Doctoral Degrees (Paediatrics and Child Health)

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Browsing Doctoral Degrees (Paediatrics and Child Health) by Subject "Cancer in children -- South Africa"

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    Nutritional status of children at cancer diagnosis and during treatment, with a focus on the association with their clinical outcome
    (Stellenbosch : Stellenbosch University, 2023-09) Schoeman, Judith; Kruger, Mariana; Ladas, Elena; Rogers, Paul; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Up to 50% of children diagnosed with cancer in low-middle-income countries are malnourished, while in paediatric oncology units (POUs) in Africa, less than half had a dedicated dietician, and only a third undertook routine nutritional assessment. Newly diagnosed children with cancer were longitudinally assessed for nutritional status in South Africa, including micronutrient assessment at diagnosis. The majority of the 320 children were well-nourished at diagnosis, while less than 15% had either stunting (14.3%), underweight (11.6%), wasting (8.1%), while a quarter (24.3%) had moderate acute malnutrition (MAM). Girls were more prone to being underweight (12.2% versus 4.5%; P = 0.027), while children five years and older had a higher prevalence of MAM (33.5% versus 14.5%; P < 0.001), with significant improvement six months after diagnosis (P < 0.001). Stunting was significantly associated with poor overall survival one year after a cancer diagnosis (HR 1.9; 95% CI 1.1, 3.3; P = 0.029). Nearly a third (27.8%) of patients had a high poverty risk that was significantly associated with stunting (P = 0.009), food insecurity (P < 0.001), and residential province (P < 0.001). Most children lived in households with a high risk of food insecurity (80%) and had an increased odds ratio for treatment abandonment (OR 4.5; 95% CI 1.0; 19.4; P = 0.045) and hazard for death (HR 3.2; 95% CI 1.02, 9.9; P = 0.046) compared to those with food security. Of 261 patients assessed for micronutrient status in two POUs, half had iron deficiency (47.6%), a third Vit A (30.6%), Vit D (32.6%), or folate (29.7%) deficiencies. There were significant associations between MAM and low levels of Vit A (48.4%; P = 0.005), Vit B12 (29.6%; P < 0.001), and folate (47.3%; P = 0.003). Male patients (40.9%; P = 0.004) and those with wasting (63.6%;P < 0.001) are associated with Vit D deficiency. Folate deficiency is significantly associated with children five years and older (39.8%; P = 0.002), residing in provinces Mpumalanga (40.9%) and Gauteng (31.5%) (P = 0.032); food insecurity (46,3%; P < 0.001), or haematological malignancy (41.4%; P = 0.004). The South African-adapted childhood cancer-specific nutritional algorithm was implemented in an intervention group versus a control group that received standard nutritional support protocol. The implementation of the algorithm led to a significant improvement in nutritional status for the malnourished patients in the intervention group, while it was insignificant for the control group. Determining socio-economic status and micronutrients at childhood cancer diagnosis in South Africa is crucial to plan appropriate nutritional interventions. Of note, stunting is associated with a poor one-year overall survival. The South African-developed algorithm successfully managed children with malnutrition at cancer diagnosis.