ASSESEMENT OF UNDER NUTRITION AND ASSOCIATED …
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Applied human nutrition Thesis and Dissertations
2020-03-18
ASSESEMENT OF UNDER
NUTRITION AND ASSOCIATED
FACTORS AMONG ADOLESCENT
GIRLS IN SODDO DACHI
WOREDA,SOUTH WEST SHEWA
Hailu, Endashaw
http://hdl.handle.net/123456789/10652
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DECLARATION
I, the undersigned, declare that the thesis comprises my own work. In compliance
with internationally accepted practices, I have acknowledged and refereed all
materials used in this work. I understand that non-adherence to the principles of
academic honesty and integrity, misrepresentation/ fabrication of any
idea/data/fact/source will constitute sufficient ground for disciplinary action by the
University and can also evoke penal action from the sources which have not been
properly cited or acknowledged.
Name of the student: Endashaw Hailu Signature _____________
Date of submission: ________________
Place: Bahir Dar
This thesis has been submitted for examination with my approval as a university
advisor.
Advisor Name: Eskinder Wolka (MPH, PhD Candidate)
Advisor’s Signature:
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© 2017
Endashaw Hailu Gelan
ALL RIGHTS RESERVED
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Bahir Dar University
Bahir Dar Institute of Technology-
School of Research and Graduate Studies
Faculty of Chemical and Food Engineering
THESIS APPROVAL SHEET
Student:
________________________________________________________________________
Name Signature Date
The following graduate faculty members certify that this student has successfully
presented the necessary written final thesis and oral presentation for partial fulfillment of
the thesis requirements for the Degree of Master of Science in Applied Human Nutrition
Approved By:
Advisor:
______________________________________________________________________
Name Signature Date
External Examiner:
________________________________________________________________________
Name Signature Date
Internal Examiner:
________________________________________________________________________
Name Signature Date
Chair Holder:
____________________________________________________________________
Name Signature Date
Faculty Dean:
________________________________________________________________________
Name Signature Date
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To my mother Felekech Gelan
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ACKNOWLEDGMENT
First of all I would like to acknowledge and express my gratitude to Bahir dar
university, Institute of technology ,school of chemical and food engineering for giving
me this opportunity and the capability to conduct this study.
For generously sharing his wisdom, time and ideas I pay homage to my Advisor Asst.
Professor Eskinder Wolka.
I would also like to express my gratitude to Oromia regional state health bureau, South
West shewa Zone health department, Soddo Dachi woreda health Office, Soddo Dachi
woreda education and training office, Terre health center, Data collectors and all the
schools where this assessment was conducted for their invaluable cooperation and
assistance.
Finally my deepest gratitude goes to my family, my friends and staff members who were
always there whenever I needed their help.
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ACCRONYM
BDU Bahir Dar University
BMI Body Mass Index
BAZ Body Mass Index for Age Z-score
DDS Dietary Diversity Score
EDHS Ethiopian Demographic Health Survey
FANTA Food and Nutrition Technical Assistance
FAO Food and Agriculture Organization
FMOH Federal Ministry of Health
HAZ Height for Age Z-score
HFIAS Household Food Insecurity Access Scale
WHO World Health Organization
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TABLE OF CONTENTS
Contents
DECLARATION ................................................................................................................. i
ACKNOWLEDGMENT..................................................................................................... v
ACCRONYM .................................................................................................................... vi
TABLE OF CONTENTS .................................................................................................. vii
Contents ............................................................................................................................ vii
LIST OF TABLES ............................................................................................................. x
LIST OF FIGURES ........................................................................................................... xi
ABSTRACT ...................................................................................................................... xii
1.INTRODUCTION ........................................................................................................... 1
1.1. Background .................................................................................................................. 1
1.2. Statement of the problem ............................................................................................. 2
1.3. Objectives of the study................................................................................................ 3
1.3.1 General Objective ...................................................................................................... 3
1.3.2.Specific Objectives .................................................................................................... 3
1.4. scope of the study......................................................................................................... 3
1.5.Significanc of the study ................................................................................................ 4
2. LITERATURE REVIEW ............................................................................................... 5
2.1. Under nutrition among adolescent girls ....................................................................... 5
2.2. Factors associated with under nutrition among adolescent girls ................................. 7
2.2.1 Socio demography ..................................................................................................... 7
2.2.2 Dietary diversity score( DDS) .................................................................................. 9
2.2.3. Food Security ............................................................................................................ 9
2.2.4.Behavior and health status ....................................................................................... 10
2.3 Conceptual frame work ............................................................................................... 11
3.METHODOLOGY ........................................................................................................ 12
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3.1. Study design ............................................................................................................... 12
3.2. Study area................................................................................................................... 12
3.3. Source and Study population ..................................................................................... 12
3.3.1. Inclusion criteria ..................................................................................................... 12
3.3.2. Exclusion criteria .................................................................................................... 12
3.3.3. Sample size determination ...................................................................................... 12
3.3.4. Sampling procedure ................................................................................................ 14
3.4. Variables of the study ................................................................................................ 17
3.4.1. Dependant variable ................................................................................................. 17
3.4.2. Independent variables ............................................................................................. 17
3.5. Standard definition (WHO growth reference 2007) .................................................. 18
3.6. Data collection procedures ......................................................................................... 19
3.6.1.Questionnaires.......................................................................................................... 19
3.6.2. Anthropometric measurements ............................................................................... 19
3.7. Data quality control.................................................................................................... 19
3.8. Data processing and analysis ..................................................................................... 20
3.9.Ethical consideration ................................................................................................... 20
3.10 Dissemination of Result ............................................................................................ 21
4.RESULT AND DISCUSSION ...................................................................................... 22
4.1.Socio demography ...................................................................................................... 22
4.2.Dietary Diversity Score (DDS) ................................................................................... 25
4.3.Food Frequency .......................................................................................................... 26
4.4.Health ,behavior and physical Activity ....................................................................... 28
4.5.Anthropometry ............................................................................................................ 29
4.6.Prevalence of under nutrition ...................................................................................... 29
4.7.Factors associated with Under Nutrition ..................................................................... 30
4.7.1Factors associated with Thinness .............................................................................. 31
4.7.2.Factors associated with stunting .............................................................................. 32
4.8.DISCUSSION ............................................................................................................. 33
5.CONCLUSION AND RECOMMENDATION ............................................................. 35
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5.1.Conclusion .................................................................................................................. 35
5.2.Reccomendations ........................................................................................................ 35
REFERENCES ................................................................................................................. 36
APPENDIXES .................................................................................................................. 39
APPENDIX 1 .................................................................................................................... 39
APPENDIX 2 .................................................................................................................... 46
APPENDIX 3 .................................................................................................................... 48
APPENDIX 4 .................................................................................................................... 58
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LIST OF TABLES
Table.1.Sample size calculation for single proportion--------------------------------------- 13
Table 2. Sample size calculation for the second for the second Objective------------------14
Table3.Sociodemography of Adolescent girls in Soddo dachi woreda,
south west,Shewwa,2017.-------------------------------------------------------------------------23
Table 4.Adolesent's 24h dietary diversity recall in soddo dachi woreda ,
Southwest shewwa 2017.--------------------------------------------------------------------------25
Table 5.Meal frequency of adolescent girls in Soddo Dachi woreda, South west
Shewwa,2017.---------------------------------------------------------------------------------------26
Table 6. Seven day food frequency of some food Items among school adolescent
consumed in Soddo dachi woreda, South West Shewwa, 2017.-----------------------------26
Table 7. Health, behavior and physical activity among adolescent girls
in Soddo dachi woreda,South west Shewwa,2017.---------------------------------------------28
Table 8. Anthropometry of adolescent school girls in Soddo Dachi woreda,
South west Shewwa,2017.-------------------------------------------------------------------------29
Table 9. Under nutrition among school adolescent girls in Soddo Dachi,
South west Shewwa,2017.-------------------------------------------------------------------------30
Table 10 .Factors associated with thinness among adolescent girls in Soddo Dachi
woreda,South west Shewwa,2017.---------------------------------------------------------------31
Table 11.Factors associated with stunting among adolescent girls in Soddo dachi woreda,
South west Shewwa,2017.-------------------------------------------------------------------------32
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LIST OF FIGURES
Figure 1. Conceptual frame work developed from literatures for casual factors
associated with under nutrition in adolescence, 2017------------------------------------------11
Figure.2 Schematic presentation of the sampling procedures and techniques in Soddo
Dachi woreda----------------------------------------------------------------------------------------16
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ABSTRACT
Introduction: Adolescence is the most important period of life where growth and
development are accompanied, leading to increased demand for nutrients which could
pose a greater risk of under nutrition. Little emphasis is given to reveal the evidence of
level of under nutrition in this age group.
Objective: the objective of this study was to assess the level of under nutrition and
associated factors among adolescent girls in Soddo Dachi woreda ,South West Shewa.
Methods: School based cross sectional study was conducted from January to February
2017, in Soddo Dachi Woreda. The data was collected by using interviewer
administered questionnaire and Anthropometry. The study was conducted among 426
second cycle primary and secondary schools (5th-10th) grade adolescent girls.
The WHO 2007 growth reference was used as a standard reference for classifying level
of under nutrition of adolescents using WHO Anthroplus software version 1.0.4. All
statistical analyses was done using the SPSS version 22 . Logistic regression model was
used to identify the relationship between independent and outcome variables. The degree
of association between dependent and independent variables were assessed using odds
ratio with 95 % confidence interval and variables with p-value less than 0.05 were
considered significant.
Major findings: The prevalence of Thinness is 14.2%( 95% C.I.) and the prevalence of
stunting is 7.2% (95 % C.I) source of drinking water and Menarche are associated with
under nutrition.
Conclusion: The prevalence of stunting is relatively low and the prevalence of thinness
is medium when compared to the WHO classification of severity of malnutrition by
prevalence among adolescent girls in Soddo Dachi woreda,South West Shewa.
Recommendations: Sources of drinking water should be improved and growing
vegetables and fruits should be encouraged.
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1.INTRODUCTION
1.1. Background
The term youth encompasses ages 10 to 24 years, while the term adolescents as defined
includes persons aged 10-19. Early adolescence, 10/13-14/15 years, Mid adolescence,
14/15-17, Late adolescence, between 17-21, but variable. (WHO,2005)
Adolescence is a period of rapid growth: up to 45% of skeletal growth takes place and 15
to 25% of adult height is achieved during adolescence . During the growth spurt of
adolescence, up to 37% of total bone mass may be accumulated. Nutrition influences
growth and development throughout infancy, childhood and adolescence; it is, however,
during the period of adolescence that nutrient needs are the greatest (WHO,2005).
In 2009, there were 1.2 billion adolescents aged 10–19 in the world, forming 18 per cent
of world population. Adolescent numbers have more than doubled since
1950.(UNICEF,2011)
The vast majority of adolescents – 88 per cent – live in developing countries. The least
developed countries are home to roughly 1 in every 6 adolescents. .( UNICEF,2011)
On current trends, however, the regional composition of adolescents is set to alter by
mid-century. In 2050, sub-Saharan Africa is projected to have more adolescents than any
other region, marginally surpassing the number in either of the Asian regions.(
UNICEF,2011)
Adolescent nutritional problems are common throughout the world. Some young people
lack adequate food and others make poor food choices. Especially Under-nutrition among
adolescents is a serious public health problem internationally, particularly in developing
countries (Damie TD.et.al,2015).
Short stature reflects previous poor socioeconomic conditions and inadequate nutrition
during childhood and adolescence. In a woman short stature is a risk factor for poor birth
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outcomes and obstetric complications. For example, short stature is associated with small
pelvic size, which increases the likelihood of difficulty during delivery and the risk of
bearing low birth weight babies. A woman is considered to be at risk if her height is
below 145 cm.(EDHS,2011)
1.2. Statement of the problem
Adolescence is commonly regarded as a relatively healthy period of the life cycle.
