Prevalence and predictors of adolescent linear growth and stunting across the urban-rural gradient in eastern Ethiopia

Objective To assess the magnitude and factors associated with adolescent linear growth and stunting in two eastern Ethiopian communities. Methods This cross-sectional study was conducted in the urban Harar Health Demographic Surveillance Site (HDSS) and rural Kersa Demographic Surveillance and Health Research Center (KDS-HRC). Univariate analysis was used to describe the data. Multiple regression models examined predictors of linear growth. Logistic regression was used to examine factors associated with stunting. Results The study included 2010 adolescents. The prevalence of stunting was 26.9% (95% CI 24.9, 28.9), with 8.1% among urban adolescents (95% CI 6.5, 9.9) vs. 47.9% among rural ones (95% CI 44.6, 51.1). There was a significant interaction between residence and sex on the risk of stunting [AOR = 4.17 (95% CI 2.66, 9.9), P < 0.001], and height-for-age z score (HAZ) (beta = -0.51, P < 0.001). For urban adolescents, older age (18 to 19 years) was negatively associated with linear growth (beta= -0.29; P < 0.001). In the rural setting, handwashing practice after toileting was positively associated with HAZ (0.62; P < 0.001) and with lower risk of stunting [AOR = 0.51 (95% CI 0.34, 0.76)]. Urban females had significantly higher HAZ than urban males [beta = 0.52; P < 0.01)], and a significantly lower risk of stunting [AOR = 0.29 (95% CI 0.18, 0.48)]. Conclusions There are significant disparities in the magnitude of stunting between urban and rural adolescents. The gender gap in stunting and linear growth, along with a high prevalence of stunting in early adolescence, calls for age-appropriate and gender-sensitive interventions. Particular attention and context-specific interventions are warranted for adolescents in these and similar rural eastern Ethiopian communities.