Prevalence of undernutrition and associated factors among adolescent pregnant women in Dolo-Ado town, Somali region, Ethiopia | BMC Pregnancy and Childbirth

Sociodemographic characteristics of adolescent pregnant women in Dolo-Ado town

As seen in Table 1, 380 pregnant adolescents were interviewed with a response rate of 100%. The data reveals several key sociodemographic and maternal characteristics. Most mothers were aged 18–19 years, accounting for 297 (78.16%), while 173 (45.53%) were aged 15–17. The majority were Somali, representing 315 (82.9%), followed by Oromo at 40 (10.53%), Amhara at 23 (6.05%), and Tigray at 2 (0.53%). In terms of religion, 345 (90.79%) of the respondents identified as Muslim, with a smaller proportion being Orthodox Christians at 33 (8.68%) and Protestants at 2 (0.53%). Slightly more mothers resided in rural areas, 198 (52.11%), compared to 182 (47.9%) in urban areas.

Regarding education, 159 (41.84%) of the mothers were illiterate, 50 (13.16%) had primary education, 121 (31.84%) had secondary education, and 59 (15.53%) attained college-level education or higher. Partner education showed a similar trend, with 214 (56.32%) being illiterate, 66 (17.37%) completing primary education, and both secondary and college-level education equally represented 50 (13.16%).

The primary occupation of mothers was housewife, reported by 202 (53.16%), while 170 (44.74%) were students. Other occupations such as trade and private work were rare, reported by 3 (0.79%) and 5 (1.32%), respectively. Family income predominantly exceeded 1501 ETB, with 315 (82.9%) of families in this category, while only 65 (17.11%) earned 1500 ETB or less.

Access to basic resources highlighted significant gaps; 173 (45.53%) lacked safe water, and 255 (67.11%) lacked access to toilets. Despite this, 207 (54.4%) had access to safe water, and 125 (32.9%) had toilet facilities.

Prevalence of undernutrition among adolescent pregnant women in Dolo-Ado, Somali Region

As shown in Fig. 1, the study assessed the prevalence of undernutrition among pregnant women in Dolo-Ado town using mid-upper arm circumference (MUAC) as an indicator. The mean MUAC of the participants was 24.2 cm (± 2.4 SD), reflecting the average nutritional status of the group and indicating some level of variability among individuals. Among the 380 women interviewed, 79 (21%) were classified as undernourished, defined by a MUAC measurement of less than 22 cm. Meanwhile, 3.2% of the women were found to be severely undernourished, indicating a critical level of nutritional deprivation that demands urgent intervention to prevent adverse maternal and neonatal health outcomes. The remaining 79% of the participants had a normal nutritional status (MUAC ≥ 22 cm), suggesting that the majority of the women met the minimum nutritional requirements to support pregnancy.

Prevalence of undernutrition among adolescent pregnant women in Dolo-Ado town, Somali region

Prevalence of food security among adolescents pregnant in Dolo-ado town, Somali region

The study revealed that among the adolescent pregnant women surveyed, 127 (33%) were from food-insecure households, while 253 (67%) were from food-secure households. These findings indicate that two-thirds of the respondents lived in food-secure conditions, suggesting that the majority had relatively better access to food resources. However, one-third of the participants faced food insecurity, underscoring the urgent need for targeted interventions.

Minimum dietary diversity score of respondents in Dolo-Ado town, Somali region

The analysis of the Minimum Dietary Diversity Score (MDD-W) among the adolescent pregnant mothers in Dolo-Ado revealed that only 11 (3%) of them met the minimum recommended dietary diversity score by consuming five or more food groups in the previous 24 h. Conversely, a significant majority, 369 (97%), failed to meet the dietary diversity threshold, consuming fewer than five food groups.

Maternal-related characteristics of respondents in Dolo-Ado town

As shown in Table 2, the analysis of maternal health and nutrition factors reveals that most women had only one previous pregnancy, with 225 (59.21%) in this category, while 26 (6.84%) had five or more pregnancies. A significant majority of pregnancies were unintended 359(94.47%). Regarding the stage of pregnancy, 260 (68.42%) were in the first trimester, followed by 110 (28.95%) in the second trimester, and 10 (2.63%) in the third trimester. Antenatal visits were attended by 297 (78.16%), while 83 (21.84%) did not attend.

