NUTRITIONAL STATUS OF ADOLESCENTS IN A SELECTED

UPAZILLA OF CHATTOGRAM HILL TRACTS

Prepared By
Rezaul Karim
ID No.: 22-2-53-890-040
4th Semester
Session: 2022
Study Centre: Chittagong Medical College & Hospital (CMCH)

Master of Public Health Program

SCHOOL OF SCIENCE AND TECHNOLOGY

BANGLADESH OPEN UNIVERSITY

Gazipur-1705

i
 EVALUATION PAGE
Master of Public Health Program
SCHOOL OF SCIENCE AND TECHNOLOGY
BANGLADESH OPEN UNIVERSITY

We the undersigned, certify that we have carefully read and recommended to the School of Science
and Technology, Bangladesh Open University, for the acceptance of the dissertation.

“Nutritional Status of Adolescents in a Selected Upazilla of Chattogram Hill Tracts”

Submitted by Rezaul Karim, ID No.: 22-2-53-890-040, 4th Semester, Session: 2022, Study Centre:
Chittagong Medical College & Hospital (CMCH), for the partial fulfillment of the requirements of
the degree of Masters of Public Health (MPH).

(Dr. Sara Farhanaj)

MBBS, MPH
Assistant Professor
Department of Community Medicine and Public Health
Institute of Applied Health science(IAHS), USTC, Chattogram
Internal Examiner

(Dr. Farid Uddin Ahmed)

MBBS, BCS (Health), MPH
Assistant Professor
Department of Community Medicine & Public Health
Rangamati Medical College, Rangamati
External Examiner

(Dr. Zubaida Khanam)

MBBS, MPH, DMU
Assistant Professor
Department of Community Medicine and Public Health
Chittagong Medical College & Hospital, Chattogram
Representative of BOU

Prof. Dr. Sayeed Mahmud

MBBS, MPH, BCS (Health), [Link] (PSM), Ph.D.
Professor, Community Medicine and Public Health
Institute of Applied Health science(IAHS), USTC, Chattogram
Chairman
ii
DECLARATION

I declare that work presented here is my own. All sources used have been cited appropriately.
Any mistakes or inaccuracies are my own. I also declare that for any publication, presentation,
or dissemination of information of the study, I would be bound to take written consent of my
supervisor.

Rezaul Karim
ID No.: 222-53-890-040
4th Semester
Session: 2022
Study Centre: Chittagong Medical College & Hospital (CMCH)

iii
 Ethical clearance certificate
Bangladesh Open University
School of Science and Technology
Gazipur-1705, Bangladesh

To Whom It May Concern

This is to certify that, we the members of the Research Ethical Committee had carefully
checked and read through the thesis proposal protocol. The Committee decided to approve the
thesis proposal Titled “Nutritional Status of Adolescents in a Selected Upazilla of
Chattogram Hill Tracts” is accepted on for final approval.

This research will be conducted by Rezaul Karim, ID No.: 22-2-53-890-040, 4th Semester,
Session: 2022, Study Centre: Chittagong Medical College & Hospital (CMCH). The candidate
is advised to follow the ethical guidelines, during the research, the applicant is advised to
complete the task sincerely, honestly, with perseverance within the time limit.

Prof.(Dr.) Sayeed Mahmud Prof.(Dr.) Swapan Kumar Chowdhury

MBBS, MPH, BCS (Health), [Link] (PSM), Ph.D. MBBS, BCS (Health), MPH, FRSH (London),
Professor, Community Medicine and Public Health CHE (USA), WHO Fellow
Institute of Applied Health science(IAHS) Professor, Community Medicine and Public Health
Chairman Southern Medical College, Chattogram
Research Ethical Committee CMCH Member-Secretary
study center, Chattogram
Research Ethical Committee CMCH
study center, Chattogram

iv
 CERTIFICATE OF GUIDANCE

This research project title “Nutritional Status of Adolescents in a Selected Upazilla of

Chattogram Hill Tracts” It was conducted & completed by Rezaul Karim ,
ID No.: 22-2-53-890-040, 4th Semester, Session: 2022, Study Centre: Chittagong Medical
College & Hospital (CMCH), student of Master of Public Health course under my guidance
and supervision. His overall performance to perform this research project was very good.

Prepared By

________________
Dr. Zubaida Khanam
MBBS, MPH, DMU
Assistant Professor
Department of Community Medicine and Public Health
Chattogram Medical College & Hospital, Chattogram
Supervisor

v
 ACKNOWLEDGEMENT
First of all, I express my heartiest respect and gratitude to Almighty Allah, whose invisible
guidance helped me to purpose and complete this work.

With much pleasure and pride, I express my deep sense of appreciation and gratitude to my
research guide Dr. Zubaida Khanam, Assistant Professor, Department of Community
Medicine, Chittagong Medical College & Hospital, Chattogram for her service, advice, active
and continuous supervision on successful accomplishment of this study and completion of the
dissertation work in the schedule time frame. I must appreciate the time, energy, expertise she
had provided for this study, were simply amazing.

At the same time, I am appreciating the cooperation and support of my participant for taking
the trouble of completing the questionnaires.

Rezaul Karim
ID No.: 222-53-890-040
4th Semester
Session: 2022
Study Centre: Chittagong Medical College & Hospital (CMCH)

vi
Contents
DECLARATION ............................................................................................................. iii
Ethical clearance certificate ............................................................................................ iv
CERTIFICATE OF GUIDANCE .................................................................................... v
ACKNOWLEDGEMENT ............................................................................................... vi
List of Figures .................................................................................................................. ix
List of Tables ................................................................................................................... x
ABSTRACT ..................................................................................................................... xi
ABBREVIATIONS ......................................................................................................... xii
INTRODUCTION ............................................................................................................ 1
1.1. Background ..................................................................................................................... 2
1.2. Research Hypothesis ....................................................................................................... 4
1.3. Research Question ........................................................................................................... 5
1.4. Objectives of the Study ................................................................................................... 5
1.5. List of variables ............................................................................................................... 6
1.6. Operational definitions .................................................................................................... 7
LITERATURE REVIEW ................................................................................................. 9
METHODOLOGY ......................................................................................................... 13
3.1. Study design .................................................................................................................. 14
3.2. Study population ........................................................................................................... 14
3.3. Study site ....................................................................................................................... 14
3.4. Study period .................................................................................................................. 15
3.5. Sample size .................................................................................................................... 15
3.6. Inclusion criteria ............................................................................................................ 16
3.7. Exclusion criteria........................................................................................................... 16
3.8 Sampling Technique....................................................................................................... 16
3.9 Data Sources and Data Collection Materials.................................................................. 16
3.10 Data Collection Procedure ........................................................................................... 17
3.11 Data Management and Analysis Plan........................................................................... 17
3.12 Quality Control and Quality Assurance ....................................................................... 18
3.13 Ethical Considerations.................................................................................................. 18
RESULTS/ FINDINGS OF THE STUDY ...................................................................... 19
vii
 4.1. Results ........................................................................................................................... 20
DISCUSSION ................................................................................................................. 29
CONCLUSION, FUNDING ........................................................................................... 32
CONCLUSION .................................................................................................................... 33
Funding................................................................................................................................. 33
LIMITATIONS AND RECOMMENDATIONS ............................................................ 34
LIMITATIONS OF THE STUDY ....................................................................................... 35
Recommendations ................................................................................................................ 35
REFERENCES ............................................................................................................... 36
APPENDICES ................................................................................................................ 40

viii
 List of Figures

Figure 1 Map of study area Khagrachari District .............................................................. 15

