Patterns and temporal trends in childhood cancer incidence in Northern Ghana: evidence from medical records, 2016 to 2023.

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Abubakari Wuni, Mudasir Mohammed Ibrahim, Peter Sambian Tonlaar, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6397628/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Oct, 2025 Read the published version in BMC Pediatrics → Version 1 posted 16 You are reading this latest preprint version Abstract Background: Childhood cancers contribute significantly to child morbidity and mortality worldwide, with an even greater burden in resource-limited settings. However, there is limited research documenting the incidence and patterns of childhood cancers in Ghana. Aim: We aimed to examine the trends and patterns of childhood cancers in Northern Ghana over a seven-year period. Methods: We conducted a retrospective descriptive analysis of medical records from the regional pediatric oncology unit at Tamale Teaching Hospital in Northern Ghana. The study included children diagnosed with cancer and admitted to the oncology unit between January 2016 and December 2023. We classified cancers based on the International Classification of Childhood Cancer and quantified the number of cases of each type, both overall and stratified by time and child characteristics. SAS JMP Professional Software (version 17.1) was used to analyze the data. Results: A total of 216 child medical records were analyzed. Most (62.5%) children were male, with 48.1% aged 0 to 3 years. The number of children admitted with cancer increased progressively over time, from 15 cases in 2016/2017 to 82 in 2022/2023. Males and those 0 to 7 years were more likely to be admitted with cancer. Ten cancer types were identified, with retinoblastoma being the most commonly diagnosed cancer (30.1%), followed by lymphomas (23.1%) and renal tumors (15.7%). Of the 184 children with admission outcome data, 56.5% died. Cancer-related deaths were highest among those diagnosed with lymphomas (28.8%) and retinoblastoma (58.3%), as well as those aged 0–3 years (45.2%) and among males (67.3%). Overall, cancer deaths declined steadily from 71.4% in 2016/2017 to 44.4% in 2022/2023. Conclusion: Our findings suggest a rise in childhood cancers in Northern Ghana, with a greater proportion of cases occurring in children between 0-7 years and among males. Trial registration: Not applicable. Clinical Trial Number: Not applicable Childhood cancer incidence treatment outcome Ghana Figures Figure 1 Figure 2 Figure 3 Introduction Childhood cancers are a leading cause of morbidity and mortality among children worldwide [1,2,3]. Despite being less common than adult cancers, childhood cancers still pose a substantial global health burden, with nearly 400,000 new cases diagnosed annually [4,5]. They are the ninth leading cause of disease burden in children [6] and contribute substantially to disability-adjusted life years (DALYs) [7], with incidence rates varying across countries [8]. In the United States, approximately 15,000 children are diagnosed with cancer each year [9], whereas in Kenya, 42,116 children were diagnosed in 2022 [10]. Notably, 80% of all childhood cancer cases occur in low- and middle-income countries (LMICs) [11,12] where diagnostic services and treatment options are often limited [13,14], leading to higher mortality than in high-income countries 15]. In Ghana, leukemia, lymphoma, retinoblastoma, Wilms’ tumor, soft tissue sarcoma, and neuroblastoma are among the most prevalent childhood cancers, with an estimated 1,200 children under age 15 diagnosed annually [16]. However, the true burden is likely underestimated due to underdiagnosis and inadequate reporting systems. Recent studies indicate a concerning increase in cases. For instance, Owusu et al. [12] found in two tertiary hospitals an increase in age-specific cancer incidence from 1.6 per 100,000 person-years in 2015 to 2.41 per 100,000 person-years in 2017, followed by a decline in 2019, highlighting fluctuations that require further investigation. Their findings also revealed a higher incidence among male children and those under five. Paintsil et al. [17] also observed a rise in childhood cancer cases from 27.2% in 2012 to 43.0% in 2014 at a tertiary hospital, with the highest prevalence among children aged 5–9 years and Burkitt’s lymphoma as the most common cancer. The continued rise in childhood cancer cases highlights the need for further investigations and a review of Ghana’s national strategy for cancer control to prioritize childhood cancers and the effective allocation of resources [18]. Understanding national trends and high-risk populations is important for developing effective control strategies, ensuring equitable resource