Assessment of the Nutritional Status, Determinants Of Malnutrition and Feeding Practices of Children With Cleft Lip and Palate in Kenya

Abstract

Background: Children with cleft lip and palate (CLP) suffer from inappropriate and inadequate feeding resulting in inadequate weight gain. This leads to malnutrition and poor growth. Some of the problems encountered due to the anatomical and physiological differences brought about by these defects include suckling disability, nasal regurgitation, inability to generate adequate suction pressure and easy fatigability while feeding. Malnutrition is a preventable cause of early childhood mortality. Objective: To assess the nutritional status, determinants of malnutrition and feeding practices of children with cleft lip and palate in Kenya. Methodology: This was a cross sectional analytical study that was carried out in hospitals participating in Smile Train/Kenya Society of Plastic, Reconstructive and Aesthetic Surgeons (KSPRAS) cleft camps across Kenya. The study also included patients managed at Kenyatta National Hospital and Dental School; University of Nairobi. All the cleft lip and palate children on follow up in cleft camps and clinics were recruited into the study. The study variables used were; patient’s age, weight, height, mid upper arm circumference (MUAC), household income, parents’/guardians’ level of education, cleft type and feeding practices. The principal investigator and research assistants carried out clinical examinations of the cleft lip and palate children so as to determine the cleft type and extent of malnutrition. They also filled in the questionnaires after interviewing the parents and guardians of patients that were enrolled in this study. Clinical assessment of the patients included history taking and physical examination. The patients’ anthropometric measurements were taken and recorded. These included the weight, height and mid upper arm circumference. Data analysis was done using Stata version 17. The WHO Z scores were used to assess the nutritional status. Fischer’s exact test and xiv Pearson chi-square were used to investigate factors associated with malnutrition. Significance was evaluated at p <0.05. Results: A total of 65 children aged less than five years were enrolled into the study. 64.6% were male and 35.4% were female. 60% were ≤ 12 months old. Of the 65 children, 40% (n=26) had combined cleft lip and palate, 16.92% (n=11) had isolated cleft palate and 43.08% (n=28) had isolated cleft lip. The study found that 33.8% were underweight (WAZ), 33.8% were stunted (HAZ) and 15.4% were wasted (WHZ). To assess the prevalence of malnutrition, underweight (WAZ) was used as the main indicator and it was used to capture both severe acute malnutrition and moderate acute malnutrition. The prevalence of malnutrition in this regard was 33.8% (n=22), with a 95% confidence interval of 22.3% to 46.7%. The study also found that of the patients with malnutrition, 12.3% had severe acute malnutrition and 21.5% had moderate acute malnutrition. The prevalence of malnutrition using MUAC as the anthropometric measurement was 24.6% (n=16) with 3.1% (n=2) having severe acute malnutrition (SAM). Feeding by spoon was the most common mode of feeding at 50.8%, followed by feeding by cup at 46.2%. The findings showed that cow milk was the most popular type of food given, at 46.2%, followed by direct breastfeeding at 44.6%. It was noted that 32.3% of the mothers gave their children expressed breast milk. The most common feeding difficulty experienced by the mothers was failure to latch at 43.1% and the most common feeding difficulty experienced by the children was nasal regurgitation at 43.1%. Malnutrition was noted to be high among children being given cow milk, in children that were being fed by cup, and in those who were fed via syringe. xv Conclusion: There is a high prevalence of malnutrition among cleft lip and palate children in Kenya. There is need for healthcare providers to develop individualized care plans to help parents/caregivers attain optimum care for their children