Skip to main content

Magnitude and associated factors of undernutrition (underweight and stunting) among school adolescent girls in Hawzen Woreda (District), Tigray regional state, Northern Ethiopia: Cross-sectional study



There is a lack of evidence concerning undernutrition (underweight and stunting) among adolescent girls in the study area, therefore, this study aimed to assess the magnitude of undernutrition and associated factors among adolescent girls in Hawzen woreda, Northern Ethiopia.


This study found that 32.2% and 33.2% of school adolescent girls were underweight and stunted respectively. Illiterate fathers were higher among underweight adolescent girls as compared to those normal-weight adolescent girls (AOR = 1.4, 95% CI; 1.1, 1.7). Underweight adolescents were higher among low-grade level adolescents (grade 4–8) as compared to grade 9–12 adolescents (AOR = 2, 95% CI; 1.4, 2.6). Unemployed mothers were higher among stunted adolescent girls as compared to the counterpart (AOR = 2.2, 95% CI; 1.1, 3.3). It would be good to consider the above-mentioned factors during the nutritional intervention of adolescents.


World Health Organization (WHO) defined adolescents as persons aged 10–19 years [1]. Adolescents gain fifty percent of adult weight and more than twenty percent of their adult height during this period. The adolescents are generally expected to enjoy good health and being less vulnerable to infection compared with under-five children and of chronic diseases compared with aging people, and hence they have generally being given little health and nutritional attention except for reproductive health concern. Undernutrition is a major public health problem among adolescent girls all over the world. In developing countries including Ethiopia, half of all adolescents fail to achieve their full genetic growth potential. Poor dietary diversity, poor dietary inadequacies, frequent illness, lack of health care access, increased nutritional requirement can affect adolescent nutrition [2,3,4]. Undernourished adolescents have lowered resistance to infection; they are more likely vulnerable to common diseases like diarrheal diseases and respiratory infections [5,6,7,8]. Adolescent’s undernutrition in Asia and Africa is generally higher with a magnitude of 32–65% and 4–30% respectively. In Sub Sahara Africa, the magnitude of adolescence under-nutrition is 15–58%, which is higher from other African countries [6, 9, 10]. There is a lack of evidence concerning adolescent girls’ undernutrition in the study area. Therefore, this study aimed to assess the magnitude and associated factors of undernutrition (underweight and stunting) among adolescent girls in Hawzen woreda, Northern Ethiopia.

Main text

Methods and materials

The study was conducted in Hawzen woreda, Tigray, Northern Ethiopia at school level from December 2017 to January 2018. Hawzen woreda is located in the Eastern part of the Tigray regional state, at a distance of 950 km from Addis Ababa and 84 km from Mekelle town. According to the 2007 Central Statistics Agency of Ethiopia (CSA), the woreda has a total population of 117,954. The woreda has 34 schools; 30 of them are primary (1–8 grade) and 4 are secondary (9–12 grade) schools. A total of 29,840 students (15,568 girls) attend their education in these schools.

The institution (school) based cross-sectional study design was applied and the study population was adolescent girl students attending their education in selected primary and secondary schools of Hawzen woreda. Adolescent girl students who were residents of the woreda for at least 6 months were included in the study but adolescent girl students who had physical deformity were excluded due to the difficulty for anthropometric measurements. The sample size was calculated using a single population proportion formula based on the prevalence rate of underweight which was 37.8% [11] and 95% level of confidence and 5% marginal error. By adding 10% for non-respondent rate, the total sample size became 398. Lottery method was used to select fifteen schools from a total of 34 schools then the total sample size was properly allocated for the selected schools according to the number of students they have. Classes (sections) and participants were selected by the lottery method. The dependent variable was undernutrition (underweight and stunting) and the independent variables were socio-demographic factors, diet, personal hygiene and sanitation, behavior and lifestyle and anthropometric measurements. Underweight is Body Mass Index (BMI) for age < − 2 standard deviation (SD). Stunting is the height for age < − 2 SD. A pre-test was done on 5% of student adolescent girls at another woreda. Training was given for 2-days. Weighing scales were calibrated with known weight object regularly. On a daily basis, the collected information was reviewed manually. Questionnaires that had missing data were returned to the data collectors to fill the missed data by contacting the adolescent girl.