Indeed, adolescents are possibly less vulnerable to infection than they were at a younger
age. This may contribute to their being somewhat neglected, but also it may mean that
there is at adolescence less interference with adequate physiological utilization of food
nutrients.(WHO,2005)
Under nutrition is a condition where there is insufficient food intake to meet energy and
nutrient needs.(Silangwe,2012)
The burden of energy, protein and micronutrient deficiencies are high in adolescents of
developing countries. The subsequent social, economic, health, and development
impact of under nutrition in adolescents is expected to be high in these countries
(Wassie.et.al.,2015)
According to EDHS 2011, female adolescents age 10-19 accounts for 24.8 % of the total
population of the country.(EDHS,2011)
In Ethiopia, children and adolescent constitutes about 48% of Ethiopian population and
about 25 percent of this age group is girls but studies among this age group were
insufficient. Few Studies in Ethiopia showed that under nutrition was common problem
among adolescent girls.( Roba KT.et.al, 2014)
The nutritional status of adolescent girls, the future mothers, contributes significantly to
the nutritional status of the community. Under-nutrition among adolescent girls is a major
public health problem leading on impaired growth. Nutritional deficiencies has far
reaching consequences, especially in adolescent girls. If their nutritional needs are not
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met, they are likely to give birth to undernourished children, thus transmitting under
nutrition to future generations.(Maiti S.et.al,2011)
One way to break the intergenerational cycle of malnutrition is to improve the nutrition of
adolescent girls prior to conception. The vicious cycle of malnutrition, if not broken, will
goes on resulting in more and more severe consequences.(Mulugeta A.et.al,2009)
1.3. Objectives of the study
1.3.1 General Objective
❖ to assess under nutrition and associated factors among adolescent girls in Soddo Dachi
woreda ,South West Shewa, Ethiopia.
1.3.2.Specific Objectives
➢ To assess the level of under nutrition among adolescent girls in Soddo Dachi woreda.
➢ To identify factors associated with under nutrtion among adolescent girls.
1.4. scope of the study
Adolescence is the second most critical period of physical growth in the life cycle after
the1st year. Twenty five percent of adult heightened during adolescence.(Gebregyiorgis
T.et.al,2016)
One major reason for focusing on adolescents is that this period of a child’s life is a
unique opportunity to break a range of vicious cycles of structural problems that are
passed from one generation to the next, such as poverty, gender discrimination, violence,
poor health and nutrition(WHO,2005)
Malnutrition in adolescents may be genetically inherited, however, the vast majority of
cases are linked with food insecurity, poor care and poor socioeconomic status
Prematurity, short maternal stature, infections, cigarette smoking, alcohol and drug use,
very young maternal age, indoor air pollution, domestic violence, closely spaced
pregnancies, hypertension, stress, and malaria are all important predictors for the
intergenerational effect of under nutrition. (Wassie.et.al.,2015)
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Anthropometric measurements remain the most practically useful means for the
assessment of the nutritional status of a population. Generally, nutritional status is
assessed by low weight for age (underweight),low height for age (stunting) and low BMI
for age (thinness) following different internationally and regionally recommended
standards.( Mansur D.I and Shakya R.,2016).
1.5.Significanc of the study
The adolescent growth spurt offers a chance to compensate for earlier growth failure,
although such potential is very limited. Adolescence is a pivotal stage of the life cycle,
and in turn, provides a unique opportunity to foster a healthy transition from childhood
to adulthood and halting generational effect of malnutrition . (Wassie.et.al.,2015)
The first strategic objective of the Ethiopian national nutrition program is to improve the
nutritional status of women (15-49 years) and adolescent girls (10-19) years.(National
nutrition program June 13- June 15).But there is limited information about the under
nutrition and associated factors in adolescent girls in Ethiopia especially including pubertal
landmarks which is critical for creating strategies and interventions on these target groups
according to Belachew T.et.al.(2011).
Therefore, this study will address the gap by assessing the under nutrition and associated
factors of adolescent school girls in Sodo Dachi Woreda, South west Shewa. And will avail
baseline information and reference data for under nutrition and its associated factors
among adolescent girls in the area. Secondly, it will provide evidences to further research
and concerned bodies to plan interventions on under nutrition.
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2. LITERATURE REVIEW
2.1. Under nutrition among adolescent girls
According to a study in central India The prevalence of wasting was 48.05% and the
prevalence of stunting was 30.39% (Gaiki and Wagh,2014 )
In a study done in Nepal by Mansur D.I and Shakya R.(2016).14.94% of the adolescent
girls were found to be thin (low BMI for age) as described by WHO criteria. and The
prevalence of stunting (low height for age) was 21.08%.
As in many other regions of the world, adolescent girls in Myanmar enter adolescence
thin and stunted. In a study conducted in the delta region of the Ayeyarwady Division in
Myanmar, they found 21% stunting and 11% thinness.(Thurnham,2013)
A study done in Visakhunpatan city, India Nearly 3/4th (74.5%) of adolescent girls were
having chronic energy deficiency (BMI <18.5). Only 25% were having normal BMI and
one girl was overweight. On further analysis it was observed that 63% (48/76) of them
were either second or third born.(Guduri.et.al.,2014)
The prevalence of under nutrition (7.6%) among the participants assessed as stunting
(height-for-age) was based on the usual pattern of food intake according to a study
conducted in South Africa.(Silangwe,2012)
A study conducted in kilosa Zambia showed that adolescent girls between the age 10 and
14 years were more stunted (63.82%) as compared to 15 to 19 years (40.84%) based on
less than third percentile of NCHS standards (P = 0.0003) . Adolescent girls between the
age 10 and 14 years were more thin (60.79%) as compared to 15 to 19 years (39.43%)
based on less than fifth percentile of NHANES standards (P = 0.0009). In the present
study, mean height, weight, and BMI were less among the adolescent girls aged between
10 and 14 years compared to 15 to 19 years(P = 0.000).(Cordiero.et.al.,2012)
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A study in Egypt indicated that more than one quarter of the studied sample are over-
Weight (27.2%) and the minority of them are under weight and obese (4.6% & 4.2%
respectively).(Abd El-Rahman.et.al.,2013)
In a study conducted in Zimbabwe stunting rates found to be at 6.7% and severe stunting
at 1% in this population (excluding pregnant adolescents, and any adolescent girls in their
19th year, as there is no internationally established cutoff for these populations).(10)
Thinness, measured by BMI-for-age Z score less than -2 standard deviations using the
WHO reference population, was at 6%, and 0.8% were found to be severely thin (BMI-
for-age Z<-3) (Materson and Mlobane,2015).
According to a study in Kilosa, Zambia The prevalence of under nutrition (BMI-for-age
<5th percentile of NCHS/WHO reference) among adolescents was
21%(Cordiero.et.al.,2012 ).
In Sudan, 29% and 17% of young public and private school girls, respectively, were
underweight, while 12% and 23% of public school girls and private school girls were
overweight.(El-Khalifa,1997)
From a study at North West Ethiopia ,overall the prevalence of girls with a low body
mass index-for-age Z score less than < −2SD were 13.6 % while 4 % were with less than
−3 SD. The overall prevalence of height-for-age Z-score less than −2 SD were 31.5 %
while14.7 % were with less than −3 SD.(Wassie.et.al.,2015)
According to a study conducted in Tigray, the cross sectional prevalence of stunting and
thinness was 26.5% and 58.3%. respectively.(Mulugeta.et.al.,2009)
The overall prevalence of thinness and stunting among adolescent school girls of Adwa
town was 21.4% and 12.2% respectively.(Gebregyiorgis.et.al.,2016)
Mild stunting was observed in 29.3% of all the girls studied in Mizan district south
western Ethiopia, but was more common in the rural group, where it was found in 40.9%
subjects compared to just 17.8% in the urban group of girls.(Berhato.et.al.,2015)
On the study which was done in Agarfa it was found that about 29 (13.68%) of the
adolescents were underweight while most of the adolescents 164 (77.36%) were
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normal according to BMI. The prevalence of overweight was 19(8.96%) among
adolescents in Agarfa town. However according to the MUAC assessment none of the
adolescents were found malnourished (Mohammed and Tefera,2015).
In Adama city Under nutrition or thinness (BMI for age z score <-2) was observed among
21.3% respondents, while 3.3 % of them were overweight and 1.0% had obesity.
Similarly 15.6% of the adolescents were stunted (Roba.et.al.,2014)
Wolde.et.al.(2014) reported that the prevalence of underweight among adolescent girls
was 28% by having BMI less than 18.5kg/m2. 66.8% had normal body mass index and
only 5.2% were at risk of developing obesity by having BMI >=25 kg/m2. The
proportions of stunted among late adolescence participants were higher than early
adolescence (57.1 % vs 42.9%); the prevalence of stunting was higher in early
adolescence (7.8% vs 6.8%) than late adolescence.
2.2. Factors associated with under nutrition among adolescent girls
2.2.1 Socio demography
On a study conducted in urban slums of hyderabad India the association between age and
the mean values of height, weight and BMI was found to be statistically significant .
(Kumar.et.al.,2014)
According to a study in Zambia household wealth index is a major factor associated with
adolescent girl underweight .The study findings reveal that, adolescents girls from poor
and average homes were more likely to be underweight as compared to those from richer
or richest households .(Bwalya,2012)
Overall, underweight among female adolescents varied according to place of residence.
The study in Zambia reveals that female adolescents in rural areas are more likely to be
underweight than those in urban areas.(Bwalya,2012)
From south Africa the correlations analysis revealed no statistical significance between
daily energy and household income .(Silangwe,2012)
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In Sudan The most significant socio-economic factor showing a strong effect on public
school girls' BMI was "father has a car." This variable reflects the importance of wealth
even more than education or father job.(El-Khalifa,1997)
A study conducted in North West Ethiopia showed that those adolescents aged 10–14
years were 6 times more likely to be stunted than those aged 18–19 years where as those
aged 15–17 were 1.4 times more likely to be thin than those aged 18–19 years . In this
study adolescents who had nutrition and health information were 2 times more likely to
be stunted than those who had no information.(Wassie.et.al.,2015)
The odds of thinness were 3.27 [AOR (95% CI) = 3.27 ()] times higher among adolescent
girls who use water from unimproved source as compared to adolescent girls who use
water from improved source according to the study conducted in Adwa
town.(Gebregyiorgis.et.al.,2016).The same study also indicated that Adolescent girls who
did not start menstruation were 2.80 [AOR (95% CI) = 2.80] times more likely to be
stunted as compared to adolescent girls who started menstruation.
The study done in south west Ethiopia showed that there was statistically significant
difference between the nutritional status (malnutrition) of adolescent girls and place of
residence , usual diet skipped , frequency of meal per day, history of diarrheal disease in
the last two weeks and family size.(Wolde.et.al.,2014)
A study done in Agarfa high school bale zone found that the associated factors of
nutritional status were family income, meal skipping in the last two weeks, number of
meals per day and dietary diversity.(Mohammed and Tefera,2015)
In a study among adolescent girls in Adama city, adolescent girls’ father and mother
education level, occupation of their fathers, were significantly associated with under
nutrition. Adolescent girls who were from an illiterate father were more likely to develop
under nutrition (thinness) compared to those born from fathers of college level training.
In addition, those adolescent girls from daily laborer fathers were twice more likely to be
undernourished compared to those adolescent girls from merchant fathers
(Roba.et.al.,2014)
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Roba.et.al(2014) indicated that adolescents from uneducated mothers and mothers who
attended primary school were more likely to have undernourishment compared to
mothers who attended some formal college training .
