MALNUTRITION AND ASSOCIATED FACTORS AMONG CHILDREN WITH AND WITHOUT DISABILITIES IN PRIMARY SCHOOLS IN GULU DISTRICT

Abstract

Background: Malnutrition and disability are areas of public health importance that require focus nationally and globally. Children with disability are at risk of malnutrition because they face several challenges such as feeding difficulties, neglect during child care and feeding practices, increased nutrient needs. These result into inadequate food intake hence malnutrition. Malnutrition can be a cause or effect of disability. They therefore require special nutrition care and attention in order to stay well nourished. Children under five years in Gulu district have a high prevalence of anemia; 46.6%. Adolescent secondary school children in Gulu have a wasting and stunting prevalence of 3.1% and 4.1% respectively. However, the actual malnutrition status of children with disability in comparison to the children without disability in Gulu district has limited literature. This study focused on determining the malnutrition prevalence and comparing it among children with and without disabilities and its associated factors in Gulu district. This will ascertain the current nutritional situation and provide guidance on prioritization and distribution of appropriate nutrition interventions. The results of the study will provide broader knowledge on nutrition among children with disability that will help to bridge the malnutrition –disability link in Gulu district, Uganda. Methods: A school based cross sectional study design of 244 primary school children aged 915years was conducted. Simple random sampling and probability proportionate to size was employed to select 122 children with disabilities from special needs schools of; Gulu primary (blind), Gulu Prison (mental), Laroo Primary (deaf) and Mother Theresa (deaf) and the comparison group of 122 children without disability from non-special needs school of Kirombe primary. Anthropometry (weight, height, age) and the biochemical test for iron deficiency anemia was used to assess malnutrition. Malnourished children (wasted, stunted, overweight,) were categorized using a nutrition index at a Z-score less than -2SD and none malnourished children at a Z –score greater than -2SD. The nutritional indicator for iron deficiency anemia was measured by the hemoglobin levels using the Hemocue Hb301 meter and classified as iron deficiency anemia (IDA) present or absent using the recommended cut offs. A semi-structured questionnaire was used to collect this information. Multivariate logistic regression at 95% confidence interval was used to assess the associated factors to nutritional status. The measure of association used was the odds ratios and the 95% confidence intervals and p-values to denote statistical significance. xi

Results: Of the 244 study participants, 8.2 %( 20/244) were wasted, 8.2 %( 20/244) were stunted, 4.92 %( 12/244) overweight and 67.62 %( 165/244) had IDA. Children with disabilities generally had higher levels of malnutrition compared to the children without disabilities. Children with disability had a higher prevalence of wasting at 9.84 %( 12/20), overweight at 8.2 %( 10/12), IDA for 9 year olds at 71.43%, IDA for 10-15yr olds at 72.22%. Both children had the same prevalence of stunting at 8.2 %( 10/20). After adjusting for potential confounders, factors significantly associated with stunting was having acute respiratory infection (Adjusted OR: 0.67; 95%CI: 0.58-0.77). Drinking water from truck (AOR: 0.24; 95%CI: 0.13-0.43) were found to be associated with wasting. Those who ate 2 and 3 meals a day were less likely to be overweight (AOR: 0.12; 95%CI: 0.02-0.49).Children who were not dewormed were more likely to suffer from iron deficiency anemia. Conclusion: The prevalence of wasting, stunting, IDA was the same in both children with and without disabilities since the difference in their prevalence was not statistically significant. However overweight prevalence was higher in children with disabilities compared to children without disabilities and the difference was statistically significant.