Debre Tabor Town is the capital of south Gondar Zone administration which is located in Amhara Region, Northcentral Ethiopia. It is 666 km from Addis-Ababa, capital of Ethiopia. It is also in the distance of 100 km southeast of Gondar and 50 km east of Lake Tana. Debre-Tabor town has three high schools; those are Thewodros II, Etegie Tayitu, and Fert. These schools give educational service for the students from Debre Tabor Town and nearby districts (Woredas). Those students came from the woreda were bringing their monthly ration or provision “Sinke in Amharic” from their families to attend their education.
Study design and period
A cross-sectional study was employed to assess the nutritional status and its associated factors among high school adolescent from September to October 2017.
Source and study population
All adolescents who were attending high school at Debre Tabor Town are included whereas adolescents with a physical deformity, pregnancy and lactation were excluded from the study.
A single population proportion formula was used to determine the sample size by using 95% confidence level (i.e. 1.96), 5% of marginal error, and 31.5 and 13.6% of proportion for stunting and thinness respectively . The calculated sample size was 332 for stunting and 181 for thinness. Then, we selected the highest sample size and the final sample size after the addition of 5% none response rate was 349.
The list of all students with their names, academic year, respective class and section were obtained from each recorded office of high schools in Debre Tabor Town. The Total numbers of actively engaged students from Etege Tayitu, Feret and Tewodrose II high schools were 787, 1305, and 2297 respectively. Based on this, the calculated sample size was allocated to each school proportionally. Then, we selected 63, 104, and 182 adolescent students from Etege Tayitu, Feret and Tewodrose II high schools respectively by simple random sampling.
Data collection methods and equipment
The questionnaire was developed by reviewing different studies. A structured face to face interview and physical measurement was done to obtain information regarding a socio-demographic status, health condition, number and types of food items included in their meal, weight and height. We used 24-h recall to determine dietary diversity score at individual level. we considered meals/snacks purchased and consumed both inside and outside at home. Atypical consumption periods during festive periods like national and religious holidays were excluded. The English version questionnaire was translated into the local language, Amharic and was translated back into English to check its consistency by another skilled person. The weights and heights were measured three times by using a weight scale with height stand machine at Frankfurt position, and then the result was recorded to the nearest 0.1 kg and 0.1 cm respectively. Before starting data collection, materials and equipment were always checked. During data collection time, communication between the data collectors, supervisors and the principal investigator were held on a daily basis to update data collection progress and address problems.
Data quality assurance
A 3 days training with pretest was given for five nurses on the basic skills of height and weight measurement, calibration of instruments, interview techniques, how to obtain written consent or assent and precautions during data collection time. After pretest, corrections were made to the questionnaire. The weight scale has been calibrated by using 1 kg standard weight and the height measurement was checked with other meter tapes. A definition of concepts and terms had been written clearly with the Amharic language to avoid ambiguity. The supervisors and data collectors were recruited outside of the study area to avoid information bias due to familiarization.
Definitions of terms
Stunting: when the adolescent’s height for age was below -2SD as compared to World Health Organization reference point .
Thinness: when the adolescent BMI-for-age Z score was <−2SD as compared to World Health Organization reference point .
Dietary Diversity Score: was measured by counting the food items consumed within the previous 24 h and were categorized as poor (consumed < 4 food groups) and good dietary diversity scores (consumed ≥4 food groups). The list of food groups was: 1. Grains, roots or tubers, 2. Vitamin A-rich plant foods, 3. Other fruits or vegetables, 4. Meat, poultry, fish, seafood, 5. Eggs, 6. Pulses/legumes/nuts, 7. Milk and milk products and 8. Foods cooked in oil/fat. All this were coded as 0 if not consumed within the past 24 h and 1 if consumed .
‘Teff”: an African cereal which is cultivated almost exclusively in Ethiopia, used mainly to make flour.
Data processing and analysis
The collected data were checked for completeness and consistency by the supervisors and the principal investigator during and after data collection. The data was managed by editing, verification, coding, classification, and tabulation during data entry and analysis. Data were entered by using Epi info 7 and Anthroplus software. Then these data were transported into SPSS version 20 statistical software for descriptive and analytical analysis. Descriptive analysis was carried out to describe the variables in number and proportion and the analytical analysis were carried out to see the crude and adjusted effect of each variable. A p-value of less than 0.2 was used to select candidate variables for multivariable logistic regression.
In this study, a p-value of less than or equal to 5% was considered as statistically significant after fitting into multivariable logistic regression models and odd ratios were calculated with a 95% of confidence interval had been used at this stage to assess the independent and multivariable effect. The Hosmer-Lemeshow goodness of fit test was performed to assess how well the constructed model was good.
A binary logistic regression was done to assess the existence of an association between independent variables and the stunting of high school adolescent students. From these explanatory variables; sex, marital status, place of residence and family size were associated with stunting. After, these variables were taken into multivariate logistic regression; sex, residence and family size were found to be significant factors for stunting. Similarly, Bivariate analysis was done to assess the existence of an association between independent variables and the thinness of high school adolescent students. Thus, sex, residence, grade, living status, and source of drinking water were found to be associated factors with the thinness of adolescent students. After fitting these variables into a multivariable logistic regression, only residence and living status were found to be significant factors for thinness.