title: An international survey of nutritional practices in low- and middle-income countries: a report from the International Society of Pediatric Oncology (SIOP) PODC Nutrition Working Group.
abstract: OBJECTIVE
  Optimal nutritional status is important in children with cancer, as it can influence clinical outcomes. To improve the nutritional health of children and adolescents receiving treatment for cancer residing in low income and middle-income countries (LMIC), we investigated nutrition practices among these nations' institutions providing treatment for childhood cancer.
  
  
  METHODS
  A cross-sectional survey of nutrition practice was administered to staff members at institutions providing treatment for children with cancer between 2011 and 2012. Countries classified as low income and middle income were divided by geographical region. Final analysis was performed with 96 surveys, which included 27 institutions from Asia, 27 institutions from Latin America and Caribbean, 27 institutions from Africa and 15 institutions from Europe.
  
  
  RESULTS
  The study found that 55% of institutions had a dietician available on their service. Access to dieticians, lack of nutrition resources and lack of nutrition education of staff were the main barriers to providing nutrition care in LMIC. Half of the institutions performed nutritional assessment at diagnosis, and the methods used varied widely. Twenty-nine percent of all institutions used complementary and alternate therapies within their clinical practice, and 35% of institutions reported that nutrition education was provided to patients and families.
  
  
  CONCLUSIONS
  Priority areas for improving the nutritional management in LMIC include the following: (1) improved nutrition education and assessment tools for doctors and nurses; (2) increased availability of nutrition education resources for families and patients; and (3) identification of the role of complementary and alternative therapies in closing gaps in symptom management in these institutions.
authors.affiliation: Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Murphy
authors.affiliation: Clinical Nutrition Services, St Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: T T
authors.initials: TT
authors.lastname: Mosby
authors.affiliation: Division of Pediatric Hematology/Oncology/Bone Marrow Transplant, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: P C
authors.initials: PC
authors.lastname: Rogers
authors.affiliation: Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.affiliation: 1] Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University, New York, NY, USA [2] Institute of Human Nutrition, Columbia University, New York, NY, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Ladas
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011795:Surveys and Questionnaires