title: Risk Factors for Malnutrition Among Children With Cerebral Palsy in Botswana.
abstract: Children with cerebral palsy in low-resource settings are at high risk of malnutrition, which further increases their risk of poor health outcomes. However, there are few available data on specific risk factors for malnutrition among children with cerebral palsy in the developing world.
  
  
  
  We performed a case-control study among children with cerebral palsy receiving care at a tertiary care hospital in Gaborone, Botswana. Children with cerebral palsy and malnutrition were identified according to World Health Organization growth curves and compared with subjects with cerebral palsy without malnutrition. Risk factors for malnutrition were identified using multivariable logistic regression models. These risk factors were then used to generate a Malnutrition Risk Score, and Receiver Operating Characteristic curves were used to identify optimal cutoffs to identify subjects at high risk of malnutrition.
  
  
  
  We identified 61 children with cerebral palsy, 26 of whom (43%) met criteria for malnutrition. Nonambulatory status (odds ratio 13.8, 95% confidence interval [CI] 3.8-50.1, P < 0.001) and a composite measure of socioeconomic status (odds ratio 1.6, 95% CI 1.0-2.5, P = 0.03) were the strongest risk factors for malnutrition. A Malnutrition Risk Score was constructed based on these risk factors, and receiver operating characteristic curve analysis demonstrated excellent performance characteristics of this score (area under the curve 0.92, 95% CI 0.89-0.94).
  
  
  
  Malnutrition is common among children with cerebral palsy in Botswana, and a simple risk score may help identify children with the highest risk. Further studies are needed to validate this screening tool and to determine optimal nutritional interventions in this population.
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Allison
authors.initials: A
authors.lastname: Johnson
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gambrah-Sampaney
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Esha
authors.initials: E
authors.lastname: Khurana
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: James
authors.initials: J
authors.lastname: Baier
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Esther
authors.initials: E
authors.lastname: Baranov
authors.affiliation: Department of Pediatrics, University of Botswana, Gaborone, Botswana.
authors.forename: Baphaleng
authors.initials: B
authors.lastname: Monokwane
authors.affiliation: Department of Pediatrics, University of Botswana, Gaborone, Botswana; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York. Electronic address: david_bearden@urmc.rochester.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Bearden
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001902:Botswana / Q000453:epidemiology; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors
keywords: Africa; International child health; cerebral palsy; malnutrition; neurological disorders