The Barriers and Facilitators to Achieving Optimal Nutrition for Pediatric Oncology Patients in Tanzania: A Mixed Methods Analysis

Background: Each year, approximately 400,000 children are diagnosed with cancer with over 85% of new cases occurring in low- and middle-income countries (LMIC). Survival rates in LMIC are 25% compared to 85% in high-income countries (HIC). Undernutrition is a key factor contributing to this disparity. Children diagnosed with cancer are at a higher risk for undernutrition, especially in low resource settings, but nutritional status remains largely unrecognized and unmonitored in many pediatric oncology hospitals in LMICs. Study aims: This study aims to first, determine the prevalence and severity of undernutrition at diagnosis, and second, evaluate existing barriers and facilitators to optimal nutrition among children with cancer at a large specialty referral hospital in Mwanza, Tanzania.

Methods: A mixed methods approach was used including quantitative surveys, and semi structured interviews that were distributed to caregivers and medical providers for children with cancer treated at Bugando Medical Centre (BMC) from May to December 2019. Results: Quantitative surveys were completed by caregivers(n=65), with a sub group completing a second KAP survey (n=51). Both caregivers (n=10) and stakeholders (n=14) also completed in-depth qualitative interviews. Using Tanzanian nutrition guidelines, the majority of pediatric cancer patients (60%) were classified as undernourished and 78.4% of caregivers reported being food insecure. Key factors perceived to contribute to poor nutrition included 1) food insecurity; 2) lack of education; and 3) community support was reported as facilitator towards achieving optimal nutrition. Additionally, parents expressed interest in being involved in nutritional education and supplementation programs during treatment. Conclusions: The study addresses a major gap in understanding factors contributing to undernutrition among children with cancer in LMIC and provides strategy targets for future interventions and policies to promote nutrition for pediatric oncology patients in Tanzania.