Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review
, Risad Sultana 1,2, Mohammad Muhit 1,2, Delwar Akbar 4, Tasneem Karim 1,2,5,6, Mahmudul Hassan Al Imam 1,2,3,7, Manik Chandra Das 1,2, Hayley Smithers-Sheedy 6, Sarah McIntyre 6, Nadia Badawi 6,8 and Gulam Khandaker 3,5,7,*Round 1
Reviewer 1 Report
It brings to attention the need for greater intervention in LMIC countries regarding the nutritional status of children with CP. It is original, timely, of interests and is well written. My only suggestion for change is clarification of the tables which are in places hard to follow.
Author Response
We would like to thank the respected reviewer for the valuable comment on our manuscript titled “Nutrition interventions for children with cerebral palsy in low- and middle-income countries: a scoping review”.
Please see below our point-by-point response to the comment.
Point 1: It brings to attention the need for greater intervention in LMIC countries regarding the nutritional status of children with CP. It is original, timely, of interests and is well written. My only suggestion for change is clarification of the tables which are in places hard to follow.
Response 1: Thank you for your helpful comment and the valuable suggestion. We have now moved the tables closer to the referenced results and clarified the captions as appropriate. Please see the revised tables in the edited version of the manuscript.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
This is a review trying to address an important question. I have a few comments as below:
- I understand why the high-income areas are not included in the review, but I wonder if there are any reviews or meta-analyses for the high-income area so far. If not, I am thinking it could be more informative and comprehensive to include those 16 papers as well, especially after adding the comparisons between the areas with different incomes.
- For the table1 that summarizes the study characteristics, it would be good to include races; for Table 3, it would be good to include the actual p-value if possible. If there is any modeling instead of simple comparisons between groups, it would be good to include as well.
Author Response
We would like to thank the respected reviewer for the constructive suggestions and helpful comments on our manuscript titled “Nutrition interventions for children with cerebral palsy in low- and middle-income countries: a scoping review”.
Please see below our point-by-point response to the comments.
Point 1: This is a review trying to address an important question. I have a few comments as below.
Response 1: Thank you for your helpful comment and valuable suggestions. We have tried to address them all. Please see below our responses and the edited version of the manuscript.
Point 2: I understand why the high-income areas are not included in the review, but I wonder if there are any reviews or meta-analyses for the high-income area so far. If not, I am thinking it could be more informative and comprehensive to include those 16 papers as well, especially after adding the comparisons between the areas with different incomes.
Response 2: Thank you for the valuable suggestion. During our literature search we identified a few reviews on interventions to improve feeding and nutritional status of children with CP [1-3], however, we could find only one systematic review on the topic from HIC[3]. This reference has now been added to our discussions (see line 345-350 in the revised manuscript). We completely agree with the respected reviewer that adding information from those 16 studies based in HICs would make the manuscript more informative and comprehensive. But considering the study aim (as pointed out by the respected reviewer as well) we decided to keep the analysis/results limited to the LMICs only. However, we have now added a supplementary file summarizing the descriptive characteristics and interventions provided in those 17 studies excluded at the last stage of study selection in the review. Please see the revised manuscript and new Supplementary table 2.
References:
- Scarpato, E.; Staiano, A.; Molteni, M.; Terrone, G.; Mazzocchi, A.; Agostoni, C. Nutritional assessment and intervention in children with cerebral palsy: a practical approach. Int J Food Sci Nutr 2017, 68, 763-770, doi:10.1080/09637486.2017.1289502.
- Snider, L.; Majnemer, A.; Darsaklis, V. Feeding interventions for children with cerebral palsy: a review of the evidence. Phys Occup Ther Pediatr 2011, 31, 58-77, doi:10.3109/01942638.2010.523397.
- Ferluga, E.D.; Archer, K.R.; Sathe, N.A.; Krishnaswami, S.; Klint, A.; Lindegren, M.L.; McPheeters, M.L. Interventions for feeding and nutrition in cerebral palsy. 2013.
Point 3: For the table1 that summarizes the study characteristics, it would be good to include races; for Table 3, it would be good to include the actual p-value if possible. If there is any modeling instead of simple comparisons between groups, it would be good to include as well.
Response 3: Thank you for the valuable suggestions. Due to the data heterogeneity, we could only report on a few common characteristics which did not include ‘race’ of the participants. For the same reason we could not include the modelling reported in some of those studies. We have added these limitations in our revised manuscript now (see line 358-361). However, we have added the original p values from respective studies as appropriate in Table 3. Please see the edited version of the manuscript.
Author Response File: Author Response.pdf
Reviewer 3 Report
This study aim to review the existing evidence on nutritional interventions for children with cerebral palsy in low- and middle-income countries. The paper is written well, and I just have minor comments as follows:
- In the abstract, the authors stated “This should be considered in planning of cost-effective nutrition-focused intervention or comprehensive services for children with CP in LMICs.” I suggested the authors modified this sentence due to they did not discuss the “cost-effective” in the manuscript.
- Please double check the tables, some “squared” did not present the correct format.
Author Response
We would like to thank the respected reviewer for the constructive suggestions and helpful comments on our manuscript titled “Nutrition interventions for children with cerebral palsy in low- and middle-income countries: a scoping review”.
Please see below our point-by-point response to the comments.
Point 1: In the abstract, the authors stated “This should be considered in planning of cost-effective nutrition-focused intervention or comprehensive services for children with CP in LMICs.” I suggested the authors modified this sentence due to they did not discuss the “cost-effective” in the manuscript.
Response 1: Thank you for the valuable comment. We have now edited the sentence accordingly. Please see line 46 of the revised manuscript.
Point 2: Please double check the tables, some “squared” did not present the correct format.
Response 2: Thank you for the keen observation and correction. We apologize for the formatting error. We have edited the ‘squared’ symbols in the table. Please see the Table 3 in the revised manuscript.
Author Response File: Author Response.pdf