Figure 2 Gender of the respondentss (n=250) ..................................................................... 20
Figure 3 Family Income status of the respondents ............................................................. 21

ix
 List of Tables

Table 1 Age groups of respondents (n=250) ........................................................................ 20

Table 2 Religion of the respondents (n=250) ....................................................................... 21
Table 3 Education status of mothers (n=250) ...................................................................... 22
Table 4 Education status of fathers (n=250) ........................................................................ 22
Table 5 knowledge of nutrition among the responding boys and girls (n=250) ............... 22
Table 6 Food Consumption Distribution of respondents ................................................... 23
Table 7 BMI of respondents (n=250) .................................................................................... 23
Table 8 MUAC of respondents (n=250) ............................................................................... 24
Table 9 Association between age groups and nutritional status (n=250) .......................... 25
Table 10 Association between gender and nutritional status (n=250) ............................. 26
Table 11 Association between Annual Family Income and Nutritional Status (n=250) . 26
Table 12 Association between nutritional knowledge and nutritional status (n=250) ... 27
Table 13 Association between MUAC and nutritional status (n=250) ............................. 28

x
 ABSTRACT
Background
In Bangladesh, adolescents account for 22% of the population, adolescence is a critical phase
of growth, and nutritional status during this period has significant implications for long-term
health outcomes. However, malnutrition remains a major public health concern in the hill tract
areas of Chattogram, where access to adequate nutrition is often limited.

Objective of the Study

This study aimed to assess the nutritional status of adolescents in Panchari Upazila, Chattogram
Hill Tracts. Additionally, it sought to examine the relationship between Mid-Upper Arm
Circumference (MUAC) and Body Mass Index (BMI) to evaluate the effectiveness of MUAC
as a screening tool for nutritional assessment in limited-resource.

Methodology
A cross-sectional study was conducted among 250 adolescents aged 10–14 years from January
2024 to April 2025. Data collection involved socio-demographic variables, dietary habits,
anthropometric measurements (BMI, MUAC), and nutritional knowledge. Descriptive
statistics were used for data analysis.

Results
The study found that 55.2% of adolescents were underweight, 42.4% had normal BMI, and
2.4% were overweight. MUAC classification revealed that 38.0% had Moderate Acute
Malnutrition (MAM) and 13.6% had Severe Acute Malnutrition (SAM). A statistically
significant correlation was observed between MUAC and BMI (r = 0.42, p < 0.01), confirming
MUAC as a reliable screening tool for nutritional assessment.

Conclusion
The high prevalence of undernutrition in the study area highlights the urgent need for targeted
nutrition programs. MUAC, due to its strong correlation with BMI, can be used as a simpler
and cost-effective alternative for nutritional assessment in resource-limited settings.

Keywords: Adolescents, Nutritional status, BMI, MUAC, Chattogram Hill Tracts,

Malnutrition

xi
 ABBREVIATIONS

BMI Body mass index

MUAC Mid-Upper Arm Circumference

WHO World Health Organization

xii
 CHAPTER-I
INTRODUCTION

1
1.1. Background

Adolescence, the transitional phase between childhood and adulthood, is a crucial period for
human growth and development. Proper nutrition during this stage serves as a cornerstone for
long-term health and well-being (Tamanna et al., 2013). Poor nutritional status in adolescence
is a key determinant of future health outcomes. This study examines the nutritional status of
adolescents in the hill tract areas of Chattogram. Globally, adolescents aged 10 to 19 years
constitute approximately 20% of the population, with Bangladesh having a slightly higher
proportion at 23%. This phase is marked by profound physiological, psychological, and bodily
changes, making adolescent health a vital concern. Adolescent nutrition is influenced by
multiple factors, including age, gender, knowledge, family dynamics, physical and biological
environments, and societal values. Key determinants such as sex, age, and the father’s
occupation significantly affect nutritional status, while maternal literacy and employment also
play a pivotal role (Bidu et al., 2016). Understanding these influences is essential for achieving
the health goals set by the Government of Bangladesh.

Despite its importance, malnutrition remains a pressing global issue among adolescents,
particularly in developing regions like Asia. Approximately 1.2 billion adolescents, accounting
for 19% of the developing world’s population, suffer from malnutrition (Akhter and Sondhiya,
2013). In Bangladesh, gender disparities are evident, with 32% of adolescent girls classified as
underweight (Alam et al., 2010). As one of the world’s most densely populated nations, with
881 people per square kilometer and 20% of its population living below the poverty line
(Economic Review, 2024), Bangladesh faces significant challenges in addressing adolescent
malnutrition.

Adolescence is a period of rapid growth, during which individuals gain up to 50% of their adult
weight, over 20% of their adult height, and nearly 50% of their adult bone mass. This requires
an increased intake of calories, protein, iron, calcium, and essential vitamins. However, studies
suggest that many adolescents fail to meet these nutritional demands, exacerbating deficiencies.
Globally, adolescents make up 16% of the population, with 85% residing in low- and middle-
income countries (LMICs). In Bangladesh, adolescents represent 22% of the population, with
many experiencing undernutrition despite a rising trend in overnutrition. This phenomenon,
known as the "individual-level double burden of malnutrition" (IDBM), highlights the

2
coexistence of undernutrition and overnutrition within the same population (Jubayer et al.,
2020).

Nutrition plays a fundamental role in human development, yet many adolescents, particularly
those in rural areas of Bangladesh, suffer from chronic malnutrition. The rapid growth
experienced during adolescence increases the demand for essential nutrients, but inadequate
consumption of nutrient-rich foods remains a prevalent issue. Adolescent girls are especially
vulnerable due to factors related to reproductive health, which further exacerbate their
nutritional challenges (Islam, 2019). Adolescence is one of the most critical periods for
physical growth and development. Nearly every organ and system in the body undergoes
significant changes, except for the brain and skull. This accelerated growth phase heightens the
need for increased energy, protein, and other vital nutrients. In particular, protein deficiency
has been shown to hinder proper adolescent growth, underscoring the importance of adequate
dietary intake during this stage. As the next generation of any nation, adolescents represent a
crucial demographic for societal well-being. However, their nutritional needs in low-income
countries are often overlooked compared to other vulnerable groups, such as young children
and women. Addressing adolescent malnutrition is essential for breaking the cycle of poverty,
preventing chronic diseases, and mitigating intergenerational malnutrition (Manzoor, 2016).

Bangladesh has made significant strides in reducing the prevalence of undernutrition and is on
track to meet the Millennium Development Goals (MDGs) for nutrition. However,
micronutrient deficiencies remain a serious public health concern. Despite numerous
interventions over the years, the persistence of these deficiencies highlights the need for
continued efforts. Recent discussions on developing strategies to address micronutrient
deficiencies have provided an opportunity to evaluate the successes and challenges of current
programs, as well as the nutritional status of children and women in the country (Ahmed et al.,
2016). Chronic malnutrition not only affects physical growth but also diminishes productivity
and physical strength due to its association with reduced lean body mass. Therefore, addressing
the root causes of adolescent malnutrition is essential to mitigate its adverse effects.

Research has shown that the nutritional status of adolescents is influenced by a variety of
environmental and socioeconomic factors. Family dynamics, socioeconomic status, and
sociodemographic characteristics all play a role in shaping nutritional outcomes. Specific
factors such as age, sex, and maternal education significantly impact how well-nourished

3
adolescents are. Additionally, a lack of nutritional knowledge and meal-skipping habits have
been linked to poor nutritional status among adolescents (Wolde et al., 2014). Given the high
prevalence of malnutrition and the unique challenges faced by adolescents in different settings,
it is crucial to identify and address the factors contributing to malnutrition. Standardized
anthropometric measurements, conducted by the same measurer, can help reduce variability
and ensure accurate assessments. Raising awareness of the factors leading to malnutrition
among adolescent boys and girls is a critical step in developing effective strategies to improve
their nutritional status.

