Skip to 0 minutes and 12 seconds HANNAH KUPER: In the previous steps we’ve been learning about how disability and health are linked using examples from non-communicable diseases, HIV, violence, water and sanitation, and access to health. These case studies have illustrated different pathways connecting disability and poor health. I’m going to put this all together now, using malnutrition as a case study and presenting some examples from our own research. It’s widely believed that malnutrition and disability are linked in a cycle, particularly in children, with malnutrition causing disability, and disability causing malnutrition. In our own work, it became very clear that these conditions were linked when we saw the high levels of malnutrition among children with cerebral palsy in our projects in Ghana and Bangladesh.
Skip to 0 minutes and 56 seconds Sadly, up to one in 10 of these children died during the course of the study, despite our best efforts, almost always from malnutrition. We therefore set out to investigate how malnutrition and childhood disability are linked, working in a poor and dry area of Kenya called Turkana. We identified about 300 children with disabilities from within the communities and a similar number of children without disabilities of the same age and sex and living in the same communities. We measured height and weight for all of these children. We found that malnutrition levels were very high among all children in Turkana because this is an area with long-term food insecurity.
Skip to 1 minute and 37 seconds But whichever way we measured malnutrition, children with disabilities were about twice as likely to be affected as children without disabilities. The question that we try to answer is ‘why?’ There are a number of active feeding programmes offered in schools in Turkana because of the high levels of food insecurity in the area. The problem is that many of the children with disabilities were not going to school, and so were not receiving these meals, which often was the major source of food in the area. So exclusion from school was one reason why children with disabilities in Turkana were more malnourished.
Skip to 2 minutes and 13 seconds Another important reason was that children with certain types of conditions, like cerebral palsy or cleft palate, had difficulties in feeding and swallowing because of their underlying health condition. These problems would make these children more vulnerable to malnutrition.
Skip to 2 minutes and 31 seconds It is well known that children with disabilities on average live in poorer households, and this may add to their risk of food shortages and malnutrition. Neglect may also be common. This can be overt where children with disabilities are given less food on purpose, or more concealed– for instance, if parents don’t take enough time to feed children who have difficulties with swallowing or chewing, so they don’t get enough food. Finally, children who are malnourished for long periods of time may develop impairments which lead to disability. For instance, they may develop a bone condition called rickets, which makes it more difficult for them to walk, or they may have general developmental delays because of chronic food shortages.
Skip to 3 minutes and 12 seconds Putting it all together, we can see that malnutrition can directly cause childhood disability through causing specific conditions like rickets or developmental delay. This is a similar pathway to HIV as a health condition causing disabilities. On the other hand, childhood disability may cause malnutrition through poverty, exclusion, and neglect, as well as because of underlying health conditions causing feeding difficulties. We have already learned that disability may cause poor health more generally through these same pathways as we learned in the previous steps. The findings from our study in Kenya were consistent with those of other researchers working in other parts of the world, lending weight to the evidence that malnutrition and childhood disability are linked.
Skip to 3 minutes and 55 seconds This means that extra efforts are needed to include children with disabilities in general feeding programmes, as well as to specifically target them with interventions against malnutrition. In conclusion, we have learned in this step that malnutrition and childhood disability are linked through a variety of pathways. This issue is important because malnutrition increases the risk of death and poor health among children with disabilities. More efforts are therefore needed to make sure that children with disabilities are included in feeding programmes. More generally, this step illustrated all the different ways that disability and poor health are linked, as we have seen from different case studies and will be discussed further in the next step with the disability spiral.
Health and disability links: malnutrition case study
In this Step, Professor Hannah Kuper (LSHTM) summarises the links among health and disability through a case study of people with disabilities and malnutrition.
In this video, she presents an overview of malnutrition and disability and an example from her research completed in Turkana, Kenya. From the study, she discusses people with disabilities link to malnutrition highlighting neglect, feeding difficulties, physical development difficulties (i.e. rickets) and exclusion from school.
Pofessor Kuper concludes by stressing the importance of improving access to people with disabilities and summarising the links among malnutrition and childhood disability through multiple pathways with serious health implications. She mentions the broader link among disability and poor health which will be further explored in the next Step.
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