NUTRITION KNOWLEDGE, DIETARY PRACTICES AND NUTRITION STATUS OF SECONDARY SCHOOL ADOLESCENTS (13-18 YEARS)

Adolescence is a vulnerable stage of life characterized by rapid growth and development and increased nutrients requirement. Good nutrition is important in promoting health and is dependent on appropriate dietary practices. Nutrition knowledge is critical for forming good eating habits and dietary practices. The dietary practices of adolescents have been described poor because of their busy schedules, peer pressure, imbalance in hormone production and independent nature of their behavior. The objective of this study was to determine socio demographic characteristics and nutrition knowledge, their association with dietary practices and nutrition status of secondary school adolescents. A total of 216 adolescents were enrolled in this cross-sectional study. Semi structured questionnaires were used to collect the data.

The data was analyzed using SPSS software package with p-value for statistical significance being set at p< 0.05. Over half (55.1%) of the adolescents had good nutrition knowledge. Nutrition knowledge increased as adolescents advanced in age and girls had slightly higher nutrition knowledge scores than boys. Majority (76.2%) of adolescents got their nutrition knowledge from school. Generally adolescents exhibited optimal dietary practices, majority (74.1%) had more than three meals in a day in reference to recommended 5-6 meals including snacks. Compared with others lunch was the most skipped meal, being missed by three out of ten adolescents. Association between socio-demographic and dietary practice based on gender was significant at p-value 0.005 with female students preferring breakfast as the heaviest meal p=0.000, χ2 =15.63, skipped meals p=0.001, χ2 =5.12, took less than two litres of water p=0.008, χ2 =9.66 and preferred fried foods p=0.003, χ2 =213.95 comparing with male. Increasing nutrition knowledge had a positive relationship but not significant (r=0.20, p= 0.294) with dietary diversity. Nutrition knowledge with number of meals taken had positive relationship but not significant (r=0.36, p=0.495) and nutrition knowledge with skipping of meals had a positive relationship but not significant (r=0.39, p=0.465).

Most (77.3%) of adolescent had normal BMI for age with the rest either being overweight (12.5%) and moderately thin (10.3%). The nutrition status did not significantly differ between the gender. Age was significantly associated with nutrition status where more of the older adolescents had normal BMI for age as compared to the younger adolescents at (p= 0.043, χ2 = 9.84,). Students who skipped meals were thin compared to those who consumed all meals p=0.041, χ2 =9.95. Students who consumed milk 3-6 times a week were 11 times more likely (OR=11.25) to be on normal nutrition status rather than overweight. Students who used fat and oils every day were six times more likely to have normal nutrition status rather than overweight (OR=5. 80).

Conclusion: The study has shown that secondary school adolescents within Ruiru Sub County had good nutrition knowledge. The nutrition knowledge increased as adolescents advanced in age with girls having slightly higher nutritional knowledge scores compared with boys. Diet for adolescents constitute high consumption of cereal based diet and low intake of high biological value protein foods. There was a gap between knowledge and practice. Despite good nutrition knowledge, adolescents, girls especially practice non optimal dietary practices that included skipping of meals particularly lunch and taking less than two litres of water daily. Most of the adolescent student had optimal dietary practices as they eat three meals in a day. Skipping of meals, especially lunch and snacking constituted the most suboptimal dietary practice by the students.

Recommendations: Interventions and education strategies to promote the intake of high biological value proteins should target school students.   Inclusion of lessons on healthy eating and optimal dietary practices (with practical aspects) in the curriculum of High Schools would alleviate the situation. There is also a need for further studies to obtain the views of school children on factors (barriers and promoters) in school which affect their desire to eat healthy foods.

 

 

 

 

 

Body mass index Cardio vascular Disease

Centre of Disease Control Centre and Prevention Diabetes Mellitus

Ethical Research Committee Kenyatta National Hospital.

Kenya Demographic Health Survey 2014 Low Nutrient Energy Dense

Low- Middle Income Countries Ministry of Education.

Ministry of Health.

National Commission for Science, Technology and Innovation None Communicable Diseases

Sustainable Development Goals Statistical Package for Social Science University of Nairobi.

Vitamin A Vitamin C

World Health Organization World Food Program

 

Adolescents in this study are defined as being between 13 to 18 years of age attending secondary school. Adopted from World Health Organization (WHO), defining adolescent as any person between ages 10 and 19.

This study defined optimal dietary practices of Adolescents as those who did not skip meals, consumed three main meals and two healthy snacks per day.

The study defined, Healthy eating as one where the adolescents achieved energy balance (for basal metabolic rate), while limiting intake of energy dense foods, free sugars, salt and highly processed foods. The diet should also have provided quality and adequate nutrients to meet the increased nutrients requirement among adolescents.

The nutrition knowledge of the student adolescents was determined by the level of knowledge on food groups, macronutrients, micronutrients, food preparation methods using multiple choices answers. The students got one mark each question for every correct response chosen. Using a marking scheme for nutrition knowledge tests the scores were rated on score percentage using five as the cut off points, the grading was categorized as: Excellent, very good, good, satisfactory and poor.

 

Nutrition status of adolescents in the study was determined using Body Mass Index (BMI) in percentiles. Student adolescents with a cut-off of less than 5th percentile were classified as underweight, while normal or healthy between 5th percentile to less than 85th percentile, overweight 85th to less than 95th percentile and obese ≥ 95th percentiles.

