SANTE MEDICAL COLLEGE SCHOOL OF PUBLIC HEALTH

NUTRITION DEPARTMENT

THE PREVALENCE OF MALNUTRITION ON DISABLED PEOPLE

AMONG AKAKI KALITI SUB CITY, ADDIS ABABA, ETHIOPIA

By:- Abebe Lobago Ebero(BSc)

June 26, 2023

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 SANTE MEDICAL COLLEGE SCHOOL OF PUBLIC HEALTH
NUTRITION DEPARTMENT

THE PREVALENCE OF MALNUTRITION ON DISABLED PEOPLE

AMONG AKAKI KALITI SUB CITY, ADDIS ABABA, ETHIOPIA

By:- Abebe Lobago Ebero(BSc)

Advisor:- Trhas Tdesse (PhD)

A THESIS PROPOSAL SUBMITTED TO SANTE MEDICAL COLLEGE SCHOOL OF

PUBLIC HEALTH NUTRITION DEPARTMENT IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH NUTRITION

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DECLARATION
I, the undersigned, declare that this proposal is my original work and has not been presented for
partial requirement of degree in any other institution and that all sources and materials used for
the work have been fully acknowledged.
Student’s Name:
Abebe Lobag Ebero ________________ _____________
Candidate Signature Date
This is to certify that the above declaration made by the candidate is correct to the best of my
knowledge as an advisor.
Approved by thesis advisor:
Trhas Tdesse (PhD)________________ ______________
Signature Date

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ACKNOWLEDGMENTS
First of all, I would like to thank my Heavenly Father for His Grace, benevolence and for giving
me the determination to overcome many trying moments to pursue my dreams. I acknowledge
with extreme gratitude the professional supervision from Trhas Tdesse (PhD). Her attention
to every detail and academic precision provided me the necessary direction and focus for my
study.

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TABLE OF CONTENTS

DECLARATION.............................................................................................................................................III
ACKNOWLEDGMENTS................................................................................................................................IV
TABLE OF CONTENTS...................................................................................................................................V
ACRONYMS AND ABBREVIATIONS.............................................................................................................VII
LIST OF TABLES.........................................................................................................................................VIII
LIST OF FIGURES.......................................................................................................................................VIII
Summary....................................................................................................................................................IX
CHAPTER ONE INTRODUCTION....................................................................................................................9
1.2. Background of the problem..............................................................................................................9
1.2. Statement of the Problem................................................................................................................1
1.3. Research Questions..........................................................................................................................3
1.4. Significance of the Study...................................................................................................................3
CHAPTER TWO RELATED LITERATURE REVIEW............................................................................................3
2.1. Basic Concepts of Disability..............................................................................................................4
2.1.1. Disability Types..............................................................................................................................4
2.1.2. Disability in Ethiopia......................................................................................................................5
2.2. Nutrition and its Concepts................................................................................................................6
2.2.1. The Nexus between Nutrition and Disability.................................................................................6
2.2.2. Disability and Poverty....................................................................................................................7
2.3. Causes of Malnutrition among Children with Disability....................................................................7
2.4. The challenges faced by mothers/caregivers with children with disabilities....................................8
2.5. Nutritional Assessment: Methods....................................................................................................9
2.6. Conceptual Framework...................................................................................................................11
CHAPTER THREE OBJECTIVES OF THE STUDY.............................................................................................12
3.1. General Objective...........................................................................................................................12
3.2. Specific Objectives..........................................................................................................................12
CHAPTER FOUR RESEARCH DESIGN AND METHODS..................................................................................13
4.1. Description of the Study Area.........................................................................................................13

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 4.2. Research Design..............................................................................................................................13
4.3. Study Population............................................................................................................................14
4.3.1.2. Exclusion Criteria......................................................................................................................14
4.4. Population sources.........................................................................................................................14
4.5. Sources of data...............................................................................................................................14
4.6. Techniques and procedures for sampling.......................................................................................14
4.7. Sample Size Determination.............................................................................................................15
4.8. Tools and Techniques in Data Collection........................................................................................16
4.8.1. Pretesting a Study Questionnaire................................................................................................16
4.8.2. Questionnaire..............................................................................................................................16
4.8.3. Anthropometric Measuring.........................................................................................................17
4.8.4. Dietary Diversity Scoring (DDS)....................................................................................................17
4.9. Quality of Data Management.........................................................................................................17
4.10. Techniques of data analysis..........................................................................................................18
4.11. Ethical Considerations..................................................................................................................18
4.12. Operational Definitions.................................................................................................................19
5. WORK PLAN.......................................................................................................................................20
6. Budget Plan.......................................................................................................................................21
REFERENCES..............................................................................................................................................22
Appendix...................................................................................................................................................26

ACRONYMS AND ABBREVIATIONS

ACPF - The African Child Policy Forum
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BMASK - (Bundes Ministeriumfür Arbeit, Soziales und Konsumentenschutz)
CSA - Central Statistics Agency
CWD - Children With Disability
FANTA - Food and Nutrition Technical Assistance
FAO - Food and Agriculture Organization
FDRE - Federal Democratic Republic of Ethiopia
FMLSACP - Federal Ministry of Labor, Social Affairs and Consumer Protection
HIDDS - Household Dietary Diversity Score
IDDS - Individual Dietary Diversity Score
IDEIA - Individuals with Disabilities Education Improvement Act
IFAD - International Fund for Agricultural Development
IFPRI - International Food Policy Research Institute
IMNCI - Integrated Management of Newborn and Childhood Illness
MAM - Moderate Acute Malnutrition
MOLSA - Ministry of Labor and Social Affairs
MUAC - Mid Upper Arm Circumference
NACS - Nutrition Assessment, Counseling, and Support
NGO - Non-Governmental Organization
NICHCY - National Dissemination Center for Children with Disabilities
PWD - People with Disability
SAM - Severe Acute Malnutrition
SMD - Severe and Multiple Disability
TGE - Transitional Government of Ethiopia
UNCRC - United Nations Convention on the Rights of the Child
UNICEF - United Nations Children’s Fund
WB - World Bank
WFP - World Food Program
WHO - World Health Organization

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LIST OF TABLES
Table 1. Mid Upper Arm Circumference classification based on age........................................................18
Table 2. Weight-for-height z-score (WHZ) cut-offs for classification of nutritional status.......................19
Table 3. Distribution of children with disability in studied area, Ethiopia Addis Ababa Akaki Kality......23

LIST OF FIGURES
Figure 1. Conceptual framework of nutrition and disability Source: constructed by the researcher...........20
Figure 2.Map of Akaki Kality Source: (24)...............................................................................................22

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Summary
Malnutrition and disability are interconnected especially in countries suffering from high levels
of malnutrition including Ethiopia. Children with disability are prone to malnutrition due to
different factors. The study was aimed to assess the nutritional status and its causes among
children with disabilities aged from six months to seventeen years old, in Akaki Kaliti sub city
Wereda 03 of Addis Ababa. This study used cross-sectional study design and the sample size was
determined by using Cochran (1977) formula and adjusted by a formula for finite population to
draw the final 272 households and children with disability. Anthropometric measurements:
height/length, weight, and mid-upper arm circumference (MUAC) will be used to study their
nutritional status. Results will be entered to SPSS 20 for further descriptive statistical analysis.
Mid-Upper Arm Circumference (MUAC) and Body Mass Index (BMI) measurement indicates
55.1% and 58.1% respectively was grouped under normal nutritional status. However, the rest
44.9% and 37.5% respectively are under moderate and severe acute malnutrition. 35.3% of
children with disability were not able to feed properly due to poor appetite, restlessness,
pharyngeal atresia, and preference of food items. The type of disability the children have, family
size, occupation and income of the household heads, and inability to take food were statistically
significant relationship and considered as underlying causes for their nutritional status.
Children with multiple disabilities, especially those children who are not able to take food
should get the required nutrition and different types of care and support services. It is important
to establish disability specific service points in health institutions and mothers/caregivers should
get counseling regarding the needs of their children with disability.
Keywords: Malnutrition, Disability, Micronutrient intake, Children, Anthropometric
Measurements.

