THE EFFECT OF NUTRITION ON THE HEALTH STATUS OF PHYSICALLY CHALLENGED CHILDREN IN SCHOOL OF SPECIAL NEEDS IN NIGERIA
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
There is, however, increasing national interest in the links between malnutrition and disability. There are a variety of possible reasons for poor nutrition in disabled children. Adequate nutrition is a fundamental prerequisite for good physical health, motor and cognitive development and social development (Meeks Gardner J et al, 2000; Waterlow JC, 2014). Malnourished children can become adults with lower physical and intellectual abilities, lower levels of productivity and higher levels of chronic illness and disability (UNICEF, 2018). Disabled people are often assumed to have poorer nutrition than their non-disabled counterparts and, indeed, surveys in developed countries have shown that disabled children and adolescents are vulnerable to poor nutritional care (Bax, 2003; Thomas et al, 2009). In contrast, far less information is available on the nutritional status of disabled children in developing countries where the situation is further complicated by widespread malnutrition among the general population. Previous studies in Nigeria (Alakija, 2008; Ojofeitimi, 2003) identified mild malnutrition in school-age children with sensory or mental impairments. Many studies of children with cerebral palsy have reported evidence of growth impairment (Hals et al, 2016; Shapiro et al, 1986; Stallings et al, 2016) or micronutrient deficiencies (Hals et al, 1996; Rampage et al, 1996). Growth retardation and feeding problems have also been noted in groups with other disabilities, including mental retardation, congenital heart disease and deaf ± blindness (Thommessen et al, 2011; Suzuki et al, 2011). Adolescents with mental retardation may also be overweight as a result of a sedentary lifestyle and over eating (Suzuki et al, 2011). There is a close relationship between poverty and disability (Coleridge, 2013). Children with disabilities living in poverty may be put at further risk of inadequate nutrition due to financial constraints or social beliefs. Economic conditions may influence the parent’s responses to their child’s condition (Mallory et al, 2013). However, disabled children in such situations are not always neglected; for example, in Tanzania disabled people were as far as possible integrated into the normal routine of the community (O’Toole & McKonkey, 2015). Estimates of the prevalence and severity of nutritional deficits among disabled children are complicated by the fact that physical disabilities will interfere with standard anthropometric measurements. For example, conditions such as kyphosis or bent legs can compromise the accuracy of standard height or length measurements and the extra arm exercise involved in using walking aids in some polio survivors can affect mid-upper arm circumference (MUAC) results. Although international guidelines suggest disregarding anthropometric results from disabled children (United Nations, 2006), these children have the same right to good nutrition as non-disabled children so it is important to solve these measurement problems. We compared the nutritional status of disabled children with their non-disabled counterparts in Nigeria to determine if the disabled children were nutritionally disadvantaged and see if a disabled child disadvantaged the nutritional status of the siblings. We also evaluated the use of demi-span and