 

The World Health Organization (WHO) defines adolescents as individuals aged 10–19 years. Adolescent’s population has increased to 18% of the world population with 88 % living in developing countries. In Kenya the proportional population of adolescents is 22%. Kenya is a low income country located in sub-Saharan Africa and undergoing rapid urbanization, industrialization and modernization resulting in changing lifestyles, dietary habits and dietary practices (Usman et al., 2017). Adolescent’s health has not been a major concern, and consequently, there has been limited research in the area of adolescent nutrition, especially in developing countries Kenya included. Adolescents are known to be less susceptible to diseases and they experience fewer life-threatening conditions than children and adults and also have less mortality and morbidity rates.

Health services in developing countries focus on children and pregnant women and therefore health needs of adolescents are not adequately investigated and addressed (Hamulka et al., 2018). However, the increased prevalence obesity worldwide has drawn attention to the diets of adolescents and children. It has been reported that adolescents are at a higher risk of becoming overweight and obese and prone to life style diseases and chronic diseases because of their unhealthy eating habits (Buxton et al., 2014). During adolescence nutritional care is key because there is increased physical growth, brain development, hormonal changes and increased nutrients requirement for growth and development (Faizi et al., 2017). 

Diets consumed by adolescents in developing countries are inadequate in terms of micronutrients, diversity and meal patterns. Some adolescents consume more than adequate amounts of calories and high-energy-dense foods, which contributes to increased occurrence of overweight and obesity. Nutrition behaviors of concern among adolescents are fast food preference, frequent snacking, skipping meals, the risk of eating disorders, the omission of certain foods from diets and occasional dieting (Faizi et al., 2017). Adolescents health has not been a concern and they do not get care that children and adults get. They are believed not to be at risk of health issues but it has been proved that diseases of adulthood are linked to dietary behaviors and practices developed during adolescence (Usman et al., 2017).Under nutrition can start before birth and continue into adolescence, adult life and also continue for generations. Nutrition issues are not well addressed especially among the adolescents. There is a gap in knowledge on nutritional value of food, poor dietary practices and is affecting adolescents negatively (Buxton et al., 2014).

Health and education of adolescents is important in a country because developments, economic prospects future of a country depends on their health and education. At this stage in life adolescents are usually in a state of experimental, identity formation, and also lifelong behavior patterns which are established and mostly determine their future health state and productivity (Usman et al., 2017).

During adolescents there is a chance to teach and equip them with nutrition knowledge and develop positive healthy eating behaviors that can last for life time and hence mitigating the current trends of non-communicable diseases and intergenerational cycle of malnutrition (Miller et al., 2015). 

Low and middle-income countries are the most affected by the current increase of non- communicable disease while malnutrition persist and therefore it is important to focus on addressing nutritional issues in adolescents to reverse and correct existing malnutrition through increasing their nutrition knowledge and practice of healthy eating (Abdullah et al., 2015).

Adolescent’s nutrition is important for current, future and intergenerational health. Kenya’s nutrition situation is characterized by stunting, micronutrients deficiencies and increased prevalence of obesity among adolescents. A formative research to inform Adolescent Programming in Kenya shows that there is prevalence of anemia (5-14 years 16.5%, 15-19 years 13.8%) and zinc deficiency 80% among adolescents ( MoH and WFP 2018). Currently the government is focusing on adolescent nutrition in order to achieve the Sustainable Development Goal 2; which advocates for zero hunger and ending malnutrition by 2030 ( MoH and WFP 2018). The influx of high dense foods in Kenyan market together with huge change in dietary habits of people has increased the incidence of overweight and obesity among adolescents. Healthy eating is not a priority and therefore there is increased habits of snacking, skipping meals and dieting among adolescents. Snacking interferes with regular meals which are healthier food choices and greater dietary diversity to meet the increased energy and nutrients requirement during this period (Faizi et al., 2017).

Adolescents are considered as low risk group for malnutrition and poor health but as they grow they engage in poor dietary habits and become adults with individual nutrition issues leading to poor health later in life. This translates into inter-generation cycle of malnutrition and development of non-communicable diseases. Under nutrition exposes adolescents to poor health, poor performance in school and over nutrition exposes them to life style diseases and can affect their self-esteem. Adolescents are more independent in their food choices and highly influenced by peer pressure and tend to ignore healthy eating (Tugault-Laflear et al., 2017).

Addressing nutrition issues for adolescent is relevant for current, future and intergenerational health in order to reduce the triple burden of malnutrition and non-communicable diseases later in life. Good nutrition knowledge is one of the few modifiable determinants of dietary behaviors and contributes to strengthen the skills and abilities needed to resist the environmental influences leading to poor dietary habits. This will bring forth a healthy nation, break the tread of intergeneration malnutrition and prevent/delay development of non-communicable diseases in adulthood (Poskitt et al., 2014).

Through this study, gaps in nutrition knowledge, dietary practice and nutrition status of the adolescents will be identified. The respondents will benefit from the study by knowing their nutrition status, those with nutrition problems will be referred to a healthy facility for further management. The school will use research findings in promoting nutrition programs in school and planning healthy menu for the students. The research findings will be useful to the ministry of health in conjunction with ministry of education and non-governmental organizations in coming up with programs to address nutrition and health issues of adolescents.

 

The aim of the study was to contribute towards adoption of healthy eating lifestyle, reduction of malnutrition and non-communicable diseases among adolescents in Ruiru Sub- County

The study will generate useful information and give a clear picture of nutrition status and nutrition issues related to dietary practice of secondary school adolescents. To come up with areas of improvement on nutrition knowledge and dietary practices among the adolescents.

The main objective of the study was to determine the socio demographic characteristics and nutrition knowledge, their association with dietary practices and nutrition status of secondary school adolescents  (13-18) in Ruiru Sub County.