CHAPTER ONE INTRODUCTION

1.2. Background of the problem
Malnutrition is a global public health problem. One in three suffers from malnutrition (1). The
link between malnutrition and disability has several aspects. Malnutrition leads to disability and
increases susceptibility to other disabling diseases (2). There are more than a billion people with
disabilities worldwide, about 15% of the total population or one in seven people. Among them,
between 110 and 190 million adults face serious problems in their daily activities. In addition, 93
million children, or one in 20 people with multiple disabilities, are under the age of 15 (3). World
Health Organizations and World Bank argues that the prevention of health problems caused by
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disability and nutritional deficiencies has been recognized as a development issue that deserves
due attention. Southeast Asia and sub-Saharan Africa, where malnutrition and nutrient
deficiencies are high, have higher numbers of people with disabilities and developmental delays
than others (4; 5). Tompsett and her colleagues argue that malnourished children grow into
adults with various health problems (eg, lower physical and mental abilities, lower productivity,
and higher levels of chronic disease and disability) (6). In Africa, 83 million children under the
age of five are malnourished, which in most cases negatively affects their health and leads to
disabilities (6). In addition, (2) points out those children with disabilities (CWD) living in
poverty may face problems related to inadequate nutrition due to financial constraints or social
beliefs. In Ethiopia, where malnutrition and poverty are high, almost a quarter of the Ethiopian
population is malnourished and the proportion of people suffering from severe malnutrition is
higher (7).For example, the number of children with disabilities between the ages of birth and 19
years of age is estimated at 300,392 in 2017 (8). Poverty, ignorance, war and drought were
considered causes of disability. The situation has been compounded by poor nutrition, limited
access to health care, education services and the high prevalence of harmful traditional practices
(9). Therefore, in 2012, the Ethiopian government developed the National Action Plan for People
with Disabilities to ensure full participation and equal opportunities for people with disabilities
and thus improve their situation in all areas of life. However, the nutritional problems of these
social classes have not been addressed (10).Therefore, the National Nutrition Program was
created to end hunger by 2030 (11). However, this article does not consider the link between
malnutrition and disability (4). Therefore, an assessment of the nutritional status and its causes is
carried out in a group of children with disabilities and their caregivers.
1.2. Statement of the Problem
Studies in various parts of the world show that health problems, socio-economic factors, lack of
food resources, poverty and high unemployment rates, education or nutrition of parents and
mothers, household income status, difficulties with feeding, and a failure to perform basic daily
tasks are all contributing factors. Self-feeding, recurrent infections and other related factors are
all contributing to disability. Malnutrition is a factor in the development of health issues such as
disability. According to a study conducted in Turkana Kenya, children with disabilities tend to be
more vulnerable to malnutrition when it occurs in large numbers among all children. (12). The
study done in Nigeria shows that malnutrition is a problem for all children with disabilities, but
especially those younger than 10 years old (6) also stated that the economic conditions of parents
can affect their response to their child's situation (14). Poverty is detrimental to household
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income. In particular, it can affect the way parents respond to their disabled children (14). A
study in Hawassa that shows children with disabilities have a higher risk of food deficiency
compared to those without. People with disabilities face a higher level of poverty and joblessness
than those without disabilities. In addition, the causes and extent of nutritional problems they
face on a daily basis have not yet been fully explored (15). Education and nutrition knowledge
by mothers are important for children's health. 2005), In addition, difficulty in feeding due to the
disability that they have worsens their nutritional status (16). According to study conducted in
Nigeria on the effects of disability, children are unable to perform daily tasks such as self-
feeding. The result is a poor nutrition status. Children with disabilities are more likely to suffer
from malnutrition than children without the issue (17). Moreover, some studies suggested that it
was necessary to improve the income status of households, especially in poor countries like
Ethiopia. Ethiopia offers little support to disabled children (18). Many parents complain that it is
difficult to obtain meaningful information regarding the type and prognosis for the disabilities
that affect their children. There are also no counseling services available to help them feed and
care for the child. There are no official statistics about the strong link between poverty, disability
and health. Malnutrition and feeding difficulties are common among children with disabilities.
They can result in impaired growth, neurodevelopment, cardio-respiratory and gastrointestinal
systems, as well as immune and cardio-respiratory impairments (19). Brothers of Good Works of
the Ethiopian Catholic Church, on the other hand has implemented community-based services
for rehabilitation, health services and nutrition assistance to more than 400 disabled children in
Akaki Kaliti sub city. Children who receive support are facing serious health and rehab
problems. These services include: physiotherapy and appliances, health care services,
counseling, social inclusion, and schooling. It is also possible to provide nutritional food for
CWD children who are malnourished and at health centers. The staff at the organization told us
that the children with disabilities admitted to this program had different problems. Some of them
have poor personal hygiene, and they are covered in urine and faces. Additionally, they appear
emaciated. Their age, height, and weight are not recorded as proportionately in their health
history. The children with disabilities. Direct observation of their physical and socio-economic
conditions of children with disability proves that this problem is prevalent among them. In the
absence of data and documentation, it is difficult for the Organization to know how to intervene
or which problem to concentrate its efforts on. It is not documented and studied the problem of
nutrition status for children with disabilities in the study region. During the intervention, the