The data were analyzed using the statistical package for social sciences (SPSS) software version 20 for analysis. Descriptive statistics were done to show the magnitude of undernutrition (underweight and stunting) and participant characteristics. Associations between dependent and independent variables were checked using binary logistic regression analysis. Variables with p value < 0.25 in the bivariate analysis were transferred to multivariable logistic regression. In multivariable logistic regression, p-value < 0.05 was used to declare statistical significance. Adjusted odds ratio with its 95% confidence intervals was also computed.


Socio-demographic and economic characteristics

A total of 398 adolescent girls (10–19 years old) from fifteen schools were enrolled in this study which made the respondent rate 100%. Majority of the study groups were in the age range of 14–19 years and almost all respondents were identified as orthodox Christian. More than two-thirds of the study participants live in rural areas. The literacy rate of fathers and mothers were found to be 72.4% (284) and 51.8% (206) respectively. About 64.6% of fathers and 69.8% of mothers were identified as farmers and housewife respectively (Table 1).

Table 1 Socio-demographic characteristics of adolescent girls in schools of Hawzen woreda, Northern Ethiopia, 2018

Dietary factors

About 94% (374) of respondents usually ate three and more than three meals per day. Enjera with shirowet was stapled diets for 97.7% of respondents. Thirty-seven percent of the participants got their routine diet from their own product (Table 2).

Table 2 Diet, lifestyle, behavioral and environmental factors among adolescent girls in schools of Hawzen woreda, Northern Ethiopia, 2018

Lifestyle and behavioral factors

About 75.9% (302) of respondent adolescent girls had work other than learning. About 62.6% (249) of adolescent girls travel less than 40 min to reach the school. Ninety-five percent (378) and 77.6% (309) of the study participants neither smoke cigarettes nor drink alcohol respectively (Table 2).

Environmental factors

From a total of 398 respondents, about 96.5% (384) use drinking water from the improved source (pipe water). Three hundred sixty-nine participants had latrine of which 39.2% (156) of the latrine was pit latrine (Table 2).

The magnitude and associated factors of undernutrition among adolescent girls

About 32.2% (128) of the adolescent girls were underweight and 33.2% (133) adolescent girls were stunted. About 8.8% (35) of adolescent girls had both underweight and stunting. In the bivariate logistic regression; residence, age, father occupation, mother occupation, father education, grade level, income, meal frequency, latrine, and illness had a p-value of < 0.25 and these variables were taken to the multivariable logistic regression model. In the multivariable logistic regression; illiterate father and low-grade level were significant factors for underweight and unemployed mother was the only significant factor for stunting. Illiterate fathers were higher among underweight adolescents compared to that normal weight (AOR = 1.4, 95% CI; 1.1, 1.7). Underweight adolescents were higher among low-grade level adolescents (grade 4–8) as compared to high-grade level adolescents (9–12) (AOR = 2, 95% CI; 1.4, 2.6). Unemployed mothers were higher among stunted adolescents as compared to the counterpart (AOR = 2.2, 95% CI; 1.1, 3.3) (Table 3).

Table 3 Bivariate and multivariable logistic regression analysis for undernutrition among adolescent girls in Hawzen woreda, Northern Ethiopia, 2018


This study showed that 32.2% of school adolescent girls were underweight. This magnitude is higher as compared to other studies conducted in Arsi Zone (14.5%), Ambo (27.2%), Adama city (21.3%), Bale Zone (13.7%), Arbaminch (19.7%), West Harage (24.24%), Northern Ethiopia (26.1%), Adwa town (21.4%), Addis Ababa (6.2%), Ethiopia (13.6%), Zambia (13.7%), Nigeria (18.6%), seven Africa countries (12.6%-31.9%), Latin America and Caribbean countries (3%-22%) [8, 12,13,14,15,16,17,18,19,20,21,22,23,24]. This might be due to the low socioeconomic status in this study area. The magnitude of underweight in this study is low as compared to the magnitude reported from studies conducted in Mekelle city (37.8%), Eastern Tigray (55%), Tigray (58.3%), Bangladesh (67%), and India (49%) [25,26,27,28,29]. This could be due to the time gap variation in which currently improved awareness about nutrition in adolescent parents and the current nutritional intervention. The magnitude of underweight in this study is consistent with the magnitude of underweight in Myanmar [28].

