Adolescent nutrition implementation guideline for Ethiopia

Abstract

According the WHO adolescence is defined as the period from 10 to 19 years, when an individual undergoes major physical growth, mental development and psychological changes. (1-6). This period is divided into early adolescence (10-13 years), which is characterized by the onset of puberty, growth, curiosity, anxiety, egocentrism and peer influence; middle adolescence (14-17 years) which is characterized by change from concrete to abstract thinking, identity, self-image and romantic and sexual relationships; and late adolescence (18-19 years), characterized by an increased independence, experimentation and important personal and future and occupational decisions. (7). It is a transition phase, in which an individual is no longer a child but not yet an adult, with the fastest physical growth in the life span following infancy.(8). The growth spurt during this period is associated with hormonal, cognitive and emotional changes that make adolescents especially vulnerable. It is also a critical period in terms of the accretion and acquisition of 40 to 60 percent of adult peak bone mass, (9-10) and significant proportion of adult height. (11) Consequently, there is a greater demand for macro- and micro-nutrients. Peer pressure, evolving food choices and habits, as well as changes in lifestyle can affect dietary and nutrient intake. (8). Suboptimal nutrition during this period can result in malnutrition with consequences (12-15) health, growth, sexual development and education. Globally, 340 million adolescents were overweight and obese in 2016, (16) with the majority being in developed and rapidly

developing countries. Adolescents in developing countries including those in sub-Saharan Africa are not spared this problem. (17) In fact, in developing countries, an increasing burden of overweight and obesity co-exists with continued high prevalence of underweight and micro-nutrient deficiencies.(18) In Ethiopia, the pooled prevalence of overweight/obesity was 11.4% (19) and 20.7%, while 27.5% were underweight and stunted, respectively (20). In addition to overweight/obesity, underweight and, stunting deficiencies of in micro-nutrients including Folic Acid, Iodine, Vitamin A, and Zinc have significant impact on the health outcomes of adolescents in lower and middle income countries. (21) . Iron requirements for adolescents are notably high in developing countries due to higher prevalence of parasitic infections, disease and low bioavailability of of dietary ironIron. (22- 23). Iron-deficiency anemia was ranked as the leading cause of adolescent disability adjusted life years (DALYs) lost in 2015 with highest rates experienced in South-East Asia followed by African low and middle income countries. In Ethiopia, 19.9% and 18.2% of late adolescent girls and boys aged 15-19 were anemic, respectively(EDHS 2016). Dietary Calcium has been identified as a nutrient of greater concern for adolescents, because of the accelerated muscular, skeletal and endocrine development during puberty, than in any other population group except pregnant women (25). Paradoxically, even in countries including Ethiopia with abundant sunshine, there is a high prevalence of Vitamin D deficiency among adolescents. (26- 27). A pocket study done in conducted in Ethiopia found that, shows 42% of school adolescents were Vitamin D deficient. (27).