Access to this full-text is provided by Wiley.
Content available from Journal of Nutrition and Metabolism
This content is subject to copyright. Terms and conditions apply.
Research Article
Magnitude of Stunting and Associated Factors among Adolescent
Students in Legehida District, Northeast Ethiopia
Wassachew Ashebir Kebede
1
and Belete Yimer Ayele
2
1
Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
2
Department of Human Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
Correspondence should be addressed to Wassachew Ashebir Kebede; ashebirwase@gmail.com
Received 20 May 2021; Revised 29 August 2021; Accepted 8 October 2021; Published 15 October 2021
Academic Editor: Eric Gumpricht
Copyright ©2021 Wassachew Ashebir Kebede and Belete Yimer Ayele. is is an open access article distributed under the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Background. Undernutrition including stunting particularly at an adolescent stage was not emphasized by various intervention
strategies in the Ethiopian context. Assessing the magnitude and potential risk factors of undernutrition is thus helpful for
policymakers to design appropriate intervention strategies. Hence, this study was aimed at assessing the magnitude of stunting
and associated factors among adolescent students in Legehida district, Northeast Ethiopia. Methods. A school-based cross-
sectional study was conducted among 424 adolescent students from February 15
th
to March 15
th
, 2018. A stratified sampling
followed by a simple random sampling technique was used to select the study participants. A pretested, structured, and self-
administered questionnaire was used to collect the required data. Height was measured by using a portable stadiometer and the
height-for-age (HFA) z-score was calculated as an indicator of stunting. SPSS version 25 and WHO AnthroPlus software were
applied to analyze the data. A multivariable logistic regression analysis was performed to identify factors associated with ad-
olescent stunting. Statistical significance was determined at a pvalue of <0.05 and association was described by using an odds ratio
at a 95% confidence interval. Results. A total of 406 adolescent students (with a response rate of 95.7%) participated in the study.
e magnitude of stunting among adolescent students in this study was 24.9% (95% CI: 24.6%–35.3%). Conclusions. Stunting
among adolescent students was significantly associated with being male [AOR �2.1; 95% CI: 1.73–5.90], meal frequency (<3/day)
[AOR �4.6; 95% CI: 2.61–8.24], infrequent handwashing practice [AOR �3.6; 95% CI: 1.30–9.40], absence of latrine facility
(AOR �5.51; 95% CI: 3.03–9.9), and consumption of unsafe water [AOR �2.8; 95% CI: 1.35–6.19]. Hence, conducting routine
nutrition screenings and assessments, promotion of proper food intake, and emphasis on nutrition education and counseling are
needed to be strengthened.
1. Background
Adolescence is a critical period of puberty characterized by
substantial physical, mental, and psychosocial changes
fundamentally observed which demand various nutrients. It
is a time of rapid physical growth with nutritional re-
quirements increasing significantly. In the human lifespan, it
is a crucial period that provides a window of opportunity for
high return on investment with nutritional interventions.
Given that prevention of malnutrition in the first 1,000 days
remains a priority, adolescence is another time in life that
offers the last window of opportunity to break the inter-
generational cycle of undernutrition [1–3]. e greater
demand for energy, protein, micronutrient, and minerals
because of the substantial rate of growth and development
makes the period vulnerable to malnutrition. Malnutrition
among adolescents includes suboptimal dietary intake of
macronutrients and micronutrients as well as overweight
and obesity linked to poor dietary quality [1]. Adolescents
are especially vulnerable to undernutrition, in part because
their rapid physical growth and development during puberty
raise their nutritional needs. e absence of adequate nu-
trition is a risk for undermining this crucial period of growth
and development. More importantly, undernutrition occurs
when people do not absorb enough nutrients to cover their
needs for energy, growth, and maintenance of a healthy
Hindawi
Journal of Nutrition and Metabolism
Volume 2021, Article ID 2467883, 7 pages
https://doi.org/10.1155/2021/2467883
immune system or using or excreting them more rapidly
than they can be replaced [4].
It was noticed that the great majority of adolescents in
the world are living in developing or emerging countries.
Indeed, adolescents are increased in number than ever
before and the largest increase by 2050 is expected to occur
in Sub-Saharan Africa. is implies that adequate nutrition
and health for this huge population group is a concern of
priority. However, the health of adolescents in general and
their optimal nutritional needs and services in particular
remain largely neglected [5]. Besides, the current experi-
ences and lessons learned informed that finding ways to
reach the health and nutritional needs of such a large group
of adolescents would remain a key challenge [6].
