Improving nutritional status of children with Cerebral palsy: a qualitative study of caregiver experiences and community‐based training in Ghana

This is a qualitative study on feeding practices of caregivers of children with cerebral palsy (CP) in West Africa. We interviewed caregivers both before and after a 1‐year training intervention on caring for children with CP and found neither deterioration nor improvement in children's nutritional status, despite some improvements in feeding practices and a reduction in reported caregiver stress. The results also highlight the extent of severe undernutrition within this vulnerable group.

Abstract

Background

Cerebral palsy (CP) is the most common childhood disability worldwide, and evidence shows that children with CP are at an increased risk of malnutrition due to feeding difficulties. This qualitative study explores caregiver experiences of feeding before and after a community‐based training program in Ghana.

Methods

Thirteen caregivers of children with CP, who were severely undernourished, were interviewed at the start of the training program. Eleven of these were interviewed again after a year of monthly group trainings and home visits, which included guidance on feeding. Four additional caregivers were interviewed at end line. Interviews explored caregivers' mealtime experiences, as well as a 24‐hr dietary recall and a structured feeding observation checklist. Children's nutritional status was assessed by anthropometry.

Results

Caregivers found mealtimes stressful due to time demands, messiness, and the pressure of providing enough quality food. They felt that the training program had helped reduced this stress and dietary recall data suggested some improved dietary quality. However, there was neither improvement nor deterioration in anthropometric status of the children.

Conclusion

Group trainings were welcomed by caregivers and notably reduced stress around feeding times. However, future work is needed in order to improve anthropometric outcomes, including, but not limited to, greater focus on nutritional requirements during caregiver training interventions. Therapeutic feeding programs must also be better utilized and need to be better equipped to care for this group of children, including deviating from standard admission and treatment protocols.

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