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Prof Jan Du Plessis
Prof Jan du Plessis is Head of the Paediatric Oncology Unit at the University of the Free State.

Many children in South Africa diagnosed with childhood cancer have a poorer overall survival rate and are more likely to abandon their treatment because they experience high poverty and food insecurity at home.

This is according to findings from a new study which Prof Jan du Plessis, Head of the Paediatric Oncology Unit at the University of the Free State (UFS), was part of. The study, titled ‘Prevalence of Poverty and Hunger at Cancer Diagnosis and Its Association with Malnutrition and Overall Survival in South Africa’, was recently published in the journal Nutrition and Cancer.

It found a high prevalence of poverty and hunger among South African children diagnosed with cancer. Food insecurity was associated with treatment abandonment and poorer overall survival.

The research was conceptualised by Judy Schoeman, dietitian at the Steve Biko Academic Hospital, as part of her PhD study. Prof Du Plessis and departmental dietitian Mariechen Herholdt, who recognised the importance and value of this study, enrolled patients, collected data, and critically reviewed the manuscript. Five different paediatric oncology units throughout the country participated.

Stunting as indicator of chronic malnutrition

Prof Du Plessis says stunting is an indicator of chronic malnutrition, and causes tissue damage, reduced function of neurotransmitters, and decreased overall development of all factors. Stunting is also associated with reduced lung growth and -function, which can influence the prevalence of pulmonary infections, have an impact on morbidity, and increase the risk of mortality. It also affects cognitive development, with poorer academic achievement and reduced economic productivity for children and adults affected by stunting.

“Our study found that South African children with malnutrition at cancer diagnosis often experienced food insecurity at home, underscoring the need to address primary rather than secondary malnutrition. This observation was especially apparent among children from rural provinces,” Prof Du Plessis says. “Many children in our study experienced high poverty and food insecurity risk at diagnosis; thus, nutritional counselling targeting dietary intake in the home setting should be a priority for these patients.”

High-quality diet may have protective effect

Recent literature has found that a high-quality diet may have a protective effect against some treatment-related toxicities of cancer treatment. Hunger at home was significantly associated with increased risk for treatment abandonment and risk of death.

Prof Du Plessis states, “According to the South African census (2015), 30 million people live on less than R84.11 (US$5) per day, and 55% of South African children live below the ultra-poverty line (R800/month or US$45.81/month)…

“In a previous South African study of children with germ cell tumours from families with higher socioeconomic status (household income of US$191/year or US$6/day), they have experienced significantly improved overall survival (OS) at five years. Indonesian children from low-income families diagnosed with acute lymphoblastic leukaemia have also experienced significantly lower event-free survival two years or longer after diagnosis than those from higher-income families.”

Prof Du Plessis says nutritional intervention should be implemented from diagnosis to improve patients’ nutritional status and survival.

Enhance collaborations to enhance outcomes

The study further illustrated that children with stunting and malnutrition at cancer diagnosis were more likely to live in poverty, thereby highlighting a group of children needing social services and support networks over and above the existing structures available to South African children with cancer.

The study underscores the need for medical centres to enhance collaboration with organisations that provide financial and/or other support to families throughout treatment to enhance outcomes.

The study came about as poor nutritional status in children with cancer has been associated with poorer cancer outcomes. Identifying modifiable risk factors that lead to poor nutrition in children with cancer is an understudied area, especially in a country such as South Africa, explains Prof Du Plessis. 

“Understanding the scope of poverty and hunger and its association with nutritional status among children undergoing cancer treatment is needed. As half of South Africans experience chronic poverty over time, food insecurity will be affected; we investigated the prevalence of poverty and food insecurity at cancer diagnosis, their association with malnutrition at the time of diagnosis, and overall survival at one year post-diagnosis.

“Malnutrition is a modifiable prognostic risk factor. The findings underscore the importance of incorporating an assessment of the risk of living in poverty and/or with food insecurity at diagnosis – and potentially throughout therapy – to ensure that families are referred to appropriate support networks. Evaluating sociodemographic factors at diagnosis is essential among South African children to identify at-risk children and implement adequate nutritional support during cancer treatment,” Prof Du Plessis concludes.

This research aligns with the UFS’s Vision 130 – to not only be a university that cares and is sustainable, but also to be a research-led, student-centred, and regionally engaged university that contributes to development and social justice. This knowledge will assist in efficiently allocating hospital resources and establishing support networks to ensure that the most vulnerable children are supported with proactive nutrition interventions while undergoing cancer treatment.

News Archive

Inter-country adoptions can offer relief
2009-08-12

 
At the occasion were, in the front: Prof. Hennie Oosthuizen, head of the Department of Criminal and Medical Law, UFS; back: Adv. Mariëtte Reyneke, head of the Unit for Children’s Rights and senior lecturer in the Department of Law of Procedure and Law of Evidence, UFS, Judge of Appeal Belinda van Heerden, and Adv. Beatri Kruger, also from the Unit for Children’s Rights and senior lecturer in the Department of Criminal and Medical Law, UFS.
Photo: Stephen Collett 


Inter-country adoptions must not be taken lightly; however, in some instances it is suitable and can bring relief to a child. These were the words of Katinka Pieterse from Abba Adoptions, which specialises in inter-country adoptions.

She was one of the expert presenters at a recent workshop on inter-country adoptions that was recently presented by the Unit for Children’s rights in the Department of Criminal and Medical Law in the Faculty of Law at the University of the Free State (UFS).

Judge of Appeal Belinda van Heerden, an expert in the field of Child and Family Law, gave an overview as well as a Southern African perspective on this controversial topic. The Hague Convention sets international standards to protect children from the inherent dangers that accompany inter-country adoptions. The South African law must be aligned with these international standards by incorporating specific stipulations as well as the Hague Convention into legislation applicable to children. There must also be acted in the best interest of the child, said Judge van Heerden. The authorities have safety measures in place to protect children from these dangers. The starting point remains that inter-country adoptions are only considered once one cannot find suitable care in the country of origin.

Prof. Sheryl Buske from the Charlotte School of Law, North Carolina in the United States of America in particular emphasised the dangers of human trafficking that can take place when inter-country adoptions do not adhere to international safety standards. She also pointed out new developments such as the role of surrogate mothers and the adoption of embryos.

The workshop was attended by a large variety of role players, varying from academics, lawyers, social workers, non-governmental organisations, law students and representatives from governmental institutions. Consequently, light was shed on the topic from a number of angles which will be of value to the respective role players. Jurists from Lesotho also expressed their gratitude for the insight they received.

The workshop was of great value to the university because it served the community with expert presentations on this new and sensitive topic. The guidelines and pitfalls that were discussed and pointed out at the workshop cleared uncertainties and brought new insight to the different professions and role players in the field. Furthermore, the bond between the academia and practice were developed and strengthened by the establishment of further cooperation between the parties.

Media Release:
Lacea Loader
Deputy Director: Media Liaison
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: loaderl.stg@ufs.ac.za  
11 August 2009

 

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