Incidence and Predictors of Wasting Among Pediatric Cancer Patients at the University of Gondar Comprehensive and Specialized Hospital (UoG- CSH), Ethiopia: Retrospective Cohort Study (2020– 2024)

Abstract Introduction: Globally, more than 400,000 new cases of pediatric cancer are diagnosed each year. Wasting, an acute form of malnutrition, is a frequent yet under-recognized complication that adversely affects treatment outcomes and survival. Despite the increasing burden of pediatric cancer in Ethiopia, evidence regarding the incidence and determinants of wasting is limited. This study aimed to assess the incidence and predictors of wasting among pediatric cancer patients at the University of Gondar Comprehensive and Specialized Hospital (UoG-CSH), Northwest Ethiopia. Methods: A facility-based retrospective follow-up study was conducted among pediatric cancer patients treated between January 2020 and December 2024. Data were collected from May 16 to June 15, 2025. A total of 342 patients were selected using simple random sampling. The incidence rate of wasting was estimated, and Kaplan–Meier survival analysis was applied to determine the median time to wasting and survival probability. Predictor variables with p < 0.20 in the bivariable analysis were included in a multivariable shared Cox proportional hazards model. Adjusted hazard ratios (AHR) with 95% confidence intervals (CI) were reported, and statistical significance was declared at p ≤ 0.05. Main Findings: More than half (52.6%) of the children developed wasting during follow-up, corresponding to an incidence rate of 4.6 per 1,000 child-days. The median time to develop wasting was 155 days. The presence of comorbidities (AHR = 1.79; 95% CI: 1.10–3.00), poor nutritional intake (AHR = 1.96; 95% CI: 1.13–3.41), mucositis (AHR = 1.67; 95% CI: 1.24–2.26), and receiving chemotherapy combined with surgery (AHR = 2.18; 95% CI: 1.39–3.18) were significant predictors of wasting. Conclusions: The incidence of wasting among pediatric cancer patients was notably high. Comorbidity, mucositis, poor dietary intake, and combined treatment modalities were independent predictors. Integrating routine nutritional screening and intervention into pediatric oncology care especially for children with treatment-related complications—could substantially improve clinical outcomes. The retrospective design and reliance on secondary data were key limitations that may have led to underestimation of some risk factors.