A Study from chiro town, west Harerge also revealed that household headed by male
were three times more likely to be stunted when compared to study participants who
came from female head household . In this study the adolescents who don’t wash their
hand after using toilet food were three times more likely to become stunting those who
wash their hand at always(Damie.et.al.,2015)
2.2.2 Dietary diversity score( DDS)
A study from Adama city indicates that adolescent girls who had low DDS were more
likely to be thin than those adolescents with high DDS. Similarly, regarding meal
diversity perception, those adolescent girls who perceived their diet was monotonous
were more likely to develop wasting compared to those who had diversified food on daily
bases(Roba.et.al.,2014)
In a study done in Agarfa high school bale zone found that one of the associated
factors of nutritional status to be dietary diversity.(Mohammed and Tefera,2015)
2.2.3. Food Security
Diet habit of adolescent girls is found to be significantly associated with BMI The
relationship indicates that girls whose diet habit was vegetarian, Their BMI was low as
compared to non vegetarian according to a study done in Raipur city chhattisgarh,
India.(Patanwar and Sharma,2013 )
A study done in Zimbabwe With 47.1% adolescent girls found to be food insecure
(moderate plus severe), food insecurity was found to be a significant issue.(Materson and
Mlobane.,2015)
In Ethiopia ,adolescents living in food secured households were 35 % times less likely to
be stunted than those living in food in secured household. (Wassie et.al.,2015)
10
A study from rural communities of Tigray says that reduction in the quantity of food was
the major impact of food shortage on adolescent girls (84%) and the
households.(Mulugeta A. et.al.,2009)
A study conducted in Jimma, south west Ethiopia revealed that Food insecure girls have
menarche one year later than their food secure peer.
The hazard of menarche showed a significant decline (P = 0.019) as severity of food
insecurity level increased, the hazard ratio (HR) for mild food insecurity and
moderate/severe food insecurity were 0.936 and 0.496,respectively compared to food
secure girls.(Belachew.et.al.,2011)
2.2.4.Behavior and health status
A study done in Adwa adolescent girls who did not start menstruation were 2.80 [AOR
(95% CI) = 2.80 ] times more likely to be stunted as compared to adolescent girls who
started menstruation( Gebregyiorgis.et.al.,2016)
The study done in south west Ethiopia indicated that the presence of diarrheal disease in
the last two weeks had significantly contributed malnutrition.(Wolde et.al,2014).
According a study in Jimma Stunted girls had menarche nearly one year later than their
non stunted peers (HR = 0.551, P < 0.001).(Belachew.et.al.,2011)
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2.3 Conceptual frame work
Figure 1. Conceptual frame work developed from literatures for casual factors associated with
under nutrition among adolescent girls, 2016.(Adapted from UNICEF ,1990 conceptual frame work)
Lively hood factors
sedentary life style(heavy physical
work)
Dietary Frequencies
Biologic Factors
Age
Menarche
Mmm
Infectious diseases
& other health
problems.
Malnutrition during fetal life(infancy),childhood
Low body stores
Source of drinking water
Hand washing
Residence
typical eating
styles of
adolescents
Cultural
patterns &
practices
Eating
disturbances
Parental education
Wealth Index
Family size
Lack of access to
nutritious and safe
food (Poverty)
Psychological factors Socio economic and environmental factors
Under nutrition(Thinness and Stunting)
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3.METHODOLOGY
3.1. Study design
Institution based cross sectional study was employed from January to February 2017 .
3.2. Study area
The study was conducted in Soddo Dachi woreda from January 2017 to March 2017.
The Woreda is located 72 KMs from the capital city Addis Ababa in the Sout west
direction. The Woreda is located in the South west Shoa Zone of the Oromia Region; it
has a latitude and longitude of 8°23′N 38°29′E/ 8°30'N 38°41'E . Administratively the
woreda is divided in to 3 kebeles, 13 gotes, and an estimated population size of 42,400 of
which 21,568 are male and 20,832 are female. Estimated number of households of the
woreda based on the 2007 census conversion factor was about 8480.( Soddo Dachi,2016)
3.3. Source and Study population
source: All adolescent girls (10-19 years) in Soddo dachi woreda, South west shoa
Study Population:- second cycle primary school and secondary school students in the
woreda
3.3.1. Inclusion criteria
Regular students in (second cycle primary and secondary schools) with permanent
residency in the woreda and who were present on the day of survey
3.3.2. Exclusion criteria
Adolescents who are not volunteer to be interviewed, Adolescents who have deformed
anthropometric appearances and adolescents who are absent at the time of data
collection.
3.3.3. Sample size determination
A single proportion formula was used to determine the sample size for the first
objective. Proportion of underweight (thinness) in adolescents girls which was about
21.3% (5), confidence level of 95% with 5% marginal error used.
13
The single proportion formula, n = Z2 p (1-p) is applied
d2
considering
Z= 1.96 at 95% confidence interval
d= margin of error
P = Proportion of under nutrition(thinness) ,The proportion (p) of adolescents’ girls of
who were thin or under nutrition was 21.3 (BMI for age z score <-2) from the study
conducted in Adama town, central Ethiopia (Roba.et.al.,2016).
n=total sample size before adding before 10% non response rate
Table.1.Sample size calculation for single proportion
Specific
objective
Assumption
P Z D N n total Reference
Objective 1 0.213 1.96 0.05 258 284 5
Considering Design effect the sample size for objective 1 was multiplied by 1.5 design
effect 284*1.5= 426 .
Therefore, the sample size for single population proportion was calculated to be 426.
14
Table 2. Sample size calculation for the second Objective
Variables Confidence
interval
Power Percent
unexposed
AOR Sample
size
10% non
response
rate
Calculated
sample size
Father's
illiteracy
95% 80 70.5 3.06 150 15 165
Dietary
Diversity
score(DDS)
95% 80 26.8 2.1 348 35 383
The sample size for the first objective was found feasible and could accommodate all the
assumptions, therefore it was taken as working sample.
3.3.4. Sampling procedure
The sample was obtained using multistage sampling technique. During the first
stage, schools were stratified into second cycle primary and secondary schools. In the
second stage from Grades( 5-8 )3 primary schools, were selected using lottery method out
of 6 clusters of primary schools, and 1 High school, which was included purposively
since it was the only Secondary school in the woreda.
The total number of adolescent girls(5th-10th students) in Soddo dachi woreda=1795
79%(1423) grade (5-8) and 21% (372) are secondary school students.
Total number of adolescent girls ( 5th-8th students) in the selected second cycle primary
schools=506
Terre primary school=317
Gugessa Donessa memorial primary school=93
Haro Lule primary school=96
There is only 1 secondary school in the woreda
15
Terre secondary school=372
Percentage and proportion of the schools from the sample size
Terre primary school=n1=317/506*337=211
n1 =211
Gugssa Donsa memorial primary school=93/506*337=62
n2=62
Haro Lule primary school=96/506 *337=64
n3=64
Terre secondary school
372 *21%=89
n4=89n=n1+n2+n3+n4=211+62+64+89=426In each school the same proportion formula
will be used to distribute the sample among each grade level and
then to each section.
16
Figure.2 Schematic presentation of the sampling procedures and techniques in Soddo Dachi woreda.
strat
ificat
ion
by
level
Soddo Dachi woreda
1795 (5-10) Students
(5th-8th schools(1423 adolescent girls)=89%
1 secondary school 372 (21%) adolescent girls
1 Secondary schools
Pro
po
rtio
n
Lottrry
Lottrry
Terre secondary
School
Haro lule and Gugessa Donessa
memorial Primary School
73
73
Terre primary
school
Pro
po
rtion
Pro
po
rtion
Pro
po
rtion
G-5
G-10
G-9
G-5
G-8
G-7
G-6
G-8
G-7
G-6
75
192
180
70
56
62
50
85
86
74
211
89
126
TOTAL SAMPLE SIZE
426
3 Second cycle primary
schools
17
3.4. Variables of the study
3.4.1. Dependant variable
➢ Under nutrition(stunting and thinness)
3.4.2. Independent variables
Socio-Demographic variables
❖ Age category
❖ Grade level
❖ Religion
❖ Family Income
❖ Residence
❖ Parental education
❖ Family size
❖ occupation of parents
❖ Source of drinking water
Dietary Diversity
24 hours recall
Food Frequency
Types of food eaten in last 7 days
Health, Behavior and Physical Activity
• Travel to and from places
• History of illness in the last 4 wee
• Spare time activities
• Menarche
• Drug use
18
3.5. Standard definition (WHO growth reference 2007)
1. Thinness: BAZ<-2SD
2. Severe thinness: BAZ <-3SD
3 Normal weight: BAZ between -2SD and +1SD
4. Over- weight: BAZ between +1SD and +2SD(equivalent to BMI 25 kg/m2 at 19 years
5. Obesity: BAZ > +2SD(equivalent to BMI 30 kg/m2 at 19 years) .
6.Stunting :HAZ<-2SD severe stunting HAZ<-3SD
7.Severe acute malnutrition MUAC<18 cm, Moderate acute malnutrition MUAC 18-
21cm,Normal MUAC>21 cm
Body Mass Index (BMI): Body weight in kilograms divided by height in meters squared
(kg/m2). This is used as an index of “fatness” among adults. Both high BMI (overweight,
BMI greater than 25) and low BMI (thinness, BMI less than 18.5) are considered as
malnutrition.
Stunting: Defined as height for age below minus two standard deviations from the
median height for age of the reference population.
Z-score: The number of standard deviations (SD) below or above the reference median
value.
Minimum Dietary Score : The 10 MDD-W groups are first summed into a score ranging
from 0 to 10. Each woman is then coded “yes” or “no” for scoring ≥ 5, followed by
calculation of the proportion of women who score from 5 to 10. if a questionnaire is
coded “1” for “yes” for either subgroup “A” or “B”, the woman receives a point for the
first MDD-W group (“Grains, white roots and tubers, and plantains”). She does not
receive an additional point if she consumed food items from both subgroups.(FAO
and FHI 360,2016)
19
3.6. Data collection procedures
3.6.1.Questionnaires
Structured questionnaires were used to collect the data. The questionnaires were adapted
from a similar study done in Harar town ,Haremaya university. The questionnaires were
developed in English and translated in to local language or Oromiffa and review was
made for consistency of translation of the language. Pretest and demonstration of
instrument was performed on 5% of the sample from neighboring woreda. In addition,
daily checkup and follow up was done by the supervisor. The questionnaire was used to
obtain background information on the adolescents and their parents’ socio-demographic,
the participants’ food frequency, dietary diversity score and physical activity pattern.
3.6.2. Anthropometric measurements
Weight was measured by a digital scale to the nearest 0.1 kg, without shoes and
minimum clothes.
Height was measured with portable stadiometer to the nearest 0.1 cm. The study
participants will stood upright on bare feet, with heels together, and buttocks and back
touching the meter rule. Single measurements were taken in each case.
MUAC was measured by marking midway between acromion (shoulder) and the
olecranon (elbow) on the vertical axis of the upper arm with the arm bent at right angle
and between the lateral and medial surface of the arm.
3.7. Data quality control
To assure the data quality high emphasis was given in designing data collection
instrument especially socio-demographic . Before starting the actual survey, the
questionnaire was pre-tested on 20 individuals from the nearby woreda schools. which
was not included in the study. And interview was conducted in private.
Throughout the course of the data collection, interviewers were supervised at each site,
regular meetings was held between the data collectors and the principal investigator
together in which problematic issues arising from interviews which were conducted and
mistakes found during editing was discussed and decisions were reached.
20
The collected data was reviewed and checked for completeness before data entry; the
incomplete data was discarded.
