiopian Health and Nutrition Research Institute)Nutrition Baseline Survey Report for the National NutritionProgram of Ethiopia EHNRI Addis Ababa Ethiopia 200910

[22] R Kt A M and T Wakayo ldquoNutritional status and its as-sociated factors among school adolescent girls in Adama cityCentral Ethiopiardquo Journal of Nutrition amp Food Sciences vol 6no 3 p 493 2016

[23] T Gebregyorgis Takele Tadesse and A Atenafu ldquoPrevalenceof thinness and stunting and associated factors among ado-lescent school girls in Adwa town north Ethiopiardquo Inter-national Journal of Food Science vol 2016 Article ID8323982 8 pages 2016

[24] B Amare B Moges F Moges et al ldquoNutritional status anddietary intake of urban residents in Gondar NorthwestEthiopiardquo BMC Public Health vol 12 p 752 2012

Journal of Environmental and Public Health 9