Prevalence and factors associated with acute malnutrition among children with epilepsy attending Mulago National Referral Hospital

Abstract

Background: Sub-Saharan Africa carries a significant burden of epilepsy and malnutrition. Children with epilepsy are predisposed to acute malnutrition through comorbid disorders, ongoing seizures, recurrent hospitalizations, social stigma and neglect. Acute malnutrition may also precipitate or perpetuate epilepsy through reduction of seizure threshold and exposure to febrile illnesses that trigger seizures. Although both epilepsy and malnutrition are widespread in Uganda, the burden of acute malnutrition among children living with epilepsy in this setting is unknown. Bridging this knowledge gap may guide the integration of nutritional support into the routine healthcare services for children living with epilepsy. Objective: To determine the prevalence and factors associated with acute malnutrition among children with epilepsy attending Mulago National Referral Hospital (MNRH). Methodology: A cross-sectional study was conducted among children with epilepsy aged 6 months to 12 years attending the neurology clinic at MNRH. Data was collected with the aid of structured questionnaires and physical exam including anthropometry. The data collected was entered into Epi data 3.1 and analyzed using STATA version 14. The prevalence of acute malnutrition was determined by calculating the total number of children with acute malnutrition over the total number of children studied. The continuous variables were summarized using median and interquartile range and categorical variables using frequencies and percentages. To determine association between the various independent variables logistic regression analysis method was used at bivariate and multivariate level. A p value of < 0.05 was considered significant. Results: We enrolled 280 children with epilepsy aged between 6 months and 12 years. The median age (IQR) was four years (1.9-7.5) and 187 (66.8%) were boys. Out of the 280 participants, 44 (15.7%), 95 CI (11.5 % - 20.1%) had acute malnutrition. The factors associated with increased odds of acute malnutrition included motor disability aOR (95% CI) 8.33 (2.27-34.5) p value 0.002, ongoing seizures in the last 6 months aOR (95% CI) 5.65 (1.34-33.9) p value 0.03 and feeding difficulties aOR (95% CI) 3.19 (1.23-8.54), p value 0.018. On the other hand, school attendance aOR (95% CI) 0.12 (0.030-0.41) p value 0.001, rural residence aOR (95% CI) 0.5(0.224-0.994) p value 0.048 and caregiver having no education or primary education aOR (95% CI) 0.4 (0.187-0.884) p value 0.018, were associated with reduced odds of acute malnutrition. xii Conclusion and recommendation: The prevalence of acute malnutrition among children with epilepsy attending Mulago National Referral Hospital was 15.7%. The factors that were significantly associated with increased likelihood of acute malnutrition included motor disability, on going seizures in the last six months and feeding difficulties. School attendance, residence in a rural area and low education of the caregiver were associated with reduced likelihood of acute malnutrition. Health workers need to routinely carry out nutritional assessment for children with epilepsy especially those with on going seizures, motor disabilities and feeding disabilities.