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Organization noted that there were gaps in identifying nutritional status and determining the
relative importance of different factors affecting the nutrition of these children. Since there were
no studies looking at the causes behind the nutritional status of children with disabilities, it was
difficult for the Organization to know what to do. This study was designed to determine the
nutritional status of disabled children and their underlying causes. In order to assess the
nutritional status, we used questionnaires, anthropometric measures and Dietary Diversity Scores
(DDS) for children with disabilities between six months and 17 years old.
1.3. Research Questions
The research questions are:
1. What is nutritional status for children with disabilities, aged six months to 17 years in the
area of study?
2. What are the main causes of the nutritional condition of children with disabilities in the
study region aged six months to seventeen years?
1.4. Significance of the Study
There is little data on the nutritional status of Children with Disability in this study area. The
majority of studies are mainly focused on inclusive education for people with disabilities, rather
than their nutritional state. There are many actors working in Ethiopia to provide care and
support for Children with Disability. Little is known, however, about their nutritional state.
Assessment of the nutritional status is important to inform all interested parties and to determine
the problems and causes that these children face. The results of this study provide useful
information for Woreda and Sub-City level planners as well as policy makers, researches and
development agents in both the government and non-governmental organizations working in
countries with similar social, cultural and physical environments.
CHAPTER TWO RELATED LITERATURE REVIEW
In this chapter, related literatures were reviewed in understanding and defining disability,
nutrition, basic concepts, causes, and the challenges.
2.1. Basic Concepts of Disability
The definition of disability connotes different meanings in different cultures by different
scholars. For instance, Stone stated that, in Britain there is a radically different way of thinking
about disability and developed ‘Social Model of Disability’ to make a difference to the lives of
disabled people (20). Disability was defined by the Australian Government National Action Plan
on Disability 2012-2020, the effect lasting more than six months with physical, mental or
psychological damage or an impairment of the sense organs for the normal participation in the
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society for day-to-day life events (21; 11). Based on the World Health Organization and
International Labour Organization’s definitions on disability, Ethiopia has defined as follows:
“A disabled person is any person unable to ensure by himself or herself a normal life, as a result
of deficiency in his or her physical or mental capabilities (22)”. In “Negarit Gazeta” the
Transitional Government of Ethiopia (TGE) Proclamation No. 101 of 1994 referred to:
“A disabled person means a person with unable to see, hear, speak or is suffering from injuries to
his limbs or from mental retardation, due to natural or manmade causes.” (23)
In addition, according to CSA a person who was unable to carry out activities for daily living
that others can do due to different types of impairments was identified as a disabled person (24).
Children with disabilities are one of the most disregarded groups of children, suffering from
extensive defilements of their rights (25). According to the UNCRC, a child means every human
being below the age of 18 years unless under the law applicable to the child (26).
2.1.1. Disability Types
The cause of the disability will determine its nature. This is how disability can be classified.
People with profound and severe intellectual disability are people who have different types of
disabilities and are extremely disabled. They cannot carry out daily tasks and have difficulty
communicating. They may have multiple disabilities at once (27). The term "severe and multiple
disabilities" (SMD) is used to describe a person who has one or more mental and emotional
problems, as well as physical ones, that require medical, educational, or psycho-social services
(28). Inclusion Europa said that people with severe disabilities were more susceptible to various
violations. They are mostly dependent on their caregiver or person of contact. Additionally, they
don't understand what to drink or eat (27).
Disability classification is based on the type of disability and physical difficulties in performing
certain tasks. Under the Individuals with Disabilities Education Act, (IDEA), there are 13 main
categories of disability based on severity and characteristics.
1. Multiple disabilities: is the presence of functional issues of two or three types of disabilities
in one individual. It is associated impairments like, mental retardation-blindness or mental
retardation, orthopedic impairment, the combination of which causes difficulty in attending
education. This does not include blindness or deafness (29).
2. Intellectual disability/Mental retardation: is the sub-average level of intellectual
functioning, which occurs simultaneously with difficulty in adaptive behaviors.
3. Autism: Autism is a serious developmental problem that significantly affects communication,
social interaction and most often appears before age 3.
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4. Deafness: This is a hearing impairment so severe that it affects the child's ability to process
verbal communication. It can be with or sans amplification.
5. Deaf blindness: A person who has both hearing and vision impairments.
6. Hearing impairments: These disabilities include difficulties with the identification of parts of
the hearing and voice as well problems related to rising and falling in position, level and quality
voice.
7. Visual impairment: This is a visual problem (including blindness), which, even when
corrected, can negatively affect a child's performance in school.
8. Orthopedic impairment: is a term used to describe physical disabilities including those
caused by congenital conditions, disease and other causes.
9. Learning disability: is a disorder that affects one or more cognitive functions, such as
memory, comprehension, and communication. It can be caused by brain damage, minimal
cerebral dysfunction, dyslexia, or developmental aphasia.
10. Emotional disturbances: This is a form of disability in which a child who has typical
intelligence struggles to establish and maintain relationships with others. The child may respond
inappropriately to normal situations or show unhappiness that permeates their mood.
11. Speech/language disorder: This is a communication problem such as stuttering.
12. Traumatic Brain Injury: A brain injury acquired by an external force those results in
functional or psychosocial impairment or both.
13. Another health impairment: having limited strength or vitality due to chronic or acute
health issues. Examples include bipolar disorder, dysphasia or other organic neurological
disorders.
2.1.2. Disability in Ethiopia
Ethiopia has no current statistics on disability. According to the World Report on Disability
published jointly by WHO and the WB in 2011, 17.6% of Ethiopians are disabled (30). Ethiopian
Central Statistics Agency Population Projections Document prepared in 2013, indicated that
Ethiopian population is projected to be 94.352.139 in 2017 (9). In the same time period, Addis
Ababa, Akaki Kaliti sub city, and Addis Ababa were estimated to have a population of 3,435,028
each. At the end 2017, the projected number of disabled people in Ethiopia was 1,037.874. The
projected numbers for Addis Ababa, Akaki Kaliti sub city, and Addis Ababa were 41,220, and
4,696. Furthermore, among the persons with disability Akaki Kaliti sub city has 932 disabled
children ranging from birth up to 19 years (9).