1.2. Research Hypothesis

This study is based on the hypothesis that there is a significant relationship between selected
adolescent characteristics—such as age, family income, dietary intake, and nutritional
knowledge—and their Body Mass Index (BMI). The null hypothesis posits that no such
relationship exists between these characteristics and BMI.

4
1.3. Research Question

● What is the nutritional status of adolescents in a selected upazilla (panchari,

khagrachari) of hill tracts area of chattogram?

1.4. Objectives of the Study

General objective:

To identify the nutritional status of adolescents in the hill tract area of Chattogram,
Bangladesh.

Specific objectives:

 To observe the food habit of adolescents of hill tracts area.

 To find out the demographic profile of adolescents in hill tracts area.
 To explore the categorization of malnutrition on the basis of BMI and MUAC.

By addressing these objectives, the study provide insights into the nutritional challenges faced
by adolescents in hill tract regions and to inform targeted interventions to improve their health
outcomes.

5
1.5. List of variables

Socio-Demographic Variables:

1. Age
2. Gender
3. Religion

Socio-Economic Variables:

6. Annual Family Income

7. Respondent's Education
8. Mother's Education
9. Father's Education
10. Nutritional Knowledge

Anthropometric Measurements:

11. Height
12. Weight
13. Body Mass Index (BMI)
14. Mid-Upper Arm Circumference (MUAC)

Nutritional and Health-Related Variables:

15. Participation in Nutrition Programs

16. Hygiene Practice
17. Food Intake

6
1.6. Operational definitions

Adolescence:

Adolescence refers to the transitional stage of development between childhood and adulthood,
typically ranging from 10 to 19 years of age. In this study, adolescence is defined as the period
from 10 to 14 years, focusing on early adolescence. This stage is characterized by significant
physical, psychological, and social changes, including rapid growth, sexual maturation, and the
development of cognitive and emotional skills.

BMI (Body Mass Index):

BMI is a measure of body fat based on an individual's weight and height. It is calculated using
the formula:

𝑊𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔)
𝐵𝑀𝐼 =
{𝐻𝑒𝑖𝑔ℎ𝑡 (𝑚)}2

In this study, BMI is categorized as:

● Underweight: BMI < 18.5

● Normal weight: BMI 18.5–24.9
● Overweight: BMI 25–29.9

MUAC (Mid-Upper Arm Circumference):

MUAC is a measure of the circumference of the upper arm, taken midway between the shoulder
and the elbow. It is used as an indicator of nutritional status, particularly in assessing
malnutrition. In this study, MUAC is categorized as cutoffs for MUAC and BMI according to
NACS as follows

● Severe Acute Malnutrition (SAM): MUAC < 16 cm

● Moderate Acute Malnutrition (MAM): MUAC 16–18.5 cm
● Normal: MUAC > 18.5 cm

7
Nutritional Knowledge:

Nutritional knowledge refers to an individual's understanding and awareness of proper

nutrition, including the importance of a balanced diet, the role of different nutrients, and the
impact of nutrition on health. In this study, nutritional knowledge is measured by the number
of correct answers to nutrition-related questions (out of 10). Higher scores indicate better
nutritional knowledge.

Hygiene Practice:

Hygiene practice refers to the behaviors and habits related to maintaining cleanliness and
preventing disease. In this study, it includes:

● Washing hands regularly with soap before and after eating.

● Washing hands regularly with soap after using the toilet.
● Regularly cutting nails.
● Regularly brushing teeth.
● Regularly taking baths.
Hygiene practice is scored based on the frequency of these behaviors (e.g.,
frequently, occasionally, rarely, not yet).

Food Intake:

Food intake refers to the quantity and quality of food consumed by an individual over a specific
period. In this study, food intake is measured using a 24-hour recall method, where respondents
report the types and amounts of food consumed in the last 24 hours. The food items are
categorized into:

● Staple foods (e.g., rice, bread).

● Non-staple foods (e.g., eggs, meat, fish, milk, vegetables).
Food intake is also converted into calorie intake to assess energy consumption.

8
 CHAPTER-II
LITERATURE REVIEW

9
Adolescence is a crucial phase of growth and development, yet it remains one of the most
overlooked periods when it comes to nutritional interventions, especially in low- and middle-
income countries (LMICs). Poor nutrition during this stage not only impacts immediate health
but also has long-term effects, including a higher risk of chronic diseases, poor reproductive
health, and the continuation of intergenerational malnutrition. With over 1.2 billion adolescents
worldwide—more than half of whom live in Asia and Africa—undernutrition and
micronutrient deficiencies remain widespread challenges. For example, in India, where
adolescents make up 21% of the population, studies indicate that 53.8% of rural adolescents
are underweight, with 17% classified as severely thin. Likewise, in Ethiopia, 22.9% of
adolescent girls experience stunted growth, and 8.82% are underweight, underscoring the
persistent issue of malnutrition. In Tanzania, a dual burden of malnutrition is becoming more
apparent, with 25% of adolescents falling outside the normal nutritional range, encompassing
both undernutrition and overnutrition. Despite the significance of this life stage, there is a lack
of comprehensive data on adolescent nutrition in LMICs, as most research focuses on children
under five or adults, leaving a gap in understanding adolescent-specific nutritional challenges.
This literature review examines findings from five studies conducted in India, Ethiopia,
Tanzania, and Bangladesh, assessing adolescent nutritional status through anthropometric
indicators such as body mass index (BMI), mid-upper arm circumference (MUAC), and height-
for-age. These studies reveal the prevalence of undernutrition, the growing concern of
overnutrition, gender disparities, and the influence of socioeconomic factors, while also
evaluating MUAC as a potential low-resource alternative to BMI. By analyzing these findings,
this review seeks to enhance understanding of adolescent nutrition in LMICs and highlight key
areas for future research and intervention.

1. A study conducted in rural Gujarat, India by Poonam K Trivedi, investigated the

nutritional status of adolescents and found that 17% were severely thin, with only about
50% having a normal BMI, indicating widespread undernutrition. Anemia was also a
concern, affecting 6% of girls and 3% of boys. The study highlighted that school-going
adolescents had better nutritional status than non-school-going adolescents, suggesting
that education and school-based nutrition programs might offer protective benefits.

10
2. In Ethiopia, a study conducted in Awash Town, Afar Region by Molla Kahssay,
focused on school-going adolescent girls and found that 22.9% were stunted, while
8.82% were thin, demonstrating a significant undernutrition burden. Early adolescence
(10–14 years), low dietary diversity, and low family income were identified as key
contributors to stunting and thinness. Girls from lower socioeconomic backgrounds and
those consuming fewer than four food groups were more likely to be undernourished.

3. Another study conducted in Sagar, India by Rachna Thakur, analyzed adolescent

nutritional status and revealed that 53.8% were thin, 44% had a normal BMI, and only
2.2% were overweight, reflecting a high prevalence of undernutrition. Boys had a
higher likelihood of being stunted (30.6%) compared to girls (3.2%), while girls were
more prone to being underweight. The Composite Index of Anthropometric Failure
(CIAF) showed that 10.6% of girls and 10% of boys were undernourished, with boys
facing a greater risk of stunting and girls experiencing higher rates of underweight.

