Balancing Culture, Nutrition, and Budget: The Design and Implementation of a Cost-Optimized Meal Plan for Pediatric Cancer Patients in Tanzania

Abstract

Pediatric cancer is a significant global health challenge, with over 80% of cases occurring in low- and middle-income countries, where survival rates are drastically lower than in high-income countries. One factor contributing to this disparity is malnutrition, which worsens treatment tolerance and survival outcomes, and is especially prominent in settings like Tanzania. Despite this burden, there is a lack of practical and context-adapted nutrition interventions.This mixed-methods implementation science study evaluated the use of diet optimization modeling to design and pilot a meal plan for pediatric cancer patients at the ICCARE hostel in Mwanza, Tanzania. Linear programming was used to design a meal plan that met nutritional targets for six key nutrients (calories, protein, iron, calcium, vitamin A, and zinc) within a 20% budget increase. The model output was then modified with local pediatric nutritionists and hostel staff to ensure stakeholder approval. The final meal plan was piloted for one week and evaluated using comparative cost and nutritional analyses, staff interviews, and surveys with caregivers and kitchen staff to assess feasibility, acceptability, and sustainability. The implemented meal plan showed modest nutritional improvements with protein, iron, calcium, and zinc increased significantly, but calories were not significantly improved and vitamin A decreased. Costs exceeded the budget cap by about 25% due to price volatility and ingredient procurement challenges. Despite the cost overrun, the intervention demonstrated strong feasibility and high acceptability among both staff and caregivers, with sustainability dependent on increased funding. This study demonstrates that linear programming can be a valuable tool for systematically designing nutritionally improved meal plans under constraints but it’s use alone is insufficient. Real-world implementation requires iterative adaptation with local stakeholders to address on-the-ground realities. Future applications should incorporate longer pilot periods, more conservative cost assumptions, and adaptive processes to achieve sustainable nutrition interventions for resource-constrained settings.