The impact of an integrated nutrition program on parental nutrition knowledge, mealtime behaviour and nutritional status of children with neurological impairments

1- An integrated nutrition training program (INTP) which adopts multidisciplinary approach in dealing with chronic malnutrition among children with neurological impairments has shown to produce positive impacts on children feeding skills and their health outcomes (Marchand V & Motil KJ, 2006) 2- This INTP was developed based on caregivers-health specialist discussion and recent literatures (Adams et.al, 2012; Das et. al, 2017; Mlinda et. al, 2018). It was designed as an early growth failure prevention as well as treatment for those who had clinically significant growth faltering. 2- The main topic of INTP is on safe feeding components which include nutrition knowledge, good positioning, chewing & swallowing stimulation, modification of food texture, responsive feeding techniques and feeding behaviour therapy. Among activities conducted were the modification of feeding utensils, stimulating chewing ability, demonstration of communication technique at mealtime and good behaviour skill training (i.e. rewards, positive reinforcement). Materials such as INTP module, healthy plate, feeding videos, kitchen appliances for texture modification, NUK sensory brush, corner chair and examples of modified feeding utensils were used during INTP. 3- Caregivers who registered their children with neurological impairments at 35 community-based rehabilitation (CBR) centres were invited and asked to sign a consent form if they agreed to participate. Then, purposive sampling based on the CBR distance from the research institution is used to assign consented caregivers into two groups. Those attended CBR within 40km from research institution were allocated as intervention while those located more than 40 km were assigned as the control. After group assignment, caregivers in the intervention required to attend the 6-session training within 3 months period i.e. once every two weeks. 4- This training should be conducted by a dietician. In this study, a trained dietician researcher conducted 6-sessions of training based on the prepared INTP module. Twenty minutes were spent on educational talk while 40 minutes were spent on practical session/skill training, where caregivers required to implement the skills together with their children. 5- Mode of delivery - each training session was conducted in a group where dietician act as facilitator and caregivers were encouraged to implement the skills as well as participate in the group discussion 6- Each training was conducted at the nearest community-based rehabilitation centres for caregivers. 7- Caregivers required to attend 6-sessions of INTP within 3 months period whereby training session was conducted once every 2 weeks i.e. session 1 & 2 in the first month, session 3 & 4 in the second month and session 5 & 6 in the third month. Each session lasted for only one hour. 8- No individual tailoring is made in this intervention 9- No modification is made for intervention in particular 10-We tried to maintain the fidelity of the intervention by contacting each caregiver prior to the training session