World Journal of Nutrition and Health, 2017, Vol. 5, No.

2, 41-45
Available online at http://pubs.sciepub.com/jnh/5/2/3
Science and Education Publishing
DOI:10.12691/jnh-5-2-3

Dietary Diversity Score and Associated Factors among

High School Adolescent Girls in Gurage Zone,
Southwest Ethiopia
Meron Worku1, Gebremariam Hailemicael2,*, Asegedech Wondmu3
1
Department of human nutrition, collage of medicine and health sciences, Wolkite University, Wolkite, Ethiopia
2
Department of Health Policies and Management, collage of medicine and health sciences, Wolkite University, Wolkite, Ethiopia
3
Department of public health, Wolkite University, Wolkite, Ethiopia
*Corresponding author: [email protected]

Abstract Introduction: Dietary diversity and the amount of animal source foods that an individual consume are
two commonly used measures for dietary quality. Healthy growth and development essentially need a balanced diet
of nutrients which includes a variety of foods from different food groups such as vegetables, fruits, grains and
animal source. Objective: To assess dietary diversity and associated factors among high school adolescent girls in
Gurage zone, southwest Ethiopia. Methodology: School based quantitative cross sectional study was conducted.
The study included 634 adolescent girls. The sample was recruited using multistage cluster sampling technique. A
dietary diversity score (DDS) and anthropometric of girls were measured. Bi-variable analysis was done to identify
candidate variables for multivariable logistic regression and those variables having a p <0.25 was entered in
multivariable logistic regression model. The results were reported by using Odds Ratio and 95% CI. P-value less
than 0.05 were considered as statistically significant. Results: The mean dietary diversity score was 4.691.46. The
prevalence of adolescents consuming less than or equal to three food groups was 20% and those consumed 3-4 food
groups was 53.2% and those consumed greater than or equal to six food groups from nine food groups was 26.8%.
Mothers education (AOR=3.44, 95% CI=1.04-7.29, P=0.24), monthly income of the household (AOR=1.56, 95%
CI=1.28-1.9, P=0.001) and residence (AOR=0.8, 95% CI=0.1-0.9, P=0.21) were significantly associated with
dietary diversity score. Conclusion: Dietary diversity score of high school adolescent girls was low in the study area.
Keywords: dietary diversity, adolescents' girls, high school
Cite This Article: Meron Worku, Gebremariam Hailemicael, and Asegedech Wondmu, Dietary Diversity
Score and Associated Factors among High School Adolescent Girls in Gurage Zone, Southwest Ethiopia. World
Journal of Nutrition and Health, vol. 5, no. 2 (2017): 41-45. doi: 10.12691/jnh-5-2-3.

These characteristics make adolescents vulnerable to a

range of nutritional issues [3]. There are 1.2 billion
1. Introduction adolescents between the ages of 10 and 19 in developing
nations, from this half of them are girls [4]. While
Dietary Diversity is defined as the number of different adolescents have typically been considered a low risk
foods or food groups consumed over a given reference group for poor health, this ignores the fact that many
period [1]. Dietary diversity (DD) and the amount of health problems later in life can be improved or avoided
animal source foods that an individual consumes are two by adopting healthy lifestyle habits in adolescence [5].
commonly used measures for dietary quality. Healthy The major reason for focusing on adolescent girls is
growth and development essentially need a balanced diet that this period of a childs life is a unique opportunity to
of nutrients which includes a variety of foods from break a range of vicious cycles of structural problems that
different food groups (vegetables, fruits, grains and animal are passed from one generation to the next, such as
source foods). Monotonous diets (consumption of similar poverty, gender discrimination, violence, poor health and
diet for longer time) based on starchy staples lack nutrition. Preparing for the demands of childbearing and
essential micronutrients and contribute to the burden of breastfeeding is timely in adolescent girls and, above all,
malnutrition and micronutrient deficiencies. Dietary preventing premature pregnancy and its associated risk for
diversity instruments have recently become the preferred both mother and child. Early intervention is particularly
method for studying dietary adequacy in developing critical in adolescent girls whose nutritional status is
countries [2]. marginal to begin with, so that they enter their first
Adolescence is a period characterized by rapid physical, pregnancy in a better nutritional state [6].
emotional, social, sexual, and psychological development In Ethiopia twenty seven percent of women had chronic
and maturation which in turn increases their requirements energy deficiency (Body mass index < 18.5), 17 % of
for energy, protein, and many vitamins and minerals. women were anemic, and 6 % of rural women are
 World Journal of Nutrition and Health 42

