Abstract
Background: Optimal nutrition for adolescent girls is critical for growth, development, and long-term health. Dietary diversity is a crucial component of feeding strategies. In resourcepoor countries, undiversified diets and low-quality monotonous diet feeding habits are frequent. This leads to poor nutritional status, particularly micronutrient deficiencies, which has an impact on adolescent females' current and future lives, as well as their kids. However, data on the magnitude of dietary diversity and associated determinants among adolescent girls in resource-poor settings such as Ethiopia, which include the research area, is sparse.
Methods: A community-based cross-sectional study design was conducted among 603 adolescent girls from randomly selected adolescent girls in Ethiopia using a multistage sampling method. The data were collected through face-to-face interviews by using a pretested structured questionnaire and entered into Epi-data 4.2.0.0 version and exported to SPSS version 20 for analyses. Multicollinearity between independent variables and model goodness fit test was checked. Bivariable and multivariable logistic regression analysis were used to determine the degree of relationship between independent and dependent variables. At a p-value of less than 0.05, the odds ratio was declared, along with the 95 percent confidence interval and the level of statistical significance.
Results: The prevalence of dietary diversity among adolescent girls was 43.8% (95% CI: 39.7%- 48.0%). having secondary and above level of education and primary education, [AOR = 4.0, 95% CI: (1.89-8.32)], being in food secure households [AOR = 6.99, 95% CI: (4.34-11.23)], skipping practice of meals [AOR = 0.54, 95% CI: (0.33-0.88)], currently being on the menstruation [AOR = 0.42, 95% CI: (0.26-0.66)] and having good knowledge about nutrition [AOR = 2.20, 95% CI: (1.32-3.56)] were significantly associated with dietary diversity among adolescent girls.
Conclusion: The prevalence of dietary diversity among adolescent girls was low in the study area. Therefore, attention should be given to fathers with no formal education, and efforts should be made to improve household food security, adolescent girls knowledge about nutrition, and minimize skipping of meals to increase adolescent girls dietary diversity and to break the vicious cycles of malnutrition.
Keywords: Dietary diversity, dietary adequacy, adolescent, girl, dietary quality, Ethiopia.
Graphical Abstract
[1]
Nithya, D.J.; Bhavani, R.V. Dietary diversity and its relationship with nutritional status among adolescents and adults in rural India. J. Biosoc. Sci., 2018, 50(3), 397-413.
[http://dx.doi.org/10.1017/S0021932017000463] [PMID: 28967344]
[http://dx.doi.org/10.1017/S0021932017000463] [PMID: 28967344]
[2]
Archero, F.; Ricotti, R.; Solito, A.; Carrera, D.; Civello, F.; Di Bella, R.; Bellone, S.; Prodam, F. Adherence to the Mediterranean diet among school children and adolescents living in northern Italy and unhealthy food behaviors associated to overweight. Nutrients, 2018, 10(9), 1322.
[http://dx.doi.org/10.3390/nu10091322] [PMID: 30231531]
[http://dx.doi.org/10.3390/nu10091322] [PMID: 30231531]
[3]
Kennedy, G.L. Evaluation of dietary diversity scores for assessment of micronutrient intake and food security in developing countries., 2009, 1-24.
[4]
Tamiru, D.; Argaw, A.; Gerbaba, M.; Nigussie, A.; Ayana, G.; Belachew, T. Improving dietary diversity of school adolescents through school based nutrition education and home gardening in Jimma Zone: Quasi-experimental design. Eat. Behav., 2016, 23, 180-186.
[http://dx.doi.org/10.1016/j.eatbeh.2016.10.009] [PMID: 27816856]
[http://dx.doi.org/10.1016/j.eatbeh.2016.10.009] [PMID: 27816856]
[5]
Roba, K.; Abdo, M.; Wakayo, T. Nutritional status and its associated factors among school adolescent girls in Adama City, Central Ethiopia. J. Nutr. Food Sci., 2016, 6(3), 2.
[6]
Vakili, M.; Abedi, P.; Sharifi, M.; Hosseini, M. Dietary diversity and its related factors among adolescents: A survey in Ahvaz-Iran. Glob. J. Health Sci., 2013, 5(2), 181-186.
[http://dx.doi.org/10.5539/gjhs.v5n2p181] [PMID: 23445707]
[http://dx.doi.org/10.5539/gjhs.v5n2p181] [PMID: 23445707]
[7]
Mulaw, G.F.; Mare, K.U.; Anbesu, E.W. Nearly one-third of lactating mothers are suffering from undernutrition in pastoral community, Afar region, Ethiopia: Community-based cross-sectional study. PLoS One, 2021, 16(7), e0254075.
