JIGJIGA UNIVERSITY

SCHOOL OF GRADUATE STUDIES

DEPARTMENT OF FOOD SCIENCE AND NUTRITION

M.SC. IN APPLIED HUMAN NUTRITION

PREVALENCE OF STUNTING AND THINNESS AMONG

ADOLESCENTS IN SOUTHWEST ETHIOPIA
BY
ABDIRAUF AHMED ISSE I.D: GSR/0404/12

SUBMITTED TO: PROF. TEFERA BELACHEW (MD, MSC, PHD)

SEPTEMBER, 2020

JIGJIGA, ETHIOPIA
 Use Adolescent data indicated in your respective group
 Determine the prevalence of stunting and thinness
 Determine whether stunting and thinness are associated with : Sex, Place of
residence, age, illness with the last one month and adolescent food insecurity
and Animal source food consumption
 Write the results and discuss the findings

General methods for all groups

Study Sample
Data for this study were generated by the Jimma Longitudinal Family Survey of Youth
(JLFSY) which followed a randomly selected sample of adolescents. The survey began in 2005
and sampled households and adolescents within households from six “Kebeles”(villages) in
Jimma Town which is a zonal city with 120,960 inhabitants (CSA, 2007) and three nearby
towns (semi-urban), and 9 rural Kebeles immediately surrounding the small towns. The three
rural districts involved were: Manna “Woreda” (district) - a coffee growing area (altitude of
1911 meters and with a total population of 149,661), Dedo “Woreda” - a highland vegetable
growing area (altitude of 2300 meters and a total population of 290,457), and Kesrsa “Woreda”
- a lower lying plain area dedicated to grains and other food crops (altitude of 1795 meters and
with a total population of 164,053)
A residence stratified random sampling was used in each of the sites to select households for
inclusion in the study. The study area was stratified into urban, semi-urban and rural areas
and a complete list of the 5795 households was generated through a door-to-door census from
all the study sites. From the list of households, 3700 were randomly selected using the
sampling frame generated from the census and screened for an eligible adolescent. The
sample size for each study site was allocated based on a probability proportional to the size
of population. Accordingly, a total of 700 households were selected from Jimma Town, 200
households each to the 3 rural towns (semi-urban areas = 600) and from the 9 rural Kebeles
(800) making a total estimated sample of 2110 adolescents. An adolescent boy or girl in the
age group 13-17 years was selected from the households that have this target age group using
a Kish table (Kish, 1949) resulting in recruitment of a total sample of 2084 adolescents for
the baseline study. JLFSY is a longitudinal study of adolescents designed to examine the
determinants of adolescent health, food security, growth, schooling, sexual maturation and
reproductive health experiences. The above age group was included in the study to be able to
capture the predictors of major events as adolescent transits to adulthood.
For this analyses a total of 1921 adolescents were included.

Measurements
To generate the data set used in this study, structured pre-tested and interviewer administered
questionnaires were used in all the three rounds of the survey. The household questionnaires
included a household registry that collected socio-demographic information on all current
resident and non-resident household members including information on their income,
household food security and household size, age and migration history. Adolescent interviews
were conducted by an interviewer of the same sex as the adolescent respondent in a private
place after the completion of interview with the household head. The study was originally
planned to have adolescent level interviews at intervals of one year and household level
 interviews two years apart. Adolescents were re-interviewed for three rounds at an interval of
one year, while households were interviewed for two rounds(at baseline and two years later)
to update the socioeconomic variables and household characteristics using a similar survey
instruments that included the food insecurity items from the baseline survey. The adolescent
questionnaire focused on issues related to adolescent’s experiences of food insecurity,
education, health and qualitative measures of the dietary intakes and anthropometric
measurements. The baseline household and adolescent interviews were completed from
August 2005 to February 2006, while year 1 and year 2 adolescent interviews were carried
out during similar seasons one year and two years apart from the baseline survey, respectively.
The questionnaires were interviewer administered and translated to the local languages
[Amharic and Oromifa] and their consistency was checked by another person who speaks both
languages.

Anthropometry
Height and weight were measured using stadiometer and Seca digital scale ( Seca Germany).
Weight was measured using portable standing scale. It has ability to measure weight from 0 to
150 Kg. The weight was recorded to the nearest 0.1 kg. It was calibrated against known weight
regularly. Before the real anthropometric data collection, a standardization exercise was
performed during the training to capture technical error of measurement (TEM). During the
procedure the subjects wore light clothes and took off their shoes. Height was measured in cm
using portable stadiometer. All girls were measured against the wall without foot wear and with
heels together and their heads positioned and eyes looking straight ahead (Frankfurt plane) so
that the line of sight was perpendicular to the body. The height was recorded to the nearest
0.1cm. The same measurer was employed for a given anthropometric measurement to avoid
variability.

