An Analysis of a Peer-Reviewed Study

In this step, you will read the following summary of a case-control study that aimed to understand nutritional outcomes for children with disabilities, compared to children without disabilities in Turkana, Kenya. As you read, think critically about the study methodology and findings.

Malnutrition and Childhood Disability in Turkana, Kenya: Results from a Case-Control Study. Kuper et al. (PLOS ONE, 2015)

Children with disabilities may be at a higher risk of malnutrition compared to children without disabilities. This increased risk may be due to exclusion from school-based food programmes (because children with disabilities are less likely to go to school), higher levels of poverty, or difficulties eating/feeding for children with certain impairments (e.g. cerebral palsy). At the time of this study, there was very little evidence on this topic, particularly from low- and middle-income countries. This case-control study took place in Turkana County, Kenya in 2013. This area was one of the poorest areas of Kenya at the time of the study, and has experienced widespread food security for many years.

Methods

This was a population-based case-control study.

Participants: “Cases” were children with disabilities aged 6 months and 10 years. Children with disabilities were identified using the Key Informant Method, which uses trained community members to identify children with potential impairments. These children are then assessed by a pediatrician using the Washington Group Questions (UNICEF child version; see step 2.2), and clinical tests (e.g. hearing, vision tests) to confirm whether the child has a disability and the type. (for more on this method, check the “see also” section). “Controls” were selected from the household (siblings nearest in age) and the neighborhood (nearest neighbor within one year of age). In total 311 “cases” were included and 496 “controls” (196 siblings, and 300 neighbors).

Measures: For both cases, and controls, a caregiver completed a questionnaire about the child which gathered information about feeding, poverty, illnesses and education. In addition, measurements of the child’s weight and height were taken. Height and weight were used to calculate indicators of general malnutrition (low weight for age), wasting (low weight for height), stunting (low height for age), and body mass index (BMI).

Results and conclusion

Children with disabilities were more likely to have malnutrition compared to all controls. This included general malnutrition, stunting, and low BMI. Children with disabilities were also nearly two times as likely to have wasting compared to neighbor controls, but not compared to siblings. Finally, children with disabilities were less likely to attend school than controls. Amongst children with disabilities, children who did not attend school were most likely to experience malnutrition. There was no statistical association between malnutrition and age, sex, feeding difficulties or poverty amongst children with disabilities. Overall, this study suggested that children with disabilities were vulnerable to malnutrition. This difference is even apparent in an area where there is widespread food insecurity and malnutrition.

Discussion

Think about the following in relation to this study:

• How was disability measured in this study? What are the strengths and limitations of this approach?
• Why was a control group included? Why were two control groups used?
• Interpret the findings presented in the table above for general malnutrition
• What do you think explains the difference between cases and controls?
• What are the implications for policy and practice?