{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:35:34Z","timestamp":1782977734846,"version":"3.54.5"},"reference-count":39,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Commercial female sex workers (CFSWs) regularly or occasionally trade sex for money. Sex work is widespread, mainly in urban areas of Ethiopia. The study on the nutritional status of CFSWs is unavailable in Ethiopia, and data are also scanty at the global level. This study aims to assess nutritional status and associated factors among CFSWs in Hawassa city, Ethiopia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This cross-sectional study used facility-based mixed data collection methods (qualitative and quantitative). The study was conducted in three key population clinics in Hawassa city. A total of 297 CFSWs were randomly selected for the \u2018quantitative survey,\u2019 and twelve (\n n<\/jats:italic>\n \u00a0=\u00a012) purposively selected participants were involved in the \u2018qualitative study.\u2019 Body mass index\/BMI (Kg\/m\n 2<\/jats:sup>\n ) was used in assessing the nutritional status of CFSWs. Statistical software packages were used for analyzing both quantitative and qualitative data. Significant variables (\n P<\/jats:italic>\n <0.05) in bivariate analysis (Chi-square test) were incorporated in the multivariable analyses. Multinomial logistic regression (MNLR) was employed where dependable variable like \u2018normal BMI\u2019 (18.5\u201324.9 kg\/m\n 2<\/jats:sup>\n ) was set as a reference category and simultaneously compared with \u2018underweight\u2019 (<18.5 BMI) and \u2019overweight\/obesity\u2019 (\u2265 25 BMI) categories. Thus, two models, namely the underweight model (model-1: Underweight versus normal BMI) and the overweight\/obesity model (model-2: overweight\/obesity versus normal), were generated.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The prevalence of underweight and overweight\/obesity among CFSWs in Hawassa city were respectively 14.1% and 16.8%. Living alone (Adjusted odds ratio\/AOR = 0.18), chewed Khat regularly (AOR = 0.23), used drugs regularly (AOR = 10.57), used drugs in exchange of sex (AOR = 4.97), and HIV positive status (AOR = 21.64) were significantly (\n P<\/jats:italic>\n \u00a0<\u00a00.05) associated with underweight (model-1). In the overweight\/obesity model-2, having jobs other than sex work (AOR = 0.11), higher daily mean income (AOR = 3.02), being hotel\/home-based CFSWs (AOR = 12.35), and presence of any chronic illness (AOR = 5.15) were significant (\n P<\/jats:italic>\n \u00a0<\u00a00.05) predictors of overweight\/obesity. From the \u2018qualitative part\u2019 of this study, it was also revealed that \u2018lack of food and money\u2019 was the main influencing factor among CFSWs to enter into the sex business.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Commercial female sex workers in this study faced a double burden of malnutrition. Multiple factors influenced their nutritional status. Substance abuse and HIV-positivity are the most significant predictors of being underweight and having higher income, being hotel\/home-based CFSWs, and suffering from any chronic illness are associated with overweight\/obesity. Government and other partners should be essential in providing comprehensive programs focusing on sexual, reproductive health, and nutrition education. Steps should be taken to improve their socioeconomic status and strengthen those good initiatives at key population clinics and other health facilities.