2. Prevalence of Obesity in Mentally Disabled Children Attending Special Education Institutes in Khartoum State

3. Dr. Rogia El sayed El Tayeb Dr. Rasha Khalid El Khider

5. Introduction The importance of overweight and obesity related to people with disabilities is a particular problem of public health importance. Obesity is more prevalent among people with disabilities than for people without disabilities and is an important risk factor for other health conditions.

6. Goal The goal of this research is to incorporate nutritional care in the multidimensional care provided to mentally disabled children.

7. Objectives 1. Determine the prevalence of obesity in the mentally disabled children attending the special education institutes in Khartoum state. 2. Detect different risk factors of obesity in the study subjects. 3. Assess the nutritional status of the study subjects.

8. Methods This is a descriptive cross sectional study for determining the prevalence and risk factors of obesity in mentally disabled children in the special education centers in Khartoum state. This study was conducted at the forty special education institutes in Khartoum state including its seven governorates (Khartoum, Jabal Olia, Omdurman, Karary, Ambdh, Bahry, and East Nile (Sharg El Neel).

10. Methods All mentally retarded children between 10-18 years attending all special education centers in Khartoum state during period from 1\12\2011 to 31\1\2012 were included in the study the number is 290 children 190 males and 100 females.

11. Study tools Interview questionnaire with personnel working at the institutes including data about different aspects of care provided for the attended children. Clinical data and causes of mental retardation were collected by reviewing the records. Demographic data, socioeconomic data and 24 hours recall sheet were collected by interview questionnaire with the mother. Nutritional assessment like anthropometric measurements was done.

12. Results

13. Socio-demographic characteristics VariableNumber=290Percent (%) Age (years) 10 -18162.4% 15 - 1810937.6% Sex Male19065.5% Female10034.5% Socioeconomic status low206.9% middle17761.0% high9332.1%

14. Body Mass Index

15. Intelligence Quotient (IQ)

16. Scoring of the institutes VariableNumber=40Percent (%) Scoring of the institutes low820.0% middle1537.5% high1742.5% Type of services in the institution Percent ≠ 100% Educational40100% Entertainment3997.5% Vocational3485.0% Sports37.5% Medical12.5%

17. Scoring of the mothers’ nutritional knowledge

18. Macronutrients consumption as percentage of total caloric intake Protein Energy ratio Carbohydrate Energy ratio Fat Energy ratio Mean14.568160.483524.9484 Std. Deviation1.625396.102475.44328 Median14.498261.120124.4641 Minimum7.1635.0212.36 Maximum19.9173.4846.84

19. Protein and calorie intake compared to RDA VariableNumber=290Percent (%) Protein <50% (unsafe)10.3% 50-<75%( needs improvement) 237.9% 75-<100% (accepted)4515.5% 100-<120% (normal)6221.4% 120% (unaccepted) ≤15954.8% Calorie <50% (unsafe)8228.3% 50-<75%( needs improvement) 13546.6% 75-<100% (accepted)6121.0% 100-<120% (normal)103.4% 120% (unaccepted) ≤20.7%

20. continue Protein Energy ratio <10 %41.4% 10- <15%17660.7% ≤15%11037.9% Carbohydrate Energy ratio <55 %4214.5% 55- <70 %23882.1% ≤ 70%103.4% Fat Energy ratio < 20 %4314.8% 20- < 30 %20871.7% ≤ 30 %3913.4%

21. BMI according to some socio- demographic and medical factors. Variables Total sample Under wt/normal wtOver wt/obese NumberPercent (%)NumberPercent (%) sex male 8645.3% 10454.7% female4646.0% 5454.0% Family size <5 4151.2% 3948.8% 5-<10 8442.6% 11357.4% ≤10 753.8% 646.2% Years in institution ≥ 5 11845.2% 14354.8% >5 1448.3% 1551.7% Socioeconomic status low 1260.0% 840.0% middle 7844.1% 9955.9% high 4245.2% 5154.8%

22. continue Variables Total sample Under wt/normal wtOver wt/obese NumberPercent (%)NumberPercent (%) Other disability Yes 2449.0% 2551.0% No 10844.8% 13355.2% Age 10-14 y 7943.6%102 56.4% 15-18y 5348.6%56 51.4% IQ Sever 3046.2%35 53.8% Moderate 4247.7%46 52.3% Mild 6043.8%77 56.2%

23. BMI according to nutritional knowledge score of the mother

24. Conclusion More than half of the sample were males (65.5%) and (34.5%) were females and less than one third (30.3%) of the sample has moderate mental retardation, more than one third (37.6%) was mildly mentally disabled and almost tenth was border line. A small proportion (4.5%) of mentally disabled children were underweight, less than half (41.0%) of them were normal, about quarter (26.2%) were at risk of obesity and (28.3%) of the sample are obese. The prevalence of obesity in females is (30.0%) and (27.4%) in males.

25. Conclusion Analysis of 24 hours dietary recall sheets revealed major deficiencies in their calcium and iron intake. Caloric intake needs improvement in (46.6%) of the sample, while (28.3%) has unsafe low intake. Mentally retarded children are lacking physical activity. IQ and socioeconomic and demographic factors don’t appear to affect body mass index.

26. Recommendations Integration of eating behavioral modification program, nutrition education, physical activity and familial support. Parent involvement for ensuring home support for the development of new behaviors. They exert a powerful influence on the eating activity, and attitude patterns of their children. Recognize the barriers to exercise and healthy diet and explain these to the patients and their families

27. Recommendations Encouragement of physical exercise in institutes, and in the child's home under the supervision of their teachers and their parents. Be aware of suitable exercise programs (for example, wheelchair sports groups) and nutrition/diet programs within the region and make these available to affected families.

28. Recommendations Monitor the weight development of the disabled children or adolescents, and in case of rapid weight increase inform patients and their families, about the overweight and its individual effects on the underlying disease National studies were recommended to precisely detect the magnitude of obesity among mentally disabled at all age groups and to probe all possible risk factors. This will be the base for nation-wide prevention and control program.

29. Thank You