distribution, facilitating early diagnosis and treatment, and ultimately reducing childhood cancer mortality. However, existing research is disproportionately concentrated in southern Ghana, leading to a skewed understanding of childhood cancer epidemiology and limiting the effectiveness of national control strategies. The sole study available from northern Ghana was a histopathological review that did not assess patient outcomes [19], thereby limiting its impact on the design of targeted interventions. This lack of nationally representative data limits national estimates and risks excluding northern Ghana from policy and resource allocation decisions. Therefore, in this study, we examined childhood cancer patterns, trends, and admission outcomes in Northern Ghana over a seven-year period using clinical data from the pediatric oncology unit at Tamale Teaching Hospital, the primary referral center for Northern Ghana. Methods Study setting and population This study is a retrospective analysis of cross-sectional clinical data from the Pediatric Oncology Unit at Tamale Teaching Hospital (TTH), the only tertiary referral and teaching hospital in Northern Ghana. This hospital serves a wide catchment area covering five of Ghana’s sixteen administrative regions, representing a geographically and socioeconomically diverse population that is underserved by specialized pediatric oncology services. The unit provides specialized services, including histopathological diagnostics, surgical interventions, chemotherapy, endocrine therapy, and follow-up care. Given its central role in pediatric oncology service delivery across the northern regions, the patient population at TTH can be considered broadly representative of the pediatric cancer burden in Northern Ghana. For this analysis, we included children under 16 years who were diagnosed with any form of cancer and admitted to the Pediatric Oncology Unit at TTH between January 2016 and December 2023. Cases with inconclusive diagnoses were excluded. Data abstraction and study variables The primary data source for this analysis was the clinical records of children admitted to the pediatric oncology unit. Data abstraction from the records was carried out using a structured, pre-designed form with clear guidelines developed to ensure consistency and completeness. The form was refined in consultation with clinicians at the oncology unit to ensure clinical relevance and contextual appropriateness. Three members of our study team, who have clinical backgrounds and are familiar with the oncology unit, carried out the data extraction. Training sessions were held prior to the commencement of data collection. The extracted data included clinical and sociodemographic information, such as patient age (classified into 0–3, 4–7, and 8–15 years), gender, date of admission, cancer type, and admission outcome. Cancer diagnoses were classified according to the International Classification of Childhood Cancer (ICCC) [20]. Treatment outcomes at discharge were recorded as “treatment completed,” “referred,” or “died during admission.” Sociodemographic variables of caregivers were captured including their relationship to the child (mother, father, or other), gender, highest educational attainment (none, primary, secondary, tertiary), occupational status (government-employed, self-employed, unemployed), religious affiliation (Muslim or Christian), and ethnic group (Mole-Dagbani, Gurunsi, Guan, Akan, or other). The caregivers’ region of residence was also recorded and categorized into three major geographic belts consistent with Ghana’s administrative classification: Northern Belt (comprising Northern, North East, Upper East, Upper West, and Savannah regions), Middle Belt (Ashanti, Bono, and Bono East), and Southern Belt (Western, Western North, Central, Greater Accra, Eastern, and Volta). Data management and analysis The extracted data were cleaned and validated prior to the analysis to ensure completeness and internal consistency. Records were examined for duplication, missingness, and logical inconsistencies. No duplicate or ambiguous entries were identified. Descriptive analyses were performed to summarize the distribution of cancer cases by patient demographics and clinical characteristics. Categorical variables were presented as frequencies and percentages. Childhood cancer types were classified based on the International Classification of Childhood Cancer (ICCC), with case counts reported overall and stratified by gender and age at diagnosis. We examined trends in cancer distribution over the seven-year study period, stratified by gender and age at diagnosis to identify potential changes in diagnostic patterns or the burden of disease over time. Clinical outcomes at discharge, defined as completion of