Double burden of malnutrition and associated factors among adolescent in Ethiopia: A systematic review and meta-analysis

Abstract

Background: As adolescence is a transition period from childhood to adulthood malnutrition occurring at this age resonates through generations. Although there were many individual studies in Ethiopia about different form of malnutrition among adolescent, their results are inconclusive indicating the need for generating a pooled estimate of adolescent nutritional status and associated factors. This review and meta-analyses aimed at estimating the pooled prevalence of different forms of malnutrition and associated factors among adolescents in Ethiopia.

Method and materials: We searched data bases from Pub Med, Cochrane Library, Health Inter Network Access to Research Initiative (HINARI), Science Direct and search engines; Google and Google Scholar and other sources; Reference of References and expert contact which were used to select the studies. Joanna Briggs Institute (JBI) quality appraisal tool was applied to identify eligible studies. STATA/SE V.14 was used to analyze the data. Effect size with 95% Confidence Interval (CI) and heterogeneity were estimated. Heterogeneity of studies was quantified with I2 statistic >50% used as an indicator of heterogeneity. Potential publication bias was assessed using Funnel plots and Egger's regression test. Trim and fill analysis was also performed. The presences of a statistical association between independent and dependent variables were declared at P <0.05. The PROSPERO registration number for the review is CRD42020159734.

Results: The pooled prevalence of overweight/obesity, stunting and thinness were 10.63% (95% CI: 8.86, 12.40), 20.06% (95% CI: 15.61, 24.51) and 21.68% (95% CI: 9.56, 33.81), respectively. Being female (OR: 2.02, CI: 1.22-3.34), low dietary diversity score (OR: 2.26 CI: 1.28-3.99) and high physical activity (OR: 0.36, 95%CI: 0.14-0.88) were significantly associated with adolescent overweight/obesity. Urban residence (OR: 0.82, 95%CI: 0.68-0.99), protected drinking water source (OR: 0.50, CI: 0.27-0.90) and having family size<5 people (OR: 0.54, CI: 0.44-0.66) were independent predictors of adolescent stunting. Early adolescent age (10-14 years) (OR: 2.38, CI: 1.70-3.34), protected water source for drinking (OR: 0.36, CI: 0.21-0.61), low wealth index (OR: 1.80, CI: 1.01-3.19) and family size <5 people (OR: 0.50, CI: 0.28-0.89) were significantly (P < 0.05) associated with adolescent thinness.

Conclusion: The prevalence of overweight/obesity, stunting and thinness are high in Ethiopian adolescents indicating the upcoming challenge of double burden of malnutrition. The results imply the presence of double burden of malnutrition among adolescents which heralds the need for programmatic and policy response in terms of addressing modifiable risk factors including: dietary practices, physical activity, water source and economic status of these adolescents.

Fig 1. PRISMA 2009 flow diagram of study selection of adolescent double burden of malnutrition in Ethiopia.

Fig 2. Forest plot of the pooled prevalence of adolescent overweight/obesity in Ethiopia.

Fig 3. Forest plot of the pooled prevalence of adolescent stunting in Ethiopia.

Fig 4. Forest plot of the pooled prevalence of adolescent thinness in Ethiopia.

Fig 5. Sensitivity analysis of stunting among adolescents in Ethiopia.

Fig 6. Sensitivity analysis of thinness among adolescents in Ethiopia.

Fig 7. Funnel plot and Eggers’ test to assess publication bias for adolescent overweight/obesity in Ethiopia.

Fig 8. Funnel plot and Eggers’ test to assess publication bias for adolescent stunting in Ethiopia.

Fig 9. Funnel plot and Eggers’ test to assess publication bias for adolescent thinness in Ethiopia.

Fig 10. Trim and fill analysis for overweight/obesity among adolescent in Ethiopia.

Fig 11. Trim and fill analysis for stunting among adolescent in Ethiopia.

Fig 12. Trim and fill analysis for thinness among adolescent in Ethiopia.

Fig 13. Pooled Odds Ratios of factors associated with overweight/obesity among adolescent in Ethiopia.

Fig 14. Pooled Odds Ratio of factors associated with stunting among adolescent in Ethiopia.

Fig 15. Pooled Odds Ratio of factors associated with thinness among adolescent in Ethiopia.

Fig 16. Sensitivity analysis of factors associated with overweight/obesity in Ethiopia.

Fig 17. Sensitivity analysis of factors associated with stunting in Ethiopia.

Fig 18. Sensitivity analysis of factors associated with thinness in Ethiopia.

Fig 19. Funnel plot and Eggers’ test to assess publication bias for factor associated with adolescent overweight/obesity in Ethiopia.

Fig 20. Funnel plot and Eggers’ test to assess publication bias for factor associated with adolescent stunting in Ethiopia.

Fig 21. Funnel plot and Eggers’ test to assess publication bias for factor associated with adolescent thinness in Ethiopia.