Perioperative Nutrition Support for Elective Surgical Cancer Patients: A Narrative Review

Misgan Mulatie Zewudie,1 Debas Yaregal Melesse,2 Tesera Dereje Filatie,2 Amare Belete Getahun,2 Biruk Adie Admass2 1Department of Anesthesia, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia; 2Department of Anesthesia, College of Medicine and Health Science, University of Gondar, Gondar, EthiopiaCorrespondence: Debas Yaregal Melesse, Tel +251948814731, Email [email protected]: This review of the literature’s current types of suggestions regarding perioperative nutrition support for surgical cancer patients was its primary goal.Methods: Appropriate kinds of literature were searched from the databases and other sources based on the process applied in a narrative review. The following databases like SCOPUS, PubMed, science direct, Google scholar, Cochrane library, MEDLINE, and Embase with Boolean operators including OR, AND, with medical heading subjects (MeSH) (preoperative AND nutrition AND cancer, malnutrition OR under-nutrition AND prevention AND management, cancer AND surgery AND analgesia, nutrition AND perioperative AND oncologic surgery, optimization AND perioperative AND nutrition AND cancer, oncological surgery AND frailty, sarcopenia AND perioperative malnutrition AND optimization, prehabilitation AND nutritional support AND cancer AND cachexia) were used. Endnote reference manager was used to remove duplications of extracted kinds of literature from different sources.Results: The total number of articles identified through database and website searches was 34,292. Of these references, 1030 duplicates were removed. Nine hundred literatures were excluded in the screening phase with the human and published periods. Eighty-nine (89) references were included in the final version of this review.Conclusion: Cancer-related malnutrition can be diagnosed using the criteria of the Global Leadership Initiative on Malnutrition (GLIM). A daily caloric consumption of 20– 35 kcal/kg, with glucose and lipids, as well as electrolytes, trace elements, and vitamins, is advised for malnutrition in cancer patients.Keywords: cancer, frailty, nutrition support, optimization, perioperative, sarcopeni

Design of a parallel cluster-randomized trial assessing the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia: Andilaye study protocol

Unimproved water, sanitation, and hygiene (WASH) behaviors are key drivers of infectious disease transmission and influencers of mental well-being. While WASH is seen as a critical enabler of health, important knowledge gaps related to the content and delivery of effective, holistic WASH programming exist. Corresponding impacts of WASH on mental well-being are also underexplored. There is a need for more robust implementation research that yields information regarding whether and how community-based, demand-side interventions facilitate progressive and sustained adoption of improved sanitation and hygiene behaviors and downstream health impacts. The purpose of this protocol is to detail the rationale and design of a cluster-randomized trial evaluating the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia.MethodsTogether with partners, we developed a theoretically-informed, evidence-based behavioral intervention called Andilaye. We randomly selected and assigned 50 sub-districts (kebeles) from three purposively selected districts (woredas)half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). During baseline, midline, and endline, we will collect data on an array of behavioral factors, potential moderators (e.g., water and sanitation insecurity, collective efficacy), and our primary study outcomes: sanitation and hygiene behaviors and mental well-being. We will perform a process evaluation to assess intervention fidelity and related attributes.DiscussionWhile CLTSH has fostered sanitation and hygiene improvements in Ethiopia, evidence of behavioral slippage, or regression to unimproved practices in communities previously declared open defecation free exists. Other limitations of CLTSH, such as its focus on disgust, poor triggering, and over-saturation of Health Extension Workers have been documented. We employed rigorous formative research and practically applied social and behavioral theory to develop Andilaye, a scalable intervention designed to address these issues and complement existing service delivery within Ethiopia's Health Extension Program. Evidence from this trial may help address knowledge gaps related to scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond.Trial registrationThis trial was registered with clinicaltrials.gov (NCT03075436) on March 9, 2017

The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: A cluster-randomized trial.

Behaviors related to water, sanitation, and hygiene (WASH) are key drivers of infectious disease transmission, and experiences of WASH are potential influencers of mental well-being. Important knowledge gaps exist related to the content and delivery of effective WASH programs and their associated health impacts, particularly within the contexts of government programs implemented at scale. We developed and tested a demand-side intervention called Andilaye, which aimed to change behaviors related to sanitation, personal hygiene, and household environmental sanitation. This theory-informed intervention was delivered through the existing Ethiopian Health Extension Programme (HEP). It was a multilevel intervention with a catalyzing event at the community level and behavior change activities at group and household levels. We randomly selected and assigned 50 kebeles (sub-districts) from three woredas (districts), half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). We collected data on WASH access, behavioral outcomes, and mental well-being. A total of 1,589 households were enrolled into the study at baseline; 1,472 households (94%) participated in an endline assessment two years after baseline, and approximately 14 months after the initiation of a multi-level intervention. The intervention did not improve construction of latrines (prevalence ratio [PR]: 0.99; 95% CI: 0.82, 1.21) or handwashing stations with water (PR: 0.96; 95% CI: 0.72, 1.26), or the removal of animal feces from the compound (PR: 1.10; 95% CI: 0.95, 1.28). Nor did it impact anxiety (PR: 0.90; 95% CI: 0.72, 1.11), depression (PR: 0.83; 95% CI: 0.64, 1.07), emotional distress (PR: 0.86; 95% CI: 0.67, 1.09) or well-being (PR: 0.90; 95% CI: 0.74, 1.10) scores. We report limited impact of the intervention, as delivered, on changes in behavior and mental well-being. The effectiveness of the intervention was limited by poor intervention fidelity. While sanitation and hygiene improvements have been documented in Ethiopia, behavioral slippage, or regression to unimproved practices, in communities previously declared open defecation free is widespread. Evidence from this trial may help address knowledge gaps related to challenges associated with scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond. Trial registration: This trial was registered with clinicaltrials.gov (NCT03075436) on March 9, 2017