Africa faces rapid urbanization, has the second highest population growth rate, makes up one-fifth of the world's youth population, and experiences stagnant rates of undernutrition. These challenges point to the need for country-specific data on rural-urban health disparities to inform development policies. This cross-sectional study examined disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among 1125 adolescents in Tanzania. Rural-urban disparities in nutritional status were significant and gendered. Findings confirm place of residence as a key determinant of BAZ, HAZ, and stunting among adolescents in Tanzania. Targeted gender-sensitive interventions among adolescents, particularly in rural areas, are needed to limit growth faltering and improve health outcomes.

Africa faces rapid urbanization, has the second highest population growth rate, makes up one-fifth of the world's youth population, and experiences stagnant rates of undernutrition. These challenges point to the need for country-specific data on rural-urban health disparities to inform development policies. This cross-sectional study examined disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among 1125 adolescents in Tanzania. Pearson's chi-square tested associations between rural/urban residence and undernutrition (BAZ <-2SD), stunting (HAZ <-2SD), anthropometric, socioeconomic, and health indicators. Multivariate linear regression identified predictors of BAZ and HAZ.

Funding: UNICEF/ Tanzania; United States National Institute of Mental Health (R01 MH66801).

Inclusion Criteria:

• Adolescents between 10 and 14 years of age

Exclusion Criteria:

• Adolescents living away from the districts and not physically present at the time of the study

This cross-sectional study merged and analyzed two independent samples of adolescents living in Tanzania. One study was conducted in Tanzania by Cordeiro et al. (2012) and the other was conducted in an urban setting by Carlson, Brennan, and Earls (2012); both conducted in 2004. The Kilosa/rural dataset was derived from a two-stage sampling plan for selection of villages and adolescents. The Moshi/urban dataset was derived from a two-stage sampling plan for a cluster randomized control trial (CRCT). From a total combined sample of 1476 adolescents aged 10-19 years across both datasets, 1237 met the age criterion for younger adolescents (10-14 years). The analytical sample for this study was 1125.