experiencing night-blindness in their most recent 2.6. Data Collection Instrument and
pregnancy [7]. Procedures
There are few studies in Ethiopia about dietary diversity
and associated factors on adolescent girls. It is only The data was collected by fifteen diploma clinical
recently that efforts, although small, have been made to nurses who were recruited based on their competency for
include adolescent girls as beneficiaries in some of the data collection. The interviewers were trained for two
health and nutrition intervention programs. Therefore this days before the actual data collection on interviewing
study aims to investigate dietary diversity and associated approach, anthropometric measurement and data recording.
factors among adolescent girls in Gurage zone, southwest Weight of adolescent girls was measured using beam
Ethiopia. balance with light closing, and was measured to the
nearest 0.1 kg, and height of adolescent girls was
measured to the nearest 0.1 cm on standing position
2. Methods and Materials without shoes. Checking accuracy of the scale and
frequent calibrating of the scale was done.
2.1. Study Design and Participants Dietary diversity was measured using the WHO & FAO
one day diversity questionnaire. The diversity questionnaire
We conducted a school based quantitative cross- used consists of 14 groups of foods, which covers almost
sectional study from March to June 2016 in Gurage zone, every food taken. Some food groups in the dietary
southwest Ethiopia.Six hundred thirty four (634) selected diversity questionnaire are combined into a single food
adolescent high school girls participated in this study. group to create the dietary diversity score. In addition the
questionnaire had a single question about any food or fast
2.2. Source and Study Population food consumed out of the house [8]. We evaluated one
usual day in the week except holidays.
All adolescent high school girls in Gurage zone,
southwest Ethiopia were source population. All selected
adolescent high school girls in Gurage zone, southwest
2.7. Data Quality Control
Ethiopia were study population. All adolescent girls who Data quality was controlled via conducting a pre-test on
were free of physical disability like Kyphosis, Scoliosis, 5 % of the samples and through supervision during data
limb deformity or who were not pregnant were included as collection. The completeness of the questionnaire was also
study participant. checked before data entry. Anthropometric measurements
of subjects were done by trained data collectors using
2.3. Sampling Method and Criteria standard procedures.
Multistage cluster sampling was used to select the study
participants. First five districts in Gurage zone were 2.8. Data Processing and Analysis
selected using simple random sampling from a total of 15
Editing and sorting of the collected questionnaires was
districts; then two sample high schools were selected by
done manually every day to check for completeness. The
using simple random sampling method from each selected
completed questionnaire were coded and entered into a
district; and finally after proportionally allocating sample
data entry template in epi-data version 3.1. After double
size to each high school; adolescent girls were selected
entry verification, the data were exported to SPSS version
using cluster sampling technique.
20.00 for analysis. Normality was checked for all
continuous variables. Interaction between different
2.4. Sample Size independent variables was checked and colinearity
The sample size of the study was calculated using diagnostics was done by checking the variance inflation
single population proportion formula by considering the factor. Means, standard deviations (SD) and percentages
following assumptions: proportion of adolescents for were used to describe the data and the results presented
bellow the mean score of dietary diversity among with narration, frequency tables and graphs. Bi-variable
Ethiopian adolescent girls is 53% [7], margin of error as analysis was done to identify candidate variables for
5 %, confidence level at 95 %, non-response rate of 10 % multivariable logistic regression then those variables
and design effect of 1.5. The final sample size for this having a p <0.25 was entered in to multivariable logistic
study was 634. regression model.The results were reported by using Odds
Ratio and 95% CI. P-value less than 0.05 were considered
as statistically significant. Wealth index was generated
2.5. Variables of the Study using a factor analysis called principal component analysis.
Dietary diversity score in adolescent girls were
considered as dependent variables in this study. 2.9. Ethical Consideration
Adolescent Girls with dietary diversity score less than six
food groups out of nine food groups were considered as Ethical clearance was obtained from institutional ethical
low dietary diversity score. Those who have dietary review board of Wolkite University. Informed verbal
diversity score greater than or equal to six food groups consent was obtained from each study participant during
considered high. Socio-demographic variables, economic data collection .Honest explanation of the survey purpose,
status, nutrition and cultural related characteristics were description of the benefits and an offer to answer all
considered as independent variables. inquiries was made to the respondents. Participants right
43 World Journal of Nutrition and Health

