Mlinda S J, Leyna G H, Massawe A
Nutrition unit, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Department of Epidemiology & Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Child Care Health Dev. 2018 May;44(3):452-461. doi: 10.1111/cch.12553. Epub 2018 Jan 30.
Feeding children with cerebral palsy (CP) is challenging and can lead to poor health outcomes. Using a facility-based intervention, we assessed the effect of a practical nutrition programme on feeding skills in caregivers of children with CP attending a pediatric clinic in urban Tanzania.
A randomized-controlled intervention study, involving 2-block stratified sample of under-5 CP children attending a specialized pediatric clinic at the Muhimbili National Hospital was done. One hundred ten moderate-to-severe, new and follow-up cases of children with CP were randomly allocated to the intervention (N = 63) and control groups (N = 47). A short nutrition education on feeding and positioning skills was provided to caregivers and occupational therapy sessions to CP children. Bivariate and multivariable logistic regression analyses of collected data were done. Statistical significance was assessed at p < .05.
The intervention significantly improved feeding skills of caregiver in the select indicators assessed. More caregivers appropriately positioned the children (AOR = 5.29; 95% CI: 2.00-13.96), fed children slowly (AOR: 5.17, 95% CI: 1.99-13.44), and involved the child during the feeding process (AOR = 3.46; 95% CI: 1.42-8.44). During feeding, caregiver's reported being less stressed (AOR = 2.53, 95% CI: 1.04-6.13) and the child's mood was more likely to be reported as improved (AOR = 3.15, 95% CI: 1.33-7.474). Although changes were observed in oral motor feeding skills (AOR = 1.67; 95% CI: 0.72-3.91) and functional feeding skills (AOR = 2.28; 95% CI: 0.86-6.06), they did not reach statistical significance in the multivariable models.
Strengthening nutrition education and services for caregivers of children with CP has great value in the care of children with special needs and may improve the health outcomes of children as well as reduce stress among parents/caregivers.
喂养脑瘫（CP）儿童具有挑战性，且可能导致不良健康后果。我们通过一项基于机构的干预措施，评估了一项实用营养计划对坦桑尼亚城市一家儿科诊所中CP患儿照料者喂养技能的影响。
开展了一项随机对照干预研究，对在姆希比利国家医院一家专门儿科诊所就诊的5岁以下CP儿童进行2组分层抽样。110例中重度、新发病例及CP患儿随访病例被随机分配至干预组（N = 63）和对照组（N = 47）。对照料者进行了关于喂养和体位摆放技能的简短营养教育，并为CP患儿安排了职业治疗课程。对收集的数据进行双变量和多变量逻辑回归分析。以p <.05评估统计学显著性。
干预显著改善了所评估的选定指标中照料者的喂养技能。更多照料者能正确摆放儿童体位（调整后比值比[AOR]=5.29；95%置信区间[CI]：2.00 - 13.96），缓慢喂养儿童（AOR：5.17，95% CI：1.99 - 13.44），并在喂养过程中让儿童参与进来（AOR = 3.46；95% CI：1.42 - 8.44）。在喂养期间，照料者报告压力减轻（AOR = 2.53，95% CI：1.04 - 6.13），且儿童情绪改善的可能性更高（AOR = 3.15，95% CI：1.33 - 7.474）。尽管在口腔运动喂养技能（AOR = 1.67；95% CI：0.72 - 3.91）和功能性喂养技能方面观察到了变化（AOR = 2.28；95% CI：0.86 - 6.06），但在多变量模型中它们未达到统计学显著性。
加强对CP患儿照料者的营养教育和服务，在照顾特殊需求儿童方面具有重要价值，可能改善儿童的健康状况，并减轻父母/照料者的压力。