4. In Tanzania, a study by Margaret Lillie, assessing young adolescents attending primary

school found that 75% had a normal BMI, while 25% fell outside the normal range,
including cases of both undernutrition and overnutrition. Males were more likely to be
stunted (30.6%) compared to females (3.2%), while females had a higher prevalence of
overweight (16.3%) compared to males (3.2%). MUAC and BMI showed a strong
positive correlation, particularly in females (r = 0.846), though MUAC cut-offs had low
sensitivity, indicating inconsistencies in identifying undernourished adolescents.

5. In Bangladesh, a study conducted in Chattogram, Cox’s Bazar by Farin Wakeya, and

Rohingya refugee camps revealed significant variations in nutritional status among
adolescent girls. The prevalence of underweight was highest in Cox’s Bazar (38.3%),
followed by Chattogram (22.5%) and the Rohingya camp (17.5%). Overweight was
more prevalent in Chattogram (10%) compared to Cox’s Bazar (9.2%) and the
Rohingya camp (2.5%). Severe acute malnutrition (SAM) was highest in the Rohingya
camp (6.5% in 10-14.9 years and 4.5% in 15-19 years), while moderate acute
malnutrition (MAM) was more common in Cox’s Bazar (24.1% in 10-14.9 years). Meal
skipping was a significant issue in Chattogram (80%) and Cox’s Bazar (65.8%),
contributing to higher rates of underweight. The study also highlighted the dual burden

11
of malnutrition, with underweight and overweight coexisting in the same populations,
particularly in urban areas like Chattogram. The findings underscore the need for
targeted interventions to address both undernutrition and overnutrition, especially in
vulnerable populations like the Rohingya refugees.

12
 CHAPTER-III
METHODOLOGY

13
Data collection and analysis, which are crucial to any form of study, are done using
methodology. It is a necessary and crucial component of carrying out any scientific inquiry or
research. This is why the study should be done with great attention and sincerity. By assessing
the facts to make the best conclusion, the researcher can acquire genuine and trustworthy data
with the aid of an appropriate approach. These chapters describe the methodological approach
and study design, including the study area, sampling strategy, data collection techniques,
methodologies for different variables, research instruments, and data processing techniques.

3.1. Study design

A descriptive cross-sectional study was employed. The integration of these approaches

enhances the robustness of the study by allowing for cross-validation of findings, thereby
increasing the validity of the results.

3.2. Study population

The study population consisted of adolescent boys and girls aged 10 to 14 years from three
villages located in the panchari upazila of Khagrachari District.

3.3. Study site

Adolescent boys and girls from the local villages in the hill tracts of the panchari upazila,
Khagrachari district participated in a descriptive and cross-sectional research. It is a district in
the Chittagong Division in Bangladesh's southeastern region. The hill tracts are unique,
characterized by mountainous terrain and lush green landscapes. These regions are influenced
by the dynamic interaction between the land's topography, forest cover, and the seasonal
weather patterns. The environment of the hill tracts is constantly changing due to rainfall, soil
erosion, and the geographical features that define the area, making it a complex and vital region
in Bangladesh.

14
 Figure 1 Map of study area Khagrachari District

3.4. Study period

The duration of the study was 14 months from January 2024 to April 2025. The study
was conducted from January 2024 to April 2025. To complete the research on time, a
plan was made. The first two months were dedicated to topic selection, about a year
literature review, and 3 months development of the protocol, while reviewing literature.
The last five months from December 2024 – April 2025 were spent on questionnaire
development, data collection, data analysis, report writing, printing, and submission of
the report.
3.5. Sample size

For calculating sample size the following formula was used:

𝑧 2  𝑝 𝑞
𝑛=
𝑑2

Here, n = desired sample size,

z = standard normal deviation; set at 1.96, which correspond to 95% confidence level.

P = prevalence rate= 50%(According to thumb rule) =0.5

q = 1-p =1-0.5 = 0.5.

d = Allowable margin error = 5% of p =0.05.

n= (1.96)2×0.5×0.5/(0.05)2= 384

So, according the above formula the desired sample size for this study is, n= 384. Due to
scarcity of time and resources sample was selected as 250.

15
3.6. Inclusion criteria
Participants must meet the following criteria to be included in this study:

1. Individuals aged 10 years to 14 years.

2. Residents of panchari upazila, Khagrachari district, Bangladesh.
3. Individuals who agree to participate and provide informed consent.

3.7. Exclusion criteria

Participants will be excluded if they meet any of the following conditions:

1. Individuals below 10 years of age and above 15 years .

2. Those who do not reside in panchari upazila, Khagrachari district, Bangladesh.
3. Individuals who are unable to provide informed consent due to medical or cognitive
impairments.
4. Those who have participated in similar studies recently, which may affect the research
outcomes.

3.8 Sampling Technique

The study site was selected purposively, and the sample was drawn from the study population
using a convenient sampling technique. This method was chosen to ensure ease of access to
the target population, particularly adolescents in the hill tracts of the panchari upazila,
Khagrachari district, Bangladesh. Adolescent boys and girls from the local villages in the hill
tracts of panchari upazila, Khagrachari district, Bangladesh participated in a descriptive and
cross-sectional research. Panchari upazila, Khagrachari district, Bangladesh is a district in
the Chittagong Division in Bangladesh's southeastern region.

3.9 Data Sources and Data Collection Materials

The following materials were used for the research work:

A pre-tested semi-structured questionnaire: This questionnaire was designed to collect data on
various aspects of adolescent nutritional status, including socio-demographic information,
dietary habits, hygiene practices and participation in nutrition programs.

16
3.10 Data Collection Procedure

The Questionnaire Form:

The questionnaire included questions tailored to meet the objectives of the study. It consisted
of mostly close-ended questions with a few open-ended questions to allow for more detailed
responses. The respondents were personally interviewed, and the questionnaire was filled out
by the researcher based on the responses provided by the participants.

Anthropometric Measurements:

Anthropometric data were collected to assess the nutritional status of the participants.
Standard procedures were followed to measure height, weight, mid-upper arm circumference
(MUAC), and calculate body mass index (BMI). Height was measured using a non-
stretchable measuring tape, and weight was recorded using a digital scale. MUAC was
measured using a non-stretchable MUAC tape at the midpoint between the shoulder and
elbow of the left arm. BMI was calculated using the formula: weight in kilograms divided by
the square of height in meters (kg/m²). These measurements provided objective data to
complement the questionnaire findings and allowed for a more comprehensive assessment of
the participants health and nutritional status.

3.11 Data Management and Analysis Plan

The collected data was cleaned, processed, and analyzed using SAS software and Colab Pro.
The results were presented in the form of numbers and percentages, and appropriate tables and
graphs were used to illustrate the findings. Descriptive statistics, correlation analysis were
employed to explore the relationships between various factors and the nutritional status of
adolescents.

17
3.12 Quality Control and Quality Assurance

To ensure the quality and reliability of the data, the following measures were taken:
1. Standard Research Protocol: A standardized research protocol was followed
throughout the study to maintain consistency and accuracy.
2. Supervisor Guidance: Regular help and guidance were sought from the supervisor to
ensure the study was conducted as per the research objectives.
3. Pre-testing of Questionnaire: The questionnai3re was pre-tested to identify any
potential issues and to ensure that the questions were clear and understandable to the
respondents.
4. Data Validation: The collected data was checked and rechecked for validity and
reliability to minimize errors.
5. Researcher Involvement: The data collection and analysis were conducted by the
researcher himself to maintain control over the quality of the data.

3.13 Ethical Considerations

Ethical clearance for the study was obtained from the Bangladesh Open University Ethics
Committee. Before recruitment, participants were informed about the purpose, duration, and
anonymity of the study. All personal information was kept confidential and was not disclosed
to the public. Participants were assured that their data would be used solely for research
purposes, and their identities would remain anonymous. Permission was also obtained from the
local authorities to conduct the research in the selected area. The study was conducted in
accordance with the Declaration of Helsinki, ensuring that ethical standards were maintained
throughout the research process.