Adolescent Food Insecurity Items

Adolescent food insecurity was measured with items that were adapted from household food
insecurity scales that were used in developing countries using four items that apply to
individual experiences. Adolescents were asked whether in the last three months they (1) had
ever worried about having enough food, (2) had to reduce food intake because of shortages
of food or lack of money to buy food, (3) had to go without having eaten because of shortage
of food or lack of money to buy food and (4) had to ask outside the home for food because of
shortage of food or lack of money to buy food. All “Yes” responses were coded “1” and “No”
responses were coded “0” and the scores were summed. Adolescents who had food insecurity
index of 1 and above were labelled as food insecure. The index has high internal consistency
(Cronbach’s Alpha=0.81).

Anthropometric Data analyses

Height for age and body mass index for age z-scores were calculated using WHO Anthro Plus
software as indicators of stunting and thinness respectively and then the data was analysed
using SPSS, crosstabs were used to assess the association between Independent and outcome
variables.
Ethical Issues
The study proposal was ethically approved by both Brown University Institutional Review Board
(IRB) and by Jimma University Ethical Review Boards (ERB). Informed verbal consent was
obtained both from each adolescent and the respective parent before any interview or
measurement. Confidentiality of the data was highly secured through not using any personally
identifiable information on the questionnaires and by locking the questionnaires in a secure
cabinet. Personal identifiers and the other part of the data are separated. The project has a separate
data entry room and separate computers with no access of other people to the room unless
authorized.
 1. STATEMENT OF THE PROBLEM
Adolescents constitute 20% of the world population and are estimated to be 1.13 billion
by the year 2025 [1]. About 25% of the Ethiopian population are adolescents [2].
Adolescence is a period of rapid growth and development by which up to 45% of skeletal
growth takes place and 15 to 25% of adult height is achieved [1, 3]. In addition to the
increased nutritional requirements during adolescence period, poor dietary diversity and
dietary inadequacies are more likely threats among adolescents due to their erratic eating
pattern and having specific psychosocial factors [1, 4, and 5].
In addition, malnutrition passes from generation to generation, because adolescent girls
that enter pregnancy with poor nutrient store are more likely to give birth to low birth
weight or intrauterine growth restricted baby that is more vulnerable to metabolic
disorders later in life [6].
So adolescence period 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 [1, 4].
Stunting: individuals whose height is below the average expected height for their age,
defined by Height- For- Age is generally a result of prolonged or repeated episodes of
undernutrition that often start before birth. [5]
Stunting is strongly associated with poverty, poor health and impaired physical and
mental development. Stunting can be reversed through ‘catch up growth’ until 2 years
of age; after which it is irreversible. [5]
Wasting: a measure of thinness defined by [Weight-For-Height (WFH) or MUAC
measurements] is characterized by rapid weight loss usually due to illness and/or
reduced food intake. [5]
Study done in Khagrachari District, Bangladesh, shows that 13.67% of adolescent girls
were severely stunted and 20.33% were moderately stunted [6]. Another study done in
rural areas of Bangladesh shows that 32% of the adolescent girls were stunted [7].
According to different studies done in India the prevalence of stunting ranges from 11.7%
to 34.2% [8–11]. Studies done in Asembo and Mumias, Kenya, and Tunisia reported that
the prevalence of thinness was 15.6% and 1.3%, respectively [12, 13].

According to Ethiopian Demographic and Health Survey shows that the prevalence of
stunting has decreased considerably from 58% in 2000 to 38% in 2016, an average
decline of more than 1 percentage point per year. On the other hand, the prevalence of
wasting changed little over the same time period, with a wasting rate of 10% at the time
of the EDHS 2016, which was the same level as in 2011. [14]

Still there is limited information about the nutritional status and associated factors in
adolescents in Ethiopia and further more studies should be made focusing on the
prevalence of stunting and thinness in Ethiopia.