treatment, referral to another facility, or in-hospital death, were analyzed in relation to child-level variables (such as age at diagnosis, sex, and cancer type), in addition to the year of admission and caregiver characteristics, to investigate potential variations in outcomes. The results are presented in cross-tabulation tables, clustered bar charts, and pie charts. All data management and statistical analysis were conducted using SAS JMP Pro, version 17. Ethical consideration Ethical approval for this study was obtained from the Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication and Ethics (reference number: CHRPF/AP /1047 /24) . Permission to access medical records was granted by the management of Tamale Teaching Hospital (reference number: TTH/R&D/SR/24/303). Data were anonymized to protect patient confidentiality by removing identifiable information. Consent to participate was not applicable, as the study was based solely on the analysis of existing medical records and did not involve any direct interaction with participants or primary data collection. However, the study adhered strictly to ethical principles regarding the secondary use of health data. All procedures were conducted in accordance with the principles of the Declaration of Helsinki, ensuring respect for patient rights, data integrity, and confidentiality. Results Sociodemographic characteristics Overall, 216 children diagnosed with cancer and admitted to the pediatric oncology unit between January 2016 and December 2023 were included in the analysis. The sociodemographic characteristics of the children and their caregivers are presented in Table 1 . The majority of the children were male (62.5%), and nearly half (48.1%) were 0 to 3 years at the time of diagnosis. Two-thirds of the caregivers were mothers (67.6%). Among the caregivers, 59.7% had no formal education, 74.5% were self-employed, 66.2% identified as Muslim, 52.8% belonged to the Mole-Dagomba ethnic group, and 94.3% lived in the Northern belt of Ghana. Table 1 Demographic characteristics of children with cancer and their caregivers Variable Number Percentage Child characteristics: Gender Male 135 62.5 Female 81 37.5 Age 0–3 years 104 48.1 4–7 years 70 32.4 8–15 years Caregiver characteristics : 42 19.4 Relationship with child Father 66 30.6 Mother 145 67.1 Others 5 2.3 Gender Male 70 32.4 Female 146 67.6 Educational level No formal education 129 59.7 Primary 49 22.7 Secondary 19 8.8 Tertiary 19 8.8 Occupation Government employee 14 6.5 Self-employed 161 74.5 Unemployed 41 19.0 Religion Christian 73 33.8 Muslim 143 66.2 Ethnic group Akan 4 1.9 Guan 7 3.2 Gurunsi 38 17.6 Mole-Dagbani 114 52.8 Others 53 24.5 Regional belt 1 Northern belt 199 94.3 Middle belt 9 4.3 Southern belt 3 1.4 Note: 1 Northern belt (Northern, Upper East, Upper West, North East, and Savannah region); Middle belt (Ashanti, Bono, and Bono East); Southern belt (Western, Western North, Central, Greater Accra, Eastern, and Volta region). Missing values = 5 Trends in childhood cancer admissions by gender and age at diagnosis Figure 1 illustrates trends in childhood cancer admissions from January 2016 to December 2023, stratified by gender and age at diagnosis. Male admissions consistently exceeded female admissions across all periods, increasing from 53.3% in 2016/17 to 67.1% in 2022/23. In contrast, female cancer admissions declined from 46.7–32.9% over the same period. The distribution of cancer admissions by age indicates that these admissions were increasingly dominated by children aged 0–3 at diagnosis, rising from 40.0% in 2016/17 to 58.5% in 2022/23. Conversely, the proportion of children aged 4–7 years declined from 46.7–23.2%, while those aged 8–15 years remained relatively stable, showing minor fluctuations between 13.3% and 18.3%. Childhood cancer classifications according to the International Classification of Childhood Cancer Of the 216 pediatric cancer cases (Table 2 ), the most prevalent childhood cancer was retinoblastoma (30.1%). This was followed by lymphomas and reticuloendothelial neoplasms (23.1%), renal tumors (15.7%), and leukemias, myeloproliferative diseases, and myelodysplastic diseases (14.4%). Other cancers included neuroblastoma and other peripheral nervous cell tumors (6.9%), soft tissue and other extraosseous sarcomas (5.1%), and hepatic tumors (1.9%). Less common types were malignant bone tumors (1.4%), germ cell tumors, trophoblastic tumors, and neoplasms of the gonads (0.9%). Other and unspecified malignant neoplasms represented just 0.5% of cases. Retinoblastoma showed a steady increase over time, with cases rising from 26.7% in 2016/17 to 32.9% in 2022/23. The highest incidence was observed in children aged 0–3 years (45.2%), and among females (34.6%). Lymphomas and reticuloendothelial