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Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum

Published online by Cambridge University Press:  09 March 2007

Aisha K. Yousafzai*
Affiliation:
Centre for International Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
Suzanne Filteau
Affiliation:
Centre for International Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
Sheila Wirz
Affiliation:
Centre for International Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
*
*Corresponding author: Dr A. K. Yousafzai, fax +44 20 7404 2062, email A.Yousafzai@ich.ucl.ac.uk
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Abstract

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The aim of the present study was to explore the nature, extent and probable causes of nutritional deficiencies among children with disabilities living in Dharavi, a slum in Mumbai, India. A cross-sectional study was conducted to investigate whether the nutritional status of children with disabilities, aged 2–6 years (n 141), was worse than that of non-disabled sibling controls (n 122) and neighbour controls (n 162). Data on food patterns, anthropometry, micronutrient status and feeding difficulties reported by parents were collected. The mean weight for age of the children with disabilities (−2·44 (sd 1·39) Z scores; n 120) was significantly lower (P<0·05) compared with the sibling (−1·70 (sd 1·20) Z scores; n 109) and neighbour (−1·83 (sd 1·290) Z scores; n 162) control groups. The children with disabilities had significantly lower (P<0·05) mean haemoglobin levels (92 (sd 23) g/l; n 134) compared with siblings (102 (sd 18) g/l; n 103) and neighbours (99 (sd 18) g/l; n 153). Relative risk (RR) analysis indicated that the disabled children with feeding difficulties were significantly more likely (P<0·05) to be malnourished, by the indicator of weight for age (RR 1·1; 95 % CI 1·08, 1·20) compared with the disabled children without a feeding difficulty. They were also significantly more likely to be malnourished using the indicators of height for age (RR 1·3; 95 % CI 1·19, 1·43) and weight for height (RR 2·4; 95 % CI 1·78, 3·23) compared with the disabled children without a feeding difficulty. Feeding difficulties were identified as a risk factor for vulnerability to inadequate nutritional status among children with disabilities.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2003