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In Ethiopia, the Ethiopian National Plan of Action of Persons with Disabilities (2012) estimates
that 95% of people with disabilities are below poverty level. According to the Ethiopian National
Plan of Action for Persons with Disabilities (2012-2021), 95% of persons with disabilities in
Ethiopia live below poverty line. Physiotherapy/rehabilitation services in Ethiopia are also
limited and accessible only in urban centers (11).
2.2. Nutrition and its Concepts
In 2016, an estimated 815,000,000 people were considered undernourished, a rise from
777,000,000 in 2015, but still lower than the approximately 900,000,000 in 2000. In 2016, the
prevalence rate of undernourishment was estimated at 11 percent, which is still far below what it
was a decade before. This recent increase in hunger is still a major concern. It poses a serious
challenge to the international commitments made by FAO and others to end world hunger by
2030. The food security situation in Sub-Saharan Africa, South-Eastern Asia, and Western Asia
has also deteriorated. Most notably, the situation has deteriorated in areas of conflict. This is
often compounded with droughts or flooding (31).
2.2.1. The Nexus between Nutrition and Disability
Malnutrition, along with disability, is a major health problem worldwide. Worldwide, it is
estimated that 1 billion people have moderate to severe disabilities. WHO in 2015 estimates that
around 93 million of those are children below the age of 15 (32). According to Nora Eleanor and
Marko, there are nearly one billion malnourished individuals in the world. The two are
interconnected, as one leads to the other. This is due to a lack in nutrition among mothers and
their young children, which leads to disability. Different health issues affect the nutritional status
of disabled children. In this context, meeting the child's nutritional requirements becomes vital.
Nutritional status can be affected by issues such as slower oral-motor growth - larger teeth and
tongues; challenges with chewing; food texture preferences; constipation; picky-eating (or eating
the same foods); or weight gain (33).
Due to the strong correlation between nutrition, disability and food intake, there are many health
problems that can result in disabilities such as physical, intellectual or sensory (34). UNICEF's
(2013) Report states that between 250,000 and 500,000 children become blinded every year
because of vitamin A deficiencies. This can easily be prevented with inexpensive oral
supplements. Children with disabilities already present are at greater risk of malnutrition.
Children with cerebral palsy or other physical disabilities may experience significant difficulty in
chewing, swallowing or even feeding themselves. This can have severe nutritional implications.
After becoming disabled, many children face severe food insecurity (25).
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2.2.2. Disability and Poverty
Poverty and disabilities are closely linked. While poverty traps people in poverty, disability is the
major cause of disability. Children from poor families are more susceptible to disability due to
inadequate healthcare, malnutrition or lack of access clean water and sanitation. They may also
be exposed to dangerous working and living conditions. Children who live in poverty have a
higher risk of developmental delays as compared to those from a higher socioeconomic
background.
In addition, a large proportion of persons with disabilities live in poverty in particular in
developing nations. They are also excluded from education, job trainings and employment.
These factors make it more likely that children with disabilities will be poor for the rest of their
lives (25). Disability and poverty are linked in a cycle of poverty causing disability and vice
versa (35).
2.3. Causes of Malnutrition among Children with Disability
Malnutrition can be caused by certain disabilities in children. These children may have problems
with their oral motor/mechanical structure, which can lead to reduced nutrient intake. A child
who has a cleft lip or palate may have difficulties sucking, chewing, and eating. Children with
cerebral Palsy often have difficulty eating, which can lead to malnutrition, illness, and even early
death (36). Similarly constipation, dysphasia, poor health status (gastroesophageal atresia),
respiratory tract infections and behavioral problems such as restlessness that result in difficulty
feeding are factors contributing to the occurrence malnutrition among children with disabilities
(37).
Children with disabilities face different risks and causes for malnutrition. These include
inadequate nutrition, poor sanitation, illness and infection, insufficient child care, violence and
neglect. These factors can increase vulnerability to malnutrition (38). Parents/caregivers can also
assume that children with disabilities will not be successful or grow as a result. This may lead to
a discouragement of breastfeeding and a reduction in food intake, or even a refusal to feed them
at all. In addition, negative attitudes toward disability can lead to mothers/caregivers being
isolated, lacking the necessary socio-economic assistance, and having limited access
information. These factors can affect the health and development a child who has a disability
(38).
Children with disabilities also suffer from a shortage of important nutrients that are necessary for
normal growth and the development of body tissue. The nutrients in food, such as protein,
carbohydrates fats, fiber, vitamins, minerals, and water, are vital for normal development.
XVI
Micronutrient deficiencies can be caused by a reduced intake of nutrients and/or a decreased
ability to absorb them. Iron, vitamin A, iodine and other micronutrients are the most common
types of deficiencies (31).
The causes of malnutrition among children with disabilities are numerous, and include both
nutritional as well as non-nutritional issues. Inadequate dietary intake is the main cause of
malnutrition in children with disabilities, including gastrointestinal disorders like oral motor
dysfunction, gastro esophageal acid reflux, and constipation. In determining the nutritional status
of disabled children, non-nutritional variables include the type and degree of disability, mobility
difficulties, and socioeconomic issues (39).
2.4. The challenges faced by mothers/caregivers with children with
disabilities
It is assumed that disabled children are unable to acquire the necessary skills to live
independently and cannot learn. People tend to view them as weak, hopeless and incapable of
learning. They are also viewed as being in need of charity. Parents with negative attitudes toward
children with disabilities can isolate, hide, deny them food, access to education and social
interaction. Due to the religious and cultural beliefs of a family, it is not uncommon for them to
be subjected social stigma and discrimination.
The studies in Namibia claim that extreme poverty is a major challenge for mothers or caregivers
with children with disabilities (40). This situation worsens in low-income households, and
especially in those where the income is based on daily labor. Children with disabilities require
more care and attention, as they may need additional services. Extended family may be able to
share their time and efforts in caring for the disabled child (40). According to Girma
Woldemariam and Timotiows Genebo, the nutritional status of women is related to their marital
status. Divorced and separated women tend have a poorer nutritional status compared with
married women (41).
2.5. Nutritional Assessment: Methods
It is the process by which an individual or a group can be assessed for their nutritional status,
using various techniques, at any given time. It is a way to determine the appropriateness of the
relationship between dietary intakes and metabolic needs (42). It is possible to obtain
information from nutritional assessments about the geographical distribution of certain
conditions and their occurrence within a particular community (42). The ability to identify
nutritional insufficiencies in high-risk populations and assess the impact of different
epidemiological variables is another advantage (43). The studies claim that nutritional
XVII
 assessments have many advantages. They help in detecting malnutrition; they assess the state of
nutrition, and then determine if any interventions are needed. Specially, it has an impact on
children as they are more susceptible to nutritional problems and their health is affected (42).
When assessing nutritional status we use both direct and indirect nutritional assessment methods.
In assessing nutrition status, direct methods are used for individuals to measure objective criteria,
while indirect methods use community health indexes that show nutritional influences (44).
Nutritional assessment involves interpreting methods such as dietary intakes, anthropometry
variables, biochemical and hematological variables and clinical and physiological assessment
methods to determine whether a person is well-nourished or not (45). The purpose of nutritional
assessment will determine whether a particular method is used or if a combination of different
methods are recommended.
Anthropometry - A method for assessing growth or changes in the human body. This method
uses height/length, body weight, skin fold thickness, head circumference and other
measurements to detect changes in the composition of the body. It can be used for assessing the
nutritional status of specific population groups such as newborns, children and adults under the
age of five.
Dietary assessment: This method uses three different approaches. The respondents are asked
about the food and beverage they consumed in the past 24 hours, the frequency of food
consumption, and a 3-day food diary. The food intake and the Recommended Dietary
Allowances are compared (43). According to the FAO Household/ Individual Digestion
Diversity Score Tercile (46; 47) if an individual takes at minimum 1-3 food group is low IDDS,
if it's equivalent to 4-5 foods it's medium IDDS, and if it's 6 or more it's high IDDS.
Micronutrient consumption is used to determine the nutritional status of an individual.
Mid Upper Arm Circumference: This is the circumference measured on the upper arm at the
point between the elbows and the shoulder. It can be used to quickly and easily determine the
nutritional status of children and adults, such as severe acute malnutrition, moderate acute
malnutrition, and normal nutrition status, as shown in Table 2.
Table 1. Mid Upper Arm Circumference classification based on age

MUAC level and nutritional status classification

Age groups
SAM MAM Normal

Children 6 - 11 months old < 11.0 cm 11.0 – 12.0 cm > 12.0 cm

Children 12 - 59 months old < 11.0 cm 11.0 – 13.0 cm > 13.0 cm
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Children 5 - 9 years old < 13.5 cm 13.5 - 14.5 cm > 14.5 cm
Children 10 - 14 years old < 16.0 cm 16.0 – 18.5 cm > 18.5 cm
Adults < 18.5 cm 18.5 – 21.0 cm > 21.0 cm
Source: Adapted from WHO, (48; 49).
Body Mass Index: This is the easiest way to relate weight and height with health outcomes.
WHO (50) defines BMI as a simple measure of weight-to height that is used to determine adult
obesity, underweight and overweight. If a person's BMI is less than 17.0 kg/m2, it indicates
severe and moderate thinness. Underweight is defined as =18.5kg/m2, >=18*5kg/m2, and
24.9kg/m2 are considered normal. A BMI of >=25kg/m2 or 29.9kg/m2 is considered overweight.
>=30kg/m2 is obese (51). Weight-for-height Z-scores of -2.0 and higher are considered to be
normal nutritional status. The weight-for-height z score of -3.0 or less is considered moderate
acute protein energy malnutrition. Severe protein-energy malnutrition can be defined as a z score
of less than -3.0 (51).
Table 2. Weight-for-height z-score (WHZ) cut-offs for classification of nutritional status

<-3 ≥-3 to <-2 ≥-2 to ≤+2 >+2 to ≤+3 >+3

Normal
Severe acute malnutrition Moderate acute
nutritional Overweight Obesity
(SAM) malnutrition (MAM)
status
Under nutrition Over nutrition
Source: (31)

2.6. Conceptual Framework

The mother's education and employment can lead to a better income as well as improved access
to health services and sanitation. All of these factors may also have a positive influence on the
nutrition status of a child with a disability. Poor sanitation, insufficient health services,
inadequate maternal and infant care, and inadequate food access all interact to affect the
nutritional status. Sanitary facilities that are not safe can also spread waterborne diseases, which
may lead to disabilities and malnutrition. A lack of care for mothers and babies is crucial in
preventing disability. In households with access to antenatal monitoring and vaccination
coverage, there are fewer cases of disability and poor nutrition.