Undernutrition is one of the most significant universal
health problems increasing the global health burden of
premature mortalities and morbidities during the childhood
period [7]. It is a highly prevalent health problem all over the
world since up to 50% of all adolescents are stunted in some
countries and numbers are significant mainly in low-income
countries [8, 9]. As an important contributor to adolescent
undernutrition, the habit of dietary intake by adolescents
needs special emphasis. It was evidenced that the diets of
adolescents in resource limited countries are generally nu-
tritionally poor. For instance, among adolescent students,
only 34% consumed fruit and 21% vegetables less than once a
day [10].
e available limited evidence on adolescent undernu-
trition revealed that some groups of adolescents face par-
ticular challenges. In this way, the odds of undernutrition
were more pronounced among adolescents of younger age
and living in rural areas and male adolescents [11]. With
respect to the burden of undernutrition among adolescents
in different regions, there is a reported magnitude of 32–65%
in Asia and 4–30% in Africa [12, 13]. With this typical
vulnerability, this group is typically overlooked by, or be-
yond the reach of, national health, education, and devel-
opment institutions. Additionally, the question of how to
reach adolescent boys with nutrition interventions remains
largely unanswered [14–16].
Like other low-income countries, there is no exception
concerning the nutritional status of adolescents in Ethiopia.
e prevalence of adolescent undernutrition in Ethiopia is
very high and is increasing over time [17]. e studies
conducted in Tehuledere district and Chiro Town, Ethiopia,
showed that the prevalence of stunting among adolescents
was 26.5% and 24.4%, respectively [18, 19]. Indeed, some
other local studies have also revealed that the prevalence of
stunting ranges from 12.5% to 47.4% [20]. Multiple factors
influence stunting among adolescents. e sociodemo-
graphic factors are among the important determinants of
stunting for adolescents [21, 22]. Additionally, reproductive
health services and environmental and WASH factors were
reported as contributing factors to adolescent stunting
[23, 24]. According to studies done in Sub-Saharan Africa,
the economy, environment, and diseases contribute to
undernutrition [25].
If left unaddressed, stunting at this stage of life would
have an important effect on health outcomes. Despite
causing significant mortality, it results in delayed physical
growth, impaired motor and cognitive development, poor
concentration, decreased ability to learn and work, and
lower final adult height [26]. It also leads to important
consequences in adult life in terms of reproductive per-
formance and risk of chronic diseases as malnutrition
passes from generation to generation [5, 26]. In this
regard, evidence-based solutions for adolescent nutri-
tional supplementation, food system and dietary intake
interventions, and integration with sexual and repro-
ductive health strategies present crucial opportunities for
improving adolescent health and well-being. Yet the
scarcity of data remains a major barrier that is preventing
governments from responding with effective policies,
strategies, and programs. In the past decades and even
today, adolescents paid little attention to nutrition-related
programs mainly in developing countries including
Ethiopia [2, 9].
Despite a lower mortality rate and relatively little
morbidity, adolescents were typically not prioritized for
targeted public health interventions. Most of the interven-
tions conducted in Ethiopia focused on under-five children
and pregnant and lactating mothers, neglecting the ado-
lescent group in nutrition-related programs [2, 24, 26, 27].
Also, there was scanty evidence on stunting in the adolescent
population mainly among student subpopulations [27, 28].
Moreover, the magnitude of stunting and factors associated
with it among adolescent students were not addressed in the
study area. Undernutrition including stunting particularly at
an adolescent stage was not emphasized by various inter-
vention strategies in the Ethiopian context. Assessing the
magnitude and potential risk factors of undernutrition is
thus helpful for policymakers to design appropriate inter-
vention strategies. erefore, this study was aimed at
assessing the magnitude of stunting and associated factors
among adolescent students in Legehida district, Northeast
Ethiopia.
2. Materials and Methods
2.1. Study Setting, Design, and Period. is study was con-
ducted in the Legehida district (administrative stage) which
is located 503 km away from Addis Ababa to the north and
600 km away from Bahir Dar city in the western direction. In
the district, there are two high schools with a total of 2,178
students, of which 842 are adolescent students in the age
range of 10 to 19 years. According to the District Education
Office 2018 report, Legehida district has a total number of
17602 students (males: 9003; females: 8599). A school-based
cross-sectional study was employed among adolescent
students aged between 10 and 19 years. e source pop-
ulation for the present study was adolescent students at-
tending a government high school in the district, and all
randomly selected adolescent students aged 10 to 19 years
were the study population. Adolescent students who were
severely ill and physically challenged for anthropometric
measurements were excluded from the study. e data
collection was conducted from February 15
th
to March 15
th
,
2018.