The magnitude of stunting in this study was 33.2%. This is higher than the study result from Arsi Zone (20.2%), Adama city (15.6%), West Hararge (7.2%), North Ethiopia (28.5%), Adwa town (12.2%), Eastern Tigray (25.5%), Tigray Region (26.5%), Addis Ababa (7.2%), Ethiopia (31.5%), Indonesia (23.6%) [12, 14, 17,18,19,20, 26, 27, 30]. The difference could be due to differences in socio-demographic and economic status. The magnitude of stunting in this study is lower as compared studies conducted in South East Asian countries; Bangladesh (48%), Myanmar (39%) and India (54%) [28, 29]. This difference may be due to the difference in cultural and dietary practices. The magnitude of stunting in this study is within the range of the magnitude reported from Latin America and Caribbean countries (7–43%) [24].

In this study, the father’s educational status was associated with adolescent girls underweight. This finding is in line with findings of studies conducted in Adama city, West Hararge and Ethiopia [14, 20, 27]. Higher educational status of a father can relate with a good income, good knowledge, availability and access to a balanced diet. Adolescent girls from grades four to eight were more likely to be underweight as compared to grade 9–12 adolescent girls. This finding is consistent with study findings conducted in Jimma zone and Zambia [21, 31]. Adolescent girls who attain higher grade level (9–12) can get awareness about nutrition from previous nutrition education interventions, from biology and chemistry [21]. This study showed that unemployed mothers were 2.2 times higher in stunted adolescent girls as compared their counter parts. This finding is in line with a study finding done in India [8]. This can be due to the low income, and food of unemployed mothers. The findings of this study showed that adolescent undernutrition is a public health concern which needs development and strengthening of nutrition interventions.


There was a possibility of recall bias and social desirability bias. Due to the nature of the study design, it was difficult to establish a cause-effect relationship.

Availability of data and materials

All data generated or analyzed during this study are included in this published article



Adjusted odds ratio


Body Mass Index


Confidence interval


Central Statistics Agency


Standard deviation


Statistical package for social science


World Health Organization


  1. 1.

    World Health Organization. Nutrition in adolescence—issues and challenges for the health sector, “Issues in Adolescent Health and Development. Geneva: Switzerland; 2005.

    Google Scholar 

  2. 2.

    Stang J, Story MT. Guidelines for adolescent nutrition services. 2005; Chapter 1, pp. 1–8. ISBN 92 41593660.

  3. 3.

    Lifshitz F, Tarim O, Smith MM. Nutrition in adolescence. Endocrinol Metab Clin North Am. 1993;22(3):673–83.

    CAS  Article  Google Scholar 

  4. 4.

    WHO. Reducing risks, promoting healthy life. The World health report. Geneva: Switzerland; 2002.

    Google Scholar 

  5. 5.

    Story M. Alton nutrition issue and adolescent pregnancy. J Nutr Food Sci. 2005;30:142–3.

    Google Scholar 

  6. 6.

    Cordeiro LS, Wilde PE, Semu H, Levinson FJ. Household food security is inversely associated with undernutrition among adolescents in Kilosa, Tanzania. J Nutr. 2012;142(9):1741–7.

    CAS  Article  Google Scholar 

  7. 7.

    Olaf M, Michael K. Malnutrition and health in developing countries. Can Med Assoc J. 2005;173(3):279–2786.

    Article  Google Scholar 

  8. 8.