to withdraw consent and discontinue participation without 3.2. Family Related Information
any form of prejudice was guaranteed. Privacy and
confidentiality of participants information was ensured Most (36.8%) of adolescent girls had mother who
throughout the process. cannot read and write. Majority (57.3%) of mothers were
housewife. Large proportions (31.1%) of adolescent girls
had father who cannot read and write and most (63.1) of
3. Results them are farmers. In majority (83.1) of households the
head was father. In most (85.6%) of the households the
type of food prepared was decided by the mother. Slightly
3.1. Sociodemographic Characteristics
over half of participants father were farmers. (Table 2)
A total of 634 high school adolescent girls completed
Table 2. Family related information among high school adolescent
the study giving a response rate of 100%. Larger girls in Gurage zone
proportions of participants (65.9%) were in the age group
of 16-19 and the remaining (34.1%) were in the age group Frequency
variables
(634)
13-15. Most (76.5%) of high school adolescent girls were
Gurage. The majority (51.6%) of participants were Mothers education
Orthodox Christians. A little more than one third (32.6%) Unable to read and write 233(36.8)
of participants were Muslim. Majority (71.5%) of them Able to read and write only 211(33.3)
reside in rural area. Most of (88%) them were unmarried.
1-4 82(12.9)
Slightly over half (56.9%) of participants were in grade
nine. (Table 1) 5-8 56(8.8)
9-12 34(5.4)
Table 1. Sociodemographic characteristics of high school adolescent
girls in Gurage zone, south Ethiopia, 2016. Diploma and above 18(2.8)
Frequency Mothers occupation
Socio-demographic variables
N=634
House wife 363(57.3)
farmer 79(12.5)
Age 14-15 216(34.1)
merchant 152(24.0)
16-19 418(65.9)
Daily laborer 10(1.6)
employed 27(4.3)
Gurage 485(76.5)
others 3(0.5)
Amhara 119(18.8)
Ethnicity Fathers education
Oromo 17(2.7)
Unable to read and write 197(31.1)
kenbata 6(1.0)
Able to read and write only 140(22.1)
Others 7(1.1)
1-4 90(14.2)

Orthodox 327(51.6) 5-8 105(16.6)

Muslim 207(32.6) 9-12 58(9.1)

Religion
Protestant 63(9.9) Diploma and above 44(6.9)

Catholic 19(3.0) Fathers occupation

Others 18(2.8) Farmer 400(63.1)
Merchant 99(15.6)
Residence Urban 181(28.5) Daily laborer 41(6.5)
Rural 453(71.5) Employed 60(9.5)
No job 19(3.0)
Married 72(11.4) others 15(2.4)
Marital status
Unmarried 558(88.0) Head of household
Divorced 4(0.6) Father 527(83.1)
Family size Mother 93(14.7)
1-4 100(15.8)
others 14(2.2)
5-10 522(82.3) Who decide the type of
>10 12(1.9) food prepared in home?
Income mother 543(85.6)
Low(< 500) 164(25.9) father 24(3.8)
Middle(501-1000) 382(60.3) children 52(8.2)
High(>1000) 88(13.9) other 15(2.4)
 World Journal of Nutrition and Health 44

