Exploring food and nutrition security perspectives among high school adolescents in Machakel District, Amhara Region, Ethiopia: a qualitative study

Abstract

Objective

This study aimed to understand adolescents’ contextual perspectives on nutrition, food security, causes of food insecurity, and the association between food adequacy and academic performance. It explored food and nutrition security among high school adolescents in Machakel District, Amhara Region, Ethiopia. The objective was to explore how food and nutrition security impact adolescents’ growth and development. Qualitative data were collected through interviews with 33 key informants including school adolescents, teachers, health workers, community members, and woreda officers and six focus group discussions across four high schools. Data were analysed using MAXQDA Pro 2020 for its user-friendliness and advanced features.

Results

Findings showed that school adolescents living away from their families faced challenges in accessing adequate food, both in quantity and variety. These school adolescents relied on various strategies to access food, including part-time work and support from friends, relatives, or the school community, to supplement their food access. Participants perceived that inadequate food access negatively affected school adolescents’ academic performance. The study explored the need for interventions to improve adolescent food and nutrition security, including nutrition education programs, funding for nutritious school meals, and collaboration between schools and local communities to support adolescents living away from families.

Introduction

Food and nutrition security exists when all individuals have sustainable food access and consume adequate, safe, and nutritious food to meet their dietary needs and preferences which needs a conducive environment [1, 2]. Global food security requires a resilient food system, research, social change, collaboration, and political commitment [3–5].

Food and nutrition security is critical for adolescent growth and well-being and their perspectives is critical for their dietary practices and overall development [6, 7]. The biological, social, and cultural development of adolescents is influenced by nutrition which is important for their health, well-being, and future achievements. Studies from Africa showed that adequate nutrition improved academic performance, attendance, and study habits [8, 9]. A variety diet during adolescence enhances physical growth and normal cognitive functioning and helps to prevent future health concerns [8–11].

Adolescents’ perceptions of food and nutrition security are shaped by socio-economic, cultural, educational, and environmental factors, with limited understanding of sustainable diets in low- and middle-income contexts [12]. High school adolescents in the rural areas of Ethiopia face food and nutrition insecurity resulted in high rates of undernutrition, skipped meals, and micronutrient deficiencies, harming students’ health and academics [13].

Despite the available literature, there remains a significant gap in research focused on adolescent perspectives on food and nutrition security. This study aims to explore adolescents’ perspective on food and nutrition security in this area where no prior qualitative research exists. Its findings will offer local insights to improve adolescent nutrition and breaking cycles of poverty and undernutrition in Ethiopia.

Methods

Study setting and design

This study was conducted in Machakel District, Amhara Region, Ethiopia (Fig. 1). Machakel District is predominantly occupied by rural agrarian community with a population of approximately 135,527 and a rural population density of 128 persons/km² [14, 15]. The district’s economy is primarily agricultural, with most farmers engaged in mixed crop and livestock production.

Fig. 1.

Map of study area.

(Source: [58, 59])

The study includes all four high schools within the district, focusing on students from rural areas who face long commutes and live in shared, low-cost rentals highlighting how structural and spatial factors affect their food and nutrition security. This study used an exploratory qualitative design to explore the perspectives on food and nutrition security of high school adolescents in the district.

Sampling technique and data collection procedure

A purposive sampling technique was employed to select participants. This non-probability sampling was used to purposefully select participants with relevant knowledge or experience in adolescent food and nutrition security.

Data was collected from November 20 to December 31, 2022, during the pre-harvest season in the district marked by food shortages. Data collection involved semi-structured key informant interviews and focus group discussions, to explore participants’ experiences in depth.

Key Informant Interviews (KIIs) (n = 33) were conducted with school adolescents, school directors, teachers, health care workers, community members who rented rooms to school adolescents (“house rentees”), and woreda officers. Focus Group Discussions (FGDs) (n = 6) were conducted with male and female high school adolescents from all grade levels (Grade 9–12). Four trained enumerators conducted the KIIs and FGDs using semi-structured interview guides. The principal investigator provided training and supervision to ensure data quality. Data saturation guided the number of KIIs and FGDs conducted.

Data analysis

Audio recordings of KIIs and FGDs were transcribed verbatim and translated from Amharic to English. Thematic analysis was conducted using MAXQDA Pro-2020 software. Inductive coding was applied to identify categories and themes, guided by grounded theory principles [16, 17]. Data source and spatial triangulations enhanced the validity and reliability of the findings. Thematic analysis based on grounded theory facilitates profound insights into complex phenomena by exploring underlying meanings, relationships, and trends. It is particularly important for investigating novel or under-researched issues [18, 19].