[http://dx.doi.org/10.1371/journal.pone.0254075] [PMID: 34242276]
[http://dx.doi.org/10.1371/journal.pone.0254075] [PMID: 34242276]
[8]
Beal, T.; Massiot, E.; Arsenault, J.E.; Smith, M.R.; Hijmans, R.J. Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes. PLoS One, 2017, 12(4), e0175554.
[http://dx.doi.org/10.1371/journal.pone.0175554] [PMID: 28399168]
[http://dx.doi.org/10.1371/journal.pone.0175554] [PMID: 28399168]
[9]
Assenga, E.A.; Kayunze, K.A. Food security incidences based on dietary energy consumption, dietary diversity and household food insecurity access scale in Chamwino District, Tanzania. Int. J. Asian Soc. Sci., 2016, 6(11), 644-658.
[http://dx.doi.org/10.18488/journal.1/2016.6.11/1.11.644.658]
[http://dx.doi.org/10.18488/journal.1/2016.6.11/1.11.644.658]
[10]
Li, Y.; Wedick, N.M.; Lai, J.; He, Y.; Hu, X.; Liu, A.; Du, S.; Zhang, J.; Yang, X.; Chen, C.; Hu, F.B.; Ma, G. Lack of dietary diversity and dyslipidaemia among stunted overweight children: The 2002 China national nutrition and health survey. Public Health Nutr., 2011, 14(5), 896-903.
[http://dx.doi.org/10.1017/S1368980010002971] [PMID: 21306667]
[http://dx.doi.org/10.1017/S1368980010002971] [PMID: 21306667]
[11]
Arimond, M.; Wiesmann, D.; Becquey, E.; Carriquiry, A.; Daniels, M.; Deitchler, M. Dietary diversity as a measure of the micronutrient adequacy of women’s diets in resource-poor areas: Summary of results from five sites Washington, DC: FANTA-2 Bridge. FHI, 2011, 360, 2011.
[12]
Steyn, N.P.; Nel, J.H.; Nantel, G.; Kennedy, G.; Labadarios, D. Food variety and dietary diversity scores in children: Are they good indicators of dietary adequacy? Public Health Nutr., 2006, 9(5), 644-650.
[http://dx.doi.org/10.1079/PHN2005912] [PMID: 16923296]
[http://dx.doi.org/10.1079/PHN2005912] [PMID: 16923296]
[13]
FAO. (Food and Agriculture Organization) and FANTA (Food and Nutrition Technical Assistant). Introducing the Minimum Dietary Diversity-Women (MDD-W) Global Dietary Diversity Indicator for Women; FAO: Washington, DC, 2014.
[14]
Ochieng, J.; Afari-Sefa, V.; Lukumay, P.J.; Dubois, T. Determinants of dietary diversity and the potential role of men in improving household nutrition in Tanzania. PLoS One, 2017, 12(12), e0189022.
[http://dx.doi.org/10.1371/journal.pone.0189022] [PMID: 29232413]
[http://dx.doi.org/10.1371/journal.pone.0189022] [PMID: 29232413]
[15]
Worku, M.; Hailemicael, G.; Wondmu, A. Dietary diversity score and associated factors among high school adolescent girls in Gurage zone, Southwest Ethiopia. World J. Nutr. Health., 2017, 5(2), 41-45.
[16]
Ga, C.; Shackleton, C. Minimum dietary diversity scores for women indicate micronutrient adequacy and food insecurity status in South African towns. Nutrients, 2017, 9(8), 812.
[17]
Reese-Masterson, A.; Murakwani, P. Assessment of adolescent girl nutrition, dietary practices and roles in Zimbabwe. Field Exch., 2016, 52, 113.
[18]
Motunrayo, F.O. Adolescent girls with low dietary diversity score are predisposed to Iron deficiency in southwestern Nigeria. ICAN: Infant, Child, & Adolescent Nutrition, 2013, 5(2)
[19]
Christina, A.; Augustina, Ba.; Danquah, A. Adolescents’ knowledge of diet-related chronic diseases and dietary practices in Ghana. Food Nutr. Sci., 2012, 3(11), 1527-1532.
[http://dx.doi.org/10.4236/fns.2012.311199]
[http://dx.doi.org/10.4236/fns.2012.311199]
[20]
Eisenberg, M.E.; Neumark-Sztainer, D. Friends’ dieting and disordered eating behaviors among adolescents five years later: Findings from Project EAT. J. Adolesc. Health, 2010, 47(1), 67-73.
