Prevalence of Malnutrition and Contributing Factors in Children With Cerebral Palsy in Malawi: A Case-Control Study

Children with cerebral palsy (CP) are at increased risk of malnutrition, yet no population-level data exist for this group in Malawi. This study aimed to estimate the prevalence of undernutrition among children with CP in Malawi compared to peers without CP, and to explore contributing factors. This cross-sectional case-control study was conducted in Mangochi District, Malawi. A total of 260 children aged 2-18 years with clinician-confirmed CP were enroled alongside 259 age- and sex-matched controls. Nutritional status was assessed using standard anthropometric measures. Feeding difficulties and household food security were captured using existing tools. Linear regression examined factors associated with weight-for-age (WAZ) and BMI-for-age z-scores (BMIZ). Children with CP had significantly worse nutritional status across all anthropometric indicators compared to controls. Stunting (90.9% vs. 45.6%), underweight (81.5% vs. 33.2%), and wasting (42.2% vs. 12.3%) were substantially higher in the CP group (all p < 0.05). Feeding dependency was prevalent in 64.7% of children with CP versus 14.5% of controls. Severe motor impairment (GMFCS IV-V), spastic CP subtype, and greater feeding difficulties, were independently associated with lower WAZ and BMIZ scores. In conclusion, malnutrition is highly prevalent among children with CP in rural Malawi, far exceeding national and regional estimates. Disability-inclusive nutrition guidelines, caregiver feeding support, and integration of CP-specific care into existing nutrition programmes are urgently needed.