RESEARCH NOTE Urban-rural disparities in the nutritional status of school adolescent girls in the Mizan district, south- western Ethiopia TM Berheto 1*, WK Mikitie 2, A Argaw 2 1Department of Public Health, Aman College of Health Sciences, Mizan Teferi, Ethiopia 2Department of Population and Family Health, Jimma University, Jimma, Ethiopia *Present Address: School of Public Health, College of Health Sciences, Wolaita Sodo University, Sodo, Ethiopia Submitted: 14 February 2014; Revised: 25 February 2015; Accepted: 17 March 2015; Published: 30 July 2015 Berheto TM, Mikitie WK, Argaw A Urban-rural disparities in the nutritional status of school adolescent girls in the Mizan district, south-western Ethiopia Rural and Remote Health 15: 2687. (Online) 2015 Available: http://www.rrh.org.au A B S T R A C T Introduction : Malnutrition that occurs during adolescence has important consequences for the future growth and development of the individual, particularly in girls in developing countries. Besides limiting growth, adolescent malnutrition has important consequences for society. Despite this, there is a lack of information on the nutritional status of adolescent girls in Ethiopia. This study was therefore performed to help redress this lack of data and to provide information for future improvements by health planners and policy makers. Methods: A comparative cross-sectional study design was employed to determine the urban–rural disparity in nutritional status of adolescent school girls in the Mizan district in south-western Ethiopia. A two-stage sampling procedure was used to randomly select 622 adolescent girls, 311 each from urban and rural locations. Trained field workers used structured questionnaires to obtain the desired information from the respondents. Anthropometric measurements of height and weight were collected using standard procedures and appropriate quality control measures. Height-for-age Z-scores and body mass index (BMI)-for-age Z-scores were generated using AnthroPlus software. The independent sample t-test and χ2 test were used to determine statistical significance. Results: There were no significant differences in the ages or physical activities of the two populations of girls studied. Consumption of cereal, vegetables, sweets, sugars, fats, meat, and eggs was similar between the two groups, although slight © TM Berheto, WK Mikitie, A Argaw, 2015. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 1 differences were found with regard to legumes, milk, and fruit consumption. No significant differences were found in the prevalence of mild underweight girls and overweight girls in the urban and rural groups (26.5% vs 22.3% and 7.5% vs 5.2%, respectively). Significant stunting was, however, present in the rural population (40.9% vs. 17.8% in the urban group). Although overall lower than the reference data provided by WHO, the mean BMI-for-age Z-scores and height-for-age Z-scores were significantly higher in the urban girls than in their rural counterparts, with mean differences of 0.18 (95% confidence interval (CI) 0.02–0.34) and 0.58 (95% CI 0.45–0.72), respectively. Conclusions: Malnutrition was present in both urban and rural adolescent girls. The most obvious disparity between the two populations was significant stunting in the rural population. There is therefore an urgent need for strategies to address severe nutritional problems in rural adolescent girls and to improve the nutrition of adolescent girls within the urban environment. Key words: adolescent girls, nutritional status, obesity, southwest Ethiopia, stunting, urban and rural disparity. Introduction opportunities of adolescent girls should have a positive impact on their individual development and also help long-term reductions in poverty 1,2. Globally, there are more than 1.2 billion adolescents aged 10– 19 years 1,2. Adolescence is one of the most dynamic stages of Although Ethiopia is a country with an extremely young development and is characterized by dramatic physical and population, very little is known about the nutritional status of its psychosocial changes in the individual 3,4. For example, adolescents 15 . Demographic and health surveys on adolescents approximately 20%, 50%, and 45% of the final adult height, aged 15 years and older are available, but relatively few studies weight, and bone mass, respectively, are attained during this have been performed on younger adolescents 16 ,17 in Ethiopia. Such period 1,5,6. Such changes result in a peak in nutritional studies also lack information obtained from both urban and rural requirements 7,8 that exceeds that occurring during the remaining environments. The present study was, therefore, carried out to lifetime 3. Deficits in nutrition during this period not only impair help address this problem by obtaining information on the growth, but also the personal development of the individual 1-3, disparity in nutritional status between adolescent girls aged 11– which will ultimately have a wider impact on society. 