ArticlePLOS global public health2025
Effectiveness of the Positive deviance and parent facilitator training strategies on the nutritional status of children and youth with cerebral palsy: A quasi-randomised trial with a factorial design.
Article in PLOS global public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
High malnutrition among children with CP in low-income countries underscores the need for community-based nutrition strategies. This study aimed to describe the effectiveness of two caregiver-led interventions including, the positive deviance (PD) and the parent facilitator training (PFT) interventions on malnutrition among children and youth (C&Y) with CP in rural Eastern Uganda. This was a 2x2 factorial quasi-randomized trial among 124 pairs of caregiver-malnourished C&Y with CP aged 2-24 years, at the Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS) in Eastern Uganda. Outcome measures included three months change in weight gain, Weight for-age-z scores and Body Mass Index for-age-z scores. Change in weight status was modelled in a multiple linear regression adjusting for baseline characteristics. Non-factorial analysis was used to determine the effect of combining both interventions on weight status. The interaction effect between PD and PFT was not statistically significant (P > 0.05). Those who received the PD intervention significantly gained more weight by 520g (adjusted coefficient = 0.52, 95%CI 0.16,0.88, p = 0.005) and improved their BMI for age z-scores (adjusted coefficient = 0.65, 95% CI 0.35,0.94, P < 0.01) than those who did not, while those who received PFT significantly improved their Weight for Age z-scores (adjusted coefficient = 0.42,95%CI 0.14,0.56, p = 0.006). Non-factorial analysis revealed a significant higher weight gain (770g) and improved BMI for age z-scores among those who received both interventions (adjusted coefficient = 0.77, 95%CI 0.22.1.37, p = 0.009). The PD alone or combined with PFT interventions improves weight status better than the PFT intervention alone. The PD and PFT caregiver-led strategies should be merged into existing community-based nutrition programs to reduce the high burden of malnutrition among C&Y with CP in low-income settings.
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