{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:19:48Z","timestamp":1783621188441,"version":"3.55.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u201319 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\n                      <jats:italic>I<\/jats:italic>\n                      \u00b2 statistic and Cochran\u2019s Q test. Publication bias was evaluated with Egger\u2019s regression test. Certainty of evidence was assessed using the GRADE framework.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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%\u201349.1%), with individual study estimates ranging from 11.7% to 67.6%. Between-study heterogeneity was substantial (\n                      <jats:italic>I<\/jats:italic>\n                      \u00b2\u2009=\u200995.3%; 95% CI: 92.7%\u201396.1%, p\u2009&lt;\u20090.001). 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\u2019s test p\u2009=\u20090.503). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353569","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:47:42Z","timestamp":1783619262000},"page":"e0353569","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, diagnostic methods, and clinical outcomes of wasting among paediatric cancer patients in Africa: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0768-1315","authenticated-orcid":true,"given":"Ivaan","family":"Pitua","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Wannyana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6763-5612","authenticated-orcid":true,"given":"Derrick Bary","family":"Abila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Bongomin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"10125","key":"pone.0353569.ref001","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S0140-6736(17)33326-3","article-title":"Global surveillance of trends in cancer survival 2000\u201314 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries","volume":"391","author":"C Allemani","year":"2018","journal-title":"The Lancet"},{"key":"pone.0353569.ref002","article-title":"Childhood cancer survival in low- and middle-income countries and the Global South: emerging evidence and critical gaps from a scoping review of observational studies","volume":"6","author":"M Santero","year":"2025","journal-title":"EJC Paediatr Oncol"},{"issue":"10","key":"pone.0353569.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0163090","article-title":"Determinants of treatment abandonment in childhood cancer: results from a global survey","volume":"11","author":"P Friedrich","year":"2016","journal-title":"PLoS One"},{"key":"pone.0353569.ref004","first-page":"445","article-title":"Tackling childhood cancer in sub-Saharan Africa","year":"2022","journal-title":"The Lancet Child Adolescent Health"},{"key":"pone.0353569.ref005","article-title":"The influence of nutrition on clinical outcomes in children with cancer","author":"RD Barr","year":"2020","journal-title":"Pediatr Blood Cancer"},{"issue":"6","key":"pone.0353569.ref006","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/S2352-4642(19)30407-9","article-title":"Nutrition during childhood cancer treatment: current understanding and a path for future research","volume":"4","author":"L Joffe","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"pone.0353569.ref007","unstructured":"7.WHO. 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