Chemotherapy-induced oral mucositis among hospitalized pediatric oncology patients in Ethiopia: occurrence and associated factors in a prospective observational study in a resource-limited setting

Oral mucositis is a clinically important toxicity of chemotherapy in children with cancer and may contribute to pain, impaired oral intake, infection, nutritional deterioration, treatment interruption, and prolonged hospitalization. Although oral mucositis has been extensively studied in high-income settings, prospective evidence from sub-Saharan Africa remains limited. This study aimed to determine the occurrence, severity, and factors associated with chemotherapy-induced oral mucositis among pediatric oncology patients admitted to Jimma University Medical Center, Ethiopia. A hospital-based prospective observational study was conducted among 120 pediatric oncology patients receiving inpatient chemotherapy at Jimma University Medical Center from July to November 2022. Oral mucositis was assessed using the World Health Organization Oral Toxicity Scale. Demographic, clinical, nutritional, laboratory, and treatment-related data were collected prospectively. Associations were examined using bivariable analyses and Firth’s penalized logistic regression, selected because only 22 outcome events occurred. Adjusted odds ratios (AORs) and 95% profile penalized likelihood confidence intervals (CIs) were reported. Statistical significance was set at p < 0.05. The estimates were interpreted as exploratory associations because of the limited events, broad regimen categories, and potential residual confounding. Among 120 pediatric oncology patients, 22 developed oral mucositis, corresponding to an observed occurrence proportion of 18.3%. Among these 22 patients, Grade III was the most common grade (36.4%), followed by Grade I (27.3%), Grade II (22.7%), and Grade IV (13.6%). Compared with the doxorubicin-based reference regimen, the MTX-based regimen was associated with higher odds of oral mucositis (AOR = 3.97; 95% profile penalized likelihood CI: 1.33–12.77; p = 0.012), whereas other chemotherapy regimens were associated with lower odds (AOR = 0.19; 95% profile penalized likelihood CI: 0.03–0.79; p = 0.021). Severe acute malnutrition was not significantly associated with mucositis after adjustment (AOR = 2.10; 95% profile penalized likelihood CI: 0.70–6.29; p = 0.184). Oral mucositis was detected in 18.3% of hospitalized pediatric oncology patients during the inpatient observation period, with Grade III being the most frequently observed severity grade. In the parsimonious Firth penalized logistic regression model, chemotherapy regimen was associated with mucositis, while the association with severe acute malnutrition was not statistically significant. These estimates are uncertain because only 22 events were observed, confidence intervals were wide, regimen categories were broad, and follow-up ended at discharge. The findings do not establish chemotherapy regimen as a definitive independent risk factor or estimate occurrence throughout the full chemotherapy course. Standardized oral assessment and supportive care remain important; larger studies with extended follow-up and detailed treatment-exposure data are needed. Not applicable.