XIX
A lack of food and diseases can lead to disability. It leads to a decrease in appetite, which
increases the need for nutrients. The body is also more susceptible to illness and infection due
the inadequate intake of good quality food. In adulthood, malnutrition can lead to chronic illness.
It may even have intergenerational consequences as women with low weight are more likely to
be malnourished. Malnutrition can worsen or be precipitated by a combination of infection and
lack food. This study examined the nutritional status, and the causes thereof, of children aged six
months to 17 years with disabilities.

Figure 1. Conceptual framework of nutrition and disability Source: constructed by the researcher

CHAPTER THREE OBJECTIVES OF THE STUDY

3.1. General Objective
This study had as its general objective to evaluate the nutritional status, and the underlying
causes of it among children with disabilities aged between six months and seventeen years in
Akaki Kaliti sub city Addis Ababa.
3.2. Specific Objectives
The specific objectives of the study were to:
 Assess the nutritional status for children with disabilities aged six months to 17 years old,
in Akaki Kaliti sub city Addis Ababa.
XX
  Identify the main causes of the nutritional condition of children with disabilities in the
area studied, aged six months to seventeen years.

CHAPTER FOUR RESEARCH DESIGN AND METHODS

4.1. Description of the Study Area
This study is being conducted in Addis Ababa - the capital of Ethiopia's Federal Democratic
Republic - specifically the Akaki Kaliti sub city. Addis Ababa, a chartered city, has three levels
of government. These are the city government, sub city administrations and district
administrations. The area of Addis Ababa is approximately 527km2, and its population will be
estimated at 3,435,028 by 2017 (9). The City is the political, social and economic hub of the
country. It is the seat of African Union and United Nations Economic Commission for Africa.
Akaki Kaliti sub city in Addis Ababa is one of Addis Ababa’s Sub-Cities. It is located near
Mountain Entoto, and the Entoto Natural Park. Its coordinates are: 9deg 14’ 0” North, 38deg 41’
0” East. It borders the districts of Kolfe Keranio Addis Ketema Arada and Yeka Sub Cities. It
has a total of 30, 18 km2. The Sub-City has also been divided into ten Woredas. In Akaki Kaliti
sub city (24), there were 3 738 persons with disabilities, and 742 children with disabilities aged
between 0-19 years. The latest data for 2017 based upon the population projections report by
CSA (9) shows that the total population in Akaki Kaliti sub city should be 335 434. In this
context, it is estimated that the total number of persons with disabilities will be 4,696, and those
aged from birth up to 19 years of age will be 932. In the Sub City, 39 institutions of health are
present (3 hospitals and 7 health centers).Figure
4.1. Map of the study area

Figure 2.Map of Akaki Kality Source: (24)

XXI
4.2. Research Design
In order to meet the stated goals, a cross sectional study design is used to assess nutrition status
and examine causes in the population studied. This includes capturing the best quantitative and
qualitative aspects to the problem. This design is useful for collecting, analyzing and mixing
quantitative and qualitative data. It also provides a better understanding of the nutritional
assessment of disabled children than either approach.
4.3. Study Population
The study is to be carried out in Akaki Kaliti sub city wereda with a focus on five Woredas. The
study will be conducted in Akaki Kaliti sub city specifically focusing on five Woredas. These
selected Woredas have 458 children from birth to age 19 with disabilities. Ethiopian Central
Statistics Agency's population projection report from 2013 will be used as a guide to estimate the
size of the study region. Data on persons with disabilities was taken from the Ethiopian Census
of 2007. It will also be estimated by comparing the percent (Rate for 10,000) to the 2017
population.
3.3.1. Inclusion Criteria and Exclusion Criteria
In this study, the mothers/caregivers of children with disabilities and their characteristics were
studied. In this study, children with disabilities aged six months to seventeen years old were
selected from five Woredas within Akaki Kaliti sub city.
4.3.1.2. Exclusion Criteria
The children who were bedridden, less than six months old, or older than 18 years of age, or
those who were not home at the time of sample collection, as well as those with severe
medical/clinical problems that led to hospital admission, weren't included. The study excluded
children with amputated or contracture extremities.
4.4. Population sources
Included in the study are mothers/caregivers with children with disabilities and children aged
between 6 months and 17 years.
4.5. Sources of data
The study collected information from both primary data and secondary sources. Primary data
will come from mothers/caregivers who have children with disabilities and anthropometric
measures like height, weight and MUAC measurements. As a secondary source of data, we also
used health professionals from five health centers as well as Brothers of Good Works workers on
the ground who was working with CWDs. Secondary data were collected by the Addis Ababa
Central Statistics Agency and Akaki Kaliti sub city Health Office.

XXII
4.6. Techniques and procedures for sampling
Mix of sampling techniques is used in this study. Akaki Kaliti sub city as well as its five
Woredas was selected on purpose. The sample homes with disabled children will also be
identified using a systematic random sampling. Akaki Kaliti sub city is divided into ten Woredas.
Woredas 3, 4, 5, and 7 have been selected. Sample households with disabled children aged 6
months to 17 were identified in these selected Woredas based on information (i.e. List of
households with disabled children) obtained from Brothers of Good Works Counseling and
Social Services Centre and Woreda Health offices. Then, using a systematic random sampling
method, the first eligible house will be selected. Table
Table 3. Distribution of children with disability in studied area, Ethiopia Addis Ababa Akaki Kality

Year Ethiopia Addis Ababa Akaki Kality

2007 2017 2007 2017 2007 2017

Total population 73,750,932 94,352,139 2,739,551 3,435,028 267,624 335,434

Number of PWD 805,535 1,037,874 32,630 41,220 3,738 4,696

% of total 1.1 1.2 1.4
population(Rate per
10,000)
Total population aged 41,939,071 47,837,055 1,043,850 1,132,895 98,851 123,898
from 0-19 years
Number of CWD aged 263,356 300,392 6,251 6,784 742 932
from 0-19 years

Source: CSA, 2007b; CSA, 2013 - Researcher computation (2019)

As shown in Table 3.1, the study areas Woredas 2, 3, 4, 5, and 7 have 77, 102, 53, 89, and 137
children with disability respectively. In this regard, 458 children with disability were part of the
study.
4.7. Sample Size Determination
Cochran (1977), who developed a formula to calculate the size of a representative study sample,
will be used in determining the sample size.
Where n is the sample size required
= The selected critical level of desired confidence (1.96)
p = Population proportion (assumed at 0.50 as this would allow for the largest sample size).

