DSpace Institution

DSpace Repository http://dspace.org

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

Downloaded from DSpace Repository, DSpace Institution's institutional repository

i

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:

ii

© 2017

Endashaw Hailu Gelan

ALL RIGHTS RESERVED

iii

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

iv

To my mother Felekech Gelan

v

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.

vi

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

vii

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

viii

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

ix

5.1.Conclusion .................................................................................................................. 35

5.2.Reccomendations ........................................................................................................ 35

REFERENCES ................................................................................................................. 36

APPENDIXES .................................................................................................................. 39

APPENDIX 1 .................................................................................................................... 39

APPENDIX 2 .................................................................................................................... 46

APPENDIX 3 .................................................................................................................... 48

APPENDIX 4 .................................................................................................................... 58

x

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

xi

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

xii

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.

1

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

2

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

3

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)

4

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.

5

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)

6

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

7

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)

8

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)

9

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)

11

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)

12

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?

----------------------

----------------------

---------------

Kutaa 5ffaa mala ittin namaa hiri’na nyaata qabu ittin addaa basuuf fayyadamu.

1 Dheerina sentimeetiriin ____Sentimeetriidhaan

2 Ulfaatina kiloogiramanidhaan ____kiloogramiidhaan

3 MUAC

--------------Sentimeetriidhaan