Evaluating a Global Clinical Nutrition Program for Pediatric Oncology in Resource-Limited Settings

Background: Children with cancer in low- and middle-income countries (LMICs) experience disproportionately high mortality. Nutritional care improves treatment tolerance and survival, yet access to trained nutrition professionals remains limited. The International Initiative for Pediatrics and Nutrition (IIPAN) was established to strengthen hospital-based clinical nutrition services through capacity-building, education, and mentorship. Objectives: To evaluate the IIPAN global clinical nutrition capacity-building program across hospitals in LMICs. Methods: A monitoring and evaluation framework was implemented across 16 hospitals in 11 countries (February 2024-June 2025). Monthly indicators captured patient characteristics, nutritional status, delivery of nutrition interventions, and dietary diversity. Nutritional status was classified using body mass index (BMI)-for-age, mid-upper arm circumference (MUAC), and height-for-age z-scores based on World Health Organization standards. Findings: Across all sites, 29,295 clinical visits were reported. Most consultations occurred in inpatient settings (79.9%) and were follow-up assessments (85.1%). Among patients, 52.5% had solid tumors and 39.6% had hematologic malignancies. Based on BMI-for-age, 10.3% were classified with severe acute malnutrition (SAM) and 13.5% with moderate acute malnutrition (MAM). Height-for-age analysis indicated that 27.2% were stunted. Nearly all hospitalized patients (95.8%) received a nutrition assessment within 24 hours of admission, and 96.0% received individualized or group nutrition education. Therapeutic foods or formulas were provided in 42.8% of consultations, while advanced nutrition therapy was administered in 3.5%. The prevalence of acute malnutrition decreased significantly between initial and follow-up assessments (38.9% to 25.2%; P < 0.001). In sites with food kitchens, provision of therapeutic nutrition was substantially higher than program-wide for both children consuming ≤50% of estimated needs (87.4% vs 55%) and for children with SAM (99.1% vs 86%). Conclusions: The IIPAN model demonstrates that integrated, hospital-based nutrition care led by trained nutritionists can reduce acute malnutrition and improve access to essential nutrition services in LMICs.