Socio-demographic Characteristics of chronically-ill special school going children
A total of 172 chronically ill children, comprising 101 (58.7%) physically disabled and 71 (41.3%) blinds were included in this study. The children were selected from 7 different schools in Lahore with a median value of 24 children participating from each school (range 11–36). Of the total participants, 117 (68%) were male and 55 (32%) were female. Medication was used by 48 (27.9%) children while 124 (72.1%) used none. Only 13 (7.6%) children reported disease present at birth (Table 1). Data were collected with the help of school caretakers. The mean age of disabled children was 11.5 years, with a mean height of 137.2 cm and a mean weight of 29.9 kg.
Table 1
Child Characteristics, Malnutrition, and Subjective Health Status
| n = 172 |
Child characteristics Age (years) (mean ± SD) | 11.5 ± 2.7 |
Weight (kg) | 29.9 ± 10.5 |
Height (cm) | 137.2 ± 18.8 |
Disability Type | n (%) |
Blind | 71 (41.3) |
Physically disabled | 101 (58.7) |
Gender | |
Male | 117 (68) |
Female | 55 (32) |
Malnutrition | |
Acute | 33 (19.2) |
Chronic | 52 (30.2) |
Both | 6 (3.5) |
None | 81 (47.1) |
Overall malnutrition | 91(52.9) |
Use of medication | |
No | 124 (72.1) |
Yes | 48 (27.9) |
Disease at birth | |
No | 159 (92.4) |
Yes | 13 (7.6) |
Malnutrition risk (STRONGKids) | |
Low risk | 98 (57) |
Moderate risk | 54 (31.4) |
High risk | 20 (11.6) |
Subjective health status | |
Mobility | |
No Problem | 74 (43) |
Some Problem | 78 (45.3) |
Severe Problem | 20 (11.6) |
Self-Care | |
No Problem | 107 (62.2) |
Some Problem | 49 (28.5) |
Severe Problem | 16 (9.3) |
Daily activities | |
No Problem | 108 (62.8) |
Some Problem | 54 (31.4) |
Severe Problem | 10 (5.8) |
Pain and discomfort | |
No Pain | 109 (63.4) |
Moderate Pain | 52 (30.2) |
Severe Pain | 11 (6.4) |
Anxiety/ depression | |
No Anxiety | 114 (66.3) |
Moderate Anxiety | 45 (26.2) |
Severe Anxiety | 13 (7.6) |
Visual analog scale (mean ± SD) | 67.5 ± 11.8 |
n: frequency, %: percentage |
Prevalence of malnutrition. The prevalence of acute malnutrition (weight-for-height <-2SD) was 19.2%, and chronic malnutrition was 30.2% (height-for-age <-2SD). Only 3.5% of children experienced both acute and chronic malnutrition. The overall prevalence of malnutrition, comprising either acute or chronic malnutrition, was found to be 52.9% (Table 1).
Risk of malnutrition (STRONG kids ). The STRONGkids questionnaire consists of 4 items for identifying children at risk of malnutrition. The percentage of children reporting ‘yes’ for high-risk disease was 43.6% while the subjective clinical assessment was 11%. Moreover, 15.1% of the children reported nutrition intake and losses, and 9.3% of the children had experienced weight loss or poor weight gain (Fig. 1)
Based on the STRONGkids questionnaire, 11.6% of children were at high risk, 31.4% were at moderate risk, and the remaining 57% were at low risk for developing malnutrition (Table 1). The highest rate of acute malnutrition was found in the low-risk group (55%) and chronic malnutrition was high in the moderate-risk group (48%). The overall prevalence of malnutrition present in the moderate-risk group was 42% and in the high-risk group it was 21%. (Supplementary Table S1).
Subjective health status of chronically-ill special children. Overall, chronically-ill children reported some severe problems in health status dimensions with 45.3% reporting some problem for mobility, 28.5% for self-care, 31.4% for daily activities, 30.2% for pain/discomfort, and 26.2% for presented anxiety/depression. Specifically, 11.6% reported severe problems with mobility, 9.3% with self-care, 5.8% with daily activities, 6.4% with pain/discomfort, and 7.6% with anxiety/depression. The mean VAS score was 67.5 (SD ± 11.8) (Table 1).
