Nutritional status of children with cerebral palsy attending Kenyatta National Hospital

Abstract

Background: Cerebral palsy is the most common cause of physical disability in childhood, occurring in 3.6 per 1,000 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Although the primary impairment in CP is in motor function, poor growth and nutritional status is common in young children with cerebral palsy and impact detrimentally on physical and cognitive development as well ,\S on health care utilization and quality of life in later childhood. Approximately one-third of children with CP are undernourished and many exhibit the consequences of malnutrition. The aim of this study was to assess the nutritional status and determine factors associated with poor nutrition in children with CP attending KNH outpatient clinics.

Objectives: The primary objective of this study was to determine the nutritional status of children with cerebral palsy and secondary objective was to find out the factors associated with poor nutritional status in these children.

Design: A hospital based cross-sectional study.

Setting: Pediatric Neurology Clinic, occupational and physiotherapy clinic of the Kenyatta national hospital.

Study Methodology: A cross-sectional study of 140 children was conducted at the KNHneurology, physiotherapy and occupational therapy clinics over a period of three months. The study participants were children with cerebral palsy aged 6 to 139 months. Sociodemographic, nutritional data were obtained from the parents/guardians, and then physical examination and anthropometric measurements (weight and height) of the children was performed. The data was analyzed using SPSS version 17.3.

Results: During the 3 months study period, children with cerebral palsy in the age of 6 to 139 months with a median age of 17.0 months (11.25-30.75) participated in the study. Most of these Children were aged 6 to 23 months 92 (65.7 %) and out of the 140 children who participated in the study, 75 (53.6%) were male. About 86.4 % of these children were in GMFCS (gross motor functional classification system) level III and above.

Overall, 70.3 % of children with cerebral palsy were malnourished, 35.0 % were severely wasted and 10.7% were severely stunted. The factors that were significantly associated with moderate to severe wasting were; age less than 2 years (p=0.0466), lack of regular source of income (p=0.04), higher GMFCS level (p= 0.035) and vomiting/regurgitation after feeding (p =0.031). Moderate to severe stunting was significantly associated with age of more than 3 years (p=< 0.001), low level of care taker's education (p=0.026) and higher GMFCS (~:;0.026).

Conclusion: 70.3 % of children with cerebral palsy were malnourished and Stunting was more prevalent in children with cerebral Palsy in the developed countries than in our study. Factors that were significantly associated with moderate to severe wasting were; Age less than 2 years (p=0.0466), lack of regular source of income (p=0.04), higher GMFCS (p= 0.035) and vomiting or regurgitation after feeding (p =0.031 ).

Moderate to severe stunting was significantly associated with; Age of more than 3 years (p=< 0.001), low level of caters education (p=0.026) and higher GMFCS (p=0.026). It is contended that malnutrition is of high prevalence in children with cerebral palsy and therefore regular assessment and timely nutritional support may improve the situation.