title: Feeding difficulties in children with cerebral palsy: low-cost caregiver training in Dhaka, Bangladesh.
abstract: BACKGROUND
  The majority of children with cerebral palsy have feeding difficulties, which, if not managed, result in stressful mealtimes, chronic malnutrition, respiratory disease, reduced quality of life for caregiver and child, and early death. In well-resourced countries, high- and low-cost medical interventions, ranging from gastrostomy tube feeding to caregiver training, are available. In resource-poor countries such as Bangladesh, the former is not viable and the latter is both scarce and its effectiveness not properly evaluated. The aim of this study was to evaluate the effectiveness of a low-cost, low-technology intervention to improve the feeding practices of carers of children with moderate-severe cerebral palsy and feeding difficulties in Bangladesh.
  
  
  METHODS
  An opportunistic sample of 37 caregivers and their children aged 1-11 years were invited to a six-session training programme following an initial feeding assessment with brief advice. During home visits, pre- and post-measures of nutritional status, chest health and feeding-related stress were taken and feeding practices were observed. A control phase was evaluated for 20 of the participant pairs following initial assessment with advice, while awaiting full training.
  
  
  RESULTS
  A minimum of four training sessions showed significant improvements in the children's respiratory health (P = 0.005), cooperation during mealtimes (P = 0.003) and overall mood (P < 0.001). Improvements in growth were inconsistent. Dramatic reductions were observed in caregiver stress (P < 0.001). A significant difference in the outcomes following advice only compared with advice plus training was also observed.
  
  
  CONCLUSIONS
  In situations of poverty, compliance is restricted by lack of education, finances and time. Nonetheless, carers with minimal formal education, living in conditions of extreme poverty were able to change feeding practices after a short, low-cost training intervention, with highly positive consequences. The availability of affordable food supplementation for this population, however, requires urgent attention.
authors.affiliation: Centre for International Health and Development, UCL Institute of Child Health, London, UK. mel.adams@uclmail.net
authors.forename: M S
authors.initials: MS
authors.lastname: Adams
authors.forename: N Z
authors.initials: NZ
authors.lastname: Khan
authors.forename: S A
authors.initials: SA
authors.lastname: Begum
authors.forename: S L
authors.initials: SL
authors.lastname: Wirz
authors.forename: T
authors.initials: T
authors.lastname: Hesketh
authors.forename: T R
authors.initials: TR
authors.lastname: Pring
mesh_terms: D001459:Bangladesh; D017028:Caregivers / Q000191:economics* / Q000193:education; D002547:Cerebral Palsy / Q000191:economics* / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D004032:Diet; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D004522:Educational Status; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000191:economics* / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009749:Nutrition Surveys; D009752:Nutritional Status; D011788:Quality of Life / Q000523:psychology; D013223:Statistics as Topic; D011795:Surveys and Questionnaires