Determining Dietary Patterns, Exploring Barriers for Diversified Dietary Consumption, and Causal Analysis of Determinant of Undernutrition Among Adolescents, Northwest Ethiopia
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Date
2024-06
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Addis Ababa University
Abstract
Background: Adolescence is a critical developmental stage susceptible to all forms of malnutrition. During adolescence, various dietary habits are established, and health-related behaviors, either positive or negative, are adopted, persisting into the next phase of the life cycle. However, a comprehensive evidence on dietary habits, dietary patterns, and causes of under nutrition has not been generated sufficiently using qualitative and quantitative approaches in the country. Therefore, this study was conducted to fill this gap among adolescents of the agrarian community of Northwest Ethiopia.
Objective: to determine dietary patterns, exploring barriers for diversified dietary consumption, and causal analysis of Undernutrition among Adolescents, Northwest Ethiopia.
Methods: An exploratory sequential mixed-method study design was employed for this study. First a community based cross-sectional survey was conducted to determine dietary pattern and its relation with nutritional status. Following the survey qualitative study was conducted to identify barriers to dietary diversification. Finally a case-control study was conducted to identify determinant factors for stunting and thinness. Data was collected using in-depth and key informant interviews, observational cheek lists, pre-tested structured and semi-structured contextually adapted questionnaires, food frequency questioner; and anthropometric measurement tools. Qualitative data analysis was conducted using ATLAS-ti version 7.1 software for thematic analysis based on inductive and thematic analysis approach. Exploratory factor analysis (EFA) was employed to derive major dietary patterns based on food consumption data, after checking for assumptions. A multivariable binary logistic regression analysis was conducted to identify factors associated with the identified dietary patterns. Nutritional status was determined using WHO Anthro-plus 2010 software. In addition, STATA version 17 was used for the causal analysis of under nutrition by conducting general structural equation modeling. To establish statistical significance, a p-value of 0.05 was used as the cutoff point. Result: Three dietary patterns, namely traditional, mixed, and animal-source foods with traditional alcoholic beverage drinking, were identified, accounting for 58.64% of the variance in the adolescent diet. In the study setting oil-seeds are accessible but there were limited consumption habit among adolescents and entire family member.
Significant variation in was observed on the burden of stunting among adolescents for each dietary patterns and consumption level. Stunting was 15.12% vs. 11.21% lower and higher traditional dietary pattern, 19.40% vs. 6.94% in lower and higher mixed dietary pattern, and the rest 8.36% vs. 17.97% in lower and higher animal source food with traditional alcoholic drinking habits of adolescent’s respectively (P-value 0.05). But there were no significant differences in thinness in the identified dietary patterns (P-value > 0.05). The diversified dietary feeding habits of adolescents are affected by multiple interconnected layers of barriers, ranging from an individual level to multi-sectorial collaboration. Adolescents dietary patterns, lack of deworming, being
female, and breakfast eating frequency were key directed and mediated determinant factors for stunting and thinness.
Conclusion: From the identified dietary pattern traditional, mixed, and animal-sourced foods were considered healthy type whereas high carbohydrate and traditional alcoholic beverages were unhealthy type. Modifiable factors were identified that could be targeted for public health interventions that influence dietary patterns of adolescents. Integrated and multifaceted intervention approaches are needed to promote a healthy diet and discourage unhealthy diets. Promoting of locally available oil seeds consumption and enhancing sea-food consumption habits of adolescents and the entire community by introducing small-scale fish farms as nutrition-sensitive intervention pilot projects in study settings and beyond. Further public health interventions should be implemented to reduce under nutrition by improving dietary behaviors, breakfast consumption habits, and providing de-worming services for adolescents. Overall promotion of local sustainable diet, which is nutritionally adequate, economically affordable and having low environmental impact, should be taken as a holistic public health nutrition strategy to overcome all form of malnutrition for adolescents.
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Dietary Patterns, Causal Analysis, Adolescents, Northwest Ethiopia