References

Agarwal, KS, Mughal, MZ, Upadhyay, P, Berry, JL, Mawer, EB & Puliyel, JM (2002) The impact of atmospheric pollution on vitamin D status of two year olds in Delhi, India. Arch Dis Child 87, 111113.CrossRefGoogle Scholar
American Dietetic Association (1992) Position of the American Dietetic Association – nutrition in comprehensive programme planning for persons with developmental disabilities. J Am Diet Assoc 92, 613615.CrossRefGoogle Scholar
Beesley, R, Filteau, SM, Tomkins, A, et al. (2000) Impact of acute malaria on plasma concentrations of transferring receptors. Trans R Soc Trop Med Hyg 94, 295298.CrossRefGoogle Scholar
Bhandari, N, Bahl, R, Sazawal, S & Bhan, K (1997) Breast feeding status alters the effect of vitamin A treatment during acute phase diarrhoea in children. J Nutr 127, 5963.CrossRefGoogle Scholar
Coleridge, P (1993) Disability, Liberation and Development. Oxford: Oxfam Publications.CrossRefGoogle Scholar
Crean, JTG, Ling, SC, Pearson, DJ, Shaw, SN, Stewart, RJ & Wilson, JH (1987) Dharavi Project 1985: an investigation into patterns of infant feeding and malnutrition in the urban slum of Dharavi in Bombay J Trop Paediatr 33, Suppl. 2, 230.Google ScholarPubMed
Durkin, MS, Davidson, LL, Desai, P, et al. (1994) Validity of the ten questions screen for childhood disability – results from population-based studies in Bangladesh, Jamaica, and Pakistan. Epidemiology 5, 283289.CrossRefGoogle ScholarPubMed
Durkin, MS, Wang, W, Shrout, PE & et al. (1995) Evaluating a ten questions screen for childhood disability – reliability and internal structure in different cultures. J Clin Epidemiol 48, 657666.CrossRefGoogle Scholar
Filteau, SM, Lietz, G, Mulokozi, G, Billota, S, Henry, CJ & Tomkins, AM (1999) Milk cytokines and sub-clinical breast inflammation in Tanzanian women – effects of dietary red palm oil or sunflower oil supplementation. Immunology 97, 596600.CrossRefGoogle ScholarPubMed
Filteau, SM, Morris, SA, Abbot, RR, et al. (1995) Influence of morbidity on serum retinol of children in a community-based study in Northern Ghana. Am J Clin Nutr 58, 192197.CrossRefGoogle Scholar
Fung, EB, Samson-Fang, L, Stallings, VA, et al. (2002) Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc 102, 361373.CrossRefGoogle ScholarPubMed
Gibson, RS (1990) Principles of Nutritional Assessment. New York: Oxford University Press.Google Scholar
Gisel, EG & Patrick, J (1988) Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet i, 283286.CrossRefGoogle Scholar
Hals, J, Ek, J, Svalastog, AG & Nilsen, H (1996) Studies on nutrition in severely neurologically disabled children in an institution. Acta Paediatr 85, 14691475.CrossRefGoogle ScholarPubMed
Harris, AD, Jones, LA, Heatley, RV, Newcomb, RG & Rhodes, J (1984) Precision of anthropometric measurements – the value of mid-arm circumference. Clin Nutr 2, 193196.CrossRefGoogle Scholar
Helander, E (1998) Prejudice and Dignity – An Introduction to Community Based Rehabilitation 2nd ed. New York UNDP.Google Scholar
Indian Census Data (1991) Census of India 1991. http://www.censusindia.net.Google Scholar
Johnson, CB & Deitz, JC (1985) Time use of mothers with pre-school children: a pilot study. Am J Occup Ther 39, 578583.CrossRefGoogle ScholarPubMed
King, FS & Burgess, A (1993) Nutrition for Developing Countries. Oxford: Oxford Medical Publications.CrossRefGoogle Scholar
Kow, F, Geissler, C & Balasubramaniam, E (1991) Are international anthropometric standards appropriate for developing countries?. J Trop Pediatr 37, 3744.CrossRefGoogle ScholarPubMed
Krick, J & Van Duyn, M (1984) The relationship between oral-motor involvement and growth – a pilot study in a paediatric population with cerebral palsy. J Am Diet Assoc 84, 555559.CrossRefGoogle Scholar
Larnert, G & Ekberg, O (1995) Positioning improves the oral and pharyngeal swallowing function in children with cerebral palsy. Acta Paediatr 84, 689692.CrossRefGoogle ScholarPubMed
Lawson, M, Thomas, M & Hardman, A (1999) Dietary and lifestyle factors affecting plasma vitamin D levels in Asian children living in England. Eur J Clin Nutr 53, 268272.CrossRefGoogle ScholarPubMed
Mallory, BL, Nichols, RW, Charlton, JI & Marfo, K (1993) Traditional and Changing Views of Disability in Developing Societies: Causes, Consequences, Cautions. Durham: World Rehabilitation Fund – The International Exchange of Experts and Information in Rehabilitation, The University of New Hampshire, NC, USA.Google Scholar
National Family Health Survey (2000) National Family Health Survey, India 1998–1999. http://www.nfhsindia.org.Google Scholar
Pai, M, Alur, M, Wirz, S, Filteau, S, Pagedar, S & Yousafzai, A (2001) A pilot study of the nutritional status of disabled and non-disabled children living in Dharavi, Mumbai. J Indian Pediatr 38, 6065.Google Scholar
Ramakrishnan, U, Latham, MC, Abel, R & Frongilo, EA (1995) Vitamin A supplementation and morbidity among pre-school children in South India. Am J Clin Nutr 61, 12951303.CrossRefGoogle ScholarPubMed
Reddihough, DS, Baikie, G & Walstab, JE (2001) Cerebral Palsy in Victoria, Australia: Mortality and causes of death. J Paediatr Child Health 37, 183186.CrossRefGoogle ScholarPubMed
Reilly, S & Skuse, D (1994) The prevalence of feeding problems in pre-school children with cerebral palsy. Dev Med Child Neurol 36, Suppl. 5Google Scholar
Reilly, S & Skuse, D (1992) Characteristics and management of feeding problems of young children with cerebral palsy. Dev Med Child Neurol 34, 379388.CrossRefGoogle ScholarPubMed