[http://dx.doi.org/10.1016/j.jadohealth.2009.12.030] [PMID: 20547294]
[http://dx.doi.org/10.1016/j.jadohealth.2009.12.030] [PMID: 20547294]
[21]
Eisenberg, M.E.; Neumark-Sztainer, D.; Story, M.; Perry, C. The role of social norms and friends’ influences on unhealthy weight-control behaviors among adolescent girls. Soc. Sci. Med., 2005, 60(6), 1165-1173.
[http://dx.doi.org/10.1016/j.socscimed.2004.06.055] [PMID: 15626514]
[http://dx.doi.org/10.1016/j.socscimed.2004.06.055] [PMID: 15626514]
[23]
Afshin, A.; Sur, P.J.; Fay, K.A.; Cornaby, L.; Ferrara, G.; Salama, J.S.; Mullany, E.C.; Abate, K.H.; Abbafati, C.; Abebe, Z.; Afarideh, M.; Aggarwal, A.; Agrawal, S.; Akinyemiju, T.; Alahdab, F.; Bacha, U.; Bachman, V.F.; Badali, H.; Badawi, A.; Bensenor, I.M.; Bernabe, E.; Biadgilign, S.K.K.; Biryukov, S.H.; Cahill, L.E.; Carrero, J.J.; Cercy, K.M.; Dandona, L.; Dandona, R.; Dang, A.K.; Degefa, M.G.; El Sayed Zaki, M.; Esteghamati, A.; Esteghamati, S.; Fanzo, J.; Farinha, C.S.S.; Farvid, M.S.; Farzadfar, F.; Feigin, V.L.; Fernandes, J.C.; Flor, L.S.; Foigt, N.A.; Forouzanfar, M.H.; Ganji, M.; Geleijnse, J.M.; Gillum, R.F.; Goulart, A.C.; Grosso, G.; Guessous, I.; Hamidi, S.; Hankey, G.J.; Harikrishnan, S.; Hassen, H.Y.; Hay, S.I.; Hoang, C.L.; Horino, M.; Ikeda, N.; Islami, F.; Jackson, M.D.; James, S.L.; Johansson, L.; Jonas, J.B.; Kasaeian, A.; Khader, Y.S.; Khalil, I.A.; Khang, Y-H.; Kimokoti, R.W.; Kokubo, Y.; Kumar, G.A.; Lallukka, T.; Lopez, A.D.; Lorkowski, S.; Lotufo, P.A.; Lozano, R.; Malekzadeh, R.; März, W.; Meier, T.; Melaku, Y.A.; Mendoza, W.; Mensink, G.B.M.; Micha, R.; Miller, T.R.; Mirarefin, M.; Mohan, V.; Mokdad, A.H.; Mozaffarian, D.; Nagel, G.; Naghavi, M.; Nguyen, C.T.; Nixon, M.R.; Ong, K.L.; Pereira, D.M.; Poustchi, H.; Qorbani, M.; Rai, R.K.; Razo-García, C.; Rehm, C.D.; Rivera, J.A.; Rodríguez-Ramírez, S.; Roshandel, G.; Roth, G.A.; Sanabria, J.; Sánchez-Pimienta, T.G.; Sartorius, B.; Schmidhuber, J.; Schutte, A.E.; Sepanlou, S.G.; Shin, M.J.; Sorensen, R.J.D.; Springmann, M.; Szponar, L.; Thorne-Lyman, A.L.; Thrift, A.G.; Touvier, M.; Tran, B.X.; Tyrovolas, S.; Ukwaja, K.N.; Ullah, I.; Uthman, O.A.; Vaezghasemi, M.; Vasankari, T.J.; Vollset, S.E.; Vos, T.; Vu, G.T.; Vu, L.G.; Weiderpass, E.; Werdecker, A.; Wijeratne, T.; Willett, W.C.; Wu, J.H.; Xu, G.; Yonemoto, N.; Yu, C.; Murray, C.J.L. Health effects of dietary risks in 195 countries, 1990-2017: A systematic analysis for the global burden of disease study 2017. Lancet, 2019, 393(10184), 1958-1972.
[http://dx.doi.org/10.1016/S0140-6736(19)30041-8] [PMID: 30954305]
[http://dx.doi.org/10.1016/S0140-6736(19)30041-8] [PMID: 30954305]
[25]
Regu, G.M.; Kim, H.; Kim, Y.J.; Paek, J.E.; Lee, G.; Chang, N.; Kwon, O. Association between dietary carotenoid intake and bone mineral density in korean adults aged 30-75 years using data from the fourth and fifth Korean national health and nutrition examination surveys (2008-2011). Nutrients, 2017, 9(9), E1025.
