الفهرس 
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Abstract
Leukemia is the second leading cause of death among children. Chemotherapy is the cornerstone of leukemia management. However, it causes severalnutritional adverse effects as vomiting, oral mucositis and diarrhea. Essentially, all of these adverse effects can cause a deficiency in food and liquid consumption, electrolyte imbalance, weight loss and consequently nutritional disorders.
Pediatric oncology nurses play a pivotal role in nutritional counselingto minimize CINSEs and emphasize HDP. Initially, the PONs should assess for nutritional risk and identify children who require nutritional support. They have tomanage nutritional problems and provide education for children on how to identify and manage nutritional problems. Therefore, the aim of the present study was to evaluate the effect of DEP on knowledge and the NS of CLC in Sana’a at Yemen.
The study was conducted in CLTU at Al-Kuwait Hospital in Sana’a at Yemen. All available CLC for a period of six months at the previously mentioned setting comprised the study subjects, their age ranged from 10-18 years old, received CHT after the first session of consolidation phase and free from renal, hepatic or cardiac diseases.
Three tools were used. Tool (I) was children’s nutritional knowledge during CHT structured interview schedule to evaluate children’s nutritional knowledge during CHT. It included two parts, part one involved socio-demographic data, medical data, dietary habits, consumption of main food groups and water as well as CINSEs. While, part two included children’s nutritional knowledge during CHT. Tool (II) was twenty four hour dietary recall assessment sheet to estimate the quantity and quality of foods and drinks that the children consumed in the last 24 hours. The last tool namely nutritional assessment parameters of CLC that included four parts, part one was anthropometric measurements, part two was biochemical tests, part three was clinical assessment to physical signs and symptoms of NS and part four was clinical assessment to CINSEs.
The developed DEP was implemented for each five children in the previously mentioned setting in four sessions. Each session took approximately one hour.
The main results of the present study revealed the following:
• The majority of children (90.5%) aged from 10 to less than 15 years with a mean age of 12.10 ±1.94.
• More than half of children (54.6%) were males.
• More than two thirds of children (68.8%) had primary education.
• More than three quarters of children (79.7%) were living in rural areas.
• The vast majority of children (97.8%) had not enough family income.
• All children were diagnosed with ALL and had VX protocol (100% for each).
• The main source of information was the nurse who constituted 36.8%.
• Only 1.9% of children reported correct answers about the definition of leukemia and the definition of CHT at pre test. Reverse, this percentage increased to (100%) at post test immediately and three months later and statistical significant differences were found (P < 0.001* for each).
• All children (100%) mentioned incorrect answers at pre test for healthy foodpyramid. On the contrary, all children (100%) mentioned correct answers at post test immediately and three months later and statistical significant difference was indicated (P < 0.001*).
• All children (100%) reported correct answers at pre test, post test immediately and three months later for the number of main meals per day. Meanwhile, all of them (100%) reported incorrect answers at pre test for number of snacks per day. Whereas, all those children (100%) reported correct answersat post test immediately and three months later and statistical significant differences were evident (P < 0.001* for each).
• All children (100%) mentioned incorrect answers at pre test for healthy food before, during and after CHT sessions. Conversely, all of them (100%) mentioned correct answers at post test immediately and three months later and statistical significant difference(P < 0.001*).
• All children (100%) reported incorrect answers about how to overcome CINSEs at pre test. Meanwhile, all of them (100%) reported correct answers at post test immediately and three months later and the differences were statistically significant where (P< 0.001* for each).
• All children (100%) had poor total knowledge score concerning nutritionduring CHT at pre test. Whereas, all of them(100%) had good total knowledge score at post test immediately and three months later.
• All children (100%) not committed to consume six food groups at pre test. While, the highest percentage of them committed to consume six food groups at post test immediately and three months later (77% and 94.7% respectively) and a statistical significant differencewas found (P < 0.001*).
• The highest percentage of children not committed to consume normal serving per day at pre test and post test immediately (100% and 94.4% respectively). While, 90.3% of them committed to consume normal serving per day at three months later and there was a statistical significant difference where(P < 0.001*).
• The minority of children had normal anthropometric measurements at pre test and post test immediately (7% for weight, 16.7% for BMI, 3.9% for MUAC and 12.8% for TSFT).In contrast, these percentages increasedat three months later to (80.2%, 93.6%, 88.6% and 81.9% respectively) with statistical significant differences (P < 0.001* for each).
• The lowest percentages of children had normal biochemical tests with the same percentages at pre test and post test immediately (3.9% for Hb, 5.8% for WBCs, 32.6% for serum creatinine and 38.2% for serum albumin). While, 75% of them had normal blood urea with the same percentageat pre test and post test immediately. At three months later, these percentages increased among those children to (88.6% for Hb, 93,3% for WBCs, 88% for blood urea, 87% for serum creatinine and 92.8% for serum albumin with statistical significant differences (P < 0.001* for each).
• The lowest percentages of children had normal hair, skin, eyes, nail and muscles at pre test and post test immediately (0.0%, 12 %, 13.9%, 37.3% and 9.2% respectively). These percentages increased to (21.4%, 90%, 90%, 42.3% and 90% respectively) at three months later and the differences were statistically significant (P < 0.001* for each).
• At pre test, the minority of children did not have nausea and vomiting(4% for each). These percentages increased to (17% for each) at post test immediately. Also, these percentages increased at three months laterto (95.5% and 100% respectively) with statistical significant differences(P < 0.001* for each).
• Only, 15% of childrendid not have diarrhea at pre test. This percentage increased at post test immediately and three months later to(59.1% and 89.7% respectively) with statistical significant difference (P < 0.001*).
• Only 1.1% of children had normal appetite at pre test. This percentage increased at post test immediately and three months laterto (70.2% and 88.6%respectively) with statistical significant difference (P < 0.001*).
• The vast majority of children (93.3%) had oral mucositis at pre test. This percentage decreased at post test immediately and three months later to (29.8% and 0.0%respectively) andthe difference was statistically significant(P < 0.001*).