2Journal of Nutrition and Metabolism
2.2. Sample Size Determination and Sampling Procedure.
A sample size of 424 adolescent students was estimated using
a single population proportion formula by considering the
following assumptions: a prevalence of stunting 50% (p �
0.5) (as there was no previous study on similar populations),
5% margin of error, 95% confidence level of significance
(Zα/2 �1.96), and a nonresponse rate of 10%. e two high
schools, Almazbum and Shikif, were included in the study.
e total samples distributed to these two schools were
proportionate to their student population size. ere were a
total of 842 students (661 students in Shikif and 181
Almazbum high schools) whose age ranges from 10 to 19
years. Accordingly, 333 students from Shikif and 91 students
from Almazbum were selected and included in the study. A
stratified sampling technique was used to select the study
participants, stratified based on grade level. e number of
sampled students was calculated from each school and di-
vided into grades (9
th
and 10
th
). A sampling frame that
contains the lists of high school students from grades 9 to 10
in the two schools was used based on the lists obtained from
the students’ record office of each school. Sample sections
were selected randomly using a simple random sampling
technique. Students from each section were selected again
using a simple random sampling.
2.3. Data Collection Procedures and Instruments. Data were
collected from the adolescent students using a structured
and self-administered questionnaire. e questionnaire
was developed based on the conceptual framework through
reviewing of different literature and it covered a range of
information on socioeconomic and demographic charac-
teristics, adolescents’ dietary practice, and environmental
and personal hygiene of adolescents. e questionnaire was
initially prepared in English and translated into the local
language (Amharic) and then translated back to English to
check the consistency by language experts. A total of ten
data collectors with diploma holder nurses and two BSc
holder supervisors participated in the data collection
process. Anthropometric data were measured at the high
school premise by well-trained field staff and monitored by
field supervisors. Height was measured using a portable
stadiometer, which consisted of an anthropometric with a
simple triangular headboard to the nearest 0.1 cm based on
the WHO recommendations [29]. For height measure-
ment, two readings were recorded and the computed av-
erage was used in the analysis. WHO AnthroPlus software
was applied to assess nutritional status in terms of stunting
of adolescent students. Such anthropometric measure-
ments were converted into height-for-age z-scores and
compared to the new 2007 WHO reference data for 5–19
years [29, 30]. en, the calculated height-for-age (HFA)
z-score was used to classify stunting [31]. ose adolescents
with height-for-age z-scores <−2SD were considered
stunted. Data quality was checked during questionnaire
designing, data collection, and data entry. e question-
naire was pretested among 5% of study subjects to the
neighboring district (Woreilu). e data collectors and
supervisors were trained at district town (Woinamba) for
one day on the objectives of the study and data quality to
minimize interindividual variability (measurement of
precision and accuracy of each trainer were calculated and
maintained during the training session).
2.4. Data Processing and Analysis. Before data entry and
cleaning, the data were checked manually for completeness
and consistency. en, data were coded and entered into
EpiData version 3.1 and exported to SPSS version 25 for
analysis. Anthropometric data were entered and analyzed
using AnthroPlus software. A descriptive summary (fre-
quency with proportions, mean and standard deviations)
was used to summarize the variable. Bivariable and multi-
variable logistic regression analyses were performed to assess
the association between different independent variables and
adolescent stunting. All variables with a pvalue <0.2 [31] in
the bivariable analysis were entered into the multivariable
logistic regression model. e odds ratio with its 95%
confidence intervals was estimated to identify factors as-
sociated with stunting. A pvalue <0.05 was considered to be
statistically significant.
2.5. Ethical Considerations. Ethical clearance of this study
was approved by the Institutional Ethical Review Committee
(IERC) of Health Sciences College of Debre Markos Uni-
versity. e official letter of cooperation was written to
Legehida district health offices and a support letter from the
district health office was written to high schools where the
study was conducted. e nature of the study was fully
explained to the study participants and parents/guardians.
Well-informed verbal and written consents were obtained
from the parents/guardians for adolescent students aged <18
years and assent was obtained from the participant before
administering the questionnaire. Participants ≥18 years were
asked to provide verbal and written consent. e collected
data were kept confidential. Each participant was given a
code number, and the data were stored in a secure protected
place.