<\/jats:p>\n <\/jats:sec>","DOI":"10.7717\/peerj.15237","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T04:40:49Z","timestamp":1682656849000},"page":"e15237","source":"Crossref","is-referenced-by-count":3,"title":["Nutritional status and its associated factors among commercial female sex workers in Hawassa city, south Ethiopia"],"prefix":"10.7717","volume":"11","author":[{"given":"Zegeye","family":"Gelan","sequence":"first","affiliation":[{"name":"School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, Hawassa, Sidama, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelalem","family":"Tafese","sequence":"additional","affiliation":[{"name":"School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, Hawassa, Sidama, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eskinder","family":"Yilma","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, SNNPR, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahbuba","family":"Kawser","sequence":"additional","affiliation":[{"name":"Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"issue":"2","key":"10.7717\/peerj.15237\/ref-1","doi-asserted-by":"publisher","first-page":"e06339","DOI":"10.1016\/j.heliyon.2021.e06339","article-title":"Prevalence and associated factors of overweight\/obesity among type2 diabetic outpatients in Southwest Ethiopia","volume":"7","author":"Abdissa","year":"2021","journal-title":"Heliyon"},{"key":"10.7717\/peerj.15237\/ref-2","doi-asserted-by":"publisher","first-page":"390","DOI":"10.4135\/9781412995627.d31","article-title":"Multinomial logistic regression","volume-title":"Best practices in quantitative methods","author":"Anderson","year":"2008"},{"issue":"4","key":"10.7717\/peerj.15237\/ref-3","doi-asserted-by":"publisher","first-page":"nzab131","DOI":"10.1093\/cdn\/nzab131","article-title":"The role of household assets in improving women\u2019s dietary diversity in Ethiopia","volume":"6","author":"Anyanwu","year":"2021","journal-title":"Current Developments in Nutrition"},{"key":"10.7717\/peerj.15237\/ref-4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.4236\/aasoci.2017.74008","article-title":"Commercialized sexual exploitation of children, adolescents and women: health and social structure in Bangladesh","volume":"7","author":"Bagley","year":"2017","journal-title":"Advances in Applied Sociology"},{"key":"10.7717\/peerj.15237\/ref-5","article-title":"General comment No. 22 on the right to sexual and reproductive health (article 12 of the International Covenant on Economic, Social, and Cultural Rights)","author":"CECR","year":"2016"},{"key":"10.7717\/peerj.15237\/ref-6","article-title":"Ethiopian National key population HIV bio-behavioral surveillance round I report","author":"Ethiopia Public Health Association\u00a0(EPHA)","year":"2013"},{"key":"10.7717\/peerj.15237\/ref-7","article-title":"HIV related estimates and projections in Ethiopia for the year 2021\u20132022","author":"Ethiopia Public Health\u00a0Institute","year":"2022"},{"key":"10.7717\/peerj.15237\/ref-8","article-title":"Ethiopian key population HIV sero-behavioral surveillance (NHSBS)-round-I progress report","author":"Ethiopia Public Health Institute\u00a0(EPHI)","year":"2014"},{"key":"10.7717\/peerj.15237\/ref-9","article-title":"Social and behavior change communication strategy for HIV, MARPs and vulnerable groups in Ethiopia","author":"Federal HIV\/AIDS Prevention and Control Office\u00a0(HAPCO)","year":"2015"},{"key":"10.7717\/peerj.15237\/ref-10","volume-title":"Minimum dietary diversity for women: a guide to measurement","author":"Food and Agriculture Organization (FAO)","year":"2016"},{"key":"10.7717\/peerj.15237\/ref-11","article-title":"Hotspot town-level mapping and female sex worker population size estimation in Ethiopia: summary report","author":"Girma","year":"2014"},{"key":"10.7717\/peerj.15237\/ref-12","doi-asserted-by":"publisher","DOI":"10.29219\/fnr.v63.1553","article-title":"Determinants of dietary diversity among women of reproductive age in two different agro-ecological zones of Rongai Sub-County, Nakuru, Kenya","volume":"63","author":"Gitagia","year":"2019","journal-title":"Food & Nutrition Research"},{"key":"10.7717\/peerj.15237\/ref-13","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1186\/s12889-015-2491-x","article-title":"Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives","volume":"15","author":"Goldenberg","year":"2015","journal-title":"BMC Public Health"},{"key":"10.7717\/peerj.15237\/ref-14","author":"Government of