Kampala, Uganda

Uganda is a lower-income country in Eastern Africa, and has been successful in reducing severe poverty relative to many of their neighboring countries. However, the country remains among the poorest in the world. Nearly half of the population is under the age of 15 and there are high rates of malnutrition in children under-five and older. The national prevalence of children under-five with stunting, wasting and overweight is 28.9%, 3.5% and 3.7%, respectively. Older children and adolescents remain undernourished (26.7%), while overweight and obesity are higher relative to neighboring countries (12%). Micronutrient deficiencies are common in Uganda due to poor dietary patterns, 28% of children under 5 are deficient in Vitamin A, and 64% have iron-deficient anemia. Other notable nutrients that are often found to be deficient in children are zinc, calcium and Vitamin B12. These deficiencies are largely the result of a diet with low levels of animal product consumption.

The estimated total incidence of childhood cancers in Eastern Africa during 2015 was around 47,753; and the crude rate for childhood cancer in Uganda is near 2,850 annual new cases per year.

IIPAN Center & Collaborators

The Uganda Cancer Institute (UCI) is a state-of-the-art facility in the country’s capital city, Kampala. UCI began as a research center but Uganda’s government noticed the need for public cancer treatment within the country. The Uganda Child Cancer Foundation (UCCF), a non-governmental organization that works with UCI, supports children and young persons suffering from cancer in Uganda by providing direct treatment and social assistance that includes food security. The Institute sees 7,000 new patients every year, approximately 10% of whom are children.

The implementation of the IIPAN nutrition program is overseen by Dr. Joyce Kambugu, Pediatric Oncology Service Director. UCI has two IIPAN-trained nutritionist, Joseph Mary Ssemujju and Ben Ochan, who are part of the multidisciplinary pediatric oncology team. They promote pediatric cancer awareness and advocacy in Uganda as well as provide incremental support to the hospital staff on nutrition therapy for children. Joseph and Ben ensure continuous nutritional assessments, and provide family and patient nutrition education.

Site Challenges

• High burden of severe acute malnutrition at diagnosis that remains throughout care.
• Limited access/variety to most nutritional formulas and nutritional laboratory tests.
• Lack of structure for implementing nutritional protocols in the inpatient and outpatient setting.  
• High provider: patient ratio.
• Loss to follow-up in nutritional care.   
• Patient/family education on a well-balanced diet.

Site Needs

• Institutional training within all disciplines in the timely and effective delivery of nutritional care and management for children with cancer.
• Establishment of hospital-wide nutritional protocols and education initiatives.
• Effective cost-reduction strategies for implementation of medical nutrition therapy.
• Integration of nutritional therapies into oncology protocols for side effect management.

(Image Source: www.observer.ug)