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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

Emma Sadleir talks about social media etiquette
2016-05-18

Description: Emma Sadlier Tags: Emma Sadlier

Emma Sadleir
Photo: Supplied

“We have all become celebrities, we have become social figures because of our power to publish information. We have all become brands, and we need to protect our brand. Digital content is sometimes dangerous content,” said Sadleir.

On 11 May 2016, the University of the Free State, in collaboration with the Postgraduate School, hosted, Emma Sadleir, a leading social media expert, in the Equitas Auditorium on the Bloemfontein Campus. She is an admitted advocate, specialising in social media law.  Dr Henriette van den Berg, Director of the Postgraduate School, described Sadleir’s presentation as a privilege for all the staff and students who attended.

Sadleir said that there are two important rules that staff and students of an institution should try to follow. The first is not to bring the name of the institution into disrepute; and the second is not to breach the goodwill of the institution or, in other words, not to bite the hand that feeds you.

“The common law, even if there is no policy, is that anything that brings the company into disrepute can lead to disciplinary consequences up to termination,” said Sadleir.

Sadleir focused on hate speech and free speech, stating that free speech is a right that is entrenched in the constitution, but, like every other right, it has limitations. She mentioned Penny Sparrow, Matt Theunissen, Velaphi Khumalo, and Judge Mabel Jansen, all of whom have been lambasted by the public over their racist posts on social media. Sadleir stressed that, even on social media, content has to be within the confines of the law, and people must remember our rights are not absolute. We have a lot of freedoms, but no one cannot disseminate hate speech.

“Would you publish whatever you thinking on a billboard, close to a busy highway with your name, picture and employers details or the institution you studying at? If you have no grounds to justify the comment, do not post it,” warned Sadlier.  

According to the South African Bill of Rights, everyone has the right to privacy, but an expectation of privacy has to be enforced. She said people over-document their lives on social media, decreasing your right to privacy drastically. “It is like CCTV footage of your life. It is simple, the more you take care of your privacy, the more you have,” said Sadleir.

Sadleir said it was important for Facebook users to have privacy settings where they can review posts where they are tagged. According to Sadleir, managing your reputation is not only limited to what you post about yourself but also managing what others post about you.

She cited a 2013 case in the Pretoria High Court in which a new wife wrote a scandalous Facebook post about her husband’s ex-wife, tagging the husband in the post. The courts found both the new wife and the husband guilty of defamation.

“If you have been tagged in something but have not been online and seen the content, you are then an innocent disseminator. The moment you are aware of the post you are liable for the content,” said Sadleir.

“It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you'll do things differently,” Sadleir said, concluding her presentation with the quotation from Warren Buffet.

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