XXIII
q = 1-p
d = level of precision desired (0.05).
Therefore;
As the population is less than 10,000, a formula for calculating the final sample will be used.
The final sample size is fn.
n = sample size as determined by the equation above
N = Population size
Even though the final sample will be 272, 5% of the respondents will not respond. 13
respondents will have been added to the study, which will result in a sample size of 272+13=285.
In the data collection phase, 11 participants refused to take part in the interview. The rest of them
were away from home at the time of data collection. The Woreda population will be used to
calculate the distribution of sampled disabled children. This study involved 46, 61 and 31 study
participants respectively in Woreda 2, 4, 5 and 7. In the study, both children with disability and
caregivers (272 respondents), were included.
Figure 3.2.
Source: Sketched May 2019
4.8. Tools and Techniques in Data Collection
In this study, qualitative and quantitative data are used to collect relevant information on the
nutritional status and underlying causes of children and caregivers with disabilities. Interview
guides will be used to collect qualitative data as well from Woreda health officers, staff and other
key informants who are working with disabled children. During key informant interviews from
Brothers of Good Works, three field workers and five urban health extension staff from each
Woreda as well as health professionals (IMNCI nurse) from four clinics were present. The
documentary analysis template will also allow for the observation of unpublished and published
documents.
4.8.1. Pretesting a Study Questionnaire
Tests on the final questionnaire will be done with 5-10 people, who are more representative of
sample population. The final question was asked: Which questionnaire do you think is not clear,
hard to understand, uncomfortable, or boring? After identifying and fixing the main problems, a
questionnaire was revised.
4.8.2. Questionnaire
This will be used for collecting quantitative and qualitative data. A carefully constructed
questionnaire will be used, with options to rank or score or questions that are closed-ended
XXIV
and/or open-ended. Dietary Diversity Score questionnaire standard will be used in the
questionnaire with some modifications. An interview guide will be created to guide the interview
to collect qualitative information from Woreda health officers and personnel working with
disabled children.
4.8.3. Anthropometric Measuring
Height: Measure the height of children with disabilities using a measuring tape. The
measurement is taken from the recumbent height or standing height. The child with disabilities
will then be told to remove all shoes and socks, wear minimal clothing and stand straight up. The
child with disability will be instructed to lie down on a flat surface if this is not feasible. The
mothers/caregivers who were responsible for the disabled child assisted in the measurement. The
measurement will be in centimeters. This information is recorded on the questionnaire.
Weight scale will be used to measure weight. Use the manufacturer's instructions for transporting
the scales to calibrate the weight scale each day. The person who was able to stand should have
placed both feet on the center of weighing scale.
MUAC: The tape will measure the circumference of the upper arm in both samples of children
with multiple disabilities. The value is read through the window on the tape, without pinching
your arm or letting it loose.
Body Mass Index: This is calculated from weight and height. After recording the age and date, it
is calculated with the following formula and recorded.
4.8.4. Dietary Diversity Scoring (DDS).
Dietary diversity scores (DDSs) are used to assess nutritional adequacy. They refer to the
number and variety of food consumed within a certain time period, most often 24 hours.
Generally, a diet that contains at least 4 DDS is seemed nutritionally sufficient. In order to better
reflect the quality of the diet, a number of food groups will be used. For example, 12 different
food categories are used in the calculation for the HDDS: Cereals (including cereals), Fish,
seafood, Roots/tubers, Pulses/legumes/nuts, Vegetables, Milk & milk products, Fruits, Oil/fats,
Meat, poultry, Sugar/honey, Eggs, and Miscellaneous The IDDS also uses eight food categories
and is calculated using the type and quantity of food groups that are consumed in the household.
This observation also allowed the interviewer the opportunity to see visual clues, as well as
observe the body language that could indicate comfort or discomfort. The interviewer could then
proceed based on these clues.

XXV
4.9. Quality of Data Management
For the purpose of obtaining quality data, Brothers of Good Works and Urban Health Extension
Workers (HEWs), who work in the study region, were used. The data collectors will be given a
special training. Study subjects are also informed of the goal of the study, and confidentiality is
maintained. The reliability of the questionnaire format is tested prior to the main study.
4.10. Techniques of data analysis
The qualitative and quantitative information will be presented in the part on data analysis
techniques, and they will be analyzed, described, and interpreted to prepare the next phase of the
research. Although the qualitative and quantitative data will be connected, the qualitative data
analysis will be followed up by a quantitative analysis.
First, qualitative data obtained by different techniques of data collection will be analyzed. The
data collected through interviews will be compiled and interpreted.
Second, data in quantitative format will be shown either as a table. In the form of questionnaires,
biographical information and demographic data about respondents will be displayed. The
gathered data will also be analyzed using statistical tools. They will be imported into Excel sheet,
Window 10 then exported to SPSS Version 20 for further analysis. The demographic and socio-
economic characteristics will be organized using descriptive statistics, such as frequency and
percentage.
In order to determine the nutritional status of children, WHO (2009) cutoff points and FANTA
2016 will be applied. Body Mass Index measurement (BMI) for children with disabilities will
also be categorized according to WHO (2010) cutoff point chart. These categories include severe
and moderate acute nutritional malnutrition, normal weight, overweight and obese. FANTA 2016
Z scores will be used to determine nutritional status. Children with weight-for-height/length of
equal or greater -2SD scores will be considered normal on the respective Z-score scales.
Children scoring below -3SD are considered severely malnourished.
In this study age, sex and disability type of the child will be considered to be independent
variables. Also, household occupation, income and family size are also taken into consideration.
Chi-square and Pearson Correlation, both statistical tools, will be used to determine the
association between dependent and independent variables. They will also be used to estimate
how independent variables influence the nutritional status for children with disabilities.
4.11. Ethical Considerations
Ethics letter will be considered in this study. Sante Medical College will send a letter to Akaki
Kaliti sub city Administration Health Office and each Woredas. The parents of children with
XXVI
disabilities will be given written consent. All information collected by different techniques,
including photos, recordings and name, will be treated as confidential.
4.12. Operational Definitions
Food security: "When everyone, at any time, has physical, social, and economic access, to
adequate, safe, and nutritious food, that meets dietary requirements and food preferences in order
to lead an active and healthy lifestyle" (UNICEF).
Children with disabilities (UNCRC, (2005)): These are children between the ages of birth and 17
years who were born with an impairment or disabling medical condition. Some of these
disabilities may be caused by illness, injuries, or poor diet.
Malnutrition - A physiological condition caused by an inadequate intake of carbohydrates,
proteins, lipids, or micronutrients.
Severe Acute Nutrition (SAM) is defined by a weight for height of 70% or lower below the
median, or 3 SDs or more below international reference values. It can also be defined as the
presence or bilateral pitting edema or a MUAC (mid-upper arm circumference) less than 115mm
in children between 6 and 60 months of age.
Acute malnutrition of moderate severity (MAM), also known as wasting, is defined as a weight
for height z score (WHZ) between 2 and 3 or a mid-upper arm circumference (MUAC), between
115 mm and 125 mm.
Under-nutrition (underweight): The body is not receiving enough nutrients. This is reflected
by biochemical tests, such as the Hemoglobin level (Hb), which indicates anemia. It can also be
reflected through anthropometric indicators, like stunting, or low height for age, or wasting, or
low weight-for weight.
Underweight is measured by comparing a child's weight for age with a population of healthy,
well-nourished children.
Overweight: A weight above a certain level that is acceptable for height.
Obese: people with excess weight and adverse health effects
Age is how long a person's lived. The nearest age will be used to categorize age. For instance,
five years plus four months will be considered to be five years.

