Knowledge, attitudes, and practices related to the intergenerational cycle of malnutrition among adolescent girls: A school-based cross-sectional study

Abstract

The intergenerational cycle of malnutrition contributes to adverse health outcomes across generations, with adolescence representing a key period for prevention. This study aimed to assess adolescent girls' knowledge, attitudes, and practices regarding the intergenerational cycle of malnutrition and to identify associated socio-demographic factors. A school-based cross-sectional study was conducted among adolescent girls in Visakhapatnam Urban, India, using a multistage probability sampling technique with probability proportional to size. Nine of 18 government secondary schools were randomly selected, followed by proportional selection of students from grades 8–10. Data were collected using a predesigned, pretested, semi-structured questionnaire. Multivariate logistic regression analysis was performed to examine factors associated with knowledge, attitude, and practice scores. A total of 316 adolescent girls were included, and 50.3%, 62.7%, and 52.5% of participants had knowledge, attitude, and practice scores above the median, respectively. Multivariate analyses found that parental education and employment status were associated with knowledge and attitude scores. A total of 316 adolescent girls were included; 50.3%, 62.7%, and 52.5% had knowledge, attitude, and practice scores above the median, respectively. Maternal education was strongly associated with good knowledge (aOR 8.84; 95%CI: 4.65–16.78; p<0.001) and favorable attitudes (aOR 1.67; 95%CI: 1.11–2.52; p=0.013), while paternal education was also associated with knowledge (aOR 2.10; 95%CI: 1.16–3.83; p=0.014) and attitude (aOR 1.49; 95%CI: 1.00–2.21; p=0.048). Only family type was significantly associated with practices (aOR 0.62; 95%CI: 0.39–0.99; p=0.047). Although adolescent girls demonstrated basic nutritional awareness, their understanding of malnutrition as a life-course and intergenerational issue remained limited. Strengthening school-based nutrition education with an explicit life-course perspective may improve informed dietary choices and support public health strategies to interrupt the intergenerational cycle of malnutrition.