Thesis:

Determinants of nutrition status among adolescents in selected secondary schools in rural Kanungu district Uganda

Adolescence is a vital period for shaping overall future health and breaking the intergenerational cycle of malnutrition. Yet over 180 million school-going adolescents globally face malnutrition thus risking their overall development and survival. Limited adolescent-specific data hinders effective interventions, as most surveys focus on under-5 children or pregnant teens. The high nutrient needs in this period should catered for to prevent future consequences. Therefore this study examined factors influencing adolescents' nutrition in rural secondary schools in Kanungu District, an under-researched mountainous region. The specific objectives were to assess the nutritional status of adolescents, identify the associated factors mainly awareness levels, diet-related factors (meal frequency and dietary diversity), and social, demographic, and economic influences. The study was conducted in selected secondary schools and due to the unknown adolescent population, Cochran’s formula was applied to calculate sample size (340). Multi-stage sampling approach and simple random sampling were used to select adolescents aged 13 to 19 years. A school-based cross-sectional analytical design alongside mixed-methods approach was employed to collect data. Informed consent from participants above 18 years and parental consent was sought for minors (below 18 years) were obtained before data collection. A KoBo interviewer-administered questionnaire was used on social demographic, diet-related and knowledge levels. Anthropometric measurements (Body Mass Index (BMI) and Mid-Upper Arm Circumference (MUAC)) determined the nutrition status. Data was exported from KoBo- software exported to Excel for cleaning and later analyzed using SPSS version 26. Qualitative data from key informants was analysed using narrative analysis whose findings complemented the quantitative verdicts. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) and a p-value ≤ 0.05 were used to determine statistical significance and associations. More than one-third (37.1%) of the respondents were malnourished, with overweight being the most prevalent form. Factors that significantly increased the odds of having a normal nutritional status included living in a father-headed household (AOR=1.8, 95% CI=1.03-3.20), meeting the recommended meal frequency (AOR=2, 95% CI=1.13-3.44), being aware about healthy dietary habits (AOR=2.2, 95% CI=0.29-0.71), having a small household size of 1-4 members (AOR=4.3, 95% CI=2.38-7.83), and having an employed guardian (AOR=2.1, 95% CI=1.17-3.93). Conversely, having only a primary level of education (AOR=3.6, 95% CI=0.11-0.68) and an inadequate dietary diversity score (AOR=2.1, 95% CI=0.28-0.76) reduced the odds of achieving normal nutritional status. Key determinants of adolescent nutrition status in the selected secondary schools included household headship, meal frequency, household size, and guardian employment status. To improve adolescent nutrition, stakeholders should integrate comprehensive nutrition education programs into school curricula that actively involve both adolescents and their guardians at appropriate stages. Policies, relevant stakeholders should promote dietary diversity and adequate meal frequency to support better nutrition outcomes among adolescents in this region.