Results and discussions

Participant demographics characteristics

Key informant interviews included various participants like school directors, teachers, adolescents, healthcare workers, and community members (Table 1). Six FGDs with 47 adolescents (ages 17–19) from grades 9–12 encouraged with varied perspectives (Table 2). The study balances group homogeneity (by academic cohort and gender) and heterogeneity to foster open, gender-sensitive dialogue and explore nuanced gendered perspectives.

Table 1.

Demographic information of KII participants (n = 33)

KII participants	Male	Female	Age (Years)	Experience (Years)
Schoolchildren Grade 11	1	1	15–19
Grade 12	5	1	16–19
Teachers	10	1	32–42	12–20
School directors	4	0	34–45	14–19
Health care worker	2	2	29–32	7–9
Woreda health office	1		45	22
Woreda education office	1		44	21
Residence room rentees	3	1	36–42

Table 2.

Demographic information of FGD participants (n = 47)

Group	FGD No.	Age	Group Composition
Group1	7	17–19	all high school schoolchildren from Grades 9–12
Group2	8	17–19	four female and 4 male high school schoolchildren from Grade 10
Group3	8	17–19	four female and 4 male high school schoolchildren from Grade 12
Group4	8	17–19	all high school schoolchildren from Grades 9–12
Group5	8	17–19	four female schoolchildren living with family and 4 male schoolchildren living alone from special classes of Grades 11–12
Group6	8	17–19	four female and 4 male high school schoolchildren from Grade 12

Themes

Qualitative analysis of the KIIs and FGDs summarized in seven key themes:

Perspectives on food and nutrition security

Study participants mainly understood food security as having adequate food to eat (quantity) and nutrition security as consuming a variety of foods (variety). Some participants also mentioned food safety in relation to nutrition. “Food security is the accessibility of food, whereas nutrition is the trend of diet and meal, which mainly emphasizes balanced diet” (Student 1_IDI).

While food security is essential, nutritional quality is equally vital. Recent research calls for integrated policies and collaborations that address both to achieve optimal health outcomes [20].

Sub-theme 1.2: Food security

Study participants described food security as multidimensional beyond availability and economic access, which includes the ability to obtain nutritious food, personal agency, dietary preferences, cultural norms, and habitual consumption patterns.

“Food security stands for the situation of individuals whether they get food or not. Food security means the capacity of an individual or household to purchase food, (Teacher 1_KII).

Food security involves reliable access to adequate, nutritious, and safe food, shaped by factors like purchasing power. Research highlights purchasing power as a key determinant of nutritional access [21]. Although food may be available, food security frameworks often overlook food safety, exacerbating efforts to achieve comprehensive food and nutrition security [22, 23]. Therefore, comprehensive and integrated approaches are essential that address income, education, and food safety to ensure food and nutrition security effectively.

Sub-theme 1.2: Nutrition security

Participants stressed that nutrition security requires not just food quantity, but also variety, balance, and mindful eating emphasizing nutrients, meal frequency, portion size, and adherence to dietary standards for healthy growth.

“When we consider nutrition, it contains carbohydrates, fats, proteins, vitamins, minerals, and water, in general” (Teacher 2_KII). “When discussing the nutrition of school adolescents, proper food safety measures are often not adequately maintained” (Teacher 3_KII).

“When we refer to the nutrition of school adolescents, we mean their daily food intake, which refers to the variety and quantity of food consumed in accordance with nutrition guidelines” (Healthcare professional 1_KII).

A systematic review of school-based nutrition interventions indicated that structured guidelines can lead to better food choices and overall health outcomes [24]. Most school adolescents understood the importance of a balanced diet during adolescence, aligning with findings from other studies on adolescent health awareness [25–27].

However, regardless of this understanding, challenges persist in ensuring dietary diversity and addressing food and nutrition insecurity [28]. Intrahousehold food intake inequalities reduce dietary diversity [29], highlighting the need for interventions targeting nutritional knowledge, socioeconomic, and systemic factors.

Participants highlighted the importance of a balanced diet for proper nutrition, echoing recent studies that link dietary choices to physical health and cognitive function [30]. Study in Australian shows that balanced diets improve cognitive function and mental health [31], reinforcing the need to promote dietary diversity for overall well-being.

