Feeding Problems, Nutrition Status and Gastrointestinal Problems of Children and Adolescents with Neurodisability in a Clinical Care Setting in Kenya

Abstract

The prevalence of neurological impairment and disability in children ranges from 8 to 180 per 1,000 in low- and middle-income countries (LMICs). In Kenya, 2.2% of the population (0.9 million people) live with some form of disability. Neurodevelopmental delay, neurodisability, and malnutrition significantly contribute to the burden of disease globally and in Africa. This study aimed to assess mealtime problem behaviors, nutritional status, and gastrointestinal (GI) issues among children and adolescents with neurodevelopmental disorders (CAWND) in clinical care settings in Kenya. A cross-sectional study was conducted at Kenyatta National Hospital involving CAWND aged 3-17 from June 2021 to June 2023. The Daniel 1999 formula was used to determine the sample size. Data collection and coding were performed using the Open Data Kit. Data was analyzed using the R programming language (R Core Team, 2022). The Brief Autism Mealtime Behavior Inventory (BAMBI) tool assessed feeding problems. Descriptive statistics were used to summarize socio-demographic characteristics. Linear discriminant analysis was employed to assess differences in nutritional status indicators by neurodevelopmental diagnosis. Associations between feeding problems and GI issues in CAWND were tested, with significance set at p < 0.05. The study included 81 CAWND, comprising 40% with autism, 28% with epilepsy, 11% with cerebral palsy, and 21% with trauma. The median age was 12 years. Malnutrition was highest among children with cerebral palsy (56% stunting, 44% wasting, and 55% underweight). Regarding feeding problems, 100% of CAWND with cerebral palsy disliked sweet foods (p = 0.024). Conversely, 91% of CAWND with epilepsy were most willing to try new foods (p = 0.024), and 65% preferred crunchy foods (p = 0.011). Additionally, 75% of CAWND with autism disliked foods requiring extensive chewing (p = 0.000), and 100% of CAWND with trauma disliked foods prepared in a specific
way (p = 0.039). The most common GI symptoms observed were constipation and diarrhea. CAWND experiences feeding problems and GI issues that adversely affect their nutritional status. Tailored strategies addressing the mealtime experiences, requirements, and preferences of CAWND are necessary. Interventions to improve nutritional status and manage GI problems are crucial for enhancing health and nutrition outcomes. Future research should explore the impact of feeding and GI problems on the health and nutrition of CAWND.