3. Results
3.1. Sociodemographic Characteristics of Adolescent Students.
Of 424 adolescent students who participated in the study,
complete data were obtained from 406 participants, making
the response rate 95.8%. Of the total respondents, males
accounted for 206 (50.7%). e mean age of the respondent
was 16.8 ±1.09 years. e majority of the participants, 296
(72.9%), were Muslim and all of the respondents were
Amhara in ethnicity. More than half (54.2%) of the par-
ticipants were living with both of their parents. e ma-
jority of the participants’ families (65%) were residing in
rural areas. With respect to family socioeconomic status,
32.2% and 60.3% were living in households with low and
middle income, respectively. Regarding parental education,
three hundred eight (75.9%) of the respondents’ fathers and
two hundred sixty (64%) of their mothers were literate
(Table 1).
Journal of Nutrition and Metabolism 3
3.2. Water and Sanitation-Related Factors. e majority of
the adolescents, 338 (83.3%), had a functional latrine at their
home and 277 (68.2%) used pipe water for drinking. More
than three-fourths of the adolescents, 341 (84%), had the
habit of washing their hands after using the toilet, and re-
garding the frequency of handwashing with soap, 314
(77.3%) of adolescent students always wash their hands
(Table 2).
3.3. Dietary and Nutritional Status of Adolescent Students.
Out of the total adolescent students, 272 (67%) had a daily
meal frequency of three and above. In terms of meal skipping
experience, 329 (81%) of respondents were skipping their
meal, and snack was the major type of meal skipped, 214
(52.7%). Based on the findings of the study, the magnitude of
stunting among adolescent students in this study was 24.9%
(95% CI: 24.6%–35.3%). More boys than girls were stunted
(33% vs. 16.5%) in this study.
3.4. Factors Associated with Stunting of Adolescent Students.
After controlling for the effects of potentially confounding
variables using multivariable logistic regression, male sex,
frequency of food intake per day, availability of latrine at
home, frequency of washing hands with soap after toilet, and
source of drinking water significantly predicted stunting
among adolescent students (p<0:05).
Accordingly, male adolescent students were more than 2
times more likely to be stunted than their female counter-
parts [AOR �2.1; 95% CI: 1.73–5.90]. Also, adolescents who
consumed food two or fewer times per day were 4.6 times
more likely to be stunted than those who consumed food
more than two times per day [AOR �4.6, 95% CI: 2.61–8.24].
A significant association was also observed between stunting
and availability of latrine, in which adolescents from families
who did not have latrine were more than 5 times more likely
to be stunted than those who had latrine at home
[AOR �5.51, 95% CI: (3.03–9.9). e frequency of washing
hands with soap after the toilet was another significant factor
for stunting, in which adolescents who sometimes wash their
hands with soap after toilet were 3.6 times more likely to be
stunted compared to those who always wash their hands
[AOR �3.6, 95% CI: (1.30–9.40)]. e odds of having
stunting were almost 3 times higher among adolescents who
get their water from river as compared with those who get it
from pipe water source water [AOR �2.8; 95% CI: 1.35–6.19]
(Table 3).
4. Discussion
is study tried to determine the magnitude of stunting and
associated factors among adolescent students. Accordingly,
the magnitude of stunting was 24.9% (95%CI: 24.6–35.3).
Male sex, daily meal frequency of less than three, infrequent
handwashing practice with soap after toilet, absence of la-
trine facility at home, and consumption of unsafe water were
significantly associated with stunting among adolescent
students.
e magnitude of stunting in this study was almost
comparable to a study conducted in Tigray (26.5%) [32] and
Gondar town (27.5%) [33]. e possible explanation for such
comparable findings could be shared social and cultural
contexts, feeding experiences, economic opportunities, and
degree of understanding about the advantage of optimal
nutrition during adolescence. Nevertheless, it is much
greater than the study conducted in Addis Ababa (7.2%) [34]
and South-Western Nigeria (15.7%) [35]. is variation
might be related to differences in the extent of awareness
among Addis Ababa and Legehida district mothers because
the relevance of optimal feeding practice and attention given
to adolescents’ nutrition by their families is likely to be
different and better in Addis Ababa than Legehida district.
Table 1: Sociodemographic characteristics of adolescent students in Legehida district, Northeast Ethiopia, 2018.
