Abstract:
Background: Cerebral palsy (CP) is a chronic disorder of posture and movement associated
with other disabilities. Among these is failure of normal development of feeding ability which
leads in slowness and inefficiency in feeding. As a result of the feeding problems children with
cerebral palsy are at increased risk of inadequate intake of nutrients compared to the general
population of children. Ultimately they are at a higher risk of developing malnutrition.
Objectives: To determine the magnitude of malnutrition and associated feeding problems among
children with cerebral palsy who were attending at Muhimbili National Hospital, Dar-es-Salaam,
Tanzania.
Methods: A descriptive cross-sectional study was conducted for a period of six months. During
the study period, 239 children with cerebral palsy were consecutively recruited. Their nutritional
status was assessed clinically and using anthropometric measurements (weight and
length/height). Malnutrition was categorized using Waterlow classification.
Results: A total of 239 children with CP aged between three months and 14 years were
recruited. Among them 146(61.1 %) children were males. Spastic type of motor disorder was the
most prevalent (56.1 %) type of cerebral palsy. About half (50.2%) of the children had severe
type of CP. Among the enrolled children 73.1 % had variable degrees of wasting. The prevalence
of severe wasting was found to be 20.1% while severe stunting accounted for 49.4% .. There was
a statistical significant direct relationship between the severity of CP and severity of
malnutrition. Severe wasting prevailed more among children with severe CP accounting for 28.3
%( p=O.OOI). More children with dyskinetic/athetoid type of CP 15(28.6%) had severe wasting.
However, this finding was not found to be statistically significant (p=0.616).
Feeding problems commonly noted among the children were inability to self feed 133(73.5%),
inability to chew solids 80(34.3%), swallowing problems 71(29.7%), cough/chocking during
feeding 65(27.2%), cry/extensor dystonia during feeding 52(21.8%) and inability of tongue
lateralization in 47(20.2%) of children.
In general, majority of the children, were taking less than 30minutes time to finish a feed.
However, for those children who were taking longer time, more than 30 minutes to more than
one hour to finish their feeds, majority were children with feeding problems. This was significant
in children who were unable to feed themselves, inappropriate wide mouth opening, inability to
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open mouth when fed, inadequate/absent tongue lateralization, no closure of lips around the
spoon, chewing problems and cough/chocking during feeding.
The presence of feeding problems was associated with increased prevalence of severe wasting
(11.1 %-45.5%) and stunting (52.5%-72.3%).
Illiteracy of the mothers/care givers was associated with having more children who were wasted
to variable degrees (p=O.044).
Conclusion: This study has shown that among this selected population of children with CP
attending MNH, the prevalence of malnutrition was relatively high. The severity of malnutrition
was found to be directly related to the severity of CP and the presence of feeding problems.
Recommendation: Growth monitoring among children with cerebral palsy should be intensified
in order to identify malnutrition and feeding problems early on, and instituting appropriate
feeding programmes, nutritional counselling and follow-up actions.