Family planning practices revealed that 326 (85.79%) of the women never used any method, with only 4 (1.05%) using modern methods. Malaria was reported during pregnancy by 103 (27.11%), while 277 (72.89%) did not have malaria. Concerning nutrition, 343 (90.26%) of women consumed two or fewer meals per day, and only 37 (9.74%) had three or more meals. Meal patterns were irregular for 143 (37.63%), whereas 237 (62.37%) followed a regular meal pattern.

Iron-folic acid supplementation was received by 271 (71.32%), while 109 (28.68%) did not take supplements. Furthermore, 152 (40%) did not receive nutrition counseling, compared to 228 (60%) who did.

Bivariate logistic regression analysis of adolescent pregnant women in Dolo-Ado town

As shown in Table 3, the results indicate that several significant factors are associated with undernutrition among adolescent pregnant women in the Dolo-Ado district. The analysis shows that maternal education is a key determinant of undernutrition. Illiterate mothers had 13(3.42%) undernourished compared to 208(54.74%) who were not, with a COR of 4.4 (2.1–9.2) and a p-value of 0.13. Primary-educated mothers had 27(7.11%) undernourished versus 47(12.37%) not undernourished, with a COR of 1.4 (3.2–3.6) and a p-value of 0.03. Secondary-educated mothers reported 15(3.95%) undernourished compared to 30(7.89%) not undernourished, with a COR of 2.5 (1.5–5.7) and a p-value of 0.14. Mothers with college and above education served as the reference group.

Place of residence showed that mothers in rural areas had a higher undernutrition rate of 76(20%) compared to 122(32.11%) not undernourished, with a COR of 37 (11–120) and a p-value of 0.21. Urban mothers had a lower rate of undernutrition, with 3(0.79%) undernourished and 179(47.11%) not undernourished, serving as the reference category.

De-worming status indicated that mothers did not receive de-worming had higher rates of undernutrition, with 72(14.74%) undernourished compared to 199(13.95%) not undernourished, yielding a COR of 5.2 (2.3–11.8) and a p-value of 0.15. mothers were de-wormed served as the reference.

IFA supplementation showed that mothers did not receive supplementation had 56(18.42%) undernourished compared to 53(78.16%) not undernourished, with a COR of 11 (6.4–20.1) and a p-value of 0.06. Mothers who received IFA supplementation served as the reference. For minimum dietary diversity, mothers consumed ≤ 5 food groups had 70(18.2%) undernutrition compared to 297(78.2%) not undernourished, with a COR of 9.5 (2.8–31.8) and a p-value of 0.04. Those with ≥ 5 food groups served as the reference group.

Food security status revealed that food-insecure households had 17(14.21%) undernourished compared to 241(2.89%) not undernourished, with a COR of 14 (7.9–26) and a p-value of 0.14. Food-secure households served as the reference. Monthly family income showed that households earning < 1500 ETB had 54(14.21%) undernourished compared to 11(2.89%) not undernourished, with a COR of 2.9 (1.4–6.0) and a p-value of 0.02. Households earning ≥ 1500 ETB served as the reference group.

Gestational age indicated that children born before 37 weeks had 71(18.68%) undernourished compared to 299(78.68%) not undernourished, with a COR of 4.8 (2.5–9.2) and a p-value of 0.13. Those born at ≥ 37 weeks served as the reference. Antenatal visits revealed that mothers who did not attend antenatal care had 62(16.32%) undernourished compared to 21(5.53%) not undernourished, with a COR of 5.1 (2.6–10.0) and a p-value of 0.10. Those who attended antenatal visits served as the reference. Malaria history showed that mothers who had malaria during pregnancy were 58(15.26%) undernourished compared to 190(50%) not undernourished, with a COR of 3.6 (1.8–7.1) and a p-value of 0.13. Mothers without malaria served as the reference group.