5. WORK PLAN
S/N Activities July2 Sep2 Nov202 Jan Feb April
XXVII
 023 023 3 202 202 2024
4 4
1 Concept note
2 Working on proposal and
submission of first draft to advisor
3 Revision of proposal based on
comments and submission of
second draft to Advisors
4 Revision of proposal based on
comments and submission of
research proposal to Advisors
5 Presentation and defense of
proposal
6 Revision of Proposal based on the
defense feedbacks and submission
of final research proposal to the
school
7 Ethical approval by the school and
communication with relevant
stakeholders
8 Select and orient data collection
team
9 Pretest and data collection process
10 Data Analysis process
11 Writing draft research paper/ report
and submission to the advisors
12 Revision of research report based
on comments and submission of
final research paper to Advisors
13 Revision of research paper based on
the defense feedbacks and
submission of final research
document/thesis to the school.
XXVIII
6. Budget Plan
S/ Categories Unit Amount No of Multiplication Total
No cost number days factor
1 Personnel
Data collectors 100 4 10 100*10*4 4000
Supervision 150 1 8 150*1*8 1200
Training of 100 4 1 100*4*1 400
data collectors
Training of 100 1 1 100*1*1 100
supervisors
Total 0

2 Stationaries
Duplication 395 4 1 395*4*1 1580
paper
Print paper 6 4 1 6*4*1 48
Pencil 16 3 1 16*3*1 48
Eraser 5 3 1 5*3*1 15
Sharpener 4 5 1 4*5*1 20
Binding 5 20 1 5*20*1 100
Telephone 50 10 1 50*10*1 500
Transportation 200 10 4 50*10*4 2000
4311

Sub total 10011

Contingency (10%) 1001.10
Grand total 11012.10

XXIX
REFERENCES

1. From promise to impact: Ending malnutrition by 2030. . IFPRI. Washington, DC. : Global nutrition
report :, 2016.

2. Poverty and disability:A survey of the literature, . Elwan, A. s.l. : social protection, , 1999. , Vol. No.
9932.

XXX
3. Global Disability Action Plan 2014-2021: Better Health for all People with Disability, . WHO. Geneva,
Switzerland: : WHO, 2015. .

4. Malnutrition and disability: Unexplored opportunities for collaboration. , . Groce, N., Challenger, E.,
Bieler, B., Farkas, A., Yilmaz, N., Schultink, W., … & Kerac, M. 308-314., s.l. : Pediatrics and International
Child Health, 2014, Vols. 34, .

5. Prevalence of under nutrition and associated factors: A cross-sectional study among rural adolescents
in West Bengal,India;. Pal, A., Pari, K., Sinha, A., & Dhara, C. 9-18., West Bengal : International Journal
of Pediatrics and Adolescent Medicine, , 2016. , Vols. 4, .

6. The nutritional status of disabled children in Nigeria- A cross-sectional survey. . Tompsett, J.,
Yousafzai, AK, & Filteau, SM. 915-919., Nigeria : European Journal of Clinical Nutrition, , 1999. , Vols. 53,
7. Global nutrition report : Nourishing the SDGs. . Initiatives., Development. Bristol, UK: : Development
Initiatives., 2017.

8. Determinants of household food security in rural Ethiopia: An Empirical Analysis. . Jemal Abafita &
Kim, K. 129-157., Rural Ethiopia : Journal of Rural Development, , 2014. , Vols. 37, .

9. Population projection of Ethiopia for All regions at Woreda level from 2014 – 2017, . CSA. Addis
Ababa, Ethiopia. : s.n., 2013.

10. Children with disabilities in Ethiopia: The hidden reality, . ACPF. Addis Ababa: : The African Child
Policy Forum., 2011.

11. National plan of action of persons with disabilities (2012 -2021), . MOLSA. Addis Ababa, Ethiopia. :
s.n., 2012.

12. National nutrition program, 2016-2020. . FDRE. s.l. :

https://eeas.europa.eu/sites/eeas/files/nnp2_pdf. , 2016., Vols. (Accessed on May 28, 2019).

13. Malnutrition and childhood disability in Turkana, Kenya: Results from a Case-Control Study. Kuper,
H., Nyapera V, Evans, J., Munyendo, D., Zuurmond, M., Frison, S. …& Kisia, J. (12):, Turkana, Kenya :
PLoS ONE , 2015. , Vol. 10. e0144926..

14. Traditional and changing views of disability in developing societies: causes, consequences, cautions,
World Rehabilitation Fund. . Mallory, B.L., Nichols, R.W., Charloton, J.I., & Marfo, K. 1. s.l. : University
of New Hampshire, Durham:The International Exchan, 1993.

15. Food security status of people with disabilities in Selassie Kebele, Hawassa Town, Southern Ethiopia. .
Tolossa., Fiseha Endale & Degefa. 105-134., Hawassa Town, : Ethiopian journal of the social sciences
and humanities, , 2017., Vols. 3, .

16. Nutritional status of disabled school children in Bloemfontein. . Dannhauser, A. & Walsh, C. (1), s.l. :
South African Journal of Clinical Nutrition,, 2007., Vol. 20:. 6-14..

17. Nutritional status in cerebral palsy: A cross-sectional comparative survey of children in Kano,
Nigeria. . Adamu Sa’idu, Sabo U.A, Gwarzo G.D, & Belonwu R.O. 156-60., Kano, Nigeria. : Niger
XXXI
Postgraduate Medical Journal, , 2018. , Vols. 25, .

18. Socio-economic determinants of nutritional status of children in Ethiopia. Anware Mohammed,

Muhdins Muhammed, & Kaushik, K. 166-176, s.l. : International Journal of Scientific and Research, ,
2016, Vols. 6,.

19. Feeding children with cerebral-palsy and swallowing difficulties. . Arvedson, J. S9–S12., s.l. :
European Journal of Clinical Nutrition,, 2013., Vols. 7, .

20. Disability and development: Learning from action and research on disability in the majority world,
Leeds:. Stone, E. (Ed.). 1–18., s.l. : The Disability Press pp., 1999.

21. National action plan on disability 2012 – 2020: Strategy of the Austrian Federal Government for the
implementation of the UN disability rights convention, . BMASK. Vienna. : s.n., 2012. .