18
 CHAPTER-IV
RESULTS/ FINDINGS OF THE
STUDY

19
4.1. Results

Socio-demographic characteristics of the respondents (n=250)

Table 1 Age groups of respondents (n=250)

Variable Response Frequency (N) Percentage (%)

Age groups 10 - 11 Years 48 19.2%
11 - 12 Years 56 22.4%
12 - 13 Years 53 21.2%
13 - 14 Years 57 22.8%
14 - below 15 Years 36 14.4%
Total 250 100.0%

Table 1 shows that the highest proportion of respondents (22.8%) were 13 years old, followed
by 11-year-olds (22.4%) and 12-year-olds (21.2%). The smallest age group was 14 years
(14.4%).

Figure 2 Gender of the respondentss (n=250)

Figure 2 demonstrations that the majority of respondents 71.6% (179) were male, while 28.4%
(71) were female.

20
 Table 2 Religion of the respondents (n=250)

Religion Frequency (N) Percentage (%)

Buddhist 130 52.0%
Muslim 98 39.2%
Hindu 22 8.8%
Total 250 100.0%

Table 2 displays that 52.0% of respondents identified as Buddhist, 39.2% as Muslim, and 8.8%
as Hindu.

Annual family income of the respondents

Fair, 8.80%

Poor, 36%

Normal, 55.20%

Fair Normal Poor

Figure 3 Family Income status of the respondents

The annual family income of the respondents ranged from taka 50 to 200 thousands, with a
mean of 95.80 thousands and a standard deviation of 31.05thousand. On the basis of their
annual family income the respondents were classified into three categories i.e. poor (<70),
normal (70-150) and fair (>150) income.

Figure 3 demonstrates that the majority of respondents 138 (55.2%) belonged to the family of
normal income group, while 90 (36.0%) were categorized as from poor and only 22 (8.8%) fell
in the fair income category.

21
 Table 3 Education status of mothers (n=250)

Response Frequency (N) Percentage (%)

Primary 126 50.4
Secondary 64 25.6
Illiterate 60 24.0
Total 250 100.0

Table 4 Education status of fathers (n=250)

Response Frequency (N) Percentage (%)

Primary 103 41.2
Secondary 81 32.4
Illiterate 66 26.4
Total 250 100.0

Tables 3 and 4 indicate that the majority of parents had only primary education, with a smaller
percentage achieving secondary education. A notable proportion of both mothers (24.0%) and
fathers (26.4%) were illiterate.

Table 5 knowledge of nutrition among the responding boys and girls (n=250)

Category Frequency (N) Percentage (%)

Fair 38 15.2
Medium 211 84.4
Poor 1 0.4
Total 250 100.0

Table 5 presents the distribution of respondents based on their level of nutritional knowledge,
categorized into Fair, Medium, and Poor knowledge. The Fair knowledge category consists of
respondents with scores 7.0 and 8.0, accounting for 15.2% of the sample, which reflects a basic
but limited understanding of nutrition. The Medium knowledge category includes respondents
from scores 4.0 to 6.0, representing the majority of respondents (84.4%). This indicates that
most of the population surveyed possessed a moderate understanding of nutrition. Finally,
Respondents classified under the Poor knowledge category represent a negligible proportion,
accounting for only 0.4% of the total sample., indicating a minimal portion with inadequate
nutritional knowledge. This distribution highlights that, while the majority have a medium level
of nutritional knowledge, there is still a small group with either a fair or poor understanding of

22
nutrition, pointing to the potential for further educational interventions aimed at improving
nutrition awareness in the population.

Types of food intake in last 24 hours’ recall method

Table 6 Food Consumption Distribution of respondents

Food Item Percentage (%)

Rice 47.0%
Dal 14.7%
Milk 10.1%
Fish 9.2%
Meat 7.0%
Vegetable 5.6%
Egg 2.7%
Biscuit 1.4%
Paratha 1.4%
Dry Fish 0.9%

Table 6 represents the food consumption distribution among the respondents. The majority of
the diet is composed of rice (47.0%), making it the staple food. Dal (14.7%) and milk (10.1%)
are also significant components of the diet. Animal protein sources such as fish (9.2%), meat
(7.0%), and eggs (2.7%) are present in moderate proportions. Vegetables make up 5.6% of the
diet, while processed foods like biscuits (1.4%) and parathas (1.4%) contribute minimally. Dry
fish, at 0.9%, is the least consumed item. This distribution highlights the dominance of
carbohydrate-rich foods in the diet, with moderate consumption of proteins and minimal
processed food intake.

Table 7 BMI of respondents (n=250)

Categories Frequency (N) Percentage (%)

Underweight (<18.5) 138 55.2
Normal (18.5-24.99) 106 42.4
Overweight (25-29.99) 6 2.4
Total 250 100.0

BMI value of the respondents ranged from 13.40 to 28.60 with a mean of 16.15 and standard
deviation of 2.19. Based on their BMI value the respondent were classified into three categories
as underweight, normal weight , overweight.
23
Table 7 shows that more than half (55.2%) of the respondents were underweight, while 42.4%
fell into the normal BMI range. A very small proportion (2.4%) were overweight.

Table 8 MUAC of respondents (n=250)

Category Frequency (N) Percentage (%)

Normal (> 18.5cm) 121 48.4%

MAM (Moderate Acute Malnutrition)(16-18.5cm) 95 38.0%

SAM (Severe Acute Malnutrition)(<16cm) 34 13.6%

Total 250 100.0%

Table 8 highlights that a significant proportion of respondents (48.4%) exhibited a normal Mid-
Upper Arm Circumference (MUAC), reflecting a healthy nutritional status. Meanwhile, 38.0%
were categorized under Moderate Acute Malnutrition (MAM), and 13.6% fell under Severe
Acute Malnutrition (SAM). This distribution underscores the urgent need for focused
nutritional interventions to address the high prevalence of MAM and SAM among the
respondents. And this indicates MUAC is a effective screenong tools in limited resource and
time.

24
Association between demographic characteristics and nutritional status

Table 9 Association between age groups and nutritional status (n=250)

Underweight Normal Count Overweight P value

Age Group Total
Count (%) (%) Count (%)

10 – 11 27 (10.8%) 20 (8.0%) 1 (0.4%)

48 (19.2%)
19.6% 18.9% 16.7%
11 – 12 30 (12.0%) 24 (9.6%) 2 (0.8%)
56 (22.4%)
21.7% 22.6% 33.3%
12 – 13 28 (11.2%) 23 (9.2%) 2 (0.8%)
53 (21.2%) <0.01*
20.3% 21.7% 33.3%
13 – 14 32 (12.8%) 24 (9.6%) 1 (0.4%)
57 (22.8%)
23.2% 22.6% 16.7%
14 – below 15 21 (8.4%) 15 (6.0%) 0 (0.0%)
36 (14.4%)
15.2% 14.2% 0.0%
Total 138 (55.2%) 106 (42.4%) 6 (2.4%)
250 (100%)
100% 100% 100%
*P<0.05 is considered as significant.