Therefore, this study addressed the gap by assessing the prevalence of stunting and
thinness in some parts of Jimma town, Ethiopia.
 2. LITERATURE REVIEW
Globally, undernutrition among adolescent girls are highly prevalent in different parts
of the world. For example, according to the study which was done by World Health
Organization (WHO) on South East Asia region (both sex) in India, Bangladesh, Nepal
and Myanmar showed around 32%, 48%, 47% and 39% of adolescents were suffered
from stunting respectively, and 53%, 67%, 36%, and 32% adolescents were affected by
thinness respectively. [15]
These are also true in different parts of the world as different scholars revealed. For
instance, the studies which were conducted in some parts of India among adolescent
girls revealed the higher prevalence of undernutrition which ranges from 32% to73.5
%. [16, 17]
Another study in Bangladesh among adolescents to determine prevalence of thinness
and stunting also showed the higher prevalence of under nutrition; and there were also
high prevalence of stunting among adolescent girls (50.3%) than boys (43.1%) [18]. In
china around 21.8 and 40.6 million children and adolescents were affected with thinness
and stunting in 2002 respectively and while 5.8 million were co- affected by stunting
and thinness. [19]
Undernutrition among adolescent girl is also a common nutritional problem in Africa
as some study shows by different researchers. For instance, the study which was
conducted in South East Nigeria reported over 20% of the adolescents were affected by
thinness and 67.3% boys and 57.8% girls, were also affected by stunting. [20]
The other study in western Kenya also showed that 12.1 % and 15.6%, of school
adolescent were stunting and thin respectively. [21]
Undernutrition among adolescent girl in Ethiopia is also a public health problem as
some studies done in different parts of the country indicated. The Ethiopia nutrition
baseline report reported in 2010 that, 23 % of adolescent girls were stunted, with girls
13 to 14 years old and rural resident were more likely to be stunted; and at the same
time 14% of adolescent girls were thin. [22]
The community based studies which were conducted in Tigray and Amhara region
showed both thinness and stunting were highly prevalent among adolescent girls of
rural Ethiopia which were 26.5% stunted and while 58.3% thin; and 13.6 % thin and
while 31.5 % stunted respectively. [23, 24]
 3. METHODS
Height for age and body mass index for age z-scores were calculated using WHO
Anthro Plus software as indicators of stunting and thinness respectively and then the
data was analysed using SPSS, crosstabs were used to assess the association between
Independent and outcome variables.
 4. RESULTS AND DISCUSSION
1. What is the prevalence of Stunting?

Frequency Percent

Normal 1618 84.2

Stunted 303 15.8

Answer:
 The prevalence of stunting is 15.8%

2. Is there a significant association between stunting and

gender?

Stunting P

Normal Stunted

Female 830 (89.2%) 100 (10.8%)

Gender <0.0001
788 (79.5%) 203 (20.5%)
Male

Answer:
 Yes, there is a significant association between stunting and
gender especially being male (20.5%) since the P-value is less
than 0.05.
 3. Is this association significant after adjusting for food
security and place of residence?

A. Adolescent Food Insecurity

Stunting P
Normal Stunted

Food Secure 1289 (84.4%) 239 (15.6%)

Adolescent food Insecurity >0.075

Food Insecure 329 (83.7%) 64 (16.3%)

Answer:
 No, adolescent food Insecurity is not significantly associated with
stunting because there is no that much difference after adjusting
for food insecurity since the p-value is greater than 0.05.

B. place of Residence

Stunting P

Normal Stunted

Urban 653 (88.1%) 88 (11.9%)

Semi-Urban 453 (83.4%) 90 (16.6%)

Place of Residence <0.0001

Rural 512 (80.4%) 125 (19.6%)

Answer:
 Yes, there is a significant association between stunting and place
of residence since the P-value is less than 0.05 for instance
residents of rural area (19.6%) are more stunted than Urban and
Semi-urban (11.9%, and 16.6%) respectively.
 4. What is the prevalence of thinness?

Frequency Percent

Normal 1559 80.7

Thin 373 19.3

Answer:
 The prevalence of thinness is 19.3%

5. Is there a significant association between thinness and

gender?

Thinness P
Normal Thin

Female 832 (89.5%) 98 (10.5%)

Gender <0.0001
728 (73.5%) 263 (26.5%)
Male

Answer:
 Yes, there is a significant association between thinness and
gender especially being male (26.5%) since the P-value is less
than 0.05.
 6. Is this association significant after adjusting for food
security and place of residence?

A. Adolescent Food Insecurity

Thinness P
Norm Thin
al

1233 295
Food Secure
(80.7%) (19.3%)
Adolescent food
>0.256
Insecurity
327 (83.2%)
Food Insecure 66 (16.8%)

Answer:
 No, adolescent food Insecurity is not significantly
associated with thinness because there is no that much
difference after adjusting for adolescent food insecurity
since the p-value is greater than 0.05
B. Place of Residence

Thinness P
Normal Thin

Urban 621 (83.8%) 120 (16.2%)

Place of Residence Semi-Urban 459 (84.5%) 84 (15.5%) <0.001

Rural 480 (75.4%) 157 (24.6%)

Answer
 Yes, there is a significant association between thinness and place
of residence since the P-value is less than 0.05 for instance
residents of rural area (24.6%) are more stunted than Urban and
Semi-urban (16.2%, and 15.5%) respectively.
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