Prevalence of malnutrition and associated feeding problems among children with cebral pasly attending Muhimbili National Hospital, Dar es Salaam, Tanzania

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

Vl 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.