Variable Category Number Percentage
Sex Female 200 49.3
Male 206 50.7
Age 14–16 368 90.6
17–19 38 9.4
Religion Orthodox 110 27.1
Muslim 296 72.9
Living condition
With father and mother 220 54.2
Father only 32 7.9
Mother only 38 9.4
With others 116 28.6
Family residence Rural 324 79.8
Urban 82 20.2
Family socioeconomic status Low 131 32.2
Middle 245 60.3
Father education Illiterate 98 24.1
Literate 308 75.9
Mother education Illiterate 146 36.0
Literate 260 64.0
Grade level 9
th
262 64.5
10
th
144 35.5
4Journal of Nutrition and Metabolism
Moreover, access to health care which is greatly influenced
by income status and availability of high-quality foods
generally can explain the existing difference in magnitude of
stunting. e discrepancy with the Nigerian study is
probably due to the marked variation in the habit of food
intake, socioeconomic status, and cultural variation between
research respondents. In Nigeria’s study, most of the study
participants were from urban residents that would impose
less risk to develop stunting associated with better dietary
practice, minimal workload, and awareness about feeding.
In this study, adolescent boys had 2.1 times higher odds
of stunting compared to girls. is result was in line with the
study findings in different parts of Ethiopia and Nigeria
[19, 25, 35]. e reason for the high prevalence of stunting
among males than females might be related to biological,
behavioral, and sociocultural mechanisms. In Ethiopia,
national nutritional programs and interventions had a
special interest and focus on adolescent girls [36]. However,
the current study shows that, compared to girls, boy ado-
lescents are significantly being affected by stunting. Hence,
nutritional programs and interventions should also give at
least equal attention to boys.
Several studies around the world indicated the associ-
ation between the frequency of dietary intake and the nu-
tritional status of an individual [19, 25, 35]. In the same way,
adolescents who had a meal frequency of two or fewer per
day had increased odds of stunting than those reporting a
higher frequency per day. e likely explanation for this
association is that infrequent intake of food is not sufficient
enough to meet the nutritional requirement. is might also
be because skipping meals leads to inadequate dietary intake.
e adolescence period has the fastest growth and the nu-
tritional requirements are increased to promote this growth
spurt. erefore, in addition to the increased nutritional
demand during the adolescence period, skipping meals leads
to being stunted. Adequate meal frequency indeed accel-
erates a linear growth of adolescents by sufficiently supplying
essential nutrients for their body size.
is study found that the absence of a latrine facility at
home was significantly associated with stunting among
adolescent students or they were more likely prone to un-
dernutrition. is finding is consistent with the study per-
formed in the East Wollega Zone [37]. is might be due to
the absence of a latrine facility which leads to open defe-
cation, increases diseases transmission, and affects nutri-
tional status directly or indirectly. It is also a fact that proper
sanitation can reduce stunting by preventing diarrheal and
parasitic diseases. However, an opposite finding has been
reported in Adwa [38]. e findings of this study indicated
that the frequency of handwashing with soap after the toilet
was significantly associated with stunting. is finding is in
line with the findings from Dangla [39], East Wollega Zone
[37], and Tehuledere district [18]. is might be due to
irregular handwashing practice after the toilet which can
cause exposure to disease occurrence and repeatedly being
affected by different infections which alter the health of the
adolescents.
is study found that adolescents who were using un-
protected water sources (from the river) were more likely to
be stunted than their counterparties. is finding is con-
sistent with studies done in the Somali region [40], Tehu-
ledere district [18], and Adwa [38]. is might be due to the
Table 2: Water and sanitation-related characteristics of adolescent students in Legehida district, Northeast Ethiopia, 2018.
Variables Category Frequency Percentage
Availability of functional latrine at home No 68 16.7
Yes 338 83.3
Source of drinking water Pipe and protected spring 277 68.2
River 129 31.8
Frequency of handwashing with soap after toilet Sometimes 92 22.7
Always 314 77.3
Table 3: Bivariable and multivariable logistic regression analysis on factors associated with stunting among adolescent students in Legehida
district, Northeast Ethiopia, 2018.