3.8. Data processing and analysis
For the first objective frequency, magnitude of malnutrition is based on the BMI for
age and cut off points using WHO growth reference 2007, Mean and standard deviation
(SD) was calculated to describe the sample population in relation to relevant variables.
For the second objective, binary logistic regression analysis was performed to explore
the association between independent and outcome variables using crude odds ratio with
95% C.I. Finally, multivariate logistic regression analysis was done to determine the
factors associated with malnutrition since the outcome variable has more than two
categorical variables.
Accordingly, adjusted odds ratios (AORs) with 95% CIs is estimated. All variables in the
bivirate analysis was taken to the multivariate logistic regression model.
The WHO 2007 growth reference was used as a standard reference for classifying
nutritional status of adolescents using WHO Anthroplus software version
1.0.4.(WHO,2010).Data entry was done by using Epi info7 and All statistical analyses
was done using SPSS version 22. Statistical significance was considered as p-value <
0.05.
3.9.Ethical consideration
Ethical clearance was obtained from Ethical review committee of Bahir dar University
and in order to obtain permission letter I contacted Oromia regional health Bureau
,Southwest shoa health department and Soddo Dachi woreda health office finally to
Obtain the permission to conduct the study in the schools I contacted Soddo Dachi
woreda eduaction and training office.
After getting permission from school to participate in the study, Assent was obtained
from children’s families by sending consent letter to the families of participants less than
18 years old and written consent was obtained for willingness of adolescents aged 18
years and above. The students’ privacy during the interview and anthropometric
21
measurement was maintained by conducting in a private place with interviewer of the
same sex (female nurse interviewers and female supervisor). They were informed that
there is no incentives and harm for their participation in this study. Finally the data
obtained from the adolescent girls kept confidential by not writing participant`s name in
the questionnaire and during interview.
3.10 Dissemination of Result
The results of the study will be presented to, Bahir Dar Institute of technology, Bahir Dar
University, school of chemical and food engineering as part of master of science thesis &
it will also get shared to Oromia regional health bureau, South West Shoa zonal health
department, Soddo dachi woreda health office and respective kebele administrations.
Efforts will be made to present the results on scientific conferences and peer reviewed
journal publications will be considered.
22
4.RESULT AND DISCUSSION
4.1.Socio demography
From the total of 426 adolescent girls, 401 responded to the questionnaire making the
response rate 95%. The mean age of the study participants was 15.27 years (15.27 ±
1.968 SD). 38.2%(153) are within the range of 10-14 and 61.8%(248) are from age 15 up
to 19. All of the of the respondents were from government schools. Two hundred
ninety(72.3%)of the mothers of the study subjects had no formal education followed by
primary level of education, 92 (22.9%). And only 10(2.5%) attended secondary and
above education.
Regarding family size 135 (38.7%) are from families that consists of less than 5 members
whereas 263(65.6%) are from families that have five and more members. And their
family income 146(37.4%) earn 500 birr,115(29.5%) get 501-1000 birr,91(23.3%)
get1001-1500 birr,28(7.2%) earn 1501-2500 birr and only 10(2.6%) earn more than 2500
birr.
Regarding father's occupation 345(86%) of the adolescent girls' fathers are farmers only
3(0.7%) are merchants or trades and 6(1.5%) are daily labourers,14(3.5%) are
government employees and 6(1.5%) are private org. employees.
Out of the 401 respondents 357(89%) came from families headed by male and 44(11%)
are from families headed by females.
Out of the 401 adolescent girls 238(59.4%) have improved source of water house hold
pipe and public pipe water the remaining 40.6%(163) get their water from unimproved
source (river, Wales, ponds ,springs).
23
Table3.Sociodemography of Adolescent girls in Soddo dachi woreda,south west,Shewwa,2017.
Variables Category Frequency Percent
Age category 10-14 153 38.2
15-19 248 61.8
Educational level 5-8 292 72.8
9-10 109 27.2
Religion Orthodox 377 94.0
Islam 4 1.0
Protestant 16 4.0
Wakefena 4 1.0
Ethnicity Oromo 395 98.5
Guhrage 1 0.2
Amhara 5 1.2
Family size Less than 5 135 33.9
5 and more 263 66.1
Mothers
educational level
No formal
education 290 74.0
Primary education 92 23.5
Secondary and
above 10 2.6
Fathers
educational level
No formal
education 165 44.1
Primary education 187 50.0
Secondary and 22 5.9
24
above
Mother's
occupation house wife 343 85.5
Farmer 4 1.0
government
employee 4 1.0
merchant/trade 27 6.7
private org.
employee 4 1.0
daily laborer 8 2.0
Other 2 .5
Fathers
Occupation Farmer 345 86.0
merchant/trade 3 0.7
daily laborer 6 1.5
government
employee 14 3.5
private org,
employee 6 1.5
Source of
Drinking water
Improved 238 59.4
Unimproved 163 40.6
Monthly Income <500 birr 146 37.4
501-1000birr 115 29.5
1001-1500 birr 91 23.3
1501-2500 birr 28 7.2
>2500 birr 10 2.6
25
Family head Male 357 89
Female 44 11
4.2.Dietary Diversity Score (DDS)
The mean DDS was 4.45± 2.334 . 104(25.9) fulfill the minimum dietary diversity score
for Women (FANTA) by scoring >=5 and the remaining 297 (74.1%) had poor dietary
diversity score or do not fulfill the minimum dietary score by scoring <5.
Table 4.Adolesent's 24h dietary diversity recall in Soddo Dachi woreda ,Southwest Shewwa 2017.
Food Type or Group Category Frequency Percent
Grains, white roots and
tubers, and plantains
YES 339 84.5
NO 62 15.5
Pulses (beans, peas and
lentils)
YES 215 53.6
NO 186 46.4
Nuts and seeds
YES 14 3.5
NO 387 96.5
Dairy
YES 29 7.2
NO 372 92.8
Meat, poultry and fish
YES 49 12.2
NO 352 87.8
Eggs
YES 25 6.2
NO 376 93.8
Dark green leafy vegetables YES 72 18.0
NO 329 82.0
26
Other vitamin A-rich fruits
and vegetables YES 7 1.7
NO 394 98.3
Other vegetables YES 49 12.2
NO 352 87.8
Other fruits YES 49 12.2
NO 352 87.8
4.3.Food Frequency
From the total of 401 respondents, 261(65.6%) of them usually ate 3 or more meals per
day.
Table5. Meal pattern of adolescent girls in Soddo Dachi woreda, Southwest Shewwa,2017.
Variable Category Frequency Percent
Three meals per day Always 193 48.1
Often 68 17.0
Sometimes 135 33.7
Never 3 0.7
Table 6. Seven day food frequency of some food Items among school adolescent consumed in Soddo
dachi woreda, South west Shewwa, 2017.
Food types Consumption
frequency
Frequency Percent
Consume milk/tea/coffee
everyday YES 137 34.2
NO 264 65.8
Pasta, rice, bread, potato YES 113 28.3
27
every day NO 287 71.8
Meat
1-2 times 159 39.7
3-4 times 26 6.5
more than 4 times 2 .5
once in 10-15 days 45 11.2
Never 167 41.6
Egg 1-2 times 219 54.6
3-4 times 31 7.7
more than 4 times 7 1.7
once in 10-15 days 23 5.7
Never 120 29.9
Cheese 1-2 times 179 0.5
3-4 times 40 44.6
more than 4 times 8 10.0
once in 10-15 days 29 2.0
Never 143 7.2
Pea, beans and other legumes 1-2 times 143 35.7
3-4 times 156 38.9
more than 4 times 85 21.2
once in 10-15 days 5 1.2
Never 12 3.0
Sweet or cake 1-2 times 47 11.7
28
3-4 times 12 3.0
once in 10-15 days 5 1.2
Never 337 84.0
4.4.Health ,behavior and physical Activity
From the total 378 who responded, 81 (21.4%) had history of illness in the past two
weeks prior to the data collection. Regarding physical activity of the respondents, 98
(24.4%) involved continuously in walking for >30 minute per day. Three
hundred(74.8%) started menarche 100(24.9%) have not started menarche .The mean age
of menarche was 13.54 with standard deviation of 1.262.
From the total 401 respondents none of them smoke shisha or chew chat.
Table 7. Health, behavior and physical activity among adolescent girls in Soddo dachi woreda,South
west Shewwa,2017.
Variables Category Frequency Percent
Menses status YES 100 25.0
NO 300 75.0
History of Illness in
the last 4 weeks NO 297 78.6
YES 81 21.4
Walking to and from
school <30 minutes 303 75.6
>=30 minutes 98 24.4
Spare time activities Walking 10 2.5
watching television 41 10.2
listening music/radio 26 6.5
using computers 13 3.2
29
reading books/study 257 64.1
exercising/ practicing sport 54 13.5
4.5.Anthropometry
Anthropometry from 401 respondents 104 (25.9%) are between 20 and 40 kilograms
297(74.1%) are 40 and above kilograms.87(21.7%) are between 100 and 150 centimeters
314 (78.3%) are above 150 centimeters in height.
Table 8.Anthropometry of adolescent school girls in Soddo Dachi woreda,South west Shewwa,2017.
Variables Category Frequency Percent
Height in CMs <150 87 21.7
>=150 314 78.3
Weight in KG 20-40 104 25.9
>40 297 74.1
MUAC in CMs <18 7 1.7
18-21 49 12.2
>21 345 86.0
4.6.Prevalence of under nutrition
Based on MUAC measurement 7(1.7%) of the respondents are severely malnourished ,
49 (12.2%) are moderately malnourished the rest 345(86%) are normal.
The prevalence of Thinness is 14.2% (C.I.95%) 5(1.2%) are severely thin,52(13%) are
thin,319(79.6%) are normal,25(6.2%) are overweight no obesity was found in the
assessment ,-3 SD,,-2 SD,-2 up to +1 SD and +1 up to +2 SD and >+3 SD.
The prevalence of stunting is 7.2% (95%C.I) 3(0.7%) are severely stunted 26(6.5%) are
stunted 372(92.8%) are normal with HAZ score ,-3 SD,,-2 SD and >= -2 SD respectively.
30
Table 9. Under nutrition among school adolescent girls in Soddo Dachi, South west Shewa, 2017.
Thinness (BAZ ) Frequency Percent
severe thinness 5 1.2
Thinness 52 13.0
Normal 319 79.6
Overweight 25 6.2
Total 401 100.0
Stunting (HAZ) Frequency Percent
severely stunted 3 0.7
Stunted 26 6.5
Normal 372 92.8
Total 401 100.0
Current nutritional status Frequency Percent
SAM 7 1.7
MAM 49 12.2
Normal 345 86.0
Total 401 100.0
4.7.Factors associated with Under Nutrition
Among socio-demographic and economic factors, educational status of mothers and
fathers of adolescent girls, their households wealth index, religion, grade, were not
significant at binary logistic regression(p values>0.2) and were removed from
multivariable logistic regression models. Among dietary habits eating meat, cheese, fast
foods predominantly diets eating vegetables and most other variables in seven day food
frequency were not significant and then removed from further analyses. Finally,
frequency of eating breakfast, Source of drinking water ,Menarche, Age category, meal
frequency, living arrangement, family income, consuming milk/tea/coffee every day,
frequency of eating boiled potato, walking to and from school filled the criteria and were
included in multivariable analysis.
31
4.7.1 Factors associated with Thinness
Table 10 .Factors associated with thinness among adolescent girls in Soddo Dachi woreda, South
West Shewa,2017.
