Prevalence and determinants of malnutrition in children with cerebral palsy aged 6-59 months in rehabilitation centers in Kampala, Uganda

Background: In Uganda, a critical health concern emerges with Cerebral Palsy (CP), affecting approximately 2.7 per 1000 children (Kakooza et al, 2017). Notably, anecdotal evidence from rehabilitation centers (RC) suggests a strong correlation between CP and the heightened risk of undernutrition and its subsequent complications in children below five years. However, the extent of undernutrition prevalence and the factors contributing to this condition among CP-afflicted children in Uganda’s rehabilitation centers remain largely unexplored. This study aimed to ascertain the prevalence of undernutrition and identify its associated factors in a sample of Ugandan children aged 6-59 months diagnosed with CP and residing in selected rehabilitation centers. Methods: In accordance with the WHO Growth Chart (WHO, 2006) as a benchmark, the study delineated undernutrition as a dependent variable using indicators such as height-for-age, weight-for-height, and weight-for-age with a standard deviation score of ≤ 2.0. This was accomplished through meticulous physical examinations and anthropometric measurements of 168 children. A modified Poisson regression model was utilized to pinpoint the determinants of undernutrition (independent variables), yielding prevalence ratios as a measure of association within 95% confidence intervals, complemented by multivariable logistic regression. Data analysis was conducted using STATA v.12, duly considering the survey design effects, including sampling weight. Results: Alarmingly, the prevalence of undernutrition among children with CP stood at 61.3%, with stunting and underweight being the most common manifestations at 39.9% and 41.7%, respectively. The study identified several key determinants of undernutrition. Age was found to be a significant factor, with children between 12-35 months (adj.PR = 1.49; 95% Confidence Interval [CI]: 1.01-2.19) and those over 35 months (adj.PR = 1.55; 95% CI: 1.03-2.32) exhibiting increased susceptibility. Additionally, dietary diversity played a crucial role, as consumption of fewer than three food groups per day was associated with a substantially elevated risk of undernutrition. The results revealed that a majority (53.6%) of the children were aged between 12 and 35 months, with a predominance of male participants (64.3%). Caregivers, primarily female (91%), frequently exhibited financial constraints (56% had no income) and limited educational background (36% lacked formal education or had only primary school education). Conclusion: In conclusion, this study highlights a disturbingly high prevalence of undernutrition (61.3%) among children aged 6-59 months with CP in Ugandan rehabilitation centers, with stunting and underweight being the most prevalent forms. Keywords Cerebral Palsy, Prevalence, Undernutrition, Uganda, Rehabilitation Centers Reference 1. Kakooza-Mwesige Angelina, Carin Andrews,Stefan Peterson, Fred Wabwire Mangen, Ann Christin Eliasson & Hans Forssberg. 2017. Prevalence of cerebral palsy in Uganda: a population based study.Available: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30374-1/fulltext#:~:text=The%20crude%20cerebral%20palsy%20prevalence,(%3C8%20years)%20children. 2. World Health Organisation (WHO) 2006. Child Growth standards based on length/height,weight and age. Acta Paediatr 76-85. Available: https://apps.who.int/iris/handle/10665/43413.