Multivariate logistic regression analysis of adolescent pregnant women in Dolo-Ado town

As shown in Table 3, the results indicate that several significant factors are associated with undernutrition  among adolescent pregnant women in the Dolo-Ado district.

In the context of maternal education, illiterate mothers were four times more likely to be undernourished compared to their literate counterparts, (AOR) of 3.9 (95% CI: 1.9–8.0). Additionally, pregnant adolescent mothers residing in rural areas were 12 times more likely to experience undernutrition than those living in urban areas (AOR of 12 (95% CI: 3.5–42.9). Regarding  monthly family income, households earning less than 1500 Birr had approximately three times the likelihood of undernutrition compared to those with higher incomes, AOR of 2.6 (95% CI: 1.2–5.4).

Food insecurity was identified as a significant predictor of undernutrition. Pregnant adolescents from food-insecure households were six times more likely to be undernourished compared to those from food-secure households, (AOR of 6.2 (95% CI: 2.8–13.9). Furthermore, mothers who consumed five or fewer food groups were 13 times more likely to experience undernutrition, (AOR of 13.1 (95% CI: 2.2–77.3).

Lastly, regarding Iron and Folic Acid (IFA) supplementation, pregnant adolescent mothers who did not receive IFA supplementation were approximately four times more likely to be undernourished compared to those who did receive it, (AOR of 3.6 (95% CI: 1.7–7.5).

As seen in Table 4, the multivariable analysis highlights significant associations between undernutrition and several factors. The analysis highlights the significant association of several factors with undernutrition. Regarding maternal education, illiterate mothers had 66(17.37%) undernourished compared to 93(24.47%) not undernourished, with an AOR of 3.9 (1.9–8.0) and a p-value of 0.05. Mothers with primary education reported 3(0.79%) undernourished versus 132(34.74%) not undernourished, yielding an AOR of 4.8 (3.1–7.2) and a p-value of 0.15. Those with secondary education had 4(1.05%) undernourished compared to 35(9.21%) not undernourished, with an AOR of 2.7 (5.2–3.4) and a p-value of 0.13. Mothers with college education and above served as the reference group.

For paternal education, illiterate fathers had 55(14.47%) undernourished versus 159(41.84%) not undernourished, with an AOR of 2.8 (1.4–5.7) and a p-value of 0.08. Fathers with primary education had 6(1.58%) undernourished compared to 78(20.53%) not undernourished, yielding an AOR of 2.1 (1.6–5.1) and a p-value of 0.02. Secondary-educated fathers reported 7(1.84%) undernourished compared to 27(7.11%) not undernourished, with an AOR of 2.5 (2.2–3.4) and a p-value of 0.03. Fathers with college education and above served as the reference group.

Place of residence revealed that mothers in rural areas had 76(20%) undernourished compared to 122(32.11%) not undernourished, with an AOR of 12 (3.5–42.9) and a p-value of 0.01. Urban, mothers with 3(0.79%) undernourished and 179(47.11%) not undernourished, served as the reference group.

IFA supplementation status showed that mothers did not receive IFA had 56(14.74%) undernourished compared to 53(13.95%) not undernourished, with an AOR of 3.6 (1.7–7.5) and a p-value of 0.02. Mothers who received IFA served as the reference group. For dietary diversity, mothers who consumed ≤ 5 food groups had 70(18.42%) undernourished compared to 297(78.16%) not undernourished, with an AOR of 13.1 (2.2–77.3) and a p-value of 0.04. Mothers consuming ≥ 5 food groups served as the reference group. Food security status revealed that mothers from food-insecure households had 17(4.47%) undernourished versus 241(63.42%) not undernourished, with an AOR of 6.2 (2.8–13.9) and a p-value of 0.03. mothers from food-secure households served as the reference group. Monthly family income showed that households earning < 1500 Birr had 54(14.21%) undernourished compared to 11(2.89%) not undernourished, with an AOR of 2.6 (1.2–5.4) and a p-value of 0.03. Households earning ≥ 1500 Birr served as the reference group.