Appendix-I: Questionnaire - English

Code/ID: _____________
Sante Medical College School of public Health
Nutrition Department
This is the research team of Sante Medical College in collaboration with Akaki Kaliti sub city's
health office interviewing care-givers for children with disabilities ranging from 6 months to 17
years of age. I'd like to ask you some questions so that we can assess the nutritional state of the

XXXII
children with disabilities who live in the Sub-City. You are not required to answer any questions
you don't wish to. You can also end the interview at any point you choose. Your honest response
to these queries will help us better understand the causes of disability and improve the nutritional
status for children in the Sub-City.
You will keep all information you provide strictly confidential. Your name will never appear on
this form or be associated with any of the information that you give us. Thank you for your
willingness to participate in this survey. Would you like to participate in this study? (If yes,
proceed. If not, stop and thank.
Please sign to confirm your agreement.
Code: _____________
Name: _______________________________ Sign: ______________ Date: ____________
Questionnaire for parents (mothers/caregivers) of children with disabilities Part I: Socio-
demographic characteristics of respondents
No 1 Questionnaires Response category
Sex of
the
1 = Male 2 = Female
respond
ent
5 = 50-59 years
1 = Below 19 years old2 = 20-
old6 = 60 and
2 Age of respondent 29 years old3 = 30-39 years
above7 = Don’t
old4 = 40-49 years old
know
3 Have you ever attended school? 1 = Yes2 = No (Skip to Qn. 5)
4 = Diploma5 =
1 = Elementary level2 =
If ‘yes’ to Q3, what is the highest Degree6 =
4 Secondary/high school3 =
level of school you attended? Masters &
TVET
above
5 What is your occupation? 1 = Weaving2 = 5 = Job
Merchant/Petty trade3 = seeking6 =
Housewife4 = Student Civil
servant/employ
ed7 = Daily

XXXIII
 labourer
8 =
Others(
Specify
)
______
______
______
______
_____
1 = Single2 = Married3 =
6 What is your marital status? Divorced4 = Separated5 =
Widowed
In number:
How many family members are
6a ________________________
living in the household?
_
How much money do you earn on
6b In Birr: __________
monthly bases (gross)?
How many of the member/s is/are
7 living with disability who is aged In number: ________
from 6 months to 17 years old?
1 = Multiple disability2 =
Intellectual disability3 =
Autism4 = Deafness/Hearing
impairment5 =
Blindness/Visual impairment6
What is the type of disability does
8 = Orthopaedic impairment7 =
the child has?
Other health impairments8 =
Emotional disturbance9 =
Others, Specify:
________________________
_____

XXXIV
Part-II: Questions for caregivers/mothers
No Questions Response category

5=
Support
from
NGO’s
1= Income from petty trade2= Income 6=
What is the source of the household from pension3= Monthly salary from Remittan
9
income? (Multiple response is possible) employment 4= Support from ce
relatives/children 7=Incom
e from
daily
labor 8=
None
9=
Others
(specif
y)
______
Whose family member is mainly
1= Father 2= Mother 3= Children4=
10 supporting the household income?
Others (specify) _________________
(Multiple response is possible)
Does your child with disability feed
11 0 = No1 = Yes (Skip to Q15)
properly food that is available at home?
________________________________
11a If ‘No’, why?
_
________________________________
11b What efforts you did to feed the child?
_
Is there any health institution for health
12 0 = No1 = Yes
care services nearby?
Do you have adequate antenatal care
13 0 = No1 = Yes (Skip to Q17)
service during pregnancy?
________________________________
13 a If ‘No’, why?
__

XXXV
 Does the child got breast feeding during
14 0 = No (Skip to Q17b)1 = Yes
child hood?
If ‘Yes’, for how long does the child got ________________________________
14a
breast feeding (in months)? __
________________________________
14b If ‘No’, why?
__
Immunization status of the child with 0 = Not immunized at all1 = Started but
14c
disability not completed2 = Fully immunized
Is there any waste disposal mechanism
15 0 = No1 = Yes
in your village?
Do you use waste disposal mechanism
16 0 = No1 = Yes
at household level?
Part-III: Dietary diversity questionnaire
Please describe the foods (meals and snacks) that you ate or drank yesterday during the day and
night, whether at home or outside the home. Start with the first food or drink of the morning.
(Write down all foods and drinks mentioned. When composite dishes are mentioned, ask for the
list of ingredients. When the respondent has finished, probe for meals and snacks not
mentioned.)
Household Child with
No Food group with examples members disability
eaten eaten
Cereals (corn/maize, rice, wheat, sorghum, millet or any other grains
Yes = 1 No Yes = 1 No
17 or foods made from these (e.g. bread, noodles, porridge, Enjera, or
=0 =0
other grain products)

Yes = 1 No Yes = 1 No
18 Roots and tubers (potatoes & other foods made from roots)
=0 =0
Vitamin A rich vegetables and tubers (pumpkin, carrot, sweet Yes = 1 No Yes = 1 No
19
potato) =0 =0
Yes = 1 No Yes = 1 No
20 Dark green leafy vegetables (Broccoli, salad, lettuce, etc.)
=0 =0
Yes = 1 No Yes = 1 No
21 Other vegetables (e.g. tomato, onion)
=0 =0
Yes = 1 No Yes = 1 No
22 Vitamin A rich fruits (mango, papaya, peach, and 100% fruit juice)
=0 =0

XXXVI
 Yes = 1 No Yes = 1 No
23 Other fruits (wild fruits and 100% fruit juice)
=0 =0
Yes = 1 No Yes = 1 No
24 Flesh/Organ meat (liver, kidney, heart, beef, pork, goat, chicken)
=0 =0
Yes = 1 No Yes = 1 No
25 Eggs
=0 =0
Yes = 1 No Yes = 1 No
26 Fish and seafood (fresh or dried fish)
=0 =0
Legumes, nuts and seeds (beans, peas, lentils, nuts, or foods made Yes = 1 No Yes = 1 No
27
from these) =0 =0
Yes = 1 No Yes = 1 No
28 Milk and milk products
=0 =0
Yes = 1 No Yes = 1 No
29 Oils and fats (oil or butter added to food or used for cooking)
=0 =0
Sweets (sugar, honey, sweetened juice drinks, chocolates, candies, Yes = 1 No Yes = 1 No
30
cookies and cakes) =0 =0

Miscellaneous - Spices, beverages (spices salt, sauce, coffee, tea, Yes = 1 No Yes = 1 No
31
alcoholic beverages) =0 =0

Part-IV: Anthropometric measurements of a child with disabilities

No Questions Response category
32 Sex of the child 1 = Male2 = Female
33 Age of the child 1 = _________________
34 Height of the child (Cm) 1 = _________________
35 Weight (Kg) 1 = _________________
36 MUAC 1 = _________________
37 BMI 1 = _________________
Code: _________________ Key Informant Interview Guide for Officers working with
children with disabilities
Interview date: _________________ Time: ____________
Part-I: Socio-demographic information
Gender: [ 1 ] Female [ 2 ] Male
Level of education: __________________________________
Organization which you are working: _________________________________________
Position: _______________________________________________________________

XXXVII
Part –II: Interview questions
Did you notice malnourishment among those children with disabilities you are working with in
Akaki Kaliti sub city? 1 = Yes 2 = No
(If ‘Yes’, continue to the next question, if ‘No’, stop the interview with thanks).
How do you rate the severity of status of malnourishment among those children with disabilities
you are working with in Akaki Kaliti sub city?
0= No problem
1= Mild problem (can be ignored with effort)
2= Moderate problem (cannot be ignored but does not influence daily activities)
3= Severe problem (cannot be ignored, often limits daily activities and affects health)
4= Very severe problem (cannot be ignored and markedly limits daily activities and affects
health)
What will be the causes of malnourishment for those children with disabilities you are working
with in Akaki Kaliti sub city?
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What efforts family members did to solve the state of malnourishment of the child with
disability? (mention the efforts done by them from your observation)
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Did you notice limitations in order to improve the nutritional status of CWDs at household level?
1 = Yes 2 = No
If ‘Yes’ for Qn. 9, mention it.
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What is the contribution of your organization in order to improve nutritional status of CWDs in
Akaki Kaliti sub city?
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If you have any suggestion you are welcome.
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Thank you for you cooperation.

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