    Tsgehana G, Takele T, Azeb A. Prevalence of Thinness and stunting and associated factors among adolescent school girls in Adwa Town, North Ethiopia. Int J Food Sci. 2016;2016:1–8.

    Google Scholar 

  9. 9.

    Rosen JE. Adolescent health and development: A Resource Guide for World Bank Operations Staff and Government Counterparts. International Bank for Reconstruction and Development Washington DC.2004.

  10. 10.

    Charles D, Hélène F, Olivier R. Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou, Burkina Faso. Nutr J. 2011;10(34):1–8.

    Google Scholar 

  11. 11.

    Elena R, Lumina C. adolescent malnutrition from anthropological perspective Bucharest, Romania. Proc Rom Acad Series. 2007;2:155–8.

    Google Scholar 

  12. 12.

    Yayehyirad Y, Abel G, Wondessen N, Dejene H, Taddesse A, Frehiwot M, et al. Undernutrition and its associated factors among adolescent girls in the rural community of Asako district, Eastern Arsi Zone, Oromia region, Eastern Ethiopia. Int J Clin Obstetr Gynecol. 2017;1(2):17–26.

    Google Scholar 

  13. 13.

    Mesert Y, Jemal H, Hailu K, Fleming F. Socioeconomic and demographic factors affecting body mass index of adolescents students aged 10–19 in Ambo (a Rural Town) in Ethiopia. Int J Biomed Sci. 2010;6(4):321–6.

    Google Scholar 

  14. 14.

    Roba KT, Abdo M, Wakayo T. Nutritional status and it’s associated factors among school adolescent girls in Adama City, Central Ethiopia. J Nutr Food Sci. 2016;6(3):1–7.

    Article  Google Scholar 

  15. 15.

    Ahmed Y, Tomas B. Nutritional status and associated risk factors among adolescents girls in Agarfa High School, Bale Zone, Oromia Region, South East Ethiopia. Int J Nutr Food Sci. 2015;4(4):445.

    Article  Google Scholar 

  16. 16.

    Dessalegn A, Jemal H, Gebrekirstos G, Desta H. assessment of the magnitude of the double burden of malnutrition and its associated factors among selected in-school adolescents in Arbaminch town, Southern Ethiopia. Int J Nutr Metab. 2017;9(4):30–7.

    Article  Google Scholar 

  17. 17.

    Damie TD, Wondafrash M, Teklehaymanot A. Nutritional status and associated factors among school adolescents in Chıro Town, West Hararge, Ethiopia. Gaziantep Med J. 2015;21(1):32–42.

    Article  Google Scholar 

  18. 18.

    Yohannes A, Gordon A, Tiffany K, Robert J, Zumin S. Prevalence and factors associated with stunting and thinness among adolescent students in Northern Ethiopia: a comparison to World Health Organization standards. Arch Public Health. 2015;73:44.

    Article  Google Scholar 

  19. 19.

    Yoseph G, Solomon S, Balem D, Gessessew B. Nutritional Status of Adolescents in Selected Government and Private Secondary Schools of Addis Ababa, Ethiopia. Int J Nutr Food Sci. 2014;3(6):504–14.

    Article  Google Scholar 

  20. 20.

    Molla M, Azeb A, Melkie E, Getu D, Adamu B, Tibebu M. Predictors of nutritional status of Ethiopian adolescent girls: a community-based cross-sectional study. BMC Nutr. 2015.

    Article  Google Scholar 

  21. 21.

    Bupe B. Nutritional status among female adolescents aged (15–19 years) in Zambia: why it matters. Horizon J Med Med Sci. 2015;1(1):001–7.

    Google Scholar 

  22. 22.

    Chukwuma B, Anthony C, Kenechi A, Kevin C, Chinomnso C, Irene A, et al. Prevalence and determinants of adolescent malnutrition in Owerri, Imo State, Nigeria. Int J Sci Healthc Res. 2016;1(3):53–63.

    Google Scholar 

  23. 23.

    Taru M, Hesham E, David T, Jason R. The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries. BMC Public Health. 2014;14:887.