The study examined the relationship between nutritional status and age among respondents in
Panchari Upazila, revealing a significant association (p < 0.01). The results suggest that as age
increases, the prevalence of malnutrition rises, while the proportion of individuals with normal
nutritional status decreases. Among 10-year-olds, 27 were underweight, 20 had normal
nutrition, and 1 was overweight. Similarly, among 11-year-olds, 30 were underweight, 24 had
normal nutrition, and 2 were overweight. The trend continues among 12-year-olds, with 28
underweight, 23 having normal nutrition, and 2 overweight, and among 13-year-olds, where
32 were underweight, 24 had normal nutrition, and 1 was overweight. By 14 years of age, the
number of underweight individuals dropped to 21, while 15 had normal nutrition, and no one
was overweight. These findings suggest a fluctuating but concerning trend in nutritional status
with increasing age, highlighting a growing public health concern in the region. The results
emphasize the urgent need for targeted nutritional interventions to address malnutrition among
adolescents and promote better dietary habits in Panchari Upazila.

25
 Table 10 Association between gender and nutritional status (n=250)

Underweight Normal Count Overweight P value

Gender Total
Count (%) (%) Count (%)

Female 38 (15.2%) 31 (12.4%) 2 (0.8%) 71 (28.4%)

27.5% 29.3% 33.3%
Male 100 (40%) 75 (30%) 4 (1.6%) 179 (71.6%) >0.05*
72.5% 70.7% 66.7%
Total 138 (55.2%) 106 (42.4%) 6 (2.4%)
250 (100%)
100% 100% 100%

*P>0.05 is considered as not significant.

The study found no significant relationship between gender and nutritional status, as indicated
by a p-value > 0.05. Among females, 38 were underweight, 31 had normal nutrition, and 2
were overweight, while among males, 100 were underweight, 75 had normal nutrition, and 4
were overweight. These findings indicate that malnutrition is prevalent in both genders, with a
substantial proportion of individuals classified as underweight. The results emphasize the need
for comprehensive public health initiatives aimed at improving nutritional status for both males
and females in Panchari Upazilla, rather than focusing on one gender alone.

Table 11 Association between Annual Family Income and Nutritional Status (n=250)

Underweight Normal Overweight P value

Income Level Total
Count (%) Count (%) Count (%)
1 (0.4%) 21 (8.4%) 0 (0.0%)
Fair 22 (8.8%)
0.7% 19.8% 0.0%

47 (18.8%) 85 (34.0%) 6 (2.4%)

Normal 138 (55.2%)
34.4% 80.2% 100.0%
<0.05 *
90 (36.0%) 0 (0.0%) 0 (0.0%)
Poor 90 (36%)
65.2% 0.0% 0.0%

138 (55.2%) 106 (42.4%) 6 (2.4%)

Total 250 (100%)
100% 100% 100%

*P<0.05 is considered as significant.

The relationship between family income and BMI status revealed a highly significant
association (p-value < 0.05), underscoring the strong influence of socio-economic status on
nutritional outcomes. The fair-income group accounted for a small proportion of the sample,
including 0.4% underweight and 8.4% with normal BMI, but no overweight individuals. In
26
contrast, the normal-income group exhibited a more diverse nutritional profile—contributing
18.8% to the underweight category, 34.0% to the normal BMI group, and all individuals (2.4%)
who were overweight. Among respondents from poor-income households, 36.0% were
underweight, with no individuals classified as having a normal or overweight BMI. These
findings highlight a clear income-related disparity in nutritional status, emphasizing the urgent
need for targeted nutrition interventions—particularly for low-income populations at risk of
undernutrition.

Table 12 Association between nutritional knowledge and nutritional status (n=250)

Knowledge Underweight Normal Count Overweight

P value
Total
Level Count (%) (%) Count (%)
25 (10.0%) 13 (5.2%) 0 (0.0%)
Fair 38 (15.2%)
18.1% 12.3% 0.0%
112 (44.8%) 93 (37.2%) 6 (2.4%)
Medium 211 (84.4%)
81.2% 87.7% 100.0%
1 (0.4%) 0 (0.0%) 0 (0.0%)
<0.05 *
Poor 1 ( 0.4%)
0.7% 0.0% 0.0%

138 (55.2%) 106 (42.4%) 6 (2.4%)

Total 250 (100%)
100% 100% 100%

*P<0.05 is considered as significant.

The association between knowledge level and nutritional status was found to be moderate
significant (p-value < 0.05). The Fair knowledge group demonstrated a somewhat more
balanced distribution, with 10.0% underweight and 5.2% having a normal BMI, but still no
overweight individuals. In contrast, the Medium (interpreted as "Good") knowledge group had
the highest proportion across all BMI categories, including 44.8% underweight, 37.2% normal,
and 2.4% overweight. Individuals with Poor knowledge were almost exclusively underweight
(0.4% of the total sample), with no participants falling into the normal or overweight BMI
categories. This trend suggests that individuals with higher nutrition-related knowledge are
more likely to maintain a healthier BMI. These findings emphasize the critical role of nutrition
education in preventing underweight conditions and promoting healthier weight management.

27
 Table 13 Association between MUAC and nutritional status (n=250)

Underweight Normal Overweight

Category Total P value
Count (%) Count (%) Count (%)

20 (8.0%) 95 (38.0%) 6 (2.4%)

Normal (>18.5 cm) 121 (48.4%)
14.5% 89.6% 100%

85 (34.0%) 10 (4.0%) 0 (0.0%)

MAM (16–18.5 cm) 95 (38%)
61.6% 9.43% 0.0%
<0.05 *
33 (13.2%) 1 (0.4%) 0 (0.0%)
SAM (<16 cm) 34 (13.6%)
23.91% 0.94% 0.0%

138 (55.2%) 106 (42.4%) 6 (2.4%)

Total 250 (100%)
100% 100% 100%

*P<0.05 is considered as significant.

The analysis showed a significant association between MUAC and nutritional status (p < 0.05).
Among those with normal MUAC (>18.5 cm), most had a normal BMI (38%), followed by
8.0% underweight and 2.4% overweight. In the MAM group (16–18.5 cm), 34% were
underweight, 4% had a normal BMI, and 0% were overweight. The SAM group (<16 cm)
almost all respondents were undernutrition, with 13.2% underweight, 0.4% normal, and 0
overweight. These findings highlight that there is slight inconsistencies in collected data though
MUAC as a reliable indicator of nutritional status and the need for early intervention in
individuals with low MUAC.

28
CHAPTER-V
DISCUSSION

29
This study provides valuable insights into the socio-demographic characteristics, dietary
patterns, nutritional knowledge, and nutritional status of the respondents. The majority (22.7%)
were 13 years old, with most falling within the 11-13 age range. A notable gender disparity
was observed, with males comprising 71.6% and females only 28.4%, possibly reflecting
socio-cultural or economic barriers to school enrollment. Further investigation is needed to
address this imbalance and ensure equitable access to education and health interventions for
girls. Religious composition aligned with regional demographics, with 52.0% of respondents
being Buddhist, 39.2% Muslim, and 8.8% Hindu. These religious affiliations may influence
dietary habits through cultural or religious food restrictions, potentially affecting dietary
diversity and nutrient intake. Socio-economic analysis showed that 55.2% of respondents
belonged to the "normal" income group, while 36.0% were classified as "poor," highlighting
economic challenges that may limit access to nutritious food. Additionally, low parental
education levels were evident, with 24.0% of mothers and 26.4% of fathers being illiterate.
Previous studies, such as those by Mulugeta et al. (2009) and Assefa et al. (2013), suggest that
parental education plays a crucial role in improving child nutrition. Dietary analysis revealed
that rice was the staple food, making up 47.0% of respondents' diets, consistent with South
Asian dietary patterns. Moderate consumption of protein-rich foods such as dal (14.7%), milk
(10.1%), fish (9.2%), and meat (7.0%) was observed, while intake of vegetables (5.6%) and
eggs (2.7%) was notably low. Limited consumption of processed foods suggests reliance on
home-cooked meals, but the deficiency in animal proteins and vegetables may lead to
micronutrient deficiencies. Similar dietary inadequacies have been reported in studies by
Wolde et al. (2014) and Ahmed et al. (2010). Regarding nutritional knowledge, 84.4% of
respondents had a medium level of awareness, while only 15.2% had fair knowledge. This
indicates a need for enhanced nutrition education programs to promote balanced diets and
healthier eating habits, as highlighted by Melaku et al. (2017). The nutritional status assessment
revealed concerning trends, with 55.2% of respondents classified as underweight, 42.4% as
normal weight, and only 2.4% as overweight. MUAC is effective as a screening tool in
resource-limited settings and further reinforced these findings, with 38.0% classified as having
Moderate Acute Malnutrition (MAM) and 13.6% as having Severe Acute Malnutrition (SAM).
These findings highlight the urgent need for targeted interventions to combat undernutrition,
consistent with research by Wolde et al. (2014) and Alam et al. (2010). Correlation analysis
showed strong positive associations between BMI and physical attributes such as weight,
height, and MUAC, consistent with research by Lillie et al. BMC Public Health (2019). Age