neoplasms followed a consistent pattern, peaking at 41.7% in 2018/19 and declining to 18.3% in 2022/23. This type was more prevalent in males (27.4%) compared to females (16.0%) and was distributed relatively evenly across age groups, with a higher incidence in children aged 8–15 years (42.9%). Leukemias, myeloproliferative diseases, and myelodysplastic diseases surged in later years, from 0% in 2016/17 to 22.0% in 2022/23. These conditions were more prevalent in older children, particularly those aged 4–7 years (20.0%) and 8–15 years (26.2%). Males (17.0%) had a higher incidence of these diseases compared to females (9.9%). Renal tumors also showed an increasing trend, rising from 6.7% in 2016/17 to 15.9% in 2022/23. These tumors were most common in children aged 0–3 years (21.2%), with a higher prevalence in males (18.5%) than in females (14.1%). Other cancer types, such as neuroblastoma and peripheral nervous cell tumors, increased from 2.8% in 2018/19 to 9.6% in 2020/21, with a higher incidence in males (6.7%) and children aged 4–7 years (11.4%). Soft tissue sarcomas and hepatic tumors remained relatively rare but were more prevalent among children aged 0–3 years (4.8%) and 4–7 years (7.1%). Table 2 Distribution of childhood cancer types by year of admission, child’s gender, and age Cancer types were classified based on the International Childhood Cancer Classification (Steliarova-Foucher et al., 2005). Total (n = 216) Year of admission Child’s gender Child age Cancer types 2016/17 2018/19 2020/21 2022/23 Male Female 0–3 years 4–7 years 8–15 years (n = 15) (n = 36) (n = 83) (n = 82) (n = 135) (n = 81) (n = 104) (n = 70) (n = 42) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Retinoblastoma 65 (30.1) 4 (26.7) 7 (19.4) 27 (32.5) 27 (32.9) 37 (27.4) 28 (34.6) 47 (45.2) 16 (22.9) 2 (4.8) Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 2 (0.9) 0 (0) 0 (0) 1 (1.2) 1 (1.2) 2 (1.5) 0 (0) 2 (1.9) 0 (0) 0 (0) Lymphomas and reticuloendothelial neoplasms 50 (23.1) 4 (26.7) 15 (41.7) 16 (19.3) 15 (18.3) 37 (27.4) 13 (16.0) 16 (15.4) 16 (22.9) 18 (42.9) Hepatic tumors 4 (1.9) 2 (13.3) 0 (0) 1 (1.2) 1 (1.2) 2 (1.5) 2 (2.5) 2 (1.9) 2 (2.9) 0 (0) Leukemias, myeloproliferative diseases, and myelodysplastic diseases 31 (14.4) 0 (0) 4 (11.1) 9 (10.8) 18 (22.0) 23 (17.0) 8 (9.9) 6 (5.8) 14 (20.0) 11 (26.2) Malignant bone tumors 3 (1.4) 0 (0) 0 (0) 3 (3.6) 0 (0) 2 (1.5) 1 (1.2) 1 (1.0) 1 (1.4) 1 (2.4) Neuroblastoma and other peripheral nervous cell tumors 15 (6.9) 2 (13.3) 1 (2.8) 8 (9.6) 4 (4.9) 9 (6.7) 6 (7.4) 2 (1.9) 8 (11.4) 5 (11.9) Renal tumors 34 (15.7) 1 (6.7) 8 (22.2) 12 (14.5) 13 (15.9) 19 (14.1) 15 (18.5) 22 (21.2) 8 (11.4) 4 (9.5) Soft tissue and other extraosseous sarcomas 11 (5.1) 2 (13.3) 1 (2.8) 6 (7.2) 2 (2.4) 3 (2.2) 8 (9.9) 5 (4.8) 5 (7.1) 1 (2.4) Other and unspecified malignant neoplasms 1 (0.5) 0 (0) 0 (0) 0 (0) 1 (1.2) 1 (0.7) 0 (0) 1 (1.0) 0 (0) 0 (0) Case counts of pediatric cancer subtypes The cancer subtypes within each major category are presented in Table 3 . Retinoblastoma (n = 65) was the single most common individual diagnosis. Among lymphomas and reticuloendothelial neoplasms, Burkitt lymphoma was the predominant subtype (n = 22). In the leukemias category, acute lymphoblastic leukemia accounted for the majority of cases (n = 22). Other notable subtype distributions included nephroblastoma (n = 34) as the leading renal tumor, rhabdomyosarcoma (n = 11) among soft tissue sarcomas, and neuroblastoma (n = 15) among tumors of the peripheral nervous system. Hepatic tumors were exclusively hepatoblastoma (n = 4), while osteosarcoma (n = 2) represented all malignant bone tumors. Germ cell tumors (n = 2) were the only tumours observed in the Germ cell tumors, trophoblastic tumors, and neoplasms of gonads category. Table 3 Case count of childhood cancer subgroups admitted from 2016 to 2023 Cancer subtypes Number Retinoblastoma Retinoblastoma 65 Germ cell tumors, trophoblastic tumors, and neoplasms of gonads Germ cell tumor 2 Lymphomas and reticuloendothelial neoplasms Burkitt lymphoma 22 Hodgkin lymphoma 3 Lymphoma 13 Non-Hodgkin lymphoma 12 Hepatic tumors Hepatoblastoma 4 Leukemias, myeloproliferative diseases, and myelodysplastic diseases Acute lymphoblastic leukemia 22 Acute myeloid leukemia 9 Malignant bone tumors Ewing’s sarcoma 1 Osteosarcoma 2 Neuroblastoma and other peripheral nervous cell tumors Neuroblastoma 15 Renal tumors Nephroblastoma 34 Soft tissue and other extraosseous sarcomas Rhabdomyosarcoma 11 Other and unspecified malignant neoplasms Paranasal sinus tumor 1 Clinical outcome on discharge Of the 216 patients, outcome data were available for 184 (85.2%). As shown in Fig. 2 , over half of these children (56.5%) died during their admission. Referrals to other facilities were recorded