Variables Category Nutritional status
Thin
N(%)
Norma
l N(%)
COR (95 %CI) AOR (95% CI)
Age
category
10-14 32 121 2.359(1.337,4.163) 1.28(0.524,3.124)
15-19 25 223 1 1
Educational
level
5-8 44 248 2.458(0.835,7.233) 0.668(0.313,1.425)
9-10 13 96 1 1
Meal
Frequency Always 31 162 1 1
Often 13 55 1 0.290(0.18,4.608)
Sometimes 12 123 1 0.350(0.021,5.796)
Never 1 2 0.195(0.016,2.313) 0.205(0.021,3.382)
Started
Menstruatio
n
Yes 29 271 1 1
No 27 73 3.456(1.927,6.20) 3.481(1.876,6.457)*
Living
arrangemen
t
With parents 41 191 2.039(1.102,3.775) 1.409(0.671,2.957)
Not with
parents 16 152 1 1
Eating
break fast
Always 33 180 1.399(0.636,3.074) 1
Usually 10 39 0.636(0.327,1.239) 1
Sometimes 14 120 0.000(0.000) 1
Never 0 5 1 1
* Significant p<0.05 ** p<0.01 *** p<0.001
32
Girls who do not start their menarche are 3.481( AOR1.876,6.457) more likely to be thin
than girls who started menarche.
4.7.2.Factors associated with stunting
Table 11.Factors associated with stunting among adolescent girls in Soddo Dachi woreda, South west
Shewwa, 2017.
Variables Category Nutritional status
Stunted
N(%)
Nor
mal
N(%)
COR (95 %CI) AOR (95% CI)
Eating boiled
potato in a
week
1-2 times 22 262 1.511(0.341,6.699) 1.913(0.398,9.199)
3-4 times 2 51 0.706(0.095,5.246) 1.116(0.135,9.210)
>4 times 2 9 4.000(0.494,32.393) 8.871(0.860,91.507)
1 time in
10-15 days 1 14 1.286(0.108,15.331)
1.362(0.102,18.219)
Consuming
milk/tea/coffee
every day
YES 6 131 1 1
NO 23 241 2.084(0.828,5.246) 2.066(0.803,5.319)
Walking <30 minutes 18 285 1 1
>30 minutes 11 87 2.002(0.911,4.400) 1
Eating break
fast
Always 15 198 0.303(0.032,2.885) 1
Usually 1 48 0.083(0.004,1.598) 0.241(0.019,3.052)
Sometimes 12 122 0.3939(0.041,3.809) 0.063(0.003,1.560)
Never 1 4 1 0.292(0.022,3.81)
Source of
drinking water
Improved 10 228 1 1
Unimproved 19 144
3.008(1.360,6.653) 2.762(1.232,6.141)*
*
* significant p<0.05 ** P<0.01 ***P<0.001
33
Adolescent girls who drink water from unimproved sources of water (river ,well, springs,
ponds) are 2.762(1.232,6.141) times more likely to be stunted than the girls that get their
drinking water from improved sources(pipe and public pipe water).
4.8.DISCUSSION
This study showed that 14.2 %(95% C.I.) of the adolescent girls were thin of which
5(1.2%) are severely thin and 52(13%) are thin.319(79.6%) have normal BMI Z score
and 25(6.2%) are overweight. Of the adolescents 7.2 % were stunted of which 3(0.7%)
are severely stunted 26(6.5%) are stunted.372(92.8%) have normal Height for age Z
score(HAZ) .
Under nutrition is one of the global public health problems. Different studies done
related to this topic showed that there is a high level of under nutrition among adolescents
especially in low income countries like the Sub -Seharan Africa. As Ethiopia is one of the
under developed countries the under nutrition problem is highly prevalent and associated
with deep rooted socio economic problems according to various studies conducted in
different parts of the country. Soddo dachi woreda is one of the woredas found in South
West Shewa of Oromia region. Even though, the findings of this study are relatively
lower than most of the studies conducted in the country with regards to prevalence of
under nutrition the problem is still prevalent.
The prevalence of thinness which is 14.2 % is in line with the study conducted in north
west Ethiopia which was 13.6%( Wassie M.et.al.,2015) and with studies done in
chirotown, Agarfa and mynamar15.5%,13.68% and11%respectively(Damie TD.et.al,
Mohammed AY and Tefera TB, Kumar S.et.al )
This result is higher than the study conducted in South Africa which was 7.6%(Silangwe
Nonthuzela,2012) and from the studies done in Egypt and Zimbabwe 4.6% and 6.8%
respectively (El-khalifa MY,Materson AR.and Mlobane Z.,2015).This difference is may
be due to socioeconomic and cultural difference in dietary habit and care practices.
The prevalence of thinness in this study was found to be much lower than the results
found in the studies conducted in Raipur city Chhattisgurh (Patnawar P.and Sharma
KKN,2013) Zambia (Bupe Bwalya Bwalya,2014), Sudan (El-Khalifa KY,1997)
34
Tigray(Mulugeta A.et.al,2009) , Adwa town (Gebregyiorgis T.et.al.,2016) ,South west
Ethiopia (Tsedeke Wolde.et.al.,2014) and Adama(Roba KT.et.al.,2014) 53.8% , 21%,
29%, 58.3%,21.4%,28%,28% and 21.3%.(Patnawar P.and Sharma KKN,Cordiero
S.et.al,El-Kahlifa MY,Mulugeta A.et.al,Gebregiorgis T.et.al,TsedekeWolde.et.al, Roba
KT.et.al).This variation is may be due to the difference among the study periods.
The prevalence of stunting was found to be 7.2%(C.I.95%) in this study. And it is
consistent with Studies conducted in Zimbabwe(10) and Chiro town (Damie Td.et.al)
7.7% and 10.4 % respectively. But it is much lower than the studies done in Tigray,
North west Ethiopia, Mizan and Adama town 26.5%,31.5% ,29.3%,15.6% and slightly
lower than the study conducted in Adwa12.2% (Gebregyiorgis T.et.al.)
Different factors are determinant to under nutrition a model was developed to study
nutritional status and associated factors among adolescent girls . This model was
influenced by direct (Lively hood factors, Dietary frequencies, Biologic factors and
infectious diseases and other health problems).And Indirect(Socio economic and
environmental factors) (El-khalifa MY,1997).
In the current study adolescent girls who do not start their menstruation cycle are
3.481(AOR 1.876,6.457) more likely to be thin than girls who started menstruation cycle.
This may because under nutrition delays menarche. This finding is in agreement with the
study conducted in Jimma done by Belachwe T.et.al(2011) where it was revealed that
Food insecure girls have menarche one year later than their food secure peers.
Unimproved sources of water (river ,well, springs, ponds) are significantly associated
with stunting . Girls who drink water from unimproved sources of water (river ,well,
springs, ponds) are 2.762(AOR 1.232,6.141) times more likely to be stunted than the
girls that get their drinking water from improved sources(pipe and public pipe water).
This is in line with the finding from Adwa town(Gebregyiorgis T.et.al,2016). This might
be due to exposure to different infections that are water born or water related which may
suppress immunity this in turn increase severity and duration of disease contributing to
poor nutritional status of the adolescent girls.
35
5.CONCLUSION AND RECOMMENDATION
5.1.Conclusion
The prevalence of stunting is relatively low and the prevalence of thinness is medium
among adolescent girls in Soddo Dachi woreda, South West Shewa, when compared to
the WHO classification of severity of malnutrition by prevalence among adolescent girls.
Not starting menarche is associated with thinness And unimproved source of drinking
water is significantly associated with stunting of the adolescent girls. Dietary diversity
score is low among the adolescent girls only 25.9% of the adolescent girls fulfill the
minimum dietary score.
5.2.Reccomendations
The responsible body for Governance in the area needs to encourage families to grow
more of its own food (fruits and vegetables) e.g peas, beans and other legumes, tomatoes,
lettuce and other crops in their home gardens as this will surely help increase the variety
of fresh fruit and vegetables available to the adolescent girls and for betterment of dietary
diversity.
Stake holders should consider to supply and improve safe sources of drinking water.
Limitations : The 24 hour recall may be exposed to bias due to social desirability.
Strength: The data collection was done using a interviewer administered structured
questionnaire and, data collectors were health professionals .
Conflict of Interest: The senior masters student has no any conflict of interest with this
study.
Key Words: Adolescent girls, under nutrition, stunting, Thinness
36
REFERENCES
Abd El-Rahman, S. I. et al .(2013). Assessment of Nutritional Status among Preparatory
School Girls in Talkha City. The Egyptian Journal of Hospital Medicine, 52: 493–505
Baliga S.et.al.(2016). Nutritional status of adolescent girls residing in rural area: a
community based cross sectional study . http://www.jscisociety.com on Saturday,
October 15, 2016, IP: 197.156.90.234]
Berhato TN, Mikitie WK and Argaw A.(2015).Urban rural disparities in the nutritional
status of school adolescent girls in Mizan district.south western Ethiopia. Rural and
remote health,15
Belachew T.etal.(2011). Food insecurity and age at menarche among adolescent girls in
Jimma zone. South west Ethiopia. Reproductive Biology and Endocrinology, 9:125
http://www.rbej.com/content/9/1/125
Bupe Bwalya Bwalya.(2015). Nutritional status among female adolescents aged (15-19)
in Zambia. why it matters. Horizon journal of medicine and medical sciences,1(1) :1-7
Chaudry K.et al.(2014).A cross sectional study to assess the nutritional status of
adolescent girls at a government senior secondary girls school at Bikaher, Rajasthan.
Indian Journal of community health, 26(02)
Cordiero S.et.al.(2012). House hold food security is inversily associated with under
nutrition amlng adolescents from Kilosa, Tanzania. The journal of nutrition.
Damie TD, Wondafrash M, Teklehaymanot AN.(2015). Nutritional status and associated
factors among school adolescent in Chıro Town, West Hararge, Ethiopia.Gaziantep Med
J , 21 (1): 32-42.
El-Khalifa MY.(2011). Nutritional status of Sudanese adolescent girls and associated
food behaviors. The University of Arizona.1997. http://hdl.handle.net/10150/282295
Ethiopian demographic and health survey 2011.
37
FAO and FHI 360. (2016). Minimum Dietary Diversity for Women: A Guide for
Measurement. Rome: FAO.
Gebregyiorgis T.et.al.(2016). Prevalence of Stunting and thinness and associated factors
in Adwa town, North Ethiopia.International journal food Food science.
http://dx.doi.org/10.1155/2016/8323982
Government of the federal democratic republic of Ethiopia. National nutrition program
June 2013-June 2015.
Guduri G.et.al.(2014). Assessment of nutritional status among early adolescent girls. (11-
14 years) attending government schools of Visakhupantan City. IOSR journal of dental
and medical sciences, 13(4):31-33.
Kumar S.et.al.(2014). nutritional status of adolescent girls of urban slums of hyderabad .
Indian journal of basic and applied medical research, 4( 1): 457-461
Maiti S. et.al.(2011). Assessment of nutritional status of rural early adolescent school
girls in Dantan-II Block, Paschim Medinipur District, west Bengal.National journal of
community medicine, 2(1)
Materson AR. and Mlobane Z.(2015). Assessment of adolescent girls nutrition, dietary
practices, and roles in Zimbabwe.
Mohammed AY and Tefera TB.(2015). Nutritional status and associated risk factors
among adolescent girls in Agarfa high school, Bale zone, Oromia region south east
Ethiopia. International Journal of nutrition and food sciences, 4(4): 445-452
Mansur.D.I. and Shakya R.(2016). Prevalence of underweight,stunting and thinness
amond adolescent girls in Karve district.Journal of Nepal paediatric society.
Mulugeta A.et.al. (2009). Nutritional Status of Adolescent Girls from Rural Communities
of Tigray, Northern Ethiopia. Ethiop.J.Health Dev, 23 (1): 5-11
Patanwar P. and Sharma KKN.(2013). Nutritional satatus of kurmi adolescent girls of
Raipur city Chhartisgarh,India. International Journal of Scientific and Research
Publications, 3(11).
