Risk factors for malnutrition among children with cerebral palsy in Botswana

Publication date: Available online 14 February 2017
Source:Pediatric Neurology
Author(s): Allison Johnson, Claudia Gambrah-Sampaney, Esha Khurana, James Baier, Esther Baranov, Baphaleng Monokwane, David R. Bearden
BackgroundChildren with cerebral palsy in low-resource settings are at high risk of malnutrition, which further increases their risk of poor health outcomes. However, there is little published data on specific risk factors for malnutrition among children with cerebral palsy in the developing world.MethodsWe performed a case-control study among children with cerebral palsy receiving care at a tertiary care hospital in Gaborone, Botswana. Children with cerebral palsy and malnutrition were identified according to World Health Organization growth curves and compared to subjects with cerebral palsy without malnutrition. Risk factors for malnutrition were identified using multivariable logistic regression models. These risk factors were then used to generate a Malnutrition Risk Score, and Receiver Operating Characteristic (ROC) curves were used to identify optimal cutoffs to identify subjects at high risk of malnutrition.ResultsWe identified 61 children with cerebral palsy, 26 of whom (43%) met criteria for malnutrition. Non-ambulatory status (OR 13.8, 95% CI 3.8-50.1, p<0.001) and a composite measure of socioeconomic status (OR 1.6, 95% CI 1.0-2.5, p=0.03) were the strongest risk factors for malnutrition. A Malnutrition Risk Score was constructed based on these risk factors, and Receiver Operating Characteristic (ROC) curve analysis demonstrated excellent performance characteristics of this score (AUC 0.92, 95% CI 0.89-0.94).ConclusionsMalnutrition is common among children with cerebral palsy in Botswana, and a simple risk score may help identify children with the highest risk. Further studies are needed to validate this screening tool and to determine optimal nutritional interventions in this population.



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