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19 June 2023 | Story André Damons | Photo André Damons
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

Internationally acclaimed academic applauded on Africa Day
2011-06-02

 
 Prof. Ali Mazrui, an internationally acclaimed and renowned academic.

One of the world’s top academics was given a warm welcome in the rather cold Free State recently.

Prof. Ali Mazrui, an internationally acclaimed and renowned academic, visited us as part of our Africa Day celebrations as arranged by the Centre for Africa Studies. He delivered a keynote address, entitled ‘Pro-democracy uprisings in an African experience: from Sharpeville to Benghazi.’

A festive atmosphere and the sound of drums welcomed this intellectual giant as well as other delegates upon their arrival at the CR Swart Auditorium on our Bloemfontein Campus. Some of the delegates who attended the Africa Day Celebrations, included: Mr Tom Amolo, High Commissioner from the Republic of Kenya; Mr Dan Kgothule, MEC of Arts and Culture in the province; Prof. Jeff and Dr Carla Ramsdell, visitors from America; Dr Allan Boesak and Prof. Nicky Morgan, Vice-Rector: Operations.

Prof. Frederick Fourie, former Vice-Chancellor and Rector of our university, also attended the celebrations, as did some scholars from neighboring schools.

Welcoming Prof. Mazrui, Prof. Jonathan Jansen, Vice-Chancellor and Rector of our university, quipped that he was relieved the world had not ended the previous weekend as was predicted, because he was looking forward to listening to such a renowned intellectual.

Prof. Lucius Botes, Dean of Humanities, followed Prof. Jansen at the podium. He said the ability to go from following a bridging course to being one of the top 100 intellectuals in the world, indeed distinguishes Prof. Mazrui as an exceptional academic. This intellectual is, among others, an Albert Luthuli Professor at the University of Jos, Nigeria and Andrew D. Professor Emeritus and Senior Scholar in Africana Studies at Cornell University.

In his introduction, Prof. Mazrui said he feels honored and flattered by this opportunity. He proceeded by referring to the history of Africa Day and added that he would rather prefer an Africa Week to an Africa Day to ensure that everybody has the opportunity to celebrate the continent.

He sang the praises of South Africa, as almost every other African country which attained liberation from European colonial rule in the 20th century, has been unable to maintain its democratic order beyond its first decade of independence.

“The Republic of South Africa, on the other hand, liberated Nelson Mandela in 1990, held its first democratic election in 1994, and already has its third president. Nearly two decades after Apartheid, South Africa has not outlawed opposition parties, or experienced a military coup, or permitted the Head of State to govern the country as a dictator.”

In his speech he compared the uprisings in Sharpeville during 1960 and Soweto during 1976 with the more recent pro-democracy uprisings in North Africa, based on the role that weapons and the lack thereof, as well as the youth and women played in the respective cases.

He concluded by saying the uprisings in Tunisia and Egypt have already resulted in ousting dictators who had been entrenched in power for decades, adding that in Libya a third dictator’s future is on the line. “Never in the history of the Arabs have there been so many popular uprisings which seem to be inspired neither by Islam nor by anti-imperialism, but in the quest for liberal reforms. Half a century earlier in Sharpeville and Soweto, South Africans experienced their own political awakening.”

Prof. Kwandiwe Kondlo, Director of the Centre for Africa Studies, closed the event with a word of thanks to the American academic and his wife, guests and attendees. He said discussions prior to the event revealed that more research has to be done regarding gender issues on the continent.

Prof. Mazrui also participated in conversations at the institute and a media briefing which was hosted earlier the day.

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