Variables Categories Stunting COR 95%CI AOR 95%CI
Yes No
Sex Male 68 (33%) 138 (67%) 2.5 (1.65–4.14) 2.1 (1.73–5.90)∗
Female 33 (16.5%) 167 (83.5%) 1 1
Frequency of food intake per day ≤2 times 64 (48%) 70 (52%) 5.8 (3.63–8.99) 4.6 (2.61–8.24)∗
>2 times 37 (13.6%) 235 (86.4%) 1 1
Frequency of washing hands with soap after toilet Sometimes 51 (55.4%) 41 (44.6%) 6.57(1.7–11.00) 3.6 (1.30–9.40)∗
Always 50 (15.9%) 264 (84.1%) 1 1
Availability of functional latrine No 42 (61.7%) 26 (38.3%) 7.63(4.59–11.4) 5.51(3.03–9.9)∗
Yes 59 (17.4%) 279 (82.6%) 1 1
Source of drinking water River 64 (49.6%) 65 (50.4%) 6.38(3.4–8.9) 2.8(1.35–6.19)∗
Pipe and protected 37 (13.4%) 240 (86.6%) 1 1
∗Statistical significant (pvalue <0.05).
Journal of Nutrition and Metabolism 5
consumption of impure water which is a vehicle for intes-
tinal parasites (water-borne diseases) and causes loss of
appetite and hence poor nutritional status directly or in-
directly. erefore, diarrhea and water-borne diseases
caused by unsafe drinking water at the households’ level
might increase the prevalence of malnutrition directly or
indirectly.
5. Conclusion
e finding of this study revealed that stunting among
adolescent students is relatively high. Male sex, daily meal
frequency of less than three, absence of latrine facility, in-
frequent handwashing practice, and unsafe source of
drinking water were the factors independently associated
with stunting among adolescent students. It is essential to
increase the nutritional knowledge of adolescent students
and their families to improve their nutritional intake and
tackle the intergenerational effect of adolescent malnutri-
tion. Hence, conducting routine nutrition screenings and
assessment, promotion of proper food intake, and emphasis
towards nutrition education and counseling are needed to be
strengthened. e health extension workers should be aware
of and implement sanitation and hygienic practices at the
household levels. It is also crucial to avail latrine at the
household level and improve the practice of handwashing
before and after doing different activities. A school-based
nutritional program might be helpful to reduce stunting in
this group of adolescent students.
Abbreviations
AOR: Adjusted odds ratio
CI: Confidence interval
COR: Crud odds ratio
HAZ: Height-for-age z-scores
OR: Odds ratio
SPSS: Statistical Packages for Social Sciences
WHO: World Health Organization.
Data Availability
e data will be available upon request from the corre-
sponding authors.
Conflicts of Interest
e authors declare that they have no conflicts of interest.
Authors’ Contributions
WA collected the data, designed the study, performed the
analysis, interpreted the data, and drafted the manuscript.
BY supervised data collection, analysis, and interpretation of
data. All the authors read and approved the final manuscript.
Acknowledgments
e authors would like to thank the Legehida District Ed-
ucation Bureau, respective high school principals, data
collectors, and study participants for their unreserved
contribution to the success of this work.
References
[1] F. Branca, E. Piwoz, W. Schultink, and L. M. Sullivan,
“Nutrition and health in women, children, and adolescent
girls,” BMJ, vol. 351, p. h4173, 2015.
[2] World Health Organization, Adolescent Nutrition: A Review of
the Situation in Selected South-East Asian Countries, WHO
Regional Office for South-East Asia, New Delhi, India, 2006.
[3] A. M. Prentice, K. A. Ward, G. R. Goldberg et al., “Critical
windows for nutritional interventions against stunting,”
American Journal of Clinical Nutrition, vol. 97, no. 5,
pp. 911–918, 2013.
[4] World Health Organization Guideline, Implementing Effective
Actions for Improving Adolescent Nutrition, World Health
Organization, Geneva, Switzerland, 2018.
[5] Global Panel on Agriculture and Food Systems for Nutrition,
Food Systems and Diets: Facing the of the 21st Century, e
International Food Policy Research Institute, London, UK,
2016.
[6] WHO Regional Office for Europe, Evaluating Implementation
of the WHO Set of Recommendations on the Marketing of
Foods and Non-Alcoholic Beverages to Children, World Health
Organization, Geneva, Switzerland, 2018.
[7] Global Nutrition Report, “Actions and accountability to
advance nutrition and sustainable development united na-
tions population fund (UNFPA): status report,” Adolescents
and Young People in Sub-Saharan Africa: Opportunities and
Challenges, United Nations, Washington, DC, USA, 2015.
[8] World Health Organization, Global Nutrition Policy Review
2016-2017, World Health Organization, Geneva, Switzerland,
2017.