Sub-theme 1.3: Inter-sectoral collaboration

Participants stressed the need for stronger collaboration between schools and health sector to improve adolescent food and nutrition security through integrated nutrition education, health literacy, and school-based services empowering healthier choices and long-term well-being.

“Our school is open to work with health care workers concerning nutrition and health. We would like to have a project on nutrition for the community and school adolescents in collaboration with the health and agricultural sector” (School director 1_KII).

A study found that poor dietary practices among adolescents were linked to limited awareness of healthy diets among both students and parents [32]. However, studies suggest that schools are ideal for nutrition interventions [33] with targeted programs improving awareness and promoting healthier adolescent eating behaviors and holistic health [34].

Food adequacy

Participants noted that school adolescents living away from their families had limited access to diverse and sufficient food due to distance, high costs, and the region’s mono-diet culture even among higher-income groups.

“In our district, all school adolescents living away from family could not get adequate food both in variety and quantity. Even those who live with family and could get enough amount of food, could not get a better variety of food, because the food culture in the area is more of a mono diet” (Teacher 4_KII).

“The culture of food consumption in this area is a mono diet. Even civil servants, merchants, and other members of the community who have better incomes in this area do not consume a variety of food” (School director 2_KII).

A review conducted in 2022 in Ethiopia revealed the prevalence of mono-cropping and consequent mono-diets, a finding supported by a study in the Amhara Region, which indicated the cultural practice of mono-diets [35, 36].

School adolescents face major food and nutrition challenges, often eating only once or twice a day. Those living away from families are especially vulnerable, frequently reducing portions or skipping meals to cope with limited supplies (Table 3).

Table 3.

Food adequacy of adolescent schoolchildren in Machakel District

Living condition	Quality	Quality description
Living with family	Better	Better access in quantity and variety in most cases Some of them have better quantity with less variety.
	Poor	Less quantity with less variety Less frequent meals Reduced meal size
Living away from family	Better	Less access to fresh food Adequate quantity with less variety Less frequent meals towards the end of the week Reduced portion size towards the end of the week
	Poor	Inadequate food Food shortage and getting hungry. Less frequent meals most of the time No variety of foods. Eating less quantity and variety just enough for survival Eating nothing the whole day

“There are school adolescents who eat only once or twice a day. The food is not sufficient to eat three times a day for the whole schooldays of the week” (Student 3_IDI).

“Some school adolescents, tell me that sometimes they come to school without eating food the whole day” (Teacher 6_KII). “In fact, there is no access to adequate quantity and variety of food. I can say they eat just enough for survival” (FGD discussant_G1).

Participants reported inadequate dietary variety for school adolescents, especially those living away from family echoing national studies showing widespread undernutrition among Ethiopian adolescents [7, 37–39].

Limited access to adequate and diverse food affects both school adolescents and the wider community. Many households prioritize filling foods over balanced diets, increasing the risk of nutritional deficiencies and signaling severe food insecurity [9].

Food sources

Families are the main food source for school adolescents, but those living away from family often rely on part-time work, community support, or charity. Income-generating activities include daily labor, shoe shining, and market-day jobs, supplemented by help from relatives, friends, and school or community members.

“Most of us live away from family in low-cost rented rooms. Our families are the main source of food for us. They cover all our expenses in most cases. Those who do not get enough support from their families engage in daily labor to cover their food and other needs at the expense of attending classes. For instance, Wednesday and Saturday are regular market days. On these days, male school adolescents participate in paid market activities. Very few orphaned school adolescents are supported by charity organizations” (Student 4_IDI).

“On Wednesdays, many school adolescents are absent from school to engage in income generating activities to support themselves. In most cases, when resources are inadequate to last through the schooldays of the week, they go back to their family to bring food, interrupting their classes” (Teacher 7_KII).

These findings align with studies from Ethiopia and regions like Sub-Saharan Africa, Southeast Asia, and South America, emphasizing the need for context-specific interventions such as school feeding programs, nutrition education, and youth income-generating activities to improve adolescent food and nutrition security [37, 40].

Food types and transportation

Adolescents living away from families brought staples like cereals, pulses, roasted grains (Qollo), barley flour (Besso), and preserved foods (dried injera or bread) from home. Food was transported by parents, marketgoers, equines, or carried by the students themselves.

