Oropharyngeal dysphagia in children with cerebral palsy: comparisons between a high- and low-resource country.
There is paucity of research investigating oropharyngeal dysphagia (OPD) in young children with cerebral palsy (CP), and most studies explore OPD in high-resource countries. This study aimed at determining the proportion and severity of OPD in preschool children with CP in Bangladesh, compared to Australia.



Cross-sectional, comparison of two cohorts. Two hundred and eleven children with CP aged 18-36 months, 81 in Bangladesh (mean = 27.6 months, 61.7% males), and 130 in Australia (mean = 27.4 months, 62.3% males). The Dysphagia Disorders Survey (DDS) - Part 2 was the primary OPD outcome for proportion and severity of OPD. Gross motor skills were classified using the Gross Motor Function Classification System (GMFCS), motor type/distribution.



(i) Bangladesh sample: proportion OPD = 68.1%; severity = 10.4 SD = 7.9. Australia sample: proportion OPD = 55.7%; severity = 7.0 SD = 7.5. (ii) There were no differences in the proportion or severity of OPD between samples when stratified for GMFCS (OR = 2.4, p = 0.051 and β = 1.2, p = 0.08, respectively).



Despite overall differences in patterns of OPD between Bangladesh and Australia, proportion and severity of OPD (when adjusted for the functional gross motor severity of the samples) were equivalent. This provides support for the robust association between functional motor severity and OPD proportion/severity in children with CP, regardless of the resource context. Implications for Rehabilitation The proportion and severity of OPD according to gross motor function level were equivalent between high- and low-resource countries (LCs). Literature from high-resource countries may be usefully interpreted by rehabilitation professionals for low-resource contexts using the GMFCS as a framework. The GMFCS is a useful classification in LCs to improve earlier detection of children at risk of OPD and streamline management pathways for optimal nutritional outcomes. Rehabilitation professionals working in LCs are likely to have a caseload weighted towards GMFCS III-V, with less compensatory OPD management options available (such as non-oral nutrition through tubes).
a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.|b Paediatric Unit, Centre for the Rehabilitation of the Paralysed , Chapain , Savar , Dhaka , Bangladesh.
Katherine A
KA
Benfer
a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.|c Menzies Health Institute of Queensland, Griffith University , Gold Coast Campus , Queensland , Australia.
Kelly A
0000-0002-5042-1925
KA
Weir
a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.|d Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia.
Kristie L
KL
Bell
e Nutrition and Clinical Services, International Centre for Diarrhoeal Disease Research , Mohakhali Dhaka , Bangladesh.
Baitun
B
Nahar
f Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia.|g School of Population Health, The University of Queensland , Herston , Australia.
Robert S
RS
Ware
d Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia.
Peter S W
PSW
Davies
a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.
Roslyn N
0000-0002-4919-5975
RN
Boyd
D001315:Australia / Q000453:epidemiology; D001459:Bangladesh / Q000453:epidemiology; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009048:Motor Skills; D020380:Needs Assessment; D009752:Nutritional Status; D012720:Severity of Illness Index
Deglutition disorders; cerebral palsy; feeding; high-resource country; low-resource country; pediatrics