Ethiopia","year":"2020","journal-title":"Hawassa City Administration"},{"key":"10.7717\/peerj.15237\/ref-15","doi-asserted-by":"publisher","first-page":"176","DOI":"10.3389\/fpsyt.2015.00176","article-title":"Mental health and functioning of female sex workers in Chittagong, Bangladesh","volume":"6","author":"Hengartner","year":"2015","journal-title":"Frontiers in Psychiatry"},{"issue":"1","key":"10.7717\/peerj.15237\/ref-16","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1186\/s12889-017-4428-z","article-title":"Burden and characteristics of HIV infection among female sex workers in Kampala, Uganda\u2014a respondent-driven sampling survey","volume":"17","author":"Hladik","year":"2017","journal-title":"BMC Public Health"},{"issue":"9","key":"10.7717\/peerj.15237\/ref-17","first-page":"334","article-title":"Nutritional status and KAP about HIV\/AIDS among floating drug addicted and commercial sex workers in Dhaka City, Bangladesh","volume":"5","author":"Huq","year":"2013","journal-title":"Journal of AIDS and HIV Research"},{"issue":"1","key":"10.7717\/peerj.15237\/ref-18","doi-asserted-by":"publisher","first-page":"18681","DOI":"10.1038\/s41598-021-98202-6","article-title":"Performance of individual dietary diversity score to identify malnutrition among patients living with HIV in Ethiopia","volume":"11","author":"Hussien","year":"2021","journal-title":"Scientific Reports"},{"issue":"8","key":"10.7717\/peerj.15237\/ref-19","doi-asserted-by":"publisher","first-page":"e039200","DOI":"10.1136\/bmjopen-2020-039200","article-title":"Prevalence of overweight\/obesity among the adult population in Ethiopia: a systematic review and meta-analysis","volume":"10","author":"Kassie","year":"2020","journal-title":"BMJ Open"},{"key":"10.7717\/peerj.15237\/ref-20","doi-asserted-by":"publisher","first-page":"9718714","DOI":"10.1155\/2020\/9718714","article-title":"Prevalence of underweight and its associated factors among reproductive age group women in Ethiopia: analysis of the 2016 Ethiopian demographic and health survey data","author":"Kassie","year":"2020","journal-title":"Journal of Environmental and Public Health"},{"issue":"6","key":"10.7717\/peerj.15237\/ref-21","doi-asserted-by":"publisher","first-page":"e091","DOI":"10.1097\/j.pbj.0000000000000091","article-title":"Socioeconomic, behavioural and sexual-health factors associated with nutritional status of FCSWs in Dhaka city, Bangladesh: a cross-sectional study","volume":"5","author":"Kawser","year":"2020","journal-title":"Porto Biomedical Journal"},{"issue":"6","key":"10.7717\/peerj.15237\/ref-22","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/nutrit\/nuaa095","article-title":"Nutritional status and eating habits of people who use drugs and\/or are undergoing treatment for recovery: a narrative review","volume":"79","author":"Mahboub","year":"2020","journal-title":"Nutrition Reviews VR"},{"issue":"1","key":"10.7717\/peerj.15237\/ref-23","first-page":"29","article-title":"Sexual lifestyle and socio-demographic profile of female floating sex workers in some selected areas of Dhaka city","volume":"7","author":"Mahejabin","year":"2014","journal-title":"Bangladesh Journals Online"},{"issue":"3","key":"10.7717\/peerj.15237\/ref-24","doi-asserted-by":"publisher","first-page":"119","DOI":"10.3923\/rjmsci.2010.119.124","article-title":"Socio-demographic condition and health complications of street-based sex workers in Rajshahi City, Bangladesh","volume":"4","author":"Mondal","year":"2010","journal-title":"Research Journal of Medical Sciences"},{"issue":"2","key":"10.7717\/peerj.15237\/ref-25","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1177\/0260106020971855","article-title":"High magnitude of food insecurity and malnutrition among people living with HIV\/AIDS in Ethiopia: a call for integration of food and nutrition security with HIV treatment and care Programme","volume":"27","author":"Nigusso","year":"2021","journal-title":"Nutrition and