30
and income exhibited moderate correlations, suggesting better nutritional outcomes among
older children and those from higher-income families. However, factors like family size,
parental education, and hygiene practices showed no significant relationship with nutritional
status. This contrasts with studies such as Hossain et al. (2013), which found stronger socio-
economic influences, emphasizing the need for context-specific interventions.

31
 CHAPTER-VI
CONCLUSION, FUNDING

32
CONCLUSION

The findings of this study highlight that malnutrition remains a significant concern among
adolescents in the hill tract areas of Chattogram. More than half of the respondents were
underweight, with a considerable proportion experiencing moderate to severe acute
malnutrition. Correlation analysis confirmed that MUAC is a strong predictor of BMI,
reinforcing its value as a cost-effective and efficient tool for adolescent nutritional assessment.
The study also revealed poor dietary diversity, with a heavy reliance on rice (47.0%), followed
by dal (14.7%) and milk (10.1%). Alarmingly low consumption of nutrient-dense foods such
as vegetables (5.6%) and eggs (2.7%) suggests a high risk of micronutrient deficiencies. These
findings emphasize the urgent need for targeted public health interventions, including school-
based nutrition programs, community awareness campaigns, and policy measures to improve
dietary diversity and combat malnutrition. Additionally, integrating MUAC into routine
adolescent health screenings could facilitate early detection and timely intervention, helping to
address nutritional deficiencies more effectively.

Funding
This study was carried out by self-sponsorship of the researcher.

33
 CHAPTER-VII
LIMITATIONS AND
RECOMMENDATIONS

34
LIMITATIONS OF THE STUDY

Limited Geographic Scope: Conducted in a single Upazila, making it less representative

of the entire hill tract region.

Cross-Sectional Design: Provides a snapshot of nutritional status at a specific time but

does not establish causal relationships.

Self-Reported Dietary Data: Subject to recall bias as dietary habits were self-reported.

Exclusion of Other Nutritional Indicators: Focused solely on BMI and MUAC, without
assessing micronutrient deficiencies.

Sample Representation: A higher proportion of male respondents (71.6%) compared to

females (28.4%) may have introduced gender bias in the results.

Human Error in Measurement: Discrepancies between BMI and MUAC could result
from human error in measurement, such as incorrect technique or equipment calibration.

Recommendations

The researcher's limited investigation did not provide all the data necessary for an accurate
assessment of the nutritional status of adolescents. Consequently, the following suggestions for
future research projects could be made:

 The present study was conducted in three villages namely Panchari Upazilla under
Khagrachari district. It will help to achieve a comparative picture of adolescent nutritional
status of the whole country’s hill tract area which will be helpful for effective policy making.

 The study was undertaken to explore the relationships of selected characteristics of adolescent
with their BMI towards nutritional status as focus variable. Therefore, it could be recommended
that further studies should be conducted with other independent and dependent variables.

 In the present study, among characteristics five of them namely age, height, weight, MUAC,
and nutritional knowledge showed significant relationships with their BMI towards nutritional
knowledge. Hence, further studies are necessary to find out nature of the relationship between
the other concerned issues to make the present findings valid.

 Research should be undertaken particularly to identify the further problems that adolescent
face in managing their nutritional status and to explore their potentialities to overcome the
problem.

35
CHAPTER VII
REFERENCES

36
1. Wakeya, K.J. (2019) Nutritional Status and Associated Factors of Adolescent Girls in
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3. Kahssay, M., Mohamed, L. and Gebre, A. (2020) 'Nutritional Status of School-Going

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Mid-Upper Arm Circumference (MUAC) for Adolescent Assessment', BMC Public Health,
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(Accessed: 03 March 2024).

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9. Lahiri, S., Biswas, A., Santra, S. and Lahiri, S.K. (2015) 'Assessment of Nutritional Status
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13. Haque, D.M., Rahman, M., Islam, M.N. and Ali, S.M.K. (2014) 'Health and Nutritional
Status of Aged People', Chattagram Maa-O-Shishu Hospital Medical College Journal, 13(1),
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14. United Nations Department of International Economic and Social Affairs (1985) Periodical
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17. Müller, O. and Krawinkel, M. (2005) 'Malnutrition and Health in Developing Countries',
Canadian Medical Association Journal (CMAJ), 173(3), pp. 279–286.

38
18. Chen, C.C., Schilling, L.S. and Lyder, C.H. (2001) 'A Concept Analysis of Malnutrition in
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19. Tsai, A.C. and Ku, P.Y. (2008) 'Population-Specific Mini Nutritional Assessment
Effectively Predicts the Nutritional State and Follow-Up Mortality of Institutionalized Elderly
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20. Suzana, S., Earland, J., Suriah, A.R. and Warnes, A.M. (2002) 'Social and Health Factors
Influencing Poor Nutritional Status among Rural Elderly Malays', Journal of Nutrition, Health
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21. Guigoz, Y. (2006) 'The Mini Nutritional Assessment (MNA) Review of the Literature –
What Does it Tell Us?', Journal of Nutrition, Health and Aging, 10(6), pp. 466–485.

22. Graf, C. (2008) 'The Lawton Instrumental Activities of Daily Living Scale', American
Journal of Nursing, 108(4), pp. 52–62.

23. CGA Toolkit Plus (n.d.) Lawton Instrumental Activities of Daily Living (IADL) Scale.
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24. World Medical Association (WMA) (2013) Declaration of Helsinki: Ethical Principles for
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39
 APPENDICES

Appendix-1: Sketch of time frame

Task Jan Feb Nov Dec Jan Feb Mar Apr

2024 2024 2024 2024 2025 2025 2025 2025

■
Topic selection

■ ■ ■
Literature review

■ ■
Development of
questionnaire

■ ■ ■
Data collection and
analysis

■ ■ ■
Report writing,
review &
corrections

■
Final print &
submission of
report

40
Appendix-2: Budget for conducting the research

SL. Particulars Quantity Month Unit cost Total cost

No (BDT)

a) Personal cost
Principal 01 lump sum lump sum 0
Investigator (PI)

b) Field cost (data collection cost)

Questionnaire 270 01 10 2550
printing and
photocopy
Data collection 06 01 lump sum 250
tools (pen, pencil,
eraser)

c) Travel cost
Principal 01 lump sum lump sum 0
Investigator (PI)

d) Equipment cost
Weight machine 1 1 1200 1500

Measuring tape 2 1 60 100

e) Other costs
Mobile call bill 1 1 1000 1000
Miscellaneous 0 0 0 1000
Grand total (BDT) 6,400/=
In word: Six thousand and four hundrad taka only.

