Lived Experience and Perceptions of Adolescents on Prevention, Causes and Consequences of Double Burden of Malnutrition in Debre Berhan City, Ethiopia: A Qualitative Study

Abstract

Background

The coexistence of undernutrition, overweight, and obesity within the same households and populations is recognized as the Double Burden of Malnutrition (DBM). A paradigm shift thinking is needed to mitigate its impact. School adolescents are the most vulnerable groups to DBM. However, lived experiences and perceptions on prevention, causes, and consequences of DBM were not well studied. Therefore, this study aims to explore the lived experiences and perceptions of adolescents about the prevention, causes, and consequences of DBM in Ethiopia.

Methods

A qualitative research method using phenomenology design was conducted among 20 purposively selected participants from private and government schools from June 3 to July 10, 2022. The further sampling process was guided by a saturation of ideas. In-depth and key informant interviews were conducted to collect the data. The most recent version of Open code 4.03 was utilized to generate meaningful codes, subthemes, and themes. The results were displayed using thematic analysis and respondents’ well-spoken verbatims.

Results

The study explored the perceptions of adolescents on the causes, prevention, and consequences of DBM. The main causes of DBM identified were poor dietary and drinking habits, poor knowledge and attitude about nutrition, low financial income, unemployment, food insecurity, poor feeding culture, physical inactivity, poor food management, educational and school-related issues, national-related issues, frequent use of ultra-processed foods, and frequent out of home eating. The majority of students were not aware of how DBM will affect their health and academic performance over the long run.

Conclusion

The findings showed that despite school adolescents’ variations in knowledge, lived experience, attitude, and perceptions, most of them have a poor understanding of the causes, consequences, and prevention mechanisms of the double burden of malnutrition. The results suggest the need for instituting double-duty interventions that have a double impact on the prevention of DBM.

Keywords:

• lived experiences
• awareness
• perception
• school adolescents
• double burden of malnutrition
• Ethiopia

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author upon reasonable request.

Ethical Considerations

The study was conducted following the criteria of the Helsinki Declaration.⁵⁹ The study proposal was ethically approved by Jimma University, Institute of Health, Institutional Review Boards (IRB) with reference number JUIH/IRB/104/22 before the start of data collection. Furthermore, permission to collect data was first obtained from the Debre Berhan city and Zonal education bureau. Before obtaining informed consent, each study participant was given a detailed explanation of the study’s title, purpose, procedure, and duration, as well as the potential risks and benefits. Before any interview or measurement, each secondary school adolescent was provided verbal, written, and signed informed consent. The participants were informed about publication of anonymized responses. The data were kept confidential by not including any personally identifiable information on the questionnaires and asking them in a secure free room. Personal identifiers and other data elements were separated. Their rights were protected during the interview. For those under the age of eighteen years, both assent from the students and consent from their parents were obtained. Finally, any ethical issues that arose during this study were resolved through continuous discussion between the researcher and JU’s IRB.

Acknowledgments

Our special thanks and sincere appreciation go to the Debre Berhan University and Jimma University for fund support. We also thank Jimma University for the approval of the ethical clearance. I would also like to acknowledge study participants, supervisors, data collectors, and data clerks for their tremendous role throughout the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Debre Berhan University and Jimma University in collaboration support this study.