Health"},{"key":"10.7717\/peerj.15237\/ref-26","doi-asserted-by":"crossref","first-page":"e372","DOI":"10.1002\/hsr2.372","article-title":"Prevalence of and risk factors for hypertension in Ethiopia: a systematic review and meta-analysis","volume":"4","author":"Tesfa","year":"2021","journal-title":"Health Science Reports"},{"issue":"2","key":"10.7717\/peerj.15237\/ref-27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.22271\/maths.2021.v6.i2a.672","article-title":"Multinomial logistic regression model for assessing factors associated with body mass index of government employees of Gulariya Municipality, Nepal","volume":"6","author":"Tharu","year":"2021","journal-title":"International Journal of Statistics and Applied Mathematics"},{"key":"10.7717\/peerj.15237\/ref-28","article-title":"Ethiopia country operational plan (COP\/ROP), strategic direction summary","author":"US\u00a0President\u2019s Emergency Plan\u00a0for AIDS Relief\u00a0(PEPFAR)","year":"2018"},{"key":"10.7717\/peerj.15237\/ref-29","article-title":"Committee on the Elimination of Discrimination against Women general recommendation No. 24: article 12 of the convention (Women and Health)","author":"United Nations","year":"1999"},{"key":"10.7717\/peerj.15237\/ref-30","author":"US\u00a0State\u00a0Department","year":"2017","journal-title":"Ethiopia 2017 trafficking in persons report"},{"key":"10.7717\/peerj.15237\/ref-31","author":"United Nations Programme\u00a0on HIV\/AIDS\u00a0(UNAIDS)","year":"2012","journal-title":"World AIDS day report 2012"},{"key":"10.7717\/peerj.15237\/ref-32","author":"United Nations Programme\u00a0on HIV\/AIDS\u00a0(UNAIDS)","year":"2014","journal-title":"The GAP report: people left behind\u2014sex workers"},{"key":"10.7717\/peerj.15237\/ref-33","article-title":"United Nations Programme on HIV\/AIDS (UNAIDS) epidemiological estimates","author":"United Nations Programme on HIV\/AIDS (UNAIDS)","year":"2021"},{"key":"10.7717\/peerj.15237\/ref-34","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1201\/b14398","volume-title":"Understanding advanced statistical methods","author":"Westfall","year":"2013"},{"key":"10.7717\/peerj.15237\/ref-35","article-title":"African Regional Health topics\/HIV\/AIDS","author":"World Health Organization (WHO)","year":"2018"},{"key":"10.7717\/peerj.15237\/ref-36","article-title":"Body mass index\u2014BMI","author":"World Health Organization (WHO)","year":"2004"},{"key":"10.7717\/peerj.15237\/ref-37","article-title":"Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low-and-middle-income countries: recommendations for a public health approach","author":"World Health Organization (WHO)","year":"2012"},{"key":"10.7717\/peerj.15237\/ref-38","article-title":"Hawassa","author":"Wikipedia","year":"2022"},{"key":"10.7717\/peerj.15237\/ref-39","article-title":"National food and nutrition commission and food and nutrition technical assistance III project (FANTA)","author":"Zambia Ministry\u00a0of Health","year":"2017","journal-title":"Nutrition guidelines for care and support of people with HIV"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/15237.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/15237.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/15237.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/15237.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T04:41:02Z","timestamp":1682656862000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/15237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,28]]},"references-count":39,"alternative-id":["10.7717\/peerj.15237"],"URL":"https:\/\/doi.org\/10.7717\/peerj.15237","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.7287\/peerj.15237v0.2\/reviews\/1","asserted-by":"object"},{"id-type":"doi","id":"10.7287\/peerj.15237v0.3\/reviews\/1","asserted-by":"object"},{"id-type":"doi","id":"10.7287\/peerj.15237v0.1\/reviews\/2","asserted-by":"object"},{"id-type":"doi","id":"10.7287\/peerj.15237v0.1\/reviews\/1","asserted-by":"object"}]},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,28]]},"article-number":"e15237"}}