38
Roba KT. Abdo M and Wakayo T.(2016). Nutritional status and associated factors
among school adolescent girls in Adama city, central Ethiopia. J Nutr .Food sci,6:3
Silangwe Nonthuzelo.(2012). Nutritional status and dietary intake of adolescen girls in
Mandlenkoshi high school Lindelani.
Soddo Dachi woreda health Office(unpublished)
Thurnham David.(2013).Nutrition of adolescent girls in low and middle income
countries. sight and life, 27(3)
Tsedeke Wolde.et.al.(2014). Nutritional status of adolescent girls living in south west of
Ethiopia.Food science and quality management ,34
UNICEF.(2011).The state of the world’s children 2011: adolescence the age of
opportunities . united nations children’s fund (unicef) .
Wassie M.et.al.(2015). Predictors of nutritional status of Ethiopian adolescent girls: a
community based cross sectional study. BMC nutrition, 1:20
WHO Anthro for personal computers, version 3.2.2, 2011:.(2010). Software for assessing
growth and development of the world's children. Geneva.
(http://www.who.int/childgrowth/software/en/ ).
WHO.(2005).Nutrition in adolescence issues and challenges for the health sector: issues
in adolescent health and development .
39
APPENDIXES
APPENDIX 1: English Version of Participant’s Consent and Information Sheet Bahir
dar University, Bahir dar Institute of Technology, School of research and graduate
studies Questionnaire to assess the nutritional status and its associated factors
among adolescent girls in Soddo dachi woreda, south west shoa, Ethiopia
I. Participant information Sheet for above 18 Years Adolescent girls Good morning
(good afternoon/ evening)
Hello. My name is _____________________and I am here on behalf of Endashaw Hailu,
a post graduate student from BDU, school of chemical and food engineering. I am here to
collect information on the current nutritional status and associated factors. I am
requesting you to participate in this study which would require your response to an
interview on some related issues, measuring weight, height, waist circumference and hip
circumference. The study findings would also be used to design and implement control
strategies in the study area in the future. Your name will not be written in this form and
will never be used in connection with any information you tell us. All information given
by you will be kept strictly confidential. Your participation is purely voluntary and you
are not obligated to answer any question you do not wish to answer. If you feel
discomfort with the interview, you can withdraw any time after you get involved in the
study. This interview will take about 30 minutes. Could I have your Permission to
continue?
1. If yes, continue the interview.
2.If no, skip to the next participant by writing reasons for his/her refusal.
_____________________________________________________________________
For any questions you have, you can contact the Principal Investigator by: 09 13 71 84
78
Interviewer:Code____________Name_______________________signature_________
Date of interview ________Time started ____________Time completed_________
Result of interview: 1. Completed 2.Respondent not available 3.Refused 4. Partially
complete Checked by:Supervisor:Name____________________________
Signature_____________
40
II. Participant consent form for above 18 years Adolescent girls
I have been informed that the purpose of this particular research project is to assess the
nutritional status of adolescent school girls’ and its associated factors. I understand that
I am selected to participate in this study randomly from selected adolescent girls. I have
been informed that participation in this study is entirely voluntary. I can refuse to answer
any specific questions or decide to terminate the study. I have been told that my
answers to questions will not be given to anyone else and no reports of this study
will ever identify me in any way. I have also been informed that my participation or my
refusal will have no effect on me and my grades. Am the invited participant, given all
relevant information concerning the purpose of this particular study, participants to
be included, the study procedure, benefits and risks of the study, consent and
confidentiality read and explained to me, I decided: to participate in the study:
Date-------------------Signature-------------------
41
III. Informed Consent Form for Parents/Guardian
Good morning (good afternoon/ evening) Hello’ my name….…………I am working
with Ato,Endashaw Hailu (the Principal Investigator) who is doing the research for
partial fulfillment of the requirement for t master of science in Applied Human
Nutrition ,Bahir dar university post graduate program. Your child has been selected
randomly to participate in this study. Since your child is under age 18, as a
parent/guardian your child participation in the study was totally based on your
willingness so you need to be aware of every detail information regarding the
study to declare your agreement concerning the study.
Title Of The Study: To assess nutritional status and associated factors among high
school adolescent girls in Soddo dachi woreda, south west shoa .
Purposes Of The Study: The study will be done for partial fulfillment of master degree
Applied human nutrition. The research will also be helpful for collect some
scientific information about the nutritional status of adolescent secondary school girls.
Procedure: The study was carried out simply by asking your child with predetermined
structured questions. Filling the questionnaire will take about 30 minute, so your child
kindly requested to return the filled questionnaire on time. However, if your child does
not want to participate in the study put the format upside down on the table and she can
leave out. Finally measurement of your child height and weight with minimum
clothing and no foot wear was taken. This will not take more than 10 minutes.
Confidentiality: All information your child gives was kept confidential and will not be
accessible to any third party; your child name will not be registered on the question sheet
so that your child will not be identified.
Risks, Benefits and Harms: Your child participation in the study no payment is
granted or has no any special privilege for your child, but participating in the study and
giving your child genuine information will provide great input to bring change in
Nutritional Status of Adolescent Secondary School girls. The procedure does not bear
42
any physical or psychological trauma on your child. Because of her refusal your child
will not face any problem on her grades and there was no significant harm and risks
further than slight discomfort due to sharing study time if your child may be busy to
respond the questions.
Rights: Your child participation in the study was totally based on your agreement and the
child has the right not to participate from the beginning, or may stop participating at any
time after starting participation. Your child refusal will have no effect on your child and
your child grades and will not be forced to give information that she does not know.
For any questions you have, you can contact Ato.Endashaw Hailu ( the Principal
Investigator) by: 09 13 71 84 78
43
IV. Consent for Parents/Guardian
I am the parent of the student asked to be a study participant. Based on the information
provided by the principal investigator, understand that the name of my child will not be
written in the format, the information provided by my child will not be used for other
purpose and will not hurt my child by any means rather the information obtained from
my child will help to identify the main nutritional problems of adolescent girls and to
solve the identified problems in the future. So I decided: to participate in the study:
Date-------------------Signature--------------------V. Verbal Assent
44
For Under Age 18 Years Adolescent Girls before Conducting Study
Greeting
Hello’ my name….…………I am working with Ato. Endashaw Hailu (the Principal
Investigator) who is doing the research for partial fulfillment of the requirement
masters of science in applied human nutrition at Bahir dar University post graduate
program. You are selected randomly to participate in this study. Since your age is under
age 18, your parent/guardian signed for you to participate in the study. Your participation
in this study selected randomly from school students. The study was carried out
simply by asking you with predetermined structured Questions. Filling the questionnaire
was taken about 30 minute, so you are kindly requested to return the filled questionnaire
on time. Your name will not be written in this form and will never be used in connection
with any information you tell us. All information given by you was kept strictly
confidential. However, if you do not want to participate in the study please put the
format upside down on the table and you can leave out. Finally measurement of
your height and weight, this will not take more than 10 minutes. Could I have your
permission to continue?
For any questions you have, you can contact the Principal Investigator by 09 13 71 84 78
Title of the Study: To assess nutritional status and factors associated with nutritional
status among adolescent girls in Soddo dachi woreda ,south west shoa.
Purposes of the Study: The study was done for partial fulfillment of masters of science
in Applied Human nutrition. The research will also be helpful for collect some
scientific information about the nutritional status of adolescent secondary school girls.
Procedure: The study was carried out simply by asking your child with predetermined
structured questions. Filling the questionnaire will take about 30 minute, so your child
kindly requested to return the filled questionnaire on time. However, if your child does
not want to participate in the study put the format upside down on the table and she can
45
leave out. Finally measurement of your child height and weight with minimum
clothing and no foot wear was taken. This will not take more than 10 minutes.
Risks, Benefits and Harms: Your child participation in the study no payment was
granted or has no any special privilege for your child, but participating in the study and
giving your child genuine information will provide great input to bring change in
Nutritional Status of Adolescent girls. The procedure does not bear any physical or
psychological trauma on your child. Because of her refusal your child will not face any
problem no significant harm and risks further than slight discomfort due to sharing study
time if your child may be busy to respond the questions. If yes, to fill the questionnaire. If
no, skip to the next participant.
Informed consent Certified by
Facilitator’s Name --------------------------------signature------------------
46
APPENDIX 2: OROMIFFAA CONSENT FORM
Insititiyyuti Teknoloojii Baahir daariti,mana barumsa enjinariingii kemikaalaafi sirna
nyaataa boca odeeffanno fi Hayyamaa, Sakatta’a sadarkaa nyaata fi wanttot issan
walqabatan ilaalchisee shamaran Aanaa Soddoo Dacii argaman ira tti kan
gaggeeffamudha.
Seensa
Maqaan koo-------------------- jedhama.Gaheen hojii koo, qorannaa Obbo.Indaashaaw
Haayilu diigrii lamaffa isatiif gaggeessu kessattii ragaa funaantuu ykn raga sassaabduu
dha. Gaaffii fi deebin godhamu kun sadarkaa nyaata fi wantota issan walqabatan
ilaalchisee ijoollee mana barumsa sadakaa 1ffaa fi 2ffaa . Aanaa Soddoo Dacii keessatti
argaman irratti odeeffanno argachuuf yaadame ti. mucaan keessan Hirmaattuu qorannoo
kanaa taatee filatamtettii
Kayyoon Qorannaa
Qorrannaan kun sadarkaa nyaataa fi wantoota issan waiiqabatan irratii , shamarran
mana barumsa sadarkaa 1ffaa fi 2ffaa Aanaa Soddoo Dacii kessatti gageefamudha kayyoo
kana galmaan gahuf, amanamummaa fi hirmannaa mucaa keesan gaaffilee qopha’aniif
deebii nu kennuu fi mucaa keessan ilaalchisee hayyamni nuuf kennitan baay’ee
barbaachisaa dha.
Miidhaa
Gaaffii fi deebin godhamu kun miidhaan mucaa kessanirati gahu hinjiru.
bu’aa
Qorannaa kana irratti hirmaachuu isheetin /keetin kalattiin fayidaan argatu hin jiru
Hirmannan mucaani kassan gootuu/ raawwatuu / kun fedhii ishee irratti qofa kan
hunda’u ta’u, yeroo barbaadde hirmaannaa ishee dhabuuf ni dandeessii. Gaaffilee siif
dhiyataniif deebii laachuu/ kennuu/ dhiisuuf mirga qabdii.
47
Yeroon mariin dabalata barbaachisaa ta’ee argame,odeeffanno dabalatatiif ishiin
gaafadha. Odeeffannoon Initaltti kessani nuuf kennitu lakkoofsa iciitiin malee maqaan
ishii hin galmaa’u waan ta’eef iciitin eegamadha. Kanaafuu, kan ilaalchisee hin
dhiphatinaa. Dabalataan, qorannaan kun sadarkaa hir’ina nyaata ijoollee mana barumsa
sadarkaa 1ffaa fi 2ffaa waluma galatti kan nu barsiiisu fi dhimmoota ciccimoo addaan
baafannee dandeetti barumsa ijoollee foyyesuuf bu’aa qaba. Mariin goonu wal-haa’iru-
malee, daqiiqaa 20-30 fudhachuu danda’a kanaafuu, fedhii mucaa kessanii irratti
hundoofnee mijeessuu ni dandeeyna. Gaaffii daranitti ibsa barabaadan yoo siqunname,
ogguun barbaaddee gaafachuu ni dandeessuu.
Waa’ee qorannaa kana ilaalchisee gaaffii ykn dhimmaa addaa yoo qabaattan, lakkoofsa
bilbilaa kanaan ------------- ittigaafatamaa koree Etiksii (Amalaa) fi qorannaa Univarisitii
Baahir Daar )----------------- walduraa duuban.
