Dietary diversity, and its associated factors among paediatric oncology patients receiving chemotherapy at Mulago National Referral Hospital cross sectional study design

Childhood cancer remains a major public health challenge, with approximately 429,000 new cases diagnosed annually worldwide, nearly 40% occurring in Africa, where most children live in low- and middle-income countries. In Uganda, an estimated 3,000 new childhood and adolescent cancer cases occur each year, yet only about 30% of affected children access specialized cancer treatment centres. Chemotherapy and the disease process increase nutritional requirements while reducing food intake, placing children at high risk of poor dietary diversity, malnutrition, treatment complications, and mortality. However, evidence on dietary diversity and its associated factors among paediatric oncology patients in Uganda remains limited. This study aimed to determine the prevalence of dietary diversity and its associated factors among paediatric oncology patients receiving chemotherapy at Mulago National Referral Hospital. A cross-sectional study was conducted among 500 children with cancer receiving chemotherapy at the Pediatric Oncology Unit of Mulago National Referral Hospital, Uganda, selected through systematic random sampling. Data were collected using structured interviewer-administered questionnaires, a data abstraction tool, 24-hour dietary recall, and anthropometric measurements, following informed consent from caregivers and assent from children aged 8 years and above. Descriptive statistics were used to summarize participant characteristics and dietary diversity, while modified Poisson regression with robust standard errors was performed to identify factors associated with dietary diversity. Variables with a p-value < 0.20 at bivariate analysis were included in the multivariable model, and statistical significance was considered at p < 0.05. The prevalence of adequate dietary diversity was 58.8% (95% CI: 54.4%–63.1%). Cereals, roots and tubers (96.0%), oils and fats (89.0%), and flesh foods (72.0%) were the most commonly consumed food groups, whereas eggs (29.2%) and dairy products (34.8%) were the least consumed. The factors which were associated with adequate dietary diversity included: urban residence (aPR = 1.24, 95% CI: 1.09–1.42), caregiver secondary (aPR = 1.29, 95% CI: 1.06–1.57) and tertiary education (aPR = 1.36, 95% CI: 1.11–1.67), self-employment (aPR = 1.22, 95% CI: 1.05–1.43), strong family support (aPR = 1.41, 95% CI: 1.19–1.66), non-use of herbal medicine (aPR = 1.27, 95% CI: 1.10–1.47), receipt of nutritional supplements (aPR = 1.18, 95% CI: 1.03–1.36), absence of swallowing difficulties (aPR = 1.31, 95% CI: 1.13–1.52), and receipt of nutrition health education (aPR = 1.34, 95% CI: 1.17–1.54). Adequate dietary diversity was achieved by slightly more than half of paediatric oncology patients receiving chemotherapy, with caregiver education, urban residence, self-employment, family support, non-use of herbal medicine, nutritional supplementation, absence of swallowing difficulties, and nutrition health education significantly associated with adequate dietary diversity. Strengthening routine nutrition assessment, counselling and education, enhancing family support, promoting appropriate nutritional supplementation, and addressing feeding difficulties should be prioritized to improve dietary diversity and nutritional outcomes among children undergoing chemotherapy.