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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

Research into veld fires in grassland can now help with scientifically-grounded evidence
2015-04-10

While cattle and game farmers are rejoicing in the recent rains which large areas of the country received in the past growing season, an expert from the University of the Free State’s Department of Animal, Wildlife, and Grassland Sciences, says that much of the highly inflammable material now available could lead to large-scale veld fires this coming winter.

Prof Hennie Snyman, professor and  researcher in the Department of Animal, Wildlife, and Grassland Sciences, warns that cattle and game farmers should be aware, in good time, of this problem which is about to rear its head. He proposes that farmers must burn firebreaks as a precaution.

At present, Prof Snyman focuses his research on the impact of fire and burning on the functioning of the grassland ecosystem, especially in the drier grassland regions.

He says the impact of fire on the functioning of ecosystems in the ‘sour’ grassland areas of Southern Africa (which includes Kwazulu-Natal, Limpopo, Mpumalanga, the Eastern Cape, and the Harrismith environs) is already well established, but less information  is available for ‘sweet’ semi-arid grassland areas. According to Prof Snyman, there is no reason to burn grassland in this semi-arid area. Grazing by animals can be effectively used because of the high quality material without having to burn it off. In the sourer pasturage, fire may well form part of the functioning of the grassland ecosystem in view of the fact that a quality problem might develop after which the grass must rejuvenate by letting it burn.

Prof Snyman, who has already been busy with the research for ten years, says quantified data on the impact of fire on the soil and plants were not available previously for the semi-arid grassland areas. Fires start frequently because of lightning, carelessness, freak accidents, or damaged power lines, and farmers must be recompensed for this damage.

The shortage of proper research on the impact of fires on soil and plants has led to burnt areas not being withdrawn from grazing for long enough. The lack of information has also led to farmers, who have lost grazing to fires, not being compensated fairly or even being over-compensated.

“When above-and below-ground plant production, together with efficient water usage, is taken into account, burnt grassland requires at least two full growing seasons to recover completely.”       

Prof Snyman says farmers frequently make the mistake of allowing animals to graze on burnt grassland as soon as it begins to sprout, causing considerable damage to the plants.

“Plant roots are more sensitive to fire than the above-ground plant material. This is the reason why seasonal above-ground production losses from fire in the first growing season after the fire can amount to half of the unburnt veld. The ecosystem must first recover completely in order to be productive and sustainable again for the long term. The faster burnt veld is grazed again, the longer the ecosystem takes to recover completely, lengthening the problem with fodder shortages further.  

Prof Snyman feels that fire as a management tool in semi-arid grassland is questionable if there is no specific purpose for it, as it can increase ecological and financial risk management in the short term.

Prof Snyman says more research is needed to quantify the impact of runaway fires on both grassland plant productivity and soil properties in terms of different seasonal climatic variations.

“The current information may already serve as valuable guidelines regarding claims arising from unforeseen fires, which often amount to thousands of rand, and are sometimes based on unscientific evidence.”

Prof Snyman’s research findings have been used successfully as guidelines for compensation aspects in several court cases.

 

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