Adolescent nutrition in Ethiopia: A systematic review and meta-analysis

Ethiopia, like many low- and middle-income countries, has undergone rapid economic growth over the last two decades that could influence the diets and nutrition of young people. With concurrent urbanisation and lifestyle transformations, overweight and obesity are emerging as significant problems among the adolescent population, alongside persisting undernutrition in large sections of the population. Although nutritional interventions are growing rapidly in Ethiopia, most of these are targeted to young children, as well as pregnant and lactating women, leaving adolescents a relatively neglected group. This work reviewed studies on adolescent nutrition to inform future interventions and guide policies and programmes for this age group.

The authors performed a systematic search for studies published in English on the prevalence of and interventions for malnutrition in adolescents aged 10-19 years in Ethiopia between 2000 and 2020. The results were checked for quality and rated as low, medium, and high using the Joanna Bridge Institute quality assessment checklists for observational and interventional studies. Seventy-eight studies were eligible for inclusion in the meta-analysis. These documented nutrition outcomes in terms of anthropometry, micronutrient status, dietary diversity, food insecurity, and eating habits.

In the meta-analysis, the pooled prevalence of stunting, thinness, and overweight/obesity was 22.4% (95% CI: 18.9, 25.9), 17.7% (95% CI: 14.6, 20.8), and 10.6% (7.9, 13.3), respectively. The prevalence of undernutrition ranged from 4% to 54% for stunting and from 5% to 29% for thinness. Overweight/obesity ranged from 1% to 17%. The prevalence of anaemia ranged from 9% to 33%. Approximately 40% to 52% of adolescents had iodine deficiency and associated risk of goitre. Frequent micronutrient deficiencies were vitamin D (42%), zinc (38%), folate (15%), and vitamin A (6.3%). About 80% and 60% of adolescents from rural and urban settings respectively were found to have low dietary diversity. 

The review showed that undernutrition (stunting, thinness, and micronutrient deficiencies) was more prevalent than overweight. The prevalence of thinness and stunting was higher among boys and rural adolescents, whereas overweight and obesity were higher among girls and urban adolescents. The review also revealed that adolescent food insecurity and low dietary diversity were common. Consequently, a large proportion of adolescents had one or more micronutrient deficiency.

The authors concluded that the adolescent population in Ethiopia faced multiple micronutrient deficiencies and a double burden of malnutrition, although undernutrition was predominant. The magnitude of nutritional problems varied by gender and setting, which calls for context-relevant interventions to effectively improve the nutrition and health of adolescents in Ethiopia.

"Although the prevalence of overweight is low compared to that of undernutrition, it appears that problems of overnutrition were emerging before Ethiopia has dealt with the burden of undernutrition."