Qorannaa kana irratti mucaan kessan akka hirmaatu yoo fedhii qabaatan,jechoota walii
galtee arimaan gadirratii mallattoo keessani nuf kaayaa .
Jechoota Walii Galtee
Waligaltee kana dubiseera ykn na dubbifameera. Gaffiin qabus naaf deeb’eera. Kaayyoo
fi bu’aan qorannoo kanaa ibsameera. Kaanaaf, mucaan koo akka itti hirmaatuu
waliigaleerra (fedhii kooti).
___________________ __________________
______________
Maqaa Mallattoo Guyyaa
Eeyyama kessaniif heddu isin galateeffnna!
48
APPENDIX 3.ENGLISH QUESTIONNAIRE
BAHIR DAR UNIVERSITY GRADUATE STUDY PROGRAMME
Q1. Questionnaire ID number _________
Q2. Residence area---------------
1. Woreda ------------- 2- kebele ............................
Q3. Name of the school ____
Q4. Result code (1=completed, 2=partially completed, 3=refused, 98=other specify)
Checked by, facilitator’s Name_________ Signature _________Date_________
Part I. Socio-demographic questionnaire
Ser.no Questions Response
101 Age years________
0102 Educational status grade ______
103
Religion?
1. Orthodox
2.Muslim
3. Protestant
4. Catholic
98. Others(specify)
104
Ethnicity?
1. Oromo
2. Guraghe
98. other (specify)
105
Which explains about your family
1. Both parent alive
2. Father alive
3. Mother alive
4. both parent died
1. with my parents
49
106 What is Your current living arrangement
2. with relatives
3. with other students in
rented house
4. living alone
5. Other arrangement
107
What is your father’s education level
1.No Formal Education
2.1-4 Grade
3. 5-8 Grade
4. 9-10 Grade
5. 11-12 Grade
6.College/University
Completed
108
Occupation of your father
1. Farmer
2. Government employee
3. Merchant/Trade
4. private Org. employee
5. Daily laborer
98. Other specify______
109
What is your mother’s education level
1. No formal education
2. 1-4 grade
3. 5-8 grade
4. 9-10 grade
5. 11-12 grade
6. College/ university
completed
110
Occupation of your mother
1. House Wife
2. Government Employee
3. Merchant /Trade
4. private Org. employee
5. Daily laborer
50
6. Farmer
98. Other Specify______
111
How many people including Yourself, live in
your household?
______number of people
112 How many rooms are available for the family?
1.only one room
2.two and above
3.other
113 Who is the head of your family? 1.male
2.female
114 How much is your annual income in birr? 1.<500 birr
2.500-1000birr
3.1000-1500 birr
4.>1500-2500 birr
5.2501-3500 birr
6.>3500 birr
115 Wealth Index Answers
116
Do you have your family privately owned
house?
1. Yes
2. No
117 Do your family have Adequate sleeping
room?
1.Yes
2.No
118 Do your family have Year round secure
income?
1.Yes
2.No
119 Do your family have Cattle? 1.Yes
2.No
120 Cash money 1.Yes
2.No
121 Do your family have Car? 1.Yes
51
2.No
122 Do your family have Television ? 1.Yes
2.No
123 Do your family have Tape/Radio? 1.Yes
2.No
124 Do your family have Telephone? 1.Yes
2.No
125 Private Water pipe 1.Yes
2.No
126 Do your household have latrine? 1.Yes
2.No
127 What is source of your drinking
water?
1. Well
2.Spring water
3. Rain water
4. Pipe water
5. Others specify
Part II: 24 hour recall questionnaires
Ser.no Questions Response
Now I would like to ask you about the foods and liquids you had yesterday during the
day or at night, either separately or combined with other foods or liquids. Did (YOU) eat
or drink: Food items
201 Any porridge or gruel (made from grains other than
teff)?
1. Yes
2. No
202 Bread, pasta, rice, noodles, biscuits, cookies or any
other food made from oats, maize, barley, wheat,
sorghum, millet, or other grain?
1. Yes
2. No
203 Any food made from teff, like injera, kita, or
porridge?
1. Yes
2. No
52
204 Irish potato ,koccho, cassava 1. Yes
2. No
205 Any carrots, hujjure, mitatisfa whicha are yellow or
orange in color in their inner parts
1. Yes
2. No
206 Any dark green, leafy vegetables like kale, spinach
or amaranth leaves?
1. Yes
2. No
207 ripe mangoes, ripe papayas? 1. Yes
2. No
208 Any other fruits or vegetables 1. Yes
2. No
209 Any liver, kidney, heart or other organ meats? 1. Yes
2. No
210 Any beef, goat, or wild edible animals’ meat 1. Yes
2. No
211 Any chicken, or other wild birds edible? 1. Yes
2. No
212 Any eggs 1. Yes
2. No
213 Any fresh or dried fish or shellfish? 1. Yes
2. No
214
Any foods made from beans, peas, lentils or pulses?
1. Yes
2. No
1. Yes
2. No
215 Any nuts or seeds such as peanuts, sesame or
sunflower seeds?
1. Yes
2. No
216 Any cheese, yogurt, milk or other milk products? 1. Yes
2. No
217 Any foods made with oil, fat, or butter? 1. Yes
53
2. No
218 Any tea or coffee? 1. Yes
2. No
219 Any sugary foods or drinks, such as pastry, cakes,
chocolates, sweets or candies, sodas, fruit juices or
drinks?
1. Yes
2. No
Part III: Food frequency questionnaire
Ser.no Questions Response
301
How many times do you consume milk/milk product
and Coffee/yogurt during 1 week?
1.1–2 times
2. 3–4 times
3. more than 4 times
4. 1 time in 10–15 days
5. Never
302
How many times do you eat pasta/rice/bread/potatoes
during 1 week?
1.1–2 times
2.3–4 times
3.more than 4 times
4.1 time in 10–15 days
5.never
303 Do you eat fruit and vegetable every day?
1. yes
2. no
304 How many times do you eat meat in 1 week?
1. 1–2 times
2. 3–4 times
3. more than 4 times
4. 1 time in 10–15 days
5. never
305
How many times do you eat eggs in 1 week?
1.1–2 times
2. 3–4 times
3. more than 4
4.1 time in 10–15 days
54
5. never
306
How many times do you eat cheese in 1 week?
1. 1–2 times
2. 3–4 times
3. more than 4 times
4. 1 time in 10–15 days
5. never
307
How many times do you eat legumes in 1 week?
1. 1–2 times
2. 3–4 times
3. more than 4 times
4. 1 time in 10–15 days
5. never
308
How many times do you eat sweets and cakes in 1
week?
1. 1–2 times
2. 3–4 times
3. more than 4 times
4. 1 time in 10–15 days
5. never
309
How many times do you eat fried potatoes in 1 week?
1. 1–2 times
2. 3–4 times
3. more than 4 times
4. 1 time in 10–15 days
5.never
310 How times do you eat in a fast-food in 1 week?
1. 1–2 times
2. 3–4 times
3. more than 4 times
4. 1 time in 10–15 days
5.never
311 How often do you eat breakfast?
1. Always
2. Often
3. Sometimes
4. never
312 Which beverage do you consume at
Break fast?
1.milk/milk product
and
coffee/cappuccino/
55
yogurt
2.fruit juice
3. tea/coffee
4.chocolate
5. Mixed (more than 2
answer)
313 At breakfast you eat
1.biscuits
2.cereals/bread
3. fruit
4.Vegetabel
5. pasta/ macoroni
6. Mixed(more than 2
answer)
98.others specify
314 Do you usually eat, lunch and dinner every day?
1.Always
2.often
3.sometimes
4.Never
315 Your diet: is 1. Different every day
2. Is different only
sometimes
during a week
3.Is different only
during the weekend
days
4. is very monotonous
316 Your diet is based mainly on 1.High protein content
foods (meat,
fish, egg, dried legumes)
2. high fat content
foods potatoes,cakes
56
with butter and cream)
3.high carbohydrate
content foods(bread,
pasta, rice, potatoes, )
4. different foods every
day
317 Your snacks are based mainly on:
1. fruit/fruit juice/fruit
and milk
2. biscuits/bread/
3. fried potatoes/pop
corn
98. others specify
318 What do you prefer to do during free
time
1.walking
2. watching TV
3.listening to
music/using the
computer
4. reading a book
5. practicing a sport
6. shopping
319
The physical activity that you practice
at school
1. tiring
2. boring
3. stimulates you to
practice sport seven out
of school
57
Part IV. Behavior, life style and Health information
ser.no Questions Response
401
During the past 7 days how long did it usually take
for you to get to and from school each day by
walking?
1. less than 5 minutes
2.less than 30 minutes
3.less than 1 hours
4.Greater than one hours
98.Other specify____
402 Do you smoke shisha?
1.Yes
2.No
403 Have you ever chew chat?
1.Yes
2.No
404 What was your age in years at your first
menstruation?
-----------years of age
405 Did you have any health problem in the last one
month (four weeks passed)?
1. Yes
2. No
406 If yes what was the health problem you had? ------------------------
Part V . Anthropometric Measurement
1 Height in centimeter.
2 Weight in kg.
3 MUAC
58
APPENDIX 4.Questionnaire( Oromiffa)
001. Lakkofsaa gaaffilee ittin addaa bahu________________
002. Bakka jireenyaa 1. Aanaa-----------------------2.Ganidda----------------------------
004. Maqaa manaa barumsichaa----------------------------------------------
003. bu’a odeffanno guutamuu kan agarsisuu(1=guutuu 2=amm ta’e kan guutamee
3=guutamuu kan didamee
98= kan biroon yoo jiratee addaa basii)
Kutaa I –gaaffii odeeffannoo bu’uraa
Lakk Gaaffi/madaalii Deebiilee
101 Umrii keessaan meeqa? _____waggaa
102 Sardarkaa barumsaa ______kutaa
103 amantii keessaan maqaa 1. Ortodoksii
2. islaama
3.protestantii
4.katoolikii
98.Kan biraa(ibsi)______
104 Sabni kee hoo?
1. Oromoo
2.Guraagee
98.Kan biraa(ibsi)_________
105 Kamtu waa’ee maatii keeti ibsa
1.maatiin lamanuu lubbuun ni jiran
2. abban koo lubbuunni jira
3. haatii koo lubbuun ni jirti
4. maatiin lamanuu lubbuun hin jiran
106 Yeroo ammaa eessa jiraatta?
1.Abbaa fi haadha kiyyaa wajjin
2.haadha kiyyaa wajjin
3.Abbaa wajjin
4.Fira kiyyaa wajjin
5.Kan biraa(ibsi)_________
107 Sadarkaan barumsaa abbaa 1.barumsaa kan hin qabnee
59
Keessaan
2.1-4 grade
3.5-8 kutaa
4.9-10 kutaa
5.11-12 kutaa
6.barumsaa kollajjii / univarsiit kan
xumuree
108
Yeroo ammaa kanaa hojiin
abba keessaan maalii?
1.Qotee bulaa
2.hojjata mootummaa
3.hojji dhuunfaata qacaraman kan
hojjatan
4.hojii guyyaa kan ojjatan haadhaa
5.warraa manaa keessaa kan
Tajaajilan daldalaa.
6.Kan biraa(ibsi)_________
109
Sadarkaa barumsaa harmee
Keetii
1. barumsaa kan hin qabnee
2.1-4 kutaa
3.5-8 kutaa
4.9-10 kutaa
5.11-12 kutaa
6. barumsaa kollajjii / univarsiit kan
xumuree
110
Yeroo ammaa kanaa hojiin haadha/
harmee keessaan maalii?
