Research Snapshots

Are children with disabilities more
likely to be malnourished?
This is a summary of the following paper: Rotenberg S, Chen S, Hunt X et al (2023) Are children
with disabilities more likely to be malnourished than children without disabilities? Evidence
from Multiple Indicator Cluster Surveys in 30 countries. BMJ Nutrition, Prevention & Health,e000779. https://www.medrxiv.org/content/10.1101/2023.09.25.23296066v1

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hallenges in accessing adequate nutrition hinder children’s development andcompromise their wellbeing. Despite evidence suggesting that children with disabilities are at a greater risk of malnutrition, nutrition programme exclusion, and mortality fromsevere wasting – compared to children without
disabilities – there is limited evidence on the nutritional outcomes of children with disabilities inlarge-scale global health surveys.
Factors that lead to increased risk of malnutrition in disabled children include feeding difficulties, inadequate energy intake, and a higher occurrence of common childhood illnesses (such as acuterespiratory infection, fever, and diarrhoeal disease).
These are worsened when coupled with inequitiesin maternal education, poverty, parental employment status, and inadequate water, sanitation, andhygiene and ICT access. Without sufficient focus
on disability, it will be impossible to achieve theSustainable Development Goal to ‘end all forms ofchild malnutrition’ or meet global child mortality reduction targets.
This study analysed data collected between
2017 and 2021 during the implementation of
the sixth round of the UNICEF-supported
Multiple Indicator Cluster Survey from 30 lowand middle-income countries. Estimations
were completed, providing adjusted prevalence
ratios for stunting, wasting, and underweight.
The study compared children aged two to four
years with and without disabilities by country
and sex. To ensure comparative analysis, thesurvey questions were standardised across thedifferent countries included in the study.
Of the 229,621 children included in thestudy, 15,071 (6.6%) had disabilities. After adjustment, the overall findings indicated thatchildren with disabilities were at a greater riskof being stunted (RR 1.16, 95% CI 1.11-1.20)
than children without disabilities. The same

Children with disabilities lack access tonutrition, health, and other services
This is a summary of the following paper: Rice I, Opondo C, Nyesigomwe L et al (2024)
Children with disabilities lack access to nutrition, health and WASH services: A secondary
data analysis. Maternal & Child Nutrition, e13642. https://doi.org/10.1111/mcn.13642

Poor diets, inadequate access to nutritionand health services (NaHS), and poor water, sanitation, and hygiene (WASH) all
increase the risk of malnutrition and infection, especially for individuals with disabilities.
The authors explored access to NaHS, household
WASH, and dietary adequacy among householdswith and without children with disabilities, inUganda. The study used cross-sectional secondary data from a survey conducted in 2021 and followed the PECO framework (STROBE, 2024) reporting guidelines. Adjusted logistic regression
was used to explore associations between disabilities, access to NaHS, WASH, and dietary adequacy.

Households with children with disabilities
experienced a higher prevalence of illnesses, including diarrhoea and skin infections.

© WFP/Giulio d'Adamo

Poor water, sanitation, and hygiene (WASH)
increase the risk of malnutrition and infection

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Of the 6,924 households included in the final
analysis, half of households with children withdisabilities reported not having access to all theservices they needed. Deworming and vaccination were reported as both the most importantand most difficult-to-access services. After adjusting for confounders, households with children
with disabilities reported 30% reduced access toservices on average, when compared to households without disabilities present (OR = 0.70; 95%
CI 0.55–0.89, p = 0.003). Interestingly, improved
WASH adequacy was strongly associated with improved access to services, including for households with children with disabilities.

The proportion of malnourished children(mid-upper arm circumference <12.5cm) was
higher among households with children withdisabilities than households without (6.3% vs.
2.4%, p < 0.001). Only 61% of children aged over
two years with disabilities reportedly ate threemeals a day – and just 14% had an adequate diet.
The study found that households with children have insufficient access to essential NaHS,
especially those households with children withdisabilities. There are concerning gaps in access

FIELD EXCHANGE ISSUE 72, April 2024 www.ennonline.net/fex

was true of wasting (RR 1.28, 95% CI 1.181.39) and underweight (RR 1.33, 95% CI 1.171.51), where significant differences were also
observed. In sex-disaggregated analyses, bothboys and girls with disabilities were significantly more likely to be malnourished thanboys and girls without disabilities. This study
affirms existing evidence that shows a higher
prevalence of malnutrition in young children
with disabilities compared with those without.
The study highlights several programmaticand policy implications. Recommendations include the development of tailored and financed
programmes within the primary healthcare system that target children with disabilities, as well as
using proactive referral mechanisms for those atrisk of malnutrition. Also, the training of healthcare workers and establishing of parental support
programmes aimed at addressing stigma, cultural
attitudes, and barriers were highlighted.
In summary, children with disabilities face
notably higher risks of various forms of malnutrition (wasting, stunting, underweight). Thisemphasises the urgency of enhancing disability inclusion within nutrition programmes. To
effectively address the nutritional needs of thisgroup, a two-way approach strategy is essential – integrating children with disabilities into
regular nutrition initiatives while also providing targeted programmes to address their specific requirements.

“This suggests that about a thirdof children do not have access toan adequate quantity of food,
while nearly three quarters do
not have access to an adequately
diverse diet, with implications
for undernutrition, particularly
micronutrient deficiencies.”to NaHS services in Uganda and households ofchildren with disabilities reported worse access,particularly for those with low WASH adequacy.
Surveys were conducted by professional surveyors, reducing the risk of information bias, andthe sample size was large with limited missing data.
However, the cross-sectional secondary data usedin the study is inherently limited and the sample ofthree districts may not be representative of Uganda as a whole. It was also not possible to adjust forindividual confounders or analyse alongside otherinformation as the data was collected at household(and not individual) level.
Nevertheless, the findings clearly indicatethat few children are receiving an adequately
diverse diet, putting them at risk of malnutrition, including micronutrient deficiencies. Gapsin these essential services exacerbate inequalities and have implications for the nutrition andhealth outcomes of children, families, and communities. To better address the need for accessto essential NaHS for families in Uganda, it remains vital that these services are inclusive, accessible, and comprehensive.

References
STROBE (2024) What is STROBE? strobe-statement.org