Published in PLOS One on 2026-07-09, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Ivaan Pitua, Daisy Wannyana, Derrick Bary Abila, Felix Bongomin
Source: PLOS One • DOI 10.1371/journal.pone.0353569
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Malnutrition is a prevalent and modifiable co-morbidity in paediatric oncology, yet no comprehensive pan-African synthesis of its burden has been conducted. This systematic review and meta-analysis estimated the pooled prevalence of wasting and acute malnutrition among paediatric cancer patients in Africa, evaluated the impact of diagnostic assessment methods on reported prevalence, and characterised associations with adverse clinical outcomes.
We searched PubMed/MEDLINE, EMBASE and Web of Science for observational studies published from January 2000 to December 2025 reporting wasting or acute malnutrition among children and adolescents (0–19 years) with confirmed malignancies in African healthcare settings. Two independent reviewers screened studies, extracted data, and appraised quality using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled prevalence was calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Publication bias was evaluated with Egger’s regression test. Certainty of evidence was assessed using the GRADE framework.
Sixteen independent cohorts comprising 2,419 paediatric cancer patients across eight African countries were included. The pooled prevalence of wasting or acute malnutrition was 39.7% (95% CI: 30.7%–49.1%), with individual study estimates ranging from 11.7% to 67.6%. Between-study heterogeneity was substantial (I² = 95.3%; 95% CI: 92.7%–96.1%, p < 0.001). Studies using mid-upper arm circumference (MUAC) consistently detected substantially higher rates of malnutrition than those relying on weight-for-height or body mass index criteria from the same patient populations. No significant publication bias was detected (Egger’s test p = 0.503). GRADE certainty of evidence was very low, primarily due to heterogeneity. Wasting was independently associated with higher chemotherapy toxicity, treatment-related neutropenia, sepsis, and reduced overall survival across two of the included cohorts.
Wasting and malnutrition affects about two in five children with cancer in the African countries studied. The diagnostic tool employed is the single most consequential determinant of detected prevalence, and weight-based metrics alone are inadequate in populations with large solid tumours. Universal adoption of MUAC-based screening, structured algorithm-guided nutritional intervention, and integration of socioeconomic vulnerability assessment into routine oncological care are evidence-based priorities for improving treatment tolerability and survival in this population.
Introduction
Childhood cancer represents one of the most pressing yet under-recognized public health challenges in Africa, where survival rates remain markedly lower than those achieved in high-income countries [1,2]. While children diagnosed with cancer in North America and Western Europe now achieve five-year survival rates exceeding 80% [2], comparable figures in sub-Saharan Africa rarely surpass 30% [2–4]. This disparity reflects not only limited access to curative therapies but also a constellation of structural barriers that undermine treatment delivery, including inadequate supportive care infrastructure, delayed diagnosis, and the pervasive burden of malnutrition [5,6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Ivaan Pitua, Daisy Wannyana, Derrick Bary Abila, Felix Bongomin. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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