1. haadhaa warraa
2.hojjata mootummaa
3.hojji dhuunfaata qacaraman kan
hojjatan
4.hojii guyyaa kan hojjatan
5.manaa keessaa kan tajaajilanmdaldalaa
6.Kan biraa (ibsi)_________
111 Si dabalatee namaa meeqaa tatan
manatti galtuu?
______ baay’ina namaa
60
112 Haala jiru fi jireenya keeti maatii
kee wajjin
1.mana tokko keessa waliin jirana
2. mana garagaara keessa jirana
3. kan bira
113 Saalaa abbaa maatii 1.Dhiira
2.Dubartii
114 Galii maatiin oggaa keessati argatan
meeqa?
1birii.<500
2.birrii500-1000
3.birii 1000-1500
4. birii1501-2500
5.birrii2501-3500
6.birrii >3500
115 Qabeenya dhunfa armaan gadii
keessa maatiin kee kam qaba
Deebii...
116 Manaa dhunfaa kessan 1.eeyyee
2.lakkii
117 mana jirenyaa gahaa 1.Eeyyee
2.lakkii
118 galii waggaa waggatii 1.eeyyee
2.akkii
119 horii 1.eeyyee
2.akkii
120 mallaqaa 1.eeyyee
2.lakkii
121 konkoolaata 1.eeyyee
2.lakkii
122 Teleevijiinii 1.eeyyee
2.lakkii
123
Teephii/Raadiyoo 1.eeyyee
2.lakkii
124 bilbila 1.Eeyyee
61
2.lakkii
125 bishaan bombaa mooraa
kessaa
1.eeyyee
2.lakkii
126 Mana boolii/mana fincaanii qabdaa?
1.Eeyyee
2.Lakkii
127
Maddi bishaan dhugaatii irra
jireessa?
1..boonoo
2.hujumoo mana jireenyaa keessa jiru
3.bishaan lagaa
4.bishaan bollaa gadii faggoo
5.burqituu/maddaa roobaa
6.kanbiroo ibsii
Kutta II: gaaffii waa’ee nyaata sa'aa 24 darbee keesatii nyaatame
Lakk Gaaffi/madaalii Deebiilee ski
Amma waa’ee nyaata yookaan dhugaatii kaleessa ganama, guyyaas tahee halkan
wolwojjiinis tahee Kophaa isaatti maal maal akka nyaattan yookaan dhugdan isin
gaafachuu barbaada?
201 Marqa/shuroo/bulluqa kan midhaan adda addaa irraa
tolfame
(Xaafiini ala worra tahan)
1.eeyyee
2.lakkii
202 Daabboo Paastaa, ruuza Buuskuta, Kukisii fi nyaata gara
biraa kan Loozii, Boqqoolluu, maashillaa, garbuu, qamadii
dangaaja/Bishingaa ykn midhaan gara biraa irraa tolfaman
1.eeyyee
2.lakkii
203 Nyaata gosa kamuu kan xaafii irraa tolfaman, kan akka
buddeenaa qixaa, marqa/shuroo?
1.eeyyee
2.lakkii
204 Dinnicha adii, Bullaa, Worqee casavaa ykn nyaata hiddaa
irraa argaman?
1.eeyyee
2.lakkii
205 Hujuree, Karotii , Mixaaxisha yookaan worra biftti keessa
isaanii Boora/keello/ burtukaan fakkaatu?
1.eeyyee
2.lakkii
62
206 Wontoota baalli nyaatamu kan bifti isaanii Magariisa tahan
worra akka raafuu(goommana, Shinkurtii?
1.eeyyee
2.lakkii
207 Paapayee bilchaate ykn mango bilchaate? 1.eeyyee
2.lakkii
208 Kudraa fi Mudraa gosa biraa kamiyyuu?
1.eeyyee
2.lakkii
209 Tiruu, kale onnee, ykn foon miya garaa keessaa kamuu? 1.eeyyee
2.lakkii
210 Foon loonii kan re’ee, ykn kan worrii tahee kan bineensan
alaa kan
nyaatamoo tahanii?
1.eeyyee
2.lakkii
211 Foon lukkuu ykn alattii nyaatamanii kamuu? 1.eeyyee
2.lakkii
212 Killee(egg) isa kamuu 1.eeyyee
2.lakkii
213 Qurxumii oo’ituu ykn kan gofamte?
1.eeyyee
2.lakkii
214 Nyaata baaqelaa atara, boloqee yookaan loozii/ocholonii
irraa
dalagaman?
1.eeyyee
2.lakkii
215 Wontoota akka talbaa suufa, saliixii fi kan kanafakkaatan? 1.eeyyee
2.lakkii
216 itittuu shalalaa/aybee/ aanan akkasumas waan aanan irraa
tolfaman?
1.eeyyee
2.lakkii
217 Nyaata zayta/ cooma ykn dhadhaan dalagaman? 1.eeyyee
2.lakkii
218 Shaayii ykn Buna? 1.eeyyee
2.lakkii
219
Nyaataa mi’aawaa tahan yookaan kan shukaara irraa
dalagaman kan
1.eeyyee
2.lakkii
63
akka keekii, chokolaatii Karameellaa cuunfaa(juusii),
mushabaqi, halawwaa ?
Kutaa III: gaaffii waa’ee baayina yeroo nyaaanni nyaatamu qabu
Lakk gaaffii Deebii
301 Guuyaa hundaa
anaan/shayii/buna argatee
dhugdaa?
1.eeyyee
2.lakkii gara G. 303 darbii
302 yoo deebiin kee eeyyee
ta’ee kubayaa meeqa meeqa
guyyaatti dhugda?
1.1-2
2.3-4
3. afur ol
303 Yoo lakkii ta’ee kubaayaa
meeqa torban tokkoo
keessatti dhugdan?
1.1–2
2.3–4
3.Yeroo 4 ol Yeroo
4.1guyyoota 10 15keessatti
5.Siruumma hin dhugne
304 Guyyaa guyyaan
pasta/ruzaa/daaboo/dinnichaa
nyaate beekta?
1. eeyyee
2. lakkii
305 Yoo lakkii ta’ee, torbaan
keessaatti yeroo meeqa
nyaataa?
1.yeroo 1–2
2. yeroo 3–4
3.yeroon4 ol
4. Yeroo 1guyyoota 10–
15keessatti
5. Siruumma hin nyaanne
306 Guyyaa guyyaa dhaan
kuduura fi muduura nyaate
ni beekta?
1.eeyyee
2. lakkii
64
307 Torban keessatti foon
yeroo meeqa nyaata?
1.yeroo1–2
2. yeroo3–4
3. yeroo4 ol
4. Yeroo 1guyyoota 10–15 keessatti
5. Siruumma hin nyaanne
308 Torban keessatti killee
yeroo meeqa nyaata?
1.yeroo1–2
2. yeroo3–4
3. yeroo4 ol
4. Yeroo 1guyyoota 10– 15keessatti
5. Siruumma hin nyaanne
309
Torban keessatti ayibii
yeroo meeqa nyaata?
1.yeroo1–2
2. yeroo3–4
3. yeroo4 ol
4. Yeroo 1guyyoota 10–15keessatti
5. Siruumma hin nyaanne
310 Torban keessatti ataara ykn
baqeelaa yeroo meeqa
nyaata?
1.yeroo1–2
2. yeroo3–4
3. yeroo4 ol
4. Yeroo 1guyyoota 10–15keessatti
5. Siruumma hin nyaanne
311
Torban keessatti mi’awaa
ykn keekii yeroo meeqa
nyaata?
1.yeroo1–2
2. yeroo3–4
3. yeroo4 ol
4. Yeroo 1guyyoota 10–15keessatti
5. Siruumma hin nyaanne
312 Torban keessatti dinnichaa
bilchaata yeroo meeqa
nyaata?
1.yeroo1–2
2. yeroo3–4
3. yeroo4 ol
4. Yeroo 1guyyoota 10–
15keessatti
65
5. Siruumma hin nyaanne 5.never
313 Nyaata daddefin
tolfemo/selittan Torban
keessatti yeroo meeqa
nyaata?
1.yeroo1–2
2. yeroo3–4
3. yeroo4 ol
4. Yeroo 1guyyoota 10–15keessatti
5. Siruumma hin nyaanne
314 Cirree kee yeroo meeqaa
nyaata ?
1.Yeroo hundaa
2.Yeroo baay’ee
3.darbedaarbe
4.siruummaa hin nyaadhuu
315 Cirree yeroo nyaatu
wantoota nama kakkasaan
/dhugaati akkami fudhata?
1.annan/annani fi buna
2. ciimaqii
3. shayii/buna
4.chokolatii
316 Cirree kee wantoota
kanneen nyaate beekta?
1.biskuutii/keekii/
2.daboo
3. kudura
4. aybii
5 pizza
317 Guyyaa guyyaan yeroo
meeqa cirree,laqaana fi
irbaata nyaata ?
1.Yeroo hundaa
2.Yeroo baay’ee
3.darbedaarbe
4.siruummaa hin nyaadhuu
318 Nyaani kee 1.yeroo hundaa garaagara
2.darbedarbee qofa garaagara
3.darbedarbee guyyoota
sanbataa qofa garaagara
4.walfakkaatadha
66
319 Nyaani kee kan hunda’uu
wantoota akkami irratti
1.nyaata pirootiniidhaan
Badhadhee(foon,qurxummii,killee,xaqanaa,
atara/baqeela)
2. nyaata faatii/comaandhaan
badhadhee )
3. nyaata karboohydratiidhaan
badhadhee (daboo, laankeetaa, pasta,
ruzii, dinnicha,biidena xaafii)
4.nyaata gosa adda addaa
320
Cireen kee maal irratii
hundahee?
1. kudurafii muduraa/ ananii
2. biskutii / daboo/laankeettaa
3. ruzaa pasta.dinchaa
4.ka biro (ibsii)-----------------------------------------------
-----------------------------------
321 Yeroo boqonnaa keetii
maal
hojjachuu feeta?
1.deemuu
2.Televiziinii laluu
3.Sirba dhageeffachuu
4.Compitaran barressuu
5.Kitaaba dubbissuu/ qayyqbqchuu
6.Ispoortii shakalu/xabachuu
322 Manaa barmusa kessaati
sochiin jabeenya
qamaa/isportiin at shakkaltuu
maal fakkaata?
1.dadhabsiisadha
2.Jibisisadhaa
3.Gamachisaa/si’eesaa
4.Mana barusa alatiis isportii ni
hoojadha/shakkala
Kutaa 4ffaa Amlaa, haala jireenya fi odeffanno fayyaa
Lakk Gaaffi/madaalii Deebiilee
401 Guyyoota turban darban keessa mana barumsaa dhaqxee
galuuf guyyaaguyyaan hangam sitti fudhata millati?
1.Daqiiqaa 5
2.Daqiiqaa 30
67
3.Sa’aa 1
98. Kan
biraa(ibsi)
402 Shisha (tamboo) ni xuuxxaa? 1.Eeyyee
2.lakkii
403 Jimma niqaamaata? 1.Eeyyee
2.Lakkii
404 Yeroo laguu jalqabaa umuriin kee meeqa ture Waggaa_______
405 Torbaan afran dabare keessa rakaaooleen fayyaa kamiyyuu si
mudatee beekaa?
1.Eeyyee
2.lakki
406 Rakaaooleen fayyaa ykn dhibee akkamtu si qunnamee ture?
----------------------
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Kutaa 5ffaa mala ittin namaa hiri’na nyaata qabu ittin addaa basuuf fayyadamu.
1 Dheerina sentimeetiriin ____Sentimeetriidhaan
2 Ulfaatina kiloogiramanidhaan ____kiloogramiidhaan
3 MUAC
--------------Sentimeetriidhaan