41
Appendix-3: Information about research for the participants (Bengali)
Research Title: “Nutritional Status of Adolescents in a Selected Upazilla of Chattogram
Hill Tracts”
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G M‡elYvq AskMÖnY Kivi Rb¨ Avgvi †Kvb AwZwi³ LiP n‡e wKbv?
bv| G M‡elYvq AskMÖnY Kivi Rb¨ Avcbv‡K †Kvb UvKv LiP Ki‡Z n‡e bv| G M‡elYvq AskMÖn‡Yi Rb¨ Avcbv‡K
†Kvb A_© cÖ`vb Kiv n‡e bv|

wbivcËv: Avcbvi †Kvb SzuwK Av‡Q wKbv?

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G M‡elYvq AskMÖnY Ki‡j Avgv‡K wK Ki‡Z n‡e?

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20 wgwbU mgq jvM‡e|

42
‡MvcbxqZv: M„nxZ Z_¨ w`‡q wK n‡e?
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Z_¨ Rvbvb AwaKvi: hw` †Kvb cÖkœ _v‡K?
hw` G Z_¨ weeiYx c‡o M‡elYv m¤ú‡K© Avcbvi †Kvb cÖkœ _v‡K Zvn‡j AskMÖnY Kiv/ bv Kivi wm×v‡šÍi c~‡e© Avcwb
Avgvi/Avgvi wkÿ‡Ki mv‡_ Av‡jvPbv Kivi my‡hvM cv‡eb| M‡elYv PjvKvjxb mg‡qI Avcwb Avgv‡K ‡h †Kvb mgq
Avcbvi wRÁvmvi Rb¨ cv‡eb|

‡h‡Kvb Z‡_¨i Rb¨ †hvMv‡hvM:

mycvifvBRvi M‡elK
Wv. RyevB`v Lvbg †iRvDj Kwig
mnKvix Aa¨vcK AvBwW: PÆMÖvg-222-53-890-040
wWcvU©‡g›U Ae KwgDwbwU †gwWwmb ‡mkb:2022
PÆMÖvg †gwW‡Kj K‡jR I nvmcvZvj gv÷vm© Ae cvewjK †nj_
PÆMÖvg| ¯‹zj Ae mv‡qÝ GÛ †UK‡bvjwR
evsjv‡`k Db¥y³ wek¦we`¨vjq|
÷vwW †m›Uvi: PÆMÖvg †gwW‡Kj K‡jR I nvmcvZvj
‡gvevBj b¤^i: 01783409472

43
Appendix-4: Informed consent form
Consent Form

m¤§wZ cÎ

Avwg G g‡g© m¤§wZ cÖ`vb KiwQ †h,

“Nutritional Status of Adolescents in a Selected Upazilla of Chattogram Hill Tracts”

1. GLv‡b †h Z_¨ ‡`qv n‡q‡Q Zv Avgv‡K cwo‡q ïbv‡bv n‡q‡Q /Avwg c‡owQ|
2. Avgv‡K cÖwµqv m¤ú‡K© we¯ÍvwiZ Rvbv‡bv n‡q‡Q|
3. Avwg wjwLZfv‡e Avgvi Z_¨ aviY Kivi e¨vcv‡i GKgZ n‡qwQ/gZvgZ †cvlY KiwQ|
4. Avwg G g‡g© AeMZ AvwQ ‡h, G M‡elYv Øviv Avwg mivmwi DcK…Z bvI n‡Z cvwi Ges Avwg †h †Kvb mgq
Avgvi m¤§wZ cÖZ¨vnvi Ki‡Z cvie| M‡elYvi †Kvb RvqMvq Avgvi bvg cÖKvk Kiv n‡e bv| Avwg M‡elYvq
_vwK ev bv _vwK Avwg ev Avgvi cwievi †Kvb mgm¨vi m¤§yLxb n‡e bv|
5. M‡elYvi †h †Kvb mgq Avwg Avgvi wb‡Ri bvg cÖZ¨vnvi Ki‡Z cvie|
6. Avwg M‡elYvi dj Ab¨ M‡elK‡`i g‡a¨ cÖKvk Kivi AbygwZ w`w”Q|

AskMÖnYKvixi ¯^vÿi:

ZvwiL:

Avwg G g‡g© †NvlYv KiwQ ‡h, Avwg m¤ú~Y© M‡elYv m¤ú‡K© AskMÖnYKvix‡K Rvwb‡qwQ|

M‡el‡Ki ¯^vÿi:

ZvwiL:

44
Appendix-4: Questionnaire Form

An Interview Schedule
On

Nutritional Status of Adolescents in a Selected Upazilla of Chattogram Hill Tracts

Name of the respondent: ………………………… Serial no:…...

Father’s/Husband’s name: ………………………. Date:………..
Village: ………………………………………….. Union: ………
Upazila: …………………………………………. District: ………

(Please furnish the information of the following items)

1. Age: What is your present age? ………....................Years
2. Gender:
3. Religion:
4. Height in meter:
5. Weight in kg:
6. BMI in kg/m2:
7. MUAC in cm:

8. Education: Please state your literacy level

Educational qualification

Academic Literacy

Illiterate Primary Secondary Higher Above

secondary

Respondents

Mothers education

Fathers education

45
 9. Annual Family Income:

Source Income
(000’TK)

Agricultural Agricultural sources

(crop/vegetable)

Fisheries

Poultry

Livestock

Others(if any)

Non Service
Agricultural
Business

Remittance

Others (if any)

Total

11. Participation in Nutrition Program:

Name of Not Participation 1 Participation 2 Participation

organization Participation Time Times 3 Or More
Times

BIRTAN

UNICEF

BRAC

46
 12. Hygiene Practice:

Personal Hygiene Maintain Frequently Occasionally Rare Not

yet

Do you wash your hand regularly with

soap before eating?

Do you wash your hand regularly with

soap after eating?

Do you wash your hand regularly with

soap after toilet?

Do you cut nail regularly?

Do brush your teeth regularly?

Do you take your bath regularly?

13. Food Intake:

Name Of Foods Amount/Meal No Of Meals

Biscuit

Bread

Rice

Egg

Fish

Meat

Dal

Dry fish

Milk

Others

47
 14. Nutritional knowledge: Please answer below the questions

Q 1: what kinds of food component?

(a) 2 (c) 3
(b) 6 (d) 8
Q 2: what is needed for body energy?
(a) Vitamin (c) water
(b) Food (d) Medicine
Q 3: which is completed or ideal food?
(a) Meat (c) vegetable
(b) Milk (d) Fruit
Q 4: Which food have more protein?
(a) Rice (c) vegetable
(b) Meat (d) Water
Q 5: Which food is high in vitamin A?
(a) Green vegetable (c) Milk
(b) Pulse (d) Meat
Q 6: what is the disease of vitamin A deficiency?
(a) Cold (c) Night blindness
(b) Fever (d) diarrhea
Q 7: Which food is high in vitamin C?
(a)Rice (c) Meat
(b)Milk (d) Lemon
Q 8: Which vitamin do you get from sun ray?
(a) Vitamin A (c) Vitamin D
(b) Vitamin E (d) Vitamin K
Q 9: Arsenic is one kind of …………
(a) Skin disease (c) Heart disease
(b) Eye disease (d) other disease
Q 10: What is the main source of calcium?
(a) Milk (c) Rice
(b) Chocolate (d) Fish

Thanks for your kind co-operation

Date: …………….

48