Nutritional Status of Children with Cerebral Palsy in Gorkha, Nepal: Findings from the Nepal Cerebral Palsy Register.

Israt Jahan,Gulam Khandaker,Nadia Badawi,Mohammad Muhit,Mahmudul Hassan Al Imam,Amir Banjara Chhetri,Ratul Ghose

doi:10.3390/nu13082537

Abstract

Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal. Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register—NCPR) was established in 2018. Children aged <18 years with confirmed CP were registered following standard protocol. Nutritional status was determined based on anthropometric measurements (height/length, weight, mid-upper-arm-circumference) following WHO guidelines. Descriptive analyses and adjusted logistic regression were completed. Results: Between June–October 2018, 182 children with CP were registered into the NCPR (mean (SD) age at assessment: 10.3 (5.0) years, 37.4% female). Overall, 51.7%, 64.1%, and 29.3% children were underweight, stunted, and thin, respectively. Furthermore, 14.3% of children with CP aged <5 years had severe wasting. Underweight and stunting were significantly higher among children with spastic CP (p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III–V) (p = 0.01, p < 0.001) and/or who were not enrolled in school (p = 0.01, p < 0.001). In adjusted analysis, GMFCS level III–V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively. Conclusions: the high rate of different forms of undernutrition among children with CP in Gorkha, Nepal is concerning. Need-based intervention should be taken as priority to improve their nutritional outcome.

Highlights

Cerebral Palsy (CP) is a non-progressive neurological condition that results from lesion to the developing brain [1]
The clinical definition of cerebral palsy (CP) used in NCPR was adopted from the Bangladesh Cerebral Palsy Register (BCPR), [13] based on the Surveillance of Cerebral Palsy in Europe (SCPE) [22] and the Australian Cerebral Palsy Register (ACPR) [23]
Among children aged ≤5 years, 14.3% (n = 4/28) had severe wasting i.e., severe acute malnutrition (SAM) according to MUAC-for-age z score (MUACZ) (i.e., MUACZ < −3SD); this proportion was 7.7% (n = 2/26) when weight-for-height z score (WHZ) was used as an indicator (i.e., WHZ < −3SD)

Summary

Introduction

Cerebral Palsy (CP) is a non-progressive neurological condition that results from lesion to the developing brain [1]. In recent years increased number of studies have focused on the nutritional status of children with CP [2,3,4,8,9,10,11,12], the evidence gap in low- and middle-income countries (LMICs) is still high. Underweight and stunting were significantly higher among children with spastic CP (p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III–V) (p = 0.01, p < 0.001) and/or who were not enrolled in school (p = 0.01, p < 0.001). GMFCS level III–V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively. Need-based intervention should be taken as priority to improve their nutritional outcome

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