The development, testing, and preliminary feasibility of an adaptable pediatric oncology nutrition algorithm for low-middle income countries

PURPOSE: Despite advances in the field of pediatric oncology, which have contributed to an overall increase in event-free survival, high rates of malnutrition in low-middle income countries (LMICs) is still a major concern. This paper aims to describe the multifaceted development process of a nutrition intervention algorithm for pediatric oncology in LMIC. METHODS: The development of evidence-based algorithm took place over seven developmental phases, utilizing an interdisciplinary process with the clinical review. Phase 1: Collaboration with the International Paediatric Oncology Nutrition Group. Phase 2: Review of peer-reviewed literature for evidence-based algorithm. Phase 3: Draft algorithm development. Phase 4: Draft algorithm presented at international meetings for stakeholder feedback. Phase 5: Consultation with LMIC dieticians to identify additional needs and feasibility of the algorithm in resource-poor settings. Phase 6: Review of the final draft algorithm by an expert panel. Phase 7: Pilot and Preliminary Feasibility. RESULTS: The nutrition algorithm was piloted in three LMIC countries (Brazil, South Africa and India). Overall the LMIC nutrition intervention algorithm was considered feasible for use with a "yes" response to the question "was the algorithm useful to know what nutrition to give the child and when" 90% of the time, rendering to the tool feasible. However, the testing process did identify several limitations that need to be considered in future versions. CONCLUSIONS: This comprehensive collaborative process with interdisciplinary health professionals has successfully developed a pediatric oncology nutrition intervention algorithm for LMIC. Further feasibility testing and a longitudinal study are required.