Yousafzai, Aisha Khizar; (2001) The nutritional status of disabled children living in Dharavi, an Indian urban slum in Mumbai. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Limited research is available on the nutritional status of children with disabilities, and even less for those living in poverty. Research is exacerbated by insufficient guidelines to assess the nutritional status of this population. Studies in developing countries are complicated by widespread malnutrition in the general population. The aim of this study was to determine the nature, extent and probable causes of nutritional deficiencies among disabled children living in Dharavi, an urban slum in Mumbai, India, in order to develop guidelines to promote the health of these vulnerable children. A case-control study was designed to investigate whether the nutritional status of disabled children was worse than that of non-disabled controls (siblings and neighbours). Knowledge skills and attitudes of carers towards nutrition, feeding practices and disability were studied. Anthropometry, micronutrient status, dietary intake and feeding difficulties of disabled children were compared to controls. In addition, appropriate measurements for heights of subjects with physical impairments were investigated. Results then provided information for workshops on nutrition and the management of feeding difficulties. 425 subjects were assessed. The proportion of children with disabilities with anthropometric scores of below -2SD (NCHS reference) was significantly greater (P<0.05) than controls, e.g. 69% of children with disabilities had weight/age data below -2 Z scores compared to 42% of siblings and 47% of neighbours. Mean haemoglobin results were significantly lower (P<0.05) for the children with disabilities (92g/l) compared to siblings (102g/l) and neighbours (99g/l) (P<0.05). Relative risk analysis indicated that children with disabilities were 1.1-1.4 times significantly more likely (P<0.05) to be malnourished if a severe feeding difficulty was present than if no feeding difficulty was present. Strong associations between height with: 1) Tibial length (P<0.001, r= 0.782); 2) Arm length (P<0.001, r= 0.903); and 3) Armspan (P<0.001, r=0.966) were found. These measurements could be used to determine a more accurate height for some children with physical impairments. Qualitative findings of feeding practices and difficulties indicated a lack of knowledge and confidence of the carer in being able to improve the nutritional status of the disabled child. Carers gave positive feedback about the workshops. Guidelines on nutrition and good feeding practices were developed.

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