Table 2
Chi-Square Comparison Between Subjective Health Status Problems With Malnutrition and Prediction of Malnutrition
Problem | Subjective health status problems |
| mobility n (%) | self-care n (%) | Usual activities n(%) | Pain/discomfort n(%) | Anxiety/discomfort n(%) |
| no problem | moderate/severe | no problem | moderate/severe | no problem | moderate/severe | no problem | moderate/severe | no problem | Moderate /severe |
Malnutrition |
No | 42(52) | 39(48) | 57(70) | 24(30) | 58(72) | 23(28) | 63(78) | 18(22) | 56(69)a | 25(31)a |
Yes | 33(36) | 58(64) | 50(55) | 41(45) | 50(55) | 41(45) | 46(51) | 45(49) | 58(64)a | 33(36)a |
STRONGkids |
Low risk | 51(52) | 47(48) | 63(64)b | 35(38)b | 65(66)c | 33(38)c | 71(72) | 27(28) | 67(68)d | 31(32)d |
High / Moderate | 25(34) | 49(66) | 44(60)b | 30(40)b | 43(58)c | 31(42)c | 38(51) | 36(49) | 47(64)d | 27(36)d |
STRONGkids: a nutritional screening tool to assess the risk of malnutrition in children.
a there was no significant association between anxiety /discomfort and malnutrition: p-value = 0.51
b,c,d there was no association among self-care, usual activities, and anxiety/discomfort with STRONGkids: p-value = 0.53, 0.55, and 0.51 respectively.
Data in Table 2 show counts compared with percentage of subjective health status problems in children with and without malnutrition, and with and without a risk of malnutrition. Children who suffer from overall malnutrition tend to experience more some/severe health status problems in different dimensions, compared to those who do not suffer from malnutrition. According to caretaker reports, children with malnutrition were more likely to experience significant problems in the mobility dimension (64%) and pain (49%) compared to non-malnourished children who reported 48% mobility and 31% anxiety/discomfort. Children at risk of malnutrition showed more some/severe problems with mobility (66%) and pain (49%) than children not at risk of malnutrition, who reported 48% for mobility and 38% for usual activities.
Children with overall malnutrition exhibited a lower VAS score of M = 65 (SD 12) than children without overall malnutrition with a VAS score of M = 70 (SD 10.9) (t -2.9) and a P value of 0.004. Children at moderate/high risk of malnutrition attained a lower VAS score of M = 66 (SD 11.5) than children with no-risk with a high VAS score of M = 68 (SD 11.9) (t -1.9) and a P value of .22 (Table 3). The overall mean VAS score for seven represented schools in Lahore was 67.5 (Fig. 2).
Table 3
Comparison of Mean VAS Scores Between the Malnutrition and the Risk of Malnutrition Groups.
Subjective health status VAS score |
| N | Mean | Std. Deviation | t value | Sig. |
Nutrition status |
Malnutrition | 91 | 65.0549 | 12.07602 | -2.9 | 0.004 |
Without malnutrition | 81 | 70.1852 | 10.96712 | | |
Risk of malnutrition |
Moderate/high risk | 74 | 66.2162 | 11.58089 | -1.2 | 0.227 |
No risk | 98 | 68.4184 | 11.96207 | | |
VAS: Visual analogue scales |
A Univariate regression model was used to determine a significant association between VAS score and malnutrition. Univariate regression analysis indicated that malnutrition in children with chronic illness was significantly associated with a worse subjective health status with 31% of the variation in the dependent variable (malnutrition) due to a linear relationship with the independent variable (VAS score) (Table 4).
Table 4
Univariate Regression Model to Check the Association Between Subjective Health Status (VAS) and Malnutrition
| Constant | Unstandardized β | SE | p-value | R2 |
Model 1 | | | | | |
Malnutrition (1 = yes) | | | |
| 62.7 | 1.6 | .72 | 0.02 | 0.31 |