| dc.description.abstract | Introduction: Malnutrition has been shown to be a common feature among cancer patients. This results from parasitic metabolic behavior of the tumour cells at the expense of the host leading to wasting away. Anorexia, vomiting, nausea and gastroenteropathy resulting from cancer treatment contribute to reduced food intake. A malnourished child with cancer faces the risk of infections, increased risk of adverse effects and toxicities during therapy, and impaired tolerance to chemotherapy. Research Question: What is the nutritional status of paediatric cancer patients admitted at Kenyatta National Hospital (KNH)?
Rationale: Results of this study offers knowledge on the magnitude of malnutrition among these children and some of the associated factors and hence gives a basis of providing these patients with nutritional interventions.
Study Design: A hospital based cross sectional survey was conducted for a period of three months from September to December 2010. Sampling: A total of 145 children were recruited for this study. Fisher's formula was used to calculate minimum sample size. Consecutive sampling was applied. Study Setting: Kenyatta National Hospital (KNH) paediatric oncology ward and the designated oncology rooms within the general paediatric wards. Study Population: The study subjects included all children below twelve years of age with confirmed malignancy admitted at Kenyatta National Hospital.
Study Procedure: Once a child was recruited, a questionnaire was administered to the parent/guardian and Weight, Height and Mid Upper Arm Circumference (MUAC) taken as per WHO standards. Z-scores for wasting (weight for height), stunting (height for age) and underweight (weight for age) were determined. Visible Severe Wasting was also assessed. Data Management and analysis: The data obtained was coded and entered into MS-Access computer application, then exported into Statistical Package for Social Sciences version 17.0 for analysis. Chi-Square test was used to test for association between categorical variables, with statistical significance set at a = 0.05 and 95% confidence interval. Multivariate analysis using Binary logistic Regression to eliminate confounders was performed.
Results: 145 children with cancer were recruited, with mean age of 6.1 years, where 81 (55.9%) were male. The commonest cancer type was Acute lymphoblastic leukemia (49; 33.7%). The overall prevalence of malnutrition was 23.4%. levels of wasting, stunting and underweight (ZScore <-250) were 19.3%, 21.4% and 28.3% respectively. MUAC picked higher levels of malnutrition in the under-five category (41.5%) compared to wasting (20.3%). 46.9% of children with large observable tumour masses had malnutrition by physical Visible Severe Wasting compared to Weight for Height (28.1%).
Newly diagnosed children with cancer were significantly associated with malnutrition compared to those on treatment (P=0.006) as well as those who had tumour masses (P= <0.001). Reduced food intake (P=O.002), recent acute infection (P=0.012) and diarrhoea one week prior to the study (P=0.014) were also significantly associated with malnutrition. Conclusion: The overall prevalence of malnutrition of children with cancer was 23.4%, four times higher than that of children in the general population (6.7%). The level of wasting, stunting and underweight were 19.3%, 21.4% and 28.3% respectively.
A newly diagnosed child with cancer (treatment na'ive),and a child with observable tumour mass had significant higher risk of malnutrition. Recent acute infection, reduced food intake and diarrhoea were significantly associated with malnutrition among children with cancer. Recommendations: Routine nutritional assessment of every child diagnosed with cancer should be undertaken to allow appropriate nutritional intervention. Efforts towards management of diarrhoea and acute infections should be strengthened among children with cancer. Further studies to determine the impact of cancer treatment on nutritional status of children are required | en_US |