[9] T. Benson and M. Shekar, Trends and Issues in Child under
Nutrition in Disease and Mortality in Sub-Saharan Africa,
World Bank, Washington, DC, USA, 2006.
[10] C. Y. Ji and T. J. Chen, “Empirical changes in the prevalence of
overweight and obesity among Chinese students from 1985 to
2010 and corresponding preventive strategies,” Biomedical
and Environmental Sciences: Biomedical and Environmental
Sciences, vol. 26, no. 1, pp. 1–12, 2013.
[11] W. He, S. A. James, M. G. Merli, and H. Zheng, “An increasing
socioeconomic gap in childhood overweight and obesity in
China,” American Journal of Public Health, vol. 104, no. 1,
pp. e14–e22, 2014.
[12] C. Hawkes, J. Harris, and S. Gillespie, “Changing diets: ur-
banization and the nutrition transition,” in IFPRI, Global
Food Policy Reportp. 35, International Food Policy Research
Institute, Washington, DC, USA, 2017.
[13] H. Assefa, T. Belachew, and L. Negash, “Socio-demographic
factors associated with underweight and stunting among
adolescents in Ethiopia,” e Pan African Medical Journal,
vol. 20, p. 252, 2015.
[14] E. C. Keats, A. I. Rappaport, R. Jain, C. Oh, S. Shah, and
Z. A. Bhutta, Diet and Eating Practices Among Adolescent Girls
in Low-and Middle-Income Countries: A Systematic Review,
Springer, Berlin, Germany, 2018.
[15] H. T. Nguyen, E. A. Frongillo, M. S. Fram, and J. Bernal,
“Prevalence of food insecurity of adolescent students from 83
countries,” e FASEB Journal, vol. 31, no. 1S, 2017.
[16] A. H. Pereira, S. Sudhanshu, and G. Holmqvist, “Prevalence
and correlates of food insecurity among children across the
6Journal of Nutrition and Metabolism
globe,” Innocents Working Papers, UNICEF Office of Re-
search, Florence, Italy, 2017.
[17] D. D. Gagebo, A. A. Kerbo, and T. angavel, “Under nu-
trition and associated factors among adolescent girls in
Damot sore district southern Ethiopia,” Journal of Nutrition
and Metabolism, vol. 2020, Article ID 5083140, 11 pages, 2020.
[18] Government of Federal Democratic Republic of Ethiopia,
National Nutrition Program 2016–2020, Government of
Federal Democratic Republic of Ethiopia, Addis Ababa, 2016.
[19] Y. A. Melaku, G. A. Zello, T. K. Gill, R. J. Adams, and Z. Shi,
“Prevalence and factors associated with stunting and thinness
among adolescent students in northern Ethiopia: a compar-
ison to world health organization standards,” Archives of
Public Health, vol. 73, no. 1, 2015.
[20] A. Tariku, A. K. Belew, K. A. Gonete et al., “Stunting and its
determinants among adolescent girls: findings from the nu-
trition surveillance project, northwest Ethiopia,” Ecology of
Food and Nutrition, vol. 58, no. 5, pp. 481–494, 2019.
[21] Y. Menber, D. Tsegaye, A. Woday, H. Cherie, and S. Kebede,
“Prevalence of stunting and associated factors among school
age children in primary schools of Haik town, south Wollo
zone, north-eastern Ethiopia, 2017,” Journal of Clinical &
Cellular Immunology, vol. 9, no. 1, p. 539, 2018.
[22] D. D. Tolessa, W. Mektie, and N. T. Aderajew, “Nutritional
status and associated factors among school adolescent in
Chiro town, west Hararge, Ethiopia,” Gaziantep Medical
Journal, vol. 21, no. 1, pp. 32–42, 2015.
[23] H. Gebremariam, S. Omer, and A. Huruy, “Assessment of
nutritional status and associated factors among school going
adolescents of Mekelle city, northern Ethiopia,” International
Journal of Nutrition and Food Sciences, vol. 4, no. 1,
pp. 118–24, 2015.
[24] M. Taru, E.-S. Hesham, T. D. David, and R. R. Jason, “e
prevalence of underweight, overweight, obesity and associated
risk factors among school-going adolescents in seven African
countries,” Public Health, vol. 14, no. 887, 2014.
