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Abstract
Many South African children live in poverty and food insecurity; therefore, malnutrition within the context of childhood cancer should be examined. Parents/caregivers completed the Poverty-Assessment Tool (divided into poverty risk groups) and the Household Hunger Scale questionnaire in five pediatric oncology units. Height, weight, and mid-upper arm circumference assessments classified malnutrition. Regression analysis evaluated the association of poverty and food insecurity with nutritional status, abandonment of treatment, and one-year overall survival (OS). Nearly a third (27.8%) of 320 patients had a high poverty risk, associated significantly with stunting (p = 0.009), food insecurity (p < 0.001) and residential province (p < 0.001) (multinomial regression). Stunting was independently and significantly associated with one-year OS on univariate analysis. The hunger scale was significant predictor of OS, as patients living with hunger at home 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. Evaluating sociodemographic factors such as poverty and food insecurity at diagnosis is essential among South African children to identify at-risk children and implement adequate nutritional support during cancer treatment.
Acknowledgements
The authors would like to acknowledge and thank the children and parents/caregivers who participated in the study, especially for their willingness to answer the two questionnaires and to disclose sensitive information. They would also like to thank the pediatric registrars, dieticians, and nursing staff of the POUs for their support in this study.
Conflict of Interest
The authors have no conflict of interest to report.
Contribution to the Manuscript
Judy Schoeman conceptualized the study. Judy Schoeman, a PhD student, designed the study, developed the Redcap database, chose the questionnaires, enrolled patients, collected data, cleaned the data, analyzed the data, and wrote the manuscript.
Mariana Kruger, Elena Ladas, and Paul Rogers assisted with the design of the study and critically reviewed the manuscript.
Ilde-Marié Kellerman, Ronelle Uys, Gita Naidu, Biance Rowe, Jan du Plessis, Mariechen Herholdt, Karla Thomas, Barry Vanemmenis, Rema Mathews, Ané Büchner, Fareed Omar and David Reynders were investigators at the different sites, enrolled patients, collected data and critically reviewed the manuscript.
Sandile Ndlovu assisted with this nested study’s statistical design, analyzed the Poverty Assessment Tool data, and critically reviewed the manuscript. Carl Lombard did the statistical analysis of the hunger scale questionnaire and critically reviewed the manuscript.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author, JS. The data are not publicly available due to data containing information that could compromise the privacy of research participants.