Nutritional status and barriers to optimal nutrition among pediatric patients with cancer in tanzania: a quantitative analysis.

BACKGROUND: Childhood cancer is a growing public health concern in low- and middle-income countries (LMICs), where over two-thirds of global pediatric cancer cases occur. Despite advances in diagnosis and treatment, malnutrition remains a major barrier to achieving better outcomes. This study aimed to assess the magnitude of undernutrition and identify barriers to optimal nutrition among pediatric patients with cancer receiving treatment at a major referral hospital in Tanzania. METHODS: Two study populations were recruited: pediatric patients with cancer and their primary caregivers. Children were assessed for undernutrition using anthropometric indicators, including mid-upper arm circumference, weight-for-age, height-for-age, body mass index-for-age Z-score, and triceps skinfold thickness. Nutritional biomarkers, including serum albumin, total protein, hemoglobin, and mean corpuscular volume, were also evaluated. Caregivers completed structured questionnaires adapted from the Hunger Vital Sign™ and the United Nations Food and Agriculture Organization Nutrition-related Knowledge, Attitude, and Practices Questionnaire to assess the risk of food insecurity and caregiver nutrition knowledge and perceptions. Binary logistic regression was used to explore predictors of undernutrition. RESULTS: A total of 65 pediatric patients were enrolled, of whom 41.54% were classified as undernourished based on at least one anthropometric indicator below age-specific thresholds. Although 44.62% had low serum albumin and 30.77% had low total protein, these biomarkers may reflect overall illness rather than nutritional deficiency alone. Anemia was observed in 53.85% of children under 5 and 38.46% of those aged 5 and older. Logistic regression showed that undernutrition was more likely among children aged 5-10 and > 10 years compared to those < 5 years (OR: 1.80; 95% CI: 0.88-3.68; p = 0.109), while anemia showed an inverse and unexpected association (OR: 0.15; 95% CI: 0.02-1.44; p = 0.100); however, neither was statistically significant. The risk of food insecurity was identified in 78.4% of households. Caregivers not at risk demonstrated significantly better nutrition knowledge and more positive perceptions than those at risk. CONCLUSION: Undernutrition is common among pediatric patients with cancer and may be influenced by clinical and socioeconomic factors, including anemia, caregiver knowledge, and household food insecurity. TRIAL REGISTRATION: This study is not a clinical trial and does not require registration. CLINICAL TRIAL NUMBER: not applicable.

Duke Scholars

Author Kristin M. Schroeder Pediatrics, Hematology-Oncology