Nutritional status and growth of children and adolescents with and without cerebral palsy in eastern Uganda: A longitudinal comparative analysis

Lukia Hamid Namaganda; Carin Andrews; Fred Wabwire-Mangen; Stefan Peterson; Hans Forssberg; Angelina Kakooza-Mwesige

doi:10.1371/journal.pgph.0001241

Nutritional status and growth of children and adolescents with and without cerebral palsy in eastern Uganda: A longitudinal comparative analysis

PLOS Glob Public Health. 2023 Jun 13;3(6):e0001241. doi: 10.1371/journal.pgph.0001241. eCollection 2023.

Authors

Lukia Hamid Namaganda^{1

2

3}, Carin Andrews^{1

4}, Fred Wabwire-Mangen^{1

2}, Stefan Peterson^{3

5

6}, Hans Forssberg^{1

4}, Angelina Kakooza-Mwesige^{1

4

7}

Affiliations

¹ CURIE Study Consortium, Iganga-Mayuge Health and Demographic Surveillance System, Iganga, Uganda.
² Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda.
³ Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
⁴ Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Health Policy Planning and Management, Makerere School of Public Health, Kampala, Uganda.
⁷ Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda.

Abstract

There is a need to understand the growth and burden of malnutrition in children with cerebral palsy (CP) in order to design appropriate inclusive nutrition strategies. We compared the nutritional status and four-year longitudinal growth of a population-based cohort of children and adolescents (C&A) with CP (n = 97; 2-17 years; 55/42 M/F), and an age and sex matched group without CP (n = 91; 2-17y; 50/41 M/F) in rural Uganda. The cohorts were assessed in 2015 and 2019 for weight, height, social demographic characteristics, and feeding related factors. Nutritional status was determined using the World Health Organization (WHO) Z-scores. Wilcoxon sign rank and Mann-Whitney tests were used to test within and between group differences. Multivariable linear regression was used to determine predictors of the change in growth. Approximately two thirds (62/97 (64%)) of C&A with CP were malnourished (with <-2SD in any of the WHO Z-scores), especially those with feeding difficulties (OR = 2.65; P = 0.032), and those who needed to be fed (OR = 3.8; P = 0.019). Both the CP and non-CP groups deviated negatively from the WHO reference growth curve for height, with a significantly slower growth in the CP group (median change score of height-for-age Z score (HAZ) between assessments = -0.80(-1.56, 0.31), p<0.01), than the non-CP group (median HAZ change score = -0.27(-0.92,0.34, p = 0.034). There was a statistically significant group difference in the median HAZ change score between the CP and non-CP groups (z = -2.21, p = 0.026). Severity of motor impairment measured by the Gross Motor Function Classification System (GMFCS-level) correlated negatively (r = -1.37,95%CI -2.67, -0.08) with the change in HAZ scores among the CP group. Children and adolescents with severe motor impairments exhibit an increased risk of malnutrition and growth retardation compared to their age matched peers without CP, which underscores the need to develop inclusive community-based nutrition strategies for children with cerebral palsy.

Copyright: © 2023 Hamid Namaganda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported by the Swedish Research Council (05474 to HF); Stiftelsen Promobilia (REF 20009 to HF); Stiftelsen Frimurare Barnhuset in Stockholm (2018/19 to HF) and Sunnerdahls Handikappfond (F09/20 to HF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. LHN, AKM, and FWM received salaries from all the funders.