for 30.4%, while only 13.0% completed treatment and were discharged. Clinical outcomes on discharge by child and caregiver characteristics Table 4 presents discharge outcomes by sociodemographic characteristics. Mortality (67.3%) and referrals (57.1%) were higher in males (67.3%) than in females (32.7%), but treatment completion did not differ between the sexes. Children aged 0–3 had the highest mortality (45.2%), referral (48.2%), and treatment completion (58.3%). Children diagnosed with retinoblastoma had the highest treatment completion (58.3%), those with leukemias had the highest referrals (23.2%), while those with lymphomas and reticuloendothelial neoplasms had the highest mortality (29.8%). Children of caregivers without formal education had higher mortality (66.3%) and referral rates (55.4%) than those with educated caregivers. However, treatment completion was higher among children of educated caregivers (62.5%). Children of employed caregivers had higher mortality (80.8%), referral (80.4%), and treatment completion (87.5%) than those of unemployed caregivers. As expected, almost all the children who were referred, died, or completed treatment lived in the Northern belt. Temporal patterns in discharge outcomes are illustrated in Fig. 3 . Cancer-related mortality decreased from 71.4% in 2016/17 to 44.4% in 2022/23, while referrals rose steadily from 21.4% in 2016/17 to 39.7% in 2022/23. Treatment completion also increased from 7.1% in 2016/17 to 15.9% in 2022/23, albeit with some fluctuations between 2018 and 2021. Table 4 Distribution of child and caregiver characteristics by childhood cancer admission outcomes (N = 184) Variable Completed treatment n (%) Referred n (%) Died n (%) Child characteristics: Gender Male 12 (50.0) 32 (57.1) 70 (67.3) Female 12 (50.0) 24 (42.9) 34 (32.7) Age 0–3 years 14 (58.3) 27 (48.2) 47 (45.2) 4–7 years 7 (29.2) 18 (32.1) 36 (34.6) 8–15 years 3 (12.5) 11 (19.6) 21 (20.2) Caregiver characteristics : Educational level Uneducated 9 (37.5) 31 (55.4) 69 (66.3) Educated 15 (62.5) 25 (44.6) 35 (33.7) Occupation Unemployed 3 (12.5) 11 (19.6) 20 (19.2) Employed 21 (87.5) 45 (80.4) 84 (80.8) Regional belt Northern belt 21 (87.5) 51 (91.1) 98 (98.0) Middle belt 2 (8.3) 3 (5.4) 2 (2.0) Southern belt 1 (4.2) 2 (3.6) 0 (0) Type of childhood cancer Retinoblastoma 14 (58.3) 11 (19.6) 30 (28.8) Germ cell tumors, trophoblastic tumors, and neoplasms of gonads 0 (0) 1 (1.8) 1 (1.0) Lymphomas and reticuloendothelial neoplasms 5 (20.8) 11 (19.6) 31 (29.8) Hepatic tumors 1 (4.2) 1 (1.8) 2 (1.9) Leukemias, myeloproliferative diseases, and myelodysplastic diseases 0 (0) 13 (23.2) 12 (11.5) Malignant bone tumors 0 (0) 2 (3.6) 1 (1.0) Neuroblastoma and other peripheral nervous cell tumors 1 (4.2) 2 (3.6) 8 (7.7) Renal tumors 3 (12.5) 11 (19.6) 14 (13.5) Soft tissue and other extraosseous sarcomas 0 (0) 3 (5.4) 5 (4.8) Other and unspecified malignant Neoplasms 0 (0) 1 (1.8) 0 (0) Note: Categories recorded: Caregiver’s educational level [Uneducated (No formal education), Educated (Primary Secondary, and Tertiary)] and Caregiver’s occupation [Unemployed, Employed (Government employee, Self-employed)] Discussion This study examined patterns and temporal trends in childhood cancer incidence at the Tamale Teaching Hospital in Northern Ghana from 2016 to 2023. The results of this study indicate a higher incidence of childhood cancer among male children compared to their female counterparts. This trend aligns with previous research by Williams et al. [21], Endalamaw et al. [22], and Williams et al.[23], which consistently reported a greater prevalence of childhood cancer among males. While the reasons for this disparity remain an area of ongoing research, several biological factors have been proposed as potential contributors. Studies suggest that a combination of immune-related, genetic, and hormone-related mechanisms may play a role in the higher incidence observed in males [24]. These findings highlight the need for further investigation into sex-based differences in childhood cancer to support the development of targeted public health interventions. The study also revealed that the highest number of childhood cancer cases occurred in children aged 0–3 years. This finding is comparable with studies by Owusu et al. [12] and Siegel [25], which reported that pediatric cancer rates are highest within this age group. This could be due to congenital genetic mutations, prenatal environmental exposures, or early-life susceptibility to carcinogens. Certain cancers, such as neuroblastoma, retinoblastoma, and Wilms' tumor, predominantly occur in infancy and early childhood [5], further supporting this observation. The immaturity of the immune system during this critical developmental phase may also contribute to the