A great majority of adolescent girls from low and middle income countries including Bangladesh are malnourished. Nearly one third (29%) of the adolescent girls of Bangladesh are stunted and the most immediate cause of which is inadequate dietary intake of nutrient rich foods and diseases. Eating patterns and behaviour is one of the important determinants of proper nutrition which widely varied among adolescent girls. However, very little studies has been conducted to date exploring the dietary pattern and food behaviour among them. Present formative research, thus was carried out to explore the eating patterns and related factors among adolescent girls, member of adolescent clubs in two selected districts in Bangladesh.
This formative research was cross sectional in nature and was conducted among adolescent girls from BRAC Adolescent Development Programme (ADP) clubs from Dhaka and Jamalpur districts. A mixed method study design was followed using both quantitative and qualitative approaches. Quantitative information was collected from 900 adolescent girls using a 7-day diary filled up by themselves, while focus group discussions (FGDs) and in-depth interviews (IDIs) was conducted to elaborate the findings from quantitative assessment.
Average monthly household income was slightly higher in Dhaka compared to Jamalpur
(BDT 14,424.4 vs. BDT 11,001.6 or USD1183.5 vs. USD140.0). Nearly half of the mothers of adolescent girl had no formal education in both areas (Dhaka: 49.9% and Jamalpur: 53.9%). In case of fathers, the percentages were 43.2 and 49.2 from Dhaka and Jamalpur respectively. The percentage of mothers who were engaged in any income generating activities were significantly (p< 0.001) higher in Dhaka compared to those from Jamalpur (44% vs. 11%). Percentage of adolescent girls involved in different types of income generating activities is significantly higher in Jamalpur compared to the girls living in Dhaka (22.5% vs. 9.5%).
Knowledge and perception
Adolescent girls from both areas had good understanding about the healthy diet. They were aware and possessed a comprehensive knowledge about the negative consequences of consuming unhealthy diets. Girls from Jamalpur districts were more aware and knowledgeable about diet and nutrition compared to their counterparts of Dhaka. About 63% girls from Dhaka and 58% girls from Jamalpur perceived their body weight as normal and this perception is more common in early adolescent girls (10-14 years old) compared to late adolescent girls (15-19 years old). To maintain perfect body weight, about 7% of adolescent girls thought that it had to do with diet control and for 10% it was about performing regular physical exercise whereas, 2.3% girls mentioned both.
Food preferences and purchase
Food preferences by adolescent girls did not match with their knowledge about healthy diet. It varies between the two areas. Girls from Jamalpur found to have more healthy foods preferences compared to those of Dhaka. It was reported that taste of the foods were one of the most important determinant of food choice. Other factors of food choices, consumption as well as purchasing were appearance, cost and availability of the foods. Adolescent girls from Dhaka found to have purchased ready-to-eat foods more frequently than girls from Jamalpur. Average expenditure for this purpose was around BDT 65 (USD 0.8)/week and father (49%) was the main source of money followed by mothers (29%). This amount of money varied between the two areas [BDT 81.7 (USD 1.0) in Dhaka vs. BDT 47.2 (USD 0.6) in Jamalpur. Early adolescent girls spent more money [BDT 73.4 (USD 0.9)] compared to we adolescent girls [BDT 52.0 (USD 0.7)] for 10-14 years vs. BDT 52.0 (USD 0.7) for 15-19 years]. Most commonly purchased food items were biscuit, Jhalmuri, fuchka, chanachur, cake, ice-cream, candy/chocolate and peanuts etc. which were mostly carbohydrate based
food items. The frequency of purchasing ready-to-eat food items varied significantly based on area and availability of different types of foods.
Consumption of foods from different food groups
Daily consumption of foods from 4 or more food groups was higher among the girls from Jamalpur compared to Dhaka (84.4% vs. 64.1%) and do not varied significantly by age groups. Weekly consumption of meat, milk and milk product, and egg by the girls were lower than that of fish consumption. About 30.8% adolescent girls never consumed milk and milk products in a week while meat and egg consumption were among 17% and 11.3% respectively. Only 4% adolescent girls consumed internal organ for at least once in a week.
Consumption of vegetables and fruits were significantly lower among the adolescent girls in both areas. 45.7% girls never consumed vitamin A rich yellow-orange vegetables in a week and 20.8% girls never consumed fruits in a week. About 57% adolescent girls consumed soft drinks/commercially produced juices at least once in a week which was comparatively higher in Dhaka (63%) than Jamalpur (51%). Consumption of junk foods was more common
among girls from Dhaka compared to girls living in Jamalpur.
Meal skipping among adolescent girls was more common in Dhaka compared to Jamalpur. Approximately half of the girls in Dhaka and 28.9% of girls in Jamalpur skipped any one of their meals (either breakfast or lunch or dinner) at least once in a week. The percentage of adolescent girls skipped breakfast at least once in a week was about seven times higher in Dhaka than Jamalpur (27.5% vs. 4.2%). Overall 24% of girls missed their lunch at least once in week. During dinner, 26.4% girls from Dhaka and 11.6% girls from Jamalpur skipped the meal. Most commonly cited reasons for meal skipping were 1) timing of school particularly early school time, 2) late wake up in the morning, 3) controlling body weight, 4) fight/turmoil with siblings or mothers, 5) less appetite and vomiting tendency in early morning etc. However, lack of fuel for cooking in morning and lack of time of mother to prepare foods for breakfast as well as for tiffin were mentioned as a cause of skipping meal in Dhaka only.
Dietary habit during menstruation
Adolescent girls were not much aware about healthy eating during menstruation. Overall, 12% of adolescent girls refrained foods or ate less amount of foods than usual during menstruation. The percentage were higher among 15-19 years aged girls compared to early adolescent girls that is 10-14 years old (15% vs. 10%). Commonly refrained foods were mostly source of animal protein i.e., fish, meat, egg and also sour foods. Identified causes of food refraining were tastelessness, bad smell, lack of appetite, nausea and suggestion from elderly peoples.
Decision maker regarding adolescent’s food
From the childhood, mothers were found responsible for the dietary behaviour of adolescent girls (as mothers are mostly involved with menu planning and food preparation including cooking). While considering the food consumption decision of the adolescent girls, mothers were most influential followed by adolescent girls themselves.
Adolescents’ perceptions on using the dietary diary
Most of the respondents found keeping diary as an exciting, enjoyable as well as useful exercise.
Conclusion and recommendations
To effectively translate food related knowledge into practice, nutrition counselling is advocated to change food related behaviour, which in turn would result in improved practice in the long run.
Context specific intervention
Since dietary behaviour widely varies based on the context such as residence, availability of foods etc. any intervention on adolescent girls should take into account the context.
Advocacy to regulate availability and marketing of unhealthy foods
Present study identified that girls tend to eat only those ready to eat food items which were available at nearby shops. Thus, it is integral to have regulatory on the availability and marketing of unhealthy ready-to-eat foods through advocacy to policy makers and established coordination with relevant ministries and authorities.
Establish evidence-based data on adolescent nutrition
Information on dietary intake pattern as well as lifestyle of the adolescent girls is extremely scarce in Bangladesh. Therefore, to initiate any large scale interventions to address the malnutrition problem of this vulnerable group, more rigorous and nationally representative research on adolescent nutrition focusing on nutritional status (including micronutrient status), dietary intake, lifestyle and psychological or emotional issues is of utmost important.