[25] F. Mesfin, A. Worku, and Y. Birhane, “Prevalence and as-
sociated factors of stunting among primary school children in
eastern Ethiopia,” Nutrition and Dietary Supplements, vol. 7,
pp. 61–68, 2015.
[26] J. H. Rah, A. A. Cronin, B. Badgaiyan, V. M. Aguayo,
S. Coates, and S. Ahmed, “Household sanitation and personal
hygiene practices are associated with child stunting in rural
India: a cross-sectional analysis of surveys,” BMJ Open, vol. 5,
no. 2, Article ID e005180, 2015.
[27] S. L. Vanessa, C. d. L. P. Israel, E. d. M. RisiaCristina et al.,
“Factors associated with the decline in stunting among
children and adolescents in Pernambuco, northeastern Bra-
zil,” Revista de Sa´
ude P´
ublica, vol. 46, no. 2, pp. 2–8, 2012.
[28] M. E. McGovern, A. Krishna, V. M. Aguayo, and
S. Subramanian, “A review of the evidence linking child
stunting to economic outcomes,” International Journal of
Epidemiology, vol. 46, no. 4, pp. 1171–1191, 2017.
[29] International Institute for Population Sciences (IIPS) and ICF,
National Family Health Survey (NFHS-4), India, 2015–16,
IIPS, Mumbai, India, 2017.
[30] World Health Organization, WHO AnthroPlus for Personal
Computers: Software for Assessing Growth of the World’s
Children and AdolescentsWorld Health Organization, Geneva,
Switzerland, 2009.
[31] M. de Onis, A. W. Onyango, E. Borghi, A. Siyam, C. Nishida,
and J. Siekmann, “Development of a WHO growth reference
for school-aged children and adolescents,” Bulletin of the
World Health Organization, vol. 85, no. 9, pp. 660–667, 2007.
[32] A. Mulugeta, F. Hagos, B. Stoecker, G. Kruseman,
V. Linderhof, and Z. Abraha, “Nutritional status of adolescent
girls from rural communities of Tigray, northern Ethiopia,”
Ethiopian Journal of Health Development, vol. 23, no. 1, 2009.
[33] S. M. Birru, A. K. Belew, and A. Tariku, “One in three ad-
olescent schoolgirls in urban northwest Ethiopia is stunted,”
e Italian Journal of Pediatrics, vol. 44, no. 1, p. 32, 2018.
[34] Y. Gebreyohannes, S. Shiferaw, B. Demtsu, and G. Bugssa,
“Nutritional status of adolescents in selected government and
private secondary schools of Addis Ababa, Ethiopia,” Inter-
national Journal of Nutrition and Food Sciences, vol. 3, no. 6,
pp. 504–514, 2014.
[35] I. O. Senbanjo, K. A. Oshikoya, O. O. Odusanya, and
O. F. Njokanma, “Prevalence of and risk factors for stunting
among high school children and adolescents in Abeokuta,”
Southwest Nigeria, vol. 29, no. 4, pp. 364–370, 2011.
[36] Federal Minister of Health of Ethiopia (FMoH), National
Nutritional Program (NNP) 2013, Federal Minister of Health
of Ethiopia (FMoH), Addis Ababa, Ethiopia, 2013.
[37] K. T. Bidu, T. Hailemariam, and E. L. Negeri, “Prevalence and
associated factors of under nutrition among adolescent stu-
dents in Gobu Seyo district , east Wollega zone, Oromia
regional state of west Ethiopia,” Journal of Public Health and
Epidemiology, vol. 10, pp. 251–269, 2018.
[38] T. Gebregyorgis, T. Tadesse, and A. Atenafu, “Prevalence of
thinness and stunting and associated factors among adoles-
cent high school girls in Adwa town, north Ethiopia,” In-
ternational Journal of Food Science, vol. 2016, Article ID
8323982, 8 pages, 2016.
[39] Y. M. Demilew and A. A. Emiru, “Under nutrition and as-
sociated factors among school adolescents in Dangila town,
northwest Ethiopia: a cross sectional study,” African Health
Sciences, vol. 18, no. 3, p. 756, 2018.
[40] A. A. Awel, T. B. Lema, and H. J. Hebo, “Nutritional status
and associated factors among primary adolescent students of
pastoral and agro-pastoral communities, Mieso Woreda,
Somali region, Ethiopia: a comparative cross-sectional study,”
Journal of Public Health And Epidemiology, vol. 8, pp. 297–
310, 2016.
Journal of Nutrition and Metabolism 7
