title: Food insecurity, school absenteeism and educational attainment of adolescents in Jimma Zone Southwest Ethiopia: a longitudinal study.
abstract: BACKGROUND
  Food insecurity not only affects physical growth and health of children but also their intellectual development, school attendance and academic performance. However, most evidences are based on studies in high income countries. Although food insecurity is common in Ethiopia, to what extent it affects school attendance and educational attainment of adolescents is not explored. We hypothesized that food insecure adolescents would be more likely to be absent from school and have lower grades attained after 1 year compared to their food secure peers.
  
  
  METHODS
  We used data from 2009 adolescents in the age group of 13-17 years from two consecutive surveys of a five year longitudinal family study in Southwest Ethiopia. A stratified random sampling was used to select participants. Regression analyses were used to compare school absenteeism and the highest grade attained after 1 year of follow-up in food secure and insecure adolescents. The analysis was adjusted for demographic factors, reported illness and workload.
  
  
  RESULTS
  Significantly more (33.0%) food insecure adolescents were absent from school compared with their food secure peers (17.8%, P < 0.001). Multivariable logistic regression analyses showed that after adjusting for gender, place of residence and gender of the household head, adolescent food insecurity [OR 1.77 (1.34-2.33)], severe household food insecurity [OR 1.62 (1.27-2.06)], illness during the past one month before the survey [OR 2.26 (1.68-3.06)], the highest grade aspired to be completed by the adolescent [OR 0.92 (0.88-0.96)], and the number of days that the adolescent had to work per week [OR 1.16 (1.07-1.26)] were independent predictors of school absenteeism. Similarly after controlling for household income and gender of the household head, adolescent food insecurity(P < 0.001), severe household food insecurity(P < 0.001), illness during the last month(P < 0.001) and rural residence(P < 0.001) were inversely associated with highest grade attained, while age of the adolescent(P < 0.001), the highest grade intended to be completed(P < 0.001) and residence in semi urban area(P < 0.001) were positively associated with the highest grade attained.
  
  
  CONCLUSIONS
  Adolescent and household food insecurity are positively associated with school absenteeism and a lower educational attainment. Programs aiming to achieve universal access to primary education in food insecure environments should integrate interventions to ensure food security of adolescents.
authors.affiliation: Department of Population and Family Health, College of Public Health and Medical Sciences, Jimma University, PO Box:1104, Jimma, Ethiopia. tefera_belachew@yahoo.com
authors.forename: Tefera
authors.initials: T
authors.lastname: Belachew
authors.forename: Craig
authors.initials: C
authors.lastname: Hadley
authors.forename: David
authors.initials: D
authors.lastname: Lindstrom
authors.forename: Abebe
authors.initials: A
authors.lastname: Gebremariam
authors.forename: Carl
authors.initials: C
authors.lastname: Lachat
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D004522:Educational Status; D005002:Ethiopia; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011203:Poverty; D012424:Rural Population; D013223:Statistics as Topic / Q000379:methods