Richardson, N (1988) Feeding Problems, Emotional and Behavioural Problems in Young Children – A Multi-disciplinary Approach. Windsor, UK: NFER.Google Scholar
Sullivan, PB & Rosenbloom, L (1996) Feeding the Disabled Child, Clinics in Developmental Medicine. London and Cambridge, UK: MacKeith Press/Cambridge University Press.Google Scholar
Rousham, EK, Northrop-Clewes, CA & Lunn, PG (1998) Maternal reports of child illness and the biochemical status of the child: the use of morbidity interviews in rural Bangladesh. Br J Nutr 80, 451456.CrossRefGoogle ScholarPubMed
Shapiro, BK, Green, P, Krick, J, Allen, D & Capute, AJ (1986) Growth of severely impaired children – neurological factors versus nutritional factors. Dev Med Child Neurol 28, 729733.CrossRefGoogle ScholarPubMed
Shaw, BNJ (1996) The respiratory consequences of neurological deficit. Feeding the Disabled Child. Clinics in Developmental Medicine, pp.4046 [Sullivan, PB, Rosenbloom, L, editor]. London and Cambridge, UK: MacKeith Press/Cambridge University Press.Google Scholar
Singh, J, Marya, RK & Sharma, A (1992) Screening of rickets in a Haryana town. J Indian Pediatr 29, 226228.Google Scholar
Singhal, S, Goyle, A & Gupta, R (1998) Quantitative food frequency questionnaire and assessment of dietary intake. Natl Med J India 11, 268275.Google ScholarPubMed
Socrates, C, Grantham-McGregor, SM, Harknett, SG & Seal, AJ (2000) Poor nutrition is a serious problem in children with cerebral palsy in Palwan, the Philippines. Int J Rehabil Res 23, 177184.CrossRefGoogle ScholarPubMed
Staiano, A, Cucchiara, S, Del Giudice, E, Andreotti, MR & Minella, R (1991) Disorders of oesophageal motilityin children with psychomotor retardation and gastro-oesophageal reflux. Eur J Pediatr 150, 638641.10.1007/BF02072624CrossRefGoogle Scholar
Staiano, A & Del Giudice, E (1994) Colonic transit and anorectal manometry in children with severe brain damage. Pediatrics 94, 169173.CrossRefGoogle ScholarPubMed
Stallings, VA, Charney, EB, Davies, JC & Cronk, CE (1993) Nutritional status and growth of children with diplegic or hemiplegic cerebral palsy. Dev Med Child Neurol 35, 9971006.10.1111/j.1469-8749.1993.tb11582.xCrossRefGoogle ScholarPubMed
Stallings, VA, Zemal, BS Davies, JC, Cronk, CE & Charney, EB (1996) Energy expenditure of children and adolescents with severe disabilities: a cerebral palsy model. Am J Clin Nutr 64, 627634.CrossRefGoogle ScholarPubMed
Sullivan, PB, Juszack, E, Lambert, BR, Rose, M, Ford-Adams, ME & Johnson, A (2002) Impact of feeding problems on nutritional intake and growth: Oxford feeding study II. Dev Med Child Neurol 44, 461467.CrossRefGoogle ScholarPubMed
Suzuki, M, Saitoh, S, Tasaki, Y, Shimomura, Y, Makishima, R & Hosoya, N (1991) Nutritional status and daily physical activity of handicapped students in Tokyo metropolitan schools for deaf, blind, mentally retarded, and physically handicapped individuals. Am J Clin Nutr 54, 11011111.CrossRefGoogle ScholarPubMed
Thomas, AP, Bax, MCO & Smyth, DPL (1989) The Health and Social Needs of Young Adults with Physical Disabilities. Clinics in Developmental Medicine no. 106 London: MacKeith Press.Google Scholar
Thommessen, M, Kase, BF, Riis, G & Heiberg, A (1991) The impact of feeding problems on growth and energy intake in children with cerebral palsy. Eur J Clin Health 45, 479487.Google ScholarPubMed
Thommessen, M, Trygg, K, Riis, G & Kase, BF (1989) Nutrition and growth retardation in 10 children with congenital deaf-blindness. J Am Diet Assoc 89, 6973.CrossRefGoogle ScholarPubMed
Tietz, NW (1995) Clinical Guide to Laboratory Tests. 3rd ed. Philadelphia, PA: WB Saunders Company.Google Scholar
Tompsett, J, Yousafzai, AK & Filteau, SM (1999) The nutritional status of disabled children in Nigeria – a cross-sectional survey Eur J Clin Nutr 53, 915919.CrossRefGoogle ScholarPubMed
Trier, H & Thomas, AG (1998) Feeding the disabled child. Nutrition 10, 801805.CrossRefGoogle Scholar
Turmusani, M, Vreede, A & Wirz, SL (2002) Some ethical issues in community-based rehabilitation initiatives in developing countries. Disabil Rehabil 24, 558564.CrossRefGoogle ScholarPubMed
United Nations (1986) How to Weigh and Measure Children – Assessing the Nutritional Status of Young Children in Household Surveys. New York: UN Department of Technical Co-operation for Development and Statistical Office.Google Scholar
Verrall, TC, Berenbaum, S, Chad, KE, et al. (2000) Children with cerebral palsy:aregivers’ nutrition knowledge, attitudes and beliefs. Can J Diet Pract Res 61, 128134.Google Scholar
Willig, TN, Carlier, L, Legrand, M,et al. (1993) Nutritional assessment in Duchenne muscular dystrophy. Dev Med Child Neurol 35, 10741082.CrossRefGoogle ScholarPubMed
World Health Organisation(1992) The Prevalence of Anaemia in Women: a tabulation of available information. Geneva: WHO.Google Scholar
Yousafzai, AK, Filteau, S, Wirz, S & Cole, TJ (2003a) The use of armspan, arm length and tibia length to assess nutritional status in children with physical impairments in Dharavi, Mumbai, India. Eur J Clin Nutr (In the Press).Google Scholar
Yousafzai, AK, Pagedar, S, Wirz, S & Filteau, S (2003b) Beliefs about feeding practices and nutrition for children with disabilities among families in Dharavi, Mumbai. Int J Rehabil Res 26, 3341.CrossRefGoogle Scholar
Zamen, SS, Khan, NA, Islam, S, et al. (1990) Validity of the "ten questions" for screening serious childhood disability – results from urban Bangladesh. Int J Epidemiol 19, 613620.CrossRefGoogle Scholar