Just half (50.0) of them ate together with their family vitamin A rich fruits and vegetables, other fruits and
(same plate) and most (86.1%) of them had fixed time for vegetable, green leafy vegetables, and legumes
eating meal. Slightly above half (56.47%) of them skipped respectively. Consumption of meat and fish, organ meat,
meals. From these 64.52, 16.48 and 18.99 skip breakfast, egg and milk and milk products was 23.3%, 95.9%, 72.4%
lunch and dinner respectively. A number of reasons were and 70.3% respectively
given by the respondents for skipping meals. Majority of
the respondents (68%) who skipped breakfast did so due 3.4. Predictors of Adolescent Girls Dietary
to lack of time; either they woke up late, or they were late
for school. Some (16%) indicated that they felt
Diversity
uncomfortable after eating breakfast; so they had decided The odds of having low dietary diversity was 1.56
to stop eating breakfast. Few (7%) of the participant (1.28-1.9) times higher among adolescents who earn less
mentioned lack of food as a reason for skipping meal. than five hundred birr per month (1 USD =22.8379ETB)
than adolescents who have greater than one thousand.
3.3. Dietary Diversity Mothers education is also important predictor of dietary
diversity. Adolescents with a mother who can only read
The mean dietary diversity score was 4.691.46. The and write were, 3.44 (1.04-7.29) times more likely to have
prevalence of adolescents consuming less than or equal to low dietary diversity than a mother who have diploma and
three food groups was 20% (127) and those consumed 3-4 above. Adolescents living in urban area were 0.8 times
food groups were 53.2% (337) and those consumed less likely to have low dietary diversity than those living
greater than or equal to six food groups were 26.8% (170). in rural area.
From those who were underweight most (78.7%) of
them consumed less than six food groups and from those
who had normal body mass index (BMI) most (73.3%) of 4. Discussion
them consumed less than six food groups. (Table 3)
Dietary diversity score is one of best indicators of both
Table 3. Distribution of dietary diversity (DDS) and its relationship
with body mass index among high school adolescent girls macronutrient and micronutrient intake. This study
showed that the mean dietary diversity was 4.691.46
DDS which is consistent with a study conducted in Kaduna
total P-value
<6 >=6 province of Nigeria among adolescents using the 24- hour
Underweight 85(78.7%) 23(21.3%) 108 recall questionnaire [9]. While this is slightly lower than
Normal 360(73.3%) 131(26.7%) 491 0.018
previous studies conducted in Ethiopia, Iran and Filipino
[7,10,11]. This could be due to the low awareness
Overweight 19(54.3%) 16(45.7%) 35
regarding diversification of diet seen in this study or it
DDS= Dietary diversity. could be because of the difference in sample size among
these studies. In this study only 26.8% of the participants
From the nine food groups 96.2%, 64.8%,84.5%,65.6% ate 6 or more food groups. This result is similar with the
and 73.3%of the participants consume starchy food, result of another study conducted in Ethiopia [7].

Table 4. Predictors of dietary diversity among high school adolescent girls

variables Low dietary diversity crude OR Adjusted OR

yes No
Income
<500 139 25 1.85(1.2-2.0) 1.56(1.28-1.9)*
500-1000 259 123 0.7(0.8-2.41) 1.48(0.84-2.61)
>1000 66 22 1 1
Mother education
Unable to read and write 189 44 1.2(0.2-2.5) 1.5(0.4-5.2)
Can only read and write 180 50 1.03(0.54-5.36) 3.44(1.04-7.29)*
1-4 56 26 0.62(0.48-5.42) 2.79(0.8-9.6)
5-8 41 15 0.78(0.36-4.5) 1.96(0.54-7.05)
9-12 22 12 0.5(0.5-7.11) 2.2(0.5-8.31)
Diploma and above 14 4 1 1
Residence
urban 115 66 0.51(0.3-0.7) 0.8(0.2-0.9)*
rural 349 104 1
45 World Journal of Nutrition and Health

In the present study, majority (96.2%) of girls 5. Conclusion

consumed cereal which is consistent with a study
conducted in Ghana which shows mostly consumed foods The mean dietary diversity of high school adolescent girls
were cereals and cereal product [12]. This could be due to was low. The prevalence of low DDS (>6 food groups) was
high production and availability of cereal based foods. high. Mothers educational level, monthly income of
This could also be due to the cultural preference of those household and residence were significantly associated with
foods. The questionnaire included a question about fast dietary diversity of adolescent girls. Considering adolescent
food consumption. Around 80% of the participants girls as one of major target groups for community based
claimed that they did not consume fast food in the last 24 nutrition recommended. Its better to give training to health
hours which is consistence with a study conducted in Iran extension workers about diversification of diet and its health
[10]. The reason could be due to mothers of most students benefits. Strengthening school education in Gurage zone
were housewives which might have contributed to the regarding nutrition is also helpful to increase dietary
lower consumption of fast foods by students. diversity of adolescents in the area.
But breakfast is very important especially among
adolescents who are still in school. This study showed that
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