Study design and population
A school-based cross-sectional study was conducted to estimate the prevalence of stunting
and its associated factors among the early adolescent girls of age 10-14 years attending
a primary governmental schools in Gondar town in January 2016 G.C. Gondar town is located in Northwest part of Ethiopia far about 735 km away from Addis
Ababa, the capital city of Ethiopia. Forty-three public primary schools are found
in Gondar town. There are 16,331 students attending in those governmental schools
and of these, 8,885 were early adolescent girls. These number could represent more
than 95% of the early adolescent girls in the community with almost similar socio-demographic
characteristics. All early adolescent girls present in selected governmental primary schools at the
time of data collection were included.
Sample size and sampling procedure
The sample size was calculated using a single population proportion formula by considering
the following assumptions: stunting among adolescent girls in Amhara region (P= 0.315) (17)
, 5% margin of error, 95% confidence level, non-response rate of 10 %, and a design effect
of 2. Accordingly, the final sample size estimated was 731. In the first stage, 10
primary schools were selected from 43 primary schools using a lottery method (23%
of all primary schools). In the second stage, the total number of adolescent girls
to be included were proportionally allocated to the size of primary schools and the
final study subjects were selected from each included primary schools by using a systematic
random sampling method.
Data collection procedures and quality
Data were collected using a pre-tested, structured and interviewer-administered questionnaire.
The questionnaire is prepared in English and translated to Amharic and to check for
its consistency, the questionnaire was back-translated to English by language experts.
Food security was assessed using the 9-item module and the sum of its affirmative
responses was taken (22). The weight of adolescent girls was measured to the nearest
0.1 kg using a calibrated SECA weighing scale with a light closing and without shoes.
The height of adolescent girls was measured to the nearest 0.1 cm on standing position
without wearing shoes using the same device that has scale and sliding headpiece.
Four diploma nurse data collectors and one BSc nurse supervisor were recruited and
trained for data collection. To assure the data quality, the questionnaire was pre-tested.
Weighing scale was calibrated to zero before taking every other measurement. The collected
data were reviewed and checked for completeness before data entry.
Variables of the study
Our dependent variable was stunting in the early adolescent (defined by WHO as a period
of life spanning the ages between 10-14 years) and it was measured as height for age Z-score (HAZ) of below minus two standard deviations (-2 SD) from
the median value of the WHO reference standard. Our independent variables include: education level of the student, educational status of the family,
family income, employment status of the family, family size, information about food
types such as teff (a type of crop used to make Enjera, a traditional food in Ethiopia),
food security status, frequency of meal per day, source of water, and hand wash habit.
These independent variables were collected by interviewing the students as most of
the questions were easy to answer by the students. Based on our extensive literature searching, this co-varieties were repeatedly reported
in other studies. The way we measured all of these variables could be found in our
data collection tool attached to this submission.
Data processing and analysis
After checking the collected data for completeness, it was entered into Epi-data version
3.1 and exported to SPSS version 20.0 for analysis. The anthropometry measurement
of height for age was calculated by WHO Anthro-plus software and those adolescent
girls with less than -2SD were considered to have stunting. The food security status of households with a row score of 0–1 was taken as food secure
and a row score of 2 & above was taken as food insecure (22). Bi-variable and the
multivariable logistic regression analysis were done to assess the association between
different explanatory variables and stunting. All variables with a p-value < 0.2 in
the bi-variable analysis were entered into the multivariable logistic regression model.
Odds ratio with its 95% confidence intervals were estimated to identify predictors
of stunting. A P-value < 0.05 was considered as statistically significant. Model fitness
was checked using the Hosmer and Lemeshow goodness of fit test (P-value = 0.99).
Ethical clearance of this study was granted by an Ethical Review Board of the University
of Gondar. Permission was also obtained from Gondar town Education Office and from
selected schools. Written consent from the guardians and a verbal assent from the
study participants was secured prior to data collection. The information collected
from this study was kept confidential. Those who were severely stunted were counseled
about their nutritional condition.