    Article  Google Scholar 

  24. 24.

    Pan American Health Organization. Underweight, short stature and overweight in adolescents and young women in Latin America and the Caribbean. 2008.

  25. 25.

    Hadush G, Omer S, Huruy A. Assessment of nutritional status and associated factors among school going adolescents of Mekelle City, Northern Ethiopia. Int J Nutr Food Sci. 2015;4(1):118–24.

    Article  Google Scholar 

  26. 26.

    Weres Z, Yebyo H, Miruts K, Gesesew H, Woldehymanot T. Assessment of adolescents’ under nutrition level among school students in Eastern Tigray, Ethiopia: a cross-sectional study. J Nutr Food Sci. 2015;5:402.

    Article  Google Scholar 

  27. 27.

    Afework M, Fitsum H, Barbara S, Gideon K, Vincent L, Zenebe A, et al. Nutritional status of adolescent girls from rural communities of Tigray, Northern Ethiopi. Ethiop J Health Dev. 2009;23(1):6–11.

    Google Scholar 

  28. 28.

    World Health Organization. Adolescent nutrition: a review of the situation in selected South-East Asian Countries. Geneva: WHO; 2006.

    Google Scholar 

  29. 29.

    Amitava P, Amal K, Arunangshu S, Prakash C. Prevalence of undernutrition and associated factors: a cross-sectional study among rural adolescents in West Bengal, India. Int J Pediatr Adolesc Med. 2017;4:9e18.

    Google Scholar 

  30. 30.

    Sitti P, Andi I, Ida R, Abdul R. Low socioeconomic status among adolescent schoolgirls with stunting in Maros district, South Sulawesi in Indonesia. Int Proc Chem Biol Environ Eng. 2016;95:75–9.

    Google Scholar 

  31. 31.

    Huruy A, Tefera B, Legesse N. Socioeconomic factors associated with underweight and stunting among adolescents of Jimma Zone, South West Ethiopia: a cross-sectional study. London: Hindawi Publishing Corporation; 2013.

    Google Scholar 

Download references


We would like to thank Tigray regional health bureau, Eastern Zone of Tigray and schools for their support and cooperation. Our special thanks go to study participants, data collectors and supervisors for their full cooperation during the research activities.


The funder was Adigrat University and the amount of the fund was 500 USA dollars. The funder didn’t have a role in the study design of the study, collection, analysis, interpretation of data and in writing the manuscript.

Author information




Conceptualization: KB. Data collection: KB, GG. Formal analysis: KB, GG. Investigation: KB, GG. Methodology: KB, GG. Project administration: KB, GG. Software: KB, GG. Supervision: KB, GG. Validation: KB, GG. Visualization: KB, GG. Writing original draft: KB, GG. Writing review and editing: KB, GG. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Kidanemaryam Berhe.

Ethics declarations

Ethics approval and consent to participant

Ethical approval was found from the ethical committee called the College of Medicine and Health Sciences Research and Community Service Ethical Committee (CMHS-RCS-EC), Adigrat University. The committee’s reference number for this research was AGU/CMHS/R/008/18. Written permission was obtained from the Tigray Regional Health Bureau, district/woreda education offices and selected schools. Further, study participants were briefed about the main objective of the study. Participants were informed that they have the full right to refuse to participate in the study or can interrupt/withdraw if they want. Confidentiality of the information was assured and the privacy of the study participants was respected and kept as well. Written informed consent was obtained from each study participant and/or from parents/guardians of < 16 years old adolescent girls. At the last adolescent girls were counseled on personal hygiene, sanitation, nutritional practices, and a healthy lifestyle.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Berhe, K., Gebremariam, G. Magnitude and associated factors of undernutrition (underweight and stunting) among school adolescent girls in Hawzen Woreda (District), Tigray regional state, Northern Ethiopia: Cross-sectional study. BMC Res Notes 13, 59 (2020).

Download citation


  • Underweight
  • Stunting
  • Adolescent girls
  • Hawzen