increased vulnerability of younger children to malignancies [26]. Hence, public health initiatives should focus on raising awareness about the early signs and symptoms of childhood cancers, promoting genetic screening for high-risk families, and reducing prenatal and early-life exposure to known carcinogens. The current study showed that the most prevalent childhood cancer was retinoblastoma. Retinoblastoma is a malignant tumor of the retina that primarily affects young children, with both hereditary and non-hereditary forms linked to mutations in the RB1 gene [27,28]. The high prevalence of retinoblastoma in this study suggests that genetic factors may be contributing to the disease burden in the studied population. In contrast, a study by Owusu et al. [12] found lymphomas as the most prevalent childhood cancer. Moreover, other studies by Ward et al. [15], Lu et al. [29], and Wu et al. [30] identified leukemia as the most common cancer in children. The variation in findings could be due to differences in geographic distribution and genetic predisposition. The mortality rate for childhood cancer in this study was high, with more than half of the affected children dying during the course of treatment. This finding is concerning and highlights significant challenges in childhood cancer management within the studied population. This was similarly observed in the study by Slone et al. [31]. However, the observed mortality rate is higher than reported in studies by Loeffen et al. [32] and Horn et al.[33], indicating a discrepancy in findings. These studies revealed that childhood cancer mortality was relatively low. The disparity in findings may be attributed to differences in healthcare infrastructure, access to specialized pediatric oncology care, and the availability of advanced treatment options and supportive care services. This highlights the urgent need for strengthened healthcare policies to improve childhood cancer management. Efforts should prioritize early detection programs, timely referral systems, expanded access to chemotherapy and radiotherapy, and enhanced supportive care, including infection control and nutritional support. In addition, this study found that mortality rates among childhood cancer patients were higher in males compared to females. A possible explanation for this trend is that males have poorer survival outcomes for childhood cancer [24]. The increased risk of childhood cancer among males may have a genetic basis, as hormonal differences between males and females during childhood are minimal [21]. This means that factors beyond hormonal influence, such as genetic susceptibility, immune response differences, and variations in tumor biology, could contribute to the observed disparity in survival rates. This result is consistent with previous studies by Curado et al. [34], Gupta et al. [35], Williams and Spector [36], and Siegel et al.[37], all of which reported higher mortality rates among male childhood cancer patients compared to females. This highlights the need for targeted interventions aimed at improving survival outcomes among male children with cancer. According to the study results, higher mortality and referral rates were predominant among children whose caregivers had no formal education. This finding emphasizes the significant role of caregiver education in determining childhood cancer outcomes. Caregivers with lower educational levels may have limited awareness of early cancer symptoms, delayed healthcare-seeking behavior, and reduced understanding of treatment protocols which can contribute to poor prognosis [38,39]. This result aligns with previous research by Moore et al. [40] and García-Quintero et al.[41] indicating that caregiver literacy and health knowledge play a crucial role in disease management and survival outcomes in pediatric oncology. Therefore, public health interventions should focus on caregiver education programs to enhance awareness of childhood cancer signs, the importance of early diagnosis, and adherence to treatment. Furthermore, the study found that cancer treatment completion was higher among children of employed caregivers compared to those of unemployed caregivers. This discovery suggests that the economic stability associated with caregiver employment plays a crucial role in ensuring adherence to cancer treatment. Employed caregivers are more likely to have financial resources which contribute to a higher likelihood of treatment completion [42]. This result is in accordance with studies by Jones [43], Bekui et al. [44], and Tran et al. [45] that have highlighted the influence of socioeconomic status on pediatric cancer treatment outcomes. This underscores the need for government policies and healthcare programs that provide financial assistance, subsidized