Undernutrition and feeding difficulties among children with disabilities in Zambia: insights for inclusive nutrition strategies

Background Understanding the burden of undernutrition in children with disabilities is crucial for designing inclusive nutrition programs and policies. This study aimed to estimate the prevalence of undernutrition and risk for feeding difficulties and describe common feeding practices among children with disabilities living with families in Zambia and receiving services at selected health centers and community-based rehabilitation centers. Methods We analyzed cross-sectional program data from 483 children aged birth to 10 years with reported special healthcare needs, collected between June 2017 and August 2021 at three health centers and ten community-based rehabilitation centers. Data included demographics, weight, height, mid-upper arm circumference (MUAC), hemoglobin concentrations, risk for feeding difficulties, and reported caregiver feeding practices. Undernutrition was assessed using the World Health Organization z -scores for anthropometric measurements, MUAC cut-off points, and anemia criteria. ANOVA and Pearson’s chi-squared tests were used to compare groups. Results More than half of the children were boys (54.2%) and under 5 years old (59.2%). Cerebral palsy was the most common special healthcare need (63.6%), followed by an unspecified “other” category (18.6%). Undernutrition was prevalent, with 62.8% underweight, 68.1% stunted, 22.6% wasted (using MUAC), and 60.5% anemic. Children with cerebral palsy had consistently lower anthropometric z -scores and higher rates of stunting, wasting, and underweight compared to children with other developmental disabilities or special healthcare needs. A risk for feeding difficulties was identified in 89.5% of the children, with common issues including coughing or choking and prolonged mealtimes. Despite these challenges, most caregivers reported practicing responsive feeding techniques at least some of the time. Conclusion These findings highlight the significant risk of undernutrition and feeding difficulties among children with disabilities, underscoring the urgent need for disability-inclusive, community-based nutrition strategies in Zambia. Stakeholders should use this information to strengthen nutrition programs and policies that uphold the rights of children with disabilities.