19 years living within rural and urban communities in the Mizan district, south-western Ethiopia. The results obtained should In Ethiopia, in contrast to boys, girls often face a reduction in provide important information for future planning to help prevent freedom and opportunities during puberty 6,9,10 . These malnutrition and also improve the development of adolescent girls restrictions are frequently increased in rural parts of Ethiopia, 8 in Ethiopia. where more than 85% of the girls live and where work burdens for adolescent girls are especially heavy 11 . Puberty is also a time when girls’ bodies prepare for the nutritional Methods demands of pregnancy and lactation required in later life 12 ,13 . Study setting and design As a result, girls are more prone to nutritional difficulties than boys 2, and nutritional deficiencies experienced by a girl A cross-sectional comparative descriptive study design was during this period can affect the future health of the employed to assess urban–rural disparities in the nutritional individual and her offspring 13 ,14 . Improving the nutritional status of adolescent school girls in Mizan district. It is located status of adolescent girls represents an important way of in the Bench-Maji zone in the Southern Regional State of breaking the intergenerational cycle of malnutrition 5,14 . Ethiopia. This district has an estimated total population of Furthermore, such an investment in increasing the 700 000; with 30% being urban residents. It is known for its © TM Berheto, WK Mikitie, A Argaw, 2015. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 favorable agro-ecology, with year-round rainfall and one of A four-item individual food security scale, developed and tested in the lowest risks of food insecurity in Ethiopia. The people in another study 19 , was used to assess food security status. The the rural parts are economically dependent on agricultural questions in the scale asked whether girls within the last month had products while the urban residents are mainly engaged in (1) ever worried about having enough food, (2) ever had to reduce market-oriented business activities and services 18 . The study food intake because of shortage of food or lack of money to buy area was selected purposively to fulfill the assumption food, (3) ever had to go without eating because of shortage of food homogeneity in population pattern, in regards to culture, or money to buy food or (4) ever had to ask outside the home for ethnicity and agro-economy in the urban and rural setting. It food. Food security status was determined as follows: girls were contains 29 schools, with female enrolment reaching 98% in ‘food secure’ only when the responses for all the four items were both the urban and rural setting during 2012. The present ‘no’; otherwise, the girls were labeled as ‘food insecure’. The survey was conducted in February 2012, corresponding to dietary practice of subjects was assessed by asking about their usual the Ethiopian post-harvest season. number of meals per day, the frequency of missed meals within the last 2 weeks, and, finally, the usual frequency of consumption Sample size and sampling for different food groups (cereals, legumes, fruits and vegetables, milk and milk products, and meat and eggs). A sample size calculation was performed using the STATCALC program of EPI INFO v6.2 (Centers for Disease Physical activity was assessed using the Adolescent Physical Control and Prevention; http://wwwn.cdc.gov/epiinfo). A Activity Recall Questionnaire (APARQ) 20 but adapted to total of 622 subjects (311 in each rural and urban study include a list of common activities performed by adolescents group) were required to detect the previously identified 16% in Mizan. Girls were asked to estimate the frequency and urban–rural stunting prevalence disparity 10 with a 95% level time spent doing the listed activities in a typical week. The of confidence, 90% power, a design effect of two, and with weight and height of each girl was taken by one of the 10% allowance. Fifteen schools with grades 5 to 10 were researchers using standard techniques and calibrated stratified into urban (seven schools) and rural (eight schools) equipment 21 , with the subjects wearing school uniform and groups based on the governmental administrative structure. no shoes. Weight was measured using a digital scale (SECA Three schools were selected from each group using the 876) to the nearest 100 g and height to the nearest 1 mm ‘probability proportional to size’ method, and female using a statometer (SECA 225). The age of the girls was adolescents were selected randomly from the two settings. confirmed from the school registers. Computer-generated random numbers were used to identify study participants from the two sampling frames. The socio-demographic information was collected to provide a logical overview of the study population to link with the Data collection and measurement results and interpretation of the data.