treatments, and transportation support for unemployed caregivers. This will ultimately improve treatment adherence and outcomes for children with cancer. Lastly, among childhood cancers, retinoblastoma had the highest treatment completion rate. This may be attributed to its distinct and visible symptoms, such as leukocoria (white pupil) and strabismus (misaligned eyes) [46,47], which may prompt caregivers to seek medical attention earlier than for other childhood cancers with more subtle presentations [48]. A key factor influencing treatment completion is caregiver awareness and knowledge about childhood cancers [39], as caregivers play a crucial role in ensuring that children receive timely medical attention and adhere to prescribed treatment plans [49]. To improve early recognition, reduce delays in seeking care, and enhance treatment adherence, community outreach initiatives should be implemented to equip caregivers with essential knowledge about childhood cancer symptoms and management. Limitations Despite the valuable insights provided, this study has some limitations. The reliance on hospital electronic records may introduce selection bias, as only children who sought care at the facility were included, potentially underrepresenting cases managed elsewhere or undiagnosed cases in the region. Also, data completeness and accuracy were dependent on the quality of medical record entry, which may have led to missing or misclassified information. The retrospective nature of the study also limited the ability to assess causality between demographic factors and clinical outcomes. Moreover, socioeconomic variables such as household income and healthcare accessibility, which could influence treatment adherence and outcomes, were not captured. Lastly, while the classification of cancer types followed the International Childhood Cancer Classification (ICCC), potential inconsistencies in diagnostic coding could have impacted the categorization of certain cases. Clinical Implications Childhood cancer is increasingly prevalent in Northern Ghana, particularly among males and younger children, highlighting an urgent need for improved early detection and treatment strategies. High mortality rates, especially for retinoblastoma and lymphomas, suggest gaps in access to timely diagnosis, specialized pediatric oncology care, and supportive therapies. Though a decline in cancer-related deaths indicates some progress, further investments in healthcare infrastructure, capacity building for early diagnosis, and enhanced treatment protocols are crucial to improving survival outcomes for affected children. Conclusion This study presents significant trends and patterns in childhood cancers in Northern Ghana between 2016 and 2023. Retinoblastoma is the most prevalent cancer type, followed by lymphomas and renal tumors. Demographically, male children, particularly those under 3 years of age, were more frequently diagnosed. A concerning trend emerged in the clinical outcomes, where the majority of children either died during treatment or were referred to other facilities, especially in the Northern belt. Mortality rates were notably higher among children of uneducated caregivers and those with employed caregivers. Geographically, the Northern belt had the highest mortality and referral rates. Furthermore, retinoblastoma demonstrated relatively better treatment completion rates compared to other cancer types. The results of the study highlight the need for improved healthcare infrastructure, caregiver education, and regional support to address childhood cancer care disparities in Northern Ghana. Abbreviations DALYs disability-adjusted life years LMICs low- and middle-income countries TTH Tamale Teaching Hospital ICCC International Childhood Cancer Classification Declarations Ethics approval and consent to participate The study received ethical approval from the Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication, and Ethics. Permission to access medical records was granted by Tamale Teaching Hospital, with data anonymized to protect confidentiality. Consent to participate was not applicable, as the study was based solely on the analysis of existing medical records and did not involve any direct interaction with participants or primary data collection. All procedures adhered to the Declaration of Helsinki, ensuring patient rights, data integrity, and confidentiality Consent for publication Not applicable. Competing Interests The authors declare no competing interest. Funding Statement This study did not receive any funding Author Contribution AW, MMI, ISM, and PST conceived the study. The design of the work was carried out by AW, MMI, ISM, PST, IA, BAN, AA, SM, and WJS. The acquisition and analysis of data were handled by AW, MMI, ISM, SM, WJS, and PST. The interpretation of the data was done by AW, MMI, ISM, SM, WJS, PST, and IA. AW, MMI, ISM, PST, IA, BAN, AA, SM, and WJS drafted the manuscript or substantively revised it. All authors reviewed and approved the final manuscript. Acknowledgement The authors express their gratitude to the Tamale Teaching Hospital and its Pediatric Oncology Unit for granting access to medical records and supporting this research. Special thanks to the hospital staff for their assistance in data collection and validation. We also acknowledge the caregivers and families whose data contributed to this study. 