The triple burden of malnutrition among adolescents in Dar es Salaam, Tanzania: The role of gender, household environment, and food insecurity

Abstract

BACKGROUND: Adolescence is a critical growth period with increased nutritional needs that can put adolescents at risk for the triple burden of malnutrition, which can impair brain development, reduce functional capacity, and heighten the risk of non-communicable diseases. Despite this, there is limited data on factors associated with adolescent malnutrition in Dar es Salaam. This study aimed to determine the prevalence and associated factors for anaemia, stunting, underweight and overweight/obesity among adolescents in Dar es Salaam. METHODS: A cross-sectional study was conducted among 507 adolescents aged 12-19 in Dar es Salaam, using multistage cluster sampling. Data was collected using a pre-validated structured questionnaire through an Open Data Kit, while anthropometric measurements were measured using a digital weighing scale and stadiometer. Hemocue machines were utilised to measure anaemia through capillary blood samples. Data analysis, including descriptive statistics and modified Poisson regression, was performed using Stata v18 to identify factors associated with malnutrition. RESULTS: Overweight affected 16%, anaemia 39%, stunting 23% and thinness 12% of all adolescents. Food insecurity affected 69% of the households and was associated with a lower overweight risk (Crude Prevalence Ratio (CPR) 0.51, 95% CI: 0.34-0.75, p = 0.001) and a higher risk for thinness (CPR 2.10, 95% CI: 1.13, 3.91, p = 0.019). After controlling for other explanatory variables, adolescents from households with unimproved toilet facilities had a higher risk of anaemia (APR 1.51, 95% CI: 1.16-1.95, p = 0.002). Girls had a lower risk of stunting (APR 0.63, 95%, CI: 0.45-0.88, p = 0.006) and thinness (APR 0.29, 95%, CI: 0.16-0.54, p < 0.001) but a higher risk for overweight (APR 2.62, 95%, CI: 1.56-4.43, p < 0.001) compared to boys. CONCLUSION: Adolescents in Dar es Salaam experience high rates of malnutrition. Food insecurity, poor sanitation, and gender-specific factors contribute significantly to these outcomes. Integrated interventions are essential to address these interlinked determinants of malnutrition in this vulnerable group.