Are children with disabilities more likely to be malnourished?

Challenges in accessing adequate nutrition hinder children’s development and compromise their wellbeing. Despite evidence suggesting that children with disabilities are at a greater risk of malnutrition, nutrition programme exclusion, and mortality from severe wasting – compared to children without disabilities – there is limited evidence on the nutritional outcomes of children with disabilities in large-scale global health surveys. 

Factors that lead to increased riskof malnutrition in disabled children include feeding difficulties, inadequate energy intake, and a higher occurrence of common childhood illnesses (such as acute respiratory infection, fever, and diarrhoeal disease). These are worsened when coupled with inequities in maternal education, poverty, parental employment status, and inadequate water, sanitation, and hygiene and ICT access. Without sufficient focus on disability, it will be impossible to achieve the Sustainable Development Goal to ‘end all forms of child malnutrition’ or meet global child mortality reduction targets.

This study analysed data collected between 2017 and 2021 during the implementation of the sixth round of the UNICEF-supported Multiple Indicator Cluster Survey from 30 low- and middle-income countries. Estimations were completed, providing adjusted prevalence ratios for stunting, wasting, and underweight. The study compared children aged two to four years with and without disabilities by country and sex. To ensure comparative analysis, the survey questions were standardised across the different countries included in the study. 

Of the 229,621 children included in the study, 15,071 (6.6%) had disabilities. After adjustment, the overall findings indicated that children with disabilities were at a greater risk of being stunted (RR 1.16, 95% CI 1.11-1.20) than children without disabilities. The same was true of wasting (RR 1.28, 95% CI 1.18-1.39) and underweight (RR 1.33, 95% CI 1.17-1.51), where significant differences were also observed. In sex-disaggregated analyses, both boys and girls with disabilities were significantly more likely to be malnourished than boys and girls without disabilities. This study affirms existing evidence that shows a higher prevalence of malnutrition in young children with disabilities compared with those without.

The study highlights several programmatic and policy implications. Recommendations include the development of tailored and financed programmes within the primary healthcare system that target children with disabilities, as well as using proactive referral mechanisms for those at risk of malnutrition. Also, the training of healthcare workers and establishing of parental support programmes aimed at addressing stigma, cultural attitudes, and barriers were highlighted.

In summary, children with disabilities face notably higher risks of various forms of malnutrition (wasting, stunting, underweight). This emphasises the urgency of enhancing disability inclusion within nutrition programmes. To effectively address the nutritional needs of this group, a two-way approach strategy is essential – integrating children with disabilities into regular nutrition initiatives while also providing targeted programmes to address their specific requirements.