Dietary diversity, nutrition knowledge and attitude among adolescents in Addis Ababa: a cross-sectional study

Background: Ethiopian urban adolescents are experiencing rapid dietary transitions that increase their risk of overweight and obesity, while undernutrition is still prevalent. Very few studies have explored their dietary practices or nutrition-related knowledge and attitudes. This study aimed to assess the dietary diversity, nutrition-related knowledge, and attitudes among school-going adolescents in Addis Ababa, Ethiopia. Methods: A school-based cross-sectional survey was conducted among 371 adolescents aged 14-19 years from public and private secondary schools using multi-stage cluster sampling. Dietary intake was assessed using a 24-h recall questionnaire. Structured questionnaires were used to collect data on nutrition knowledge and attitudes. Descriptive statistics and multivariate logistic regression were used to explore associations. Results: Only 33.7% of adolescents achieved adequate dietary diversity (≥5 food groups). While most participants consumed cereals daily, intake of fruits, vegetables, and animal-source foods was limited. The mean knowledge score was 11.27 (SD = 6.26) out of a possible 25 score. 51.2% of participants scored below the mean with major gaps in knowledge of micronutrient-rich food sources. Slightly more than half (52.7%) of participants had a favourable attitude using the mean score (60.6, SD = 7.47) as the cut-off. Private school attendance was associated with higher dietary diversity (AOR = 2.47, 95% CI: 1.50-4.08). Adolescents with secondary or tertiary educated fathers (AOR = 1.48, 95% CI: 1.07-2.04; AOR = 1.67, 95% CI: 1.16-2.39) and tertiary educated mothers (AOR = 1.82, 95% CI: 1.27-2.62) had better dietary diversity. In addition, higher nutrition knowledge scores were associated with higher odds of achieving adequate dietary diversity (AOR = 1.06, 95% CI: 1.01-1.10). Conclusion: Adolescents in Addis Ababa demonstrate suboptimal dietary diversity and limited nutrition knowledge, with pronounced socio-economic disparities. Urgent, school-based interventions that integrate nutrition education along with improvements to the food environment are essential to foster healthy dietary behaviours.