[http://dx.doi.org/10.3390/nu9091025] [PMID: 28926945]
[http://dx.doi.org/10.3390/nu9091025] [PMID: 28926945]
[26]
Ray, O.; Wamani, H.; Bukneya, J. Factors associated with dietary diversity among women of reproductive age (15-49 years) in Agago District. Nurs. Times, 2014, 1(2), 1-86.
[27]
Coates, J.; Swindale, A. Household Food Insecurity Access Scale (HFIAS) for measure of food acess. Indicator Guide VERSION 3; Food and Techincal Assistance Project, Academy for Educational Development: Washington D.C., 2007, pp. 1-36.
[28]
CSA. Central Statistical Agency (CSA) [Ethiopia] and ICF. 2016. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF. Report; , 2016, p. 551.
[29]
Mohammed, A.Y.; Tefera, T.B. Nutritional status and associated risk factors among adolescent girls in Agarfa high school, Bale Zone, Oromia Region, South East Ethiopia. Int J Nutr Food Sci., 2015, 4(4), 445-452.
[http://dx.doi.org/10.11648/j.ijnfs.20150404.15]
[http://dx.doi.org/10.11648/j.ijnfs.20150404.15]
[30]
Yemaneh, Y.; Girma, A.; Nigussie, W.; Hailu, D.; Alemayehu, T.; Mesfin, F. Undernutrition and its associated factors among adolescent girls in rural community of Aseko district, Eastern Arsi Zone, Oromia region, Eastern Ethiopia. World Health, 2017, 1(2), 17-26.
[31]
Birru, S.M.; Tariku, A.; Belew, A.K. Improved dietary diversity of school adolescent girls in the context of urban Northwest Ethiopia: 2017. Ital. J. Pediatr., 2018, 44(1), 48.
[http://dx.doi.org/10.1186/s13052-018-0490-0] [PMID: 29695264]
[http://dx.doi.org/10.1186/s13052-018-0490-0] [PMID: 29695264]
[32]
Syeda, S.A; Nahian, R.; Ahad, M.; Monoarul, Ha.; Khaleda, I. Dietary diversity and nutritional status of adolescent girls in selected urban slum of Dhaka City in Bangladesh. Nutr. Food Sci. Int. J., 2018, 7(3), 1-5.
[33]
Nithya, D.J.; Bhavani, R.V.; Bhavani, RV. Dietary diversity and its relationship with nutritional status among adolescets and adults in rural India. J. Biosoc. Sci., 2018, 50(3), 397-413.
[http://dx.doi.org/10.1017/S0021932017000463] [PMID: 28967344]
[http://dx.doi.org/10.1017/S0021932017000463] [PMID: 28967344]
[34]
Regasa, R.T.; Said, J.H. Assessment of nutritional status and dietary diversity among in-school adolescents of East wollega Zone, Ethiopia. Assessment, 2017, 61, 1-6.
[35]
Wassie, M.M.; Gete, A.A.; Yesuf, E.; Alene, G.D.; Belay, Aa.; Moges, T. Predictors of nutritional status of Ethiopian adolescent girls: A community based cross sectional study. BMC Nutr., 2015, 1(1), 1-7.
[36]
Oldewage-Theron, W.; Egal, A.; Moroka, T. Nutrition knowledge and dietary intake of adolescents in Cofimvaba, Eastern Cape, South Africa. Ecol. Food Nutr., 2015, 54(2), 138-156.
[http://dx.doi.org/10.1080/03670244.2014.959944] [PMID: 25514183]
[http://dx.doi.org/10.1080/03670244.2014.959944] [PMID: 25514183]
[37]
Workicho, A.; Belachew, T.; Feyissa, G.T.; Wondafrash, B.; Lachat, C.; Verstraeten, R.; Kolsteren, P. Household dietary diversity and animal source food consumption in Ethiopia: Evidence from the 2011 welfare monitoring survey. BMC Public Health, 2016, 16(1), 1192.
[http://dx.doi.org/10.1186/s12889-016-3861-8] [PMID: 27884138]
[http://dx.doi.org/10.1186/s12889-016-3861-8] [PMID: 27884138]
[38]
Belachew, T.; Lindstrom, D.; Gebremariam, A.; Hogan, D.; Lachat, C.; Huybregts, L.; Kolsteren, P. Food insecurity, food based coping strategies and suboptimal dietary practices of adolescents in Jimma zone Southwest Ethiopia. PLoS One, 2013, 8(3), e57643.
[http://dx.doi.org/10.1371/journal.pone.0057643] [PMID: 23554864]
[http://dx.doi.org/10.1371/journal.pone.0057643] [PMID: 23554864]
Article Metrics
4