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Ann Transl Med. 2015;3(17):250. https://doi.org/10.3978/j.issn.2305-5839.2015.08.14 Wu Y, Deng Y, Wei B, Xiang D, Hu J, Zhao P, et al. Global, regional, and national childhood cancer burden, 1990–2019: An analysis based on the Global Burden of Disease Study 2019. J Adv Res. 2022; 40:233 − 47. https://doi.org/10.1016/j.jare.2022.06.001 Slone JS, Chunda-Liyoka C, Perez M, Mutalima N, Newton R, Chintu C, et al. Pediatric Malignancies, Treatment Outcomes and Abandonment of Pediatric Cancer Treatment in Zambia. PLoS One. 2014;9(2): e89102. https://doi.org/10.1371/journal.pone.0089102 Loeffen EAH, Knops RRG, Boerhof J, Feijen EAM, Merks JHM, Reedijk AMJ, et al. Treatment-related mortality in children with cancer: Prevalence and risk factors. Eur J Cancer. 2019; 121:113 − 22. https://doi.org/10.1016/j.ejca.2019.08.008 Horn SR, Stoltzfus KC, Mackley HB, Lehrer EJ, Zhou S, Dandekar SC, et al. Long-term causes of death among pediatric patients with cancer. Cancer. 2020;126(13):3102-13. https://doi.org/10.1002/cncr.32885 Curado MP, Pontes T, Guerra-Yi ME, Cancela MDC. Leukemia mortality trends among children, adolescents, and young adults in Latin America. Rev Panam Salud Publica. 2011;29(2):96–102. https://doi.org/10.1590/S1020-49892011000200004 Gupta S, Morris SK, Suraweera W, Aleksandrowicz L, Dikshit R, Jha P. Childhood Cancer Mortality in India: Direct Estimates from a Nationally Representative Survey of Childhood Deaths. J Glob Oncol. 2016;2(6):403 − 11. https://doi.org/10.1200/JGO.2015.000935 Williams LA, Spector LG. Survival Differences Between Males and Females Diagnosed with Childhood Cancer. JNCI Cancer Spectra. 2019;3(2):pkz032. https://doi.org/10.1093/jncics/pkz032 Siegel DA, Richardson LC, Henley SJ, Wilson RJ, Dowling NF, Weir HK, et al. Pediatric cancer mortality and survival in the United States, 2001–2016. Cancer. 2020;126(19):4379-89. https://doi.org/10.1002/cncr.33080 Li S, He Y, Liu J, Chen K, Yang Y, Tao K, et al. An umbrella review of socioeconomic status and cancer. Nat Commun. 2024;15(1):1. https://doi.org/10.1038/s41467-024-54444-2 Nurhidayah I, Hendriyani D, Adistie F, Nurhaeni N, Mediani HS. Factors Influencing Treatment-Seeking Behavior Among Caregivers of Children with Cancer: A Scoping Review. J Multidiscip Healthc. 2025; 18:563 − 78. https://doi.org/10.2147/JMDH.S497004 Moore C, Gallagher P, Dunne S. Health literacy, eHealth literacy and their association with burden, distress, and self-efficacy among cancer caregivers. Front Psychol. 2024; 15:1283227. https://doi.org/10.3389/fpsyg.2024.1283227 García-Quintero X, Bastardo Blanco D, Vásquez L, Fuentes-Alabí S, Benites-Majano S, Maza M, et al. Health literacy on quality of life for children with cancer: Modules on pediatric palliative care. Rev Panam Salud Publica. 2023;47: e134. https://doi.org/10.26633/RPSP.2023.134 Fakeye KMB, Samuel LJ, Wolff JL. Financial Contributions and Experiences of Non-Spousal, Employed Family Caregivers. J Appl Gerontol. 2022;41(12):2459-68. https://doi.org/10.1177/07334648221115261 Jones BL. The Challenge of Quality Care for Family Caregivers in Pediatric Cancer Care. Semin Oncol Nurs. 2012;28(4):213 − 20. https://doi.org/10.1016/j.soncn.2012.09.003 Bekui BAA, Ohene LA, Badzi C, Ampomah MO, Aziato L. Physical and socioeconomic burden of caregiving on family caregivers of children with cancer at a tertiary Hospital in Ghana. Nurs Open. 2023;10(2):915 − 25. https://doi.org/10.1002/nop2.1359 Tran YH, Coven SL, Park S, Mendonca EA. Social determinants of health and pediatric cancer survival: A systematic review. Pediatr Blood Cancer. 2022;69(5):e29546. https://doi.org/10.1002/pbc.29546 O'Brien JM. Retinoblastoma: Clinical Presentation and the Role of Neuroimaging. AJNR Am J Neuroradiol. 2001;22(3):427-9. PMID: 11237964 Balmer A, Munier F. Differential diagnosis of leukocoria and strabismus, first presenting signs of retinoblastoma. Clin Ophthalmol. 2007;1(4):431-9. https://doi.org/10.2147/OPTH.S1369 Nazemi KJ, Malempati S. Emergency department presentation of childhood cancer. Emerg Med Clin North Am. 2009;27(3):477 − 95. https://doi.org/10.1016/j.emc.2009.