Assessing Dietary Practices of Ethiopian Adolescents

We used three measures including dietary diversity [20] –[21] (link), food variety [23] (link)–[24] (link) and consumption of animal source foods [25] –[27] (link) to gauge their dietary practices. Dietary diversity [DD] was assessed using a food frequency questionnaire containing 30 food items that are commonly consumed in the study area. The list of food items was developed based on an extensive interview of the data collectors who are from the study area and who knew the culture and language and key informants in the study area on the types of foods commonly consumed. The food frequency questionnaire was pre-tested on 200 adolescents and the food items commonly consumed in the area and the patterns over the week days observed during the pretest were used to refine the food frequency questionnaire. Participants were asked to report the frequency of consumption of each food per day, per week or per month using the past 3 months as a reference [33] (link). Given the large variation of dietary habits in the local community over the days of the week, the consumption of each food item per day [34] (link) was not taken as a cut-off point to define consumers. Rather, adolescents were coded as a “consumer” of a food item if they had consumed the food item at least once per week [35] . As there is no Ethiopian classification of food groups, the 30 food items [Table 1] of the food frequency questionnaire were grouped into seven groups [gains/vegetables/fruits/dairy/protein foods/oils/Discretionary calories] [Table 2] according to the MyPyramid classification for healthy eating [36] . A Dietary Diversity Score (DDS) was constructed by counting the intake of the food groups over a period of one week [37] (link) based on the definition that it is the sum of food groups consumed over the reference period. For example, an adolescent who consumed one item from each of the food groups at least once during the week would have the maximum DDS of 7. The DDS was converted into tertiles and the highest tertile was used to define “high” dietary diversity score, while the two lower tertiles combined were labeled as “low” dietary diversity score. Food Variety Score [FVS] is the frequency of individual food items consumed in the reference period. It was calculated by counting the consumption of each of the 30 individual food items over the reference period of one week [28] (link), [37] (link) with the maximum FVS to be thirty. The mean FVS were compared by background characteristics and food security status.
Animal Source Food [ASF] intake was assessed by summing the number of times each animal source food was consumed over the days of the week. Frequency of ASF consumption was divided into tertiles and the highest tertile was used to define “high” frequency of consumption of ASF, while the two lower tertiles were labeled as “low” frequency of ASF consumption.
We adjusted our analysis for household dependency ratio calculated as the ratio of people who are not expected to be productive [age groups greater than 64 and less than 15 years] to the number of people who are expected to be potentially productive [age 15–64 years]. The dependency ratio was divided in to tertiles. We also adjusted for adolescent educational status categorized based on the current classification the Ministry of Education as “primary” [grade 8 and below] and secondary and above [Grade 9 and above].
Adolescent food insecurity was measured using items adapted from household food insecurity scales that were previously validated for use in developing countries [38] (link)–[40] (link), the details of the methods are described elsewhere[41] (link). Four items that amply to individual experiences adolescents were used to assess food insecurity. Briefly, adolescents were asked whether in the last three months they (1) had ever worried about having enough food; (2) had to reduce food intake because of shortages of food or money to buy food; (3) had to go without having eaten because of shortage of food or money to buy food and (4) had to ask outside the home for food because of shortage of food or money to buy food. All “Yes” responses were coded “1” and “No” responses were coded “0” and the scores were summed. Adolescents who had food insecurity score of 1 and above were labeled as food insecure. The index has high internal consistency (Cronbach’s Alpha = 0.81).
The study was approved by the Ethical Review Boards of both Brown University (USA) and Jimma University (Ethiopia). Informed verbal consent was obtained both from the parents and each respondent before the interview or measurement as approved by the ethical review committees which followed and documented the study process through supervisory visits.