Childhood Disability and Nutrition: Findings from a Population-Based Case Control Study in Rural Bangladesh

Abstract

Background: Evidence regarding the complex relationship between childhood disability and malnutrition is limited in low and middle income countries. We aimed to measure the association between childhood disability and malnutrition in rural Bangladesh. Method: We conducted a population-based case control study among children aged <18 years in a rural sub-district (i.e., Shahjadpur) in Bangladesh. Children with permanent disability (i.e., Cases) and their age/sex-matched peers (i.e., Controls) were identified from the local community utilizing the key informant method. Socioeconomic, anthropometric, and educational information was collected using a pre-tested questionnaire. Only Cases underwent detailed medical assessment for clinical and rehabilitation information. Descriptive and bivariate analyses were performed. Results: Between October 2017 and February 2018, 1274 Cases and 1303 Controls were assessed. Cases had 6.6 times and 11.8 times higher odds of being severely underweight and severely stunted respectively than Controls. Although epileptic children had the highest overall prevalence of malnutrition, the age/sex-adjusted odds of malnutrition were significantly higher among children with physical impairments. Underweight and/or stunting among children with disability was significantly associated with parental educational qualification, socioeconomic status and mainstream school attendance. Conclusion: The significantly high proportion of severe malnutrition among children with disability calls for urgent action and implementation of inclusive nutrition intervention programs in rural Bangladesh.

A comparison of nutritional status between children with and without disabilities

“…Observation of similar trends in the proportions of severely underweight among children with a disability was 293 (43.3%) vis-a-vis 81 (12.1%) among children without a disability was seen. [ 1 ] These study findings and the present study have found similar results, though the parameters for the nutritional status used were different (weight and height for age and weight for height instead of WHO BMI centiles). Because of these inherent differences in the methods used in the evaluation the nutritional status, comparison in the rates of overnutrition (overweight and obesity) was not possible.…”

“…Jahan I et al ., Bangladesh, in 2019 showed significant differences in rates of severely wasted children among of whom 25 (20.4%) when compared to 7 (2.7%) children without disability. [ 1 ] The rate of severe stunting was also notably higher i.e. 599 (48.0%) compared to children without disability, where it was only 115 (9.1%).…”

“…Of every four children with disabilities, three children reside in low-and middle-income countries (LMICs). [ 1 ] 38% stunting, 21% wasting, and about 36% underweight rates were estimated in Indian children as per the latest survey conducted by the National Family Health Survey-4 (NFHS-4). [ 2 ] The percentage of children in rural areas who were stunted was 41% which was much higher compared to urban areas, that is, 34%.…”

“…However, varied results on association between childhood disability and Overweight and obesity were found. [ 6 ] Studies from Kenya,[ 7 ] Bangladesh[ 1 ] highlighted that children with disabilities were likely to be underweight and stunted compared to their non-disabled peers. However, in India, published studies have primarily focused on urban slum areas[ 8 ] and there is limited data on malnutrition and childhood disability in rural areas of India where majority of individuals with disabilities reside.…”

Risk factors for early childhood disability in Bangladesh: Evidence from Multiple Indicator Cluster Survey 2019

“…Previous research was unable to find the basic relationship between early childhood disability and associated factors. These studies may suffer from various limitations, such as inadequate focus on specific (cognitive) disability [ 18 ], use of limited statistical methods [ 19 ], and small sample size with the specific region [ 20 ]. Although, some of the studies used multivariable linear and binary logistic regressions to identify the potential determinants of childhood disability [ 18 , 21 , 22 ], none of the studies used ordinal logistic regression to find out the child, family, and community-level determinants.…”