“School adolescents who live in rented low-cost rooms bring uncooked food items or bread from their families. Some school adolescents from wealthy families who had adequate food and other inputs to prepare food may cook and eat fresh food” (Room rentee 1_KII).

“There is no vehicle transportation in all directions in this area. In most cases, school adolescents carry their food to the town. In some cases, school adolescents and families decide to use traditional transport mechanisms, such as horses, mules, or donkeys” (Teacher 8_KII).

Many school adolescents rely on family-sent staples like bread, injera, besso, and qollo. In rural Ethiopia, poor transport and remote schools worsen food insecurity and student attrition, reflecting broader dietary challenges shaped by socioeconomic and environmental constraints [41, 42].

Food shortage experiences

Some adolescents, especially from low-income families or living away from home, experienced food shortages often seasonally during pre-harvest or intermittently when home-brought food ran out.

“Some school adolescents may go to sleep without food and sometimes stay the whole day and night eating nothing. Some school adolescents come to our office seeking advice on what to do in case of food shortage” (Teacher 9_KII).

“The food security situation of school adolescents is dependent on seasons. Now, it is the lean season, and there is food scarcity for most community members and school adolescents, as well” (School director 3_KII).

“School adolescents who live away from family could experience shortage of food at the end of the schooldays of the week. For those living with family, it depends on the family’s socio-economic status. Shortage of food for school adolescents could be either temporary (pre-harvest) or long-term (throughout the year)” (Healthcare professional 3_KII).

This study explored those adolescent high schoolers in the district experienced food and nutritional insecurity. Similarly findings from Nigeria reported a high prevalence of food insecurity among adolescents [43]. Other studies have shown varying prevalence rates of food insecurity among adolescents. Globally, approximately 30% of adolescents experienced food insecurity [40]. In Hargeisa City, the prevalence of food insecurity among school adolescents was 59.21% [44]. A study also indicated significant seasonal differences in food security and dietary diversity between pre- and post-harvest periods in eastern Ethiopia [45]. Similarly, researchers in rural southern Ethiopia found improved food security and dietary diversity during the main post-harvest season [46].

Gender disparities affect adolescent food security: boys often lack cooking skills, increasing their vulnerability, while girls despite better food management face greater food insecurity if from poor families, due to cultural restrictions limiting mobility and lack of work opportunities.

“Male school adolescents do not have the required skill in food preparation and, thus, lack the motivation to prepare food. So, they are more exposed to hunger. On the other hand, female school adolescents have better exposure and experience in food preparation, and they cook their own food” (FGD discussant_G2).

“Females from very poor families are more affected by shortage of food. Unlike males, female school adolescents have less freedom to move around and search for work to buy food. Culture puts so much pressure on them that they are more affected by food shortages. Male school adolescents from wealthier families and with poor cooking skills are also at risk” (FGD discussant_G3).

Moreover, cultural beliefs in women’s resilience to hunger obscure the serious risks of inadequate female nutrition, reinforcing intergenerational malnutrition and highlighting the need for gender-sensitive nutritional interventions.

“There is a saying in Amharic which could translate literally as “Women’s saliva is thick,” which indicates that women can naturally stay longer without food or with very small amount of food. However, if females do not get proper nutrition, it will lead to inter-generational malnutrition problems” (Student 5_IDI).

Traditional gender roles and early socialization limit boys’ cooking skills, making them more vulnerable when living away from family. In contrast, girls often have more food preparation experience. Studies show a strong link between cooking skills and dietary diversity, highlighting their importance for improved nutrition [47].

Many school adolescents reported food scarcity aligning with studies in Ethiopia that highlight widespread adolescent food insecurity influenced by family socioeconomic status, living conditions, and individual behaviors [40, 48]. Male school adolescents living away from family faced greater food and nutritional insecurity than females, likely due to poorer cooking and home management skills echoing findings from a 95-country study [40].

Food adequacy and academic performance

Food security and living conditions significantly impact on rural adolescents’ academics as malnutrition, poor sanitation, and limited diets impair cognition unlike urban peers who benefit from healthier environments. A balanced diet is essential for focus and learning.

“Academic performance depends on upbringing. We grow in rural areas, and our mental development has been affected by malnutrition. Urban children could get a balanced diet, safe water, and a better environment. Rural children, on the other hand, though we can access food, the safety of the food, sanitation, and personal hygiene are very poor in most cases (Student 6_IDI).

“There is a direct relationship between quality of food and academic performance. If we eat a mono diet, we may be malnourished so that we cannot study properly. On the other hand, if we eat a balanced diet, our mental development is good which contributes to better academic performance. When school adolescents are hungry, they become tired and cannot understand what they learn. School adolescents can be attentive when they eat adequate food both in variety and quantity” (Student 7_IDI).

Adequate food access enhances academic performance, while hunger and nutritional insecurity hinder concentration, energy, and overall educational outcomes [49, 50]. Food and nutritional insecurity can also affect adolescents’ cognitive performance, including attention and vigilance [51]. Studies consistently show a strong positive link between food adequacy and academic performance among adolescent students [44, 52, 53]. This finding highlights the critical role of food security in academic success, as learning demands sufficient mental energy.

While most adolescents acknowledged the link between food adequacy and academics, some noted that factors like study habits, resources, and motivation also influence performance.

“I do not think that adequate food has a direct relationship with academic performance. Sometimes, the opposite might happen. For instance, those school adolescents from wealthy families have no interest in education, because they think that a smooth life will continue as it is now. On the contrary, those school adolescents who come from poor families might strongly struggle to change the history of their families and study hard. Thus, they become good performers in their studies” (Student 8_KII).

Though food access is vital for academic success, other factors like motivation and socioeconomic background also matter. Latib and colleagues argued that focusing solely on food may ignore broader systemic influences [54].

Strategies for improvement

Participants suggested improving food security and academics through government nutrition programs, school meals, health and school-led education, community-driven agriculture, and youth involvement in farming and awareness. Achieving adequate food and academic success depends on all stakeholders fulfilling their roles, with awareness creation being the key strategy.

“Last year, there was a movement in the town about nutrition initiated by an NGO. The motto was “Migbien Beguaroye,” which literally translates as “My food in my home garden.” Around twenty-five adolescent high schoolers were selected and were engaged in this project. This year, the NGO project was phased out. When the incentive was discontinued, school adolescents stopped their participation in the project. (Healthcare professional 4_KII).

This finding underscored the nutritional value of home gardening for adolescents, aligning with studies from Southwest Ethiopia [55]. However, sustaining initiatives post external support is challenging. Tanzanian evidence shows home gardens improve nutrition and resilience, but ongoing training and resources are essential to maintain progress [56].

“Health sector should coordinate with high schools for awareness creation. The education sector, particularly schools, is the center of awareness creation and dissemination of information to the community. Parents love their children, so if we provide information through their children, it could be easily disseminated and accepted” (Healthcare professional 1_KII).

This stresses the need for health sector-school coordination to inform families, yet research shows weak collaboration often limits support for students with health issues [57].

Conclusion and recommendations

Participants viewed food security as having enough food and nutrition as dietary diversity but raised concerns about the overlooked issue of food safety. This study highlighted the complex challenges adolescents face, especially those living away from family face in accessing safe, and nutritious food. Comprehensive food and nutrition security requires not just availability, but also quality and safety, which are vital for adolescent health, cognitive development, and success. To improve food and nutrition security, targeted and contextualized interventions are vital that should address the complex interplay between socio-economic status, food access, and dietary preferences.

Strength and limitations of the study

The study’s qualitative design is a key strength, offering deep insight into adolescents lived experiences within their sociocultural context. However, its limited scope and non-representative sample restrict the generalizability of findings beyond the study area.

Abbreviations

KIIs

Key Informant Interviews

FGDs

Focus Group Discussions

NGO

Nongovernmental Organization

LMICs

Low- and middle-income countries

Author contributions

Conceptualization: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaData curation: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaFormal analysis: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaInvestigation: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaMethodology: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaProject administration: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaResources: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaSoftware: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaSupervision: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaValidation: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaVisualization: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, NigatuWriting– original draft: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu RegassaWriting– review & editing: Matyas Atnafu Alehegn, Mogessie Ashenafi, Mesay Mulugeta, Nigatu Regassa.

Funding

There is no funding provided.

Data availability

The datasets used and analyzed during the current study are available upon reasonable request from the corresponding author.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and ethical clearance was given by IRB of Addis Ababa University (Approval No. 0004/2022) on November 14, 2022. Informed consent to participate was obtained from all the participants or their guardians for minors. Participants’ anonymity and confidentiality were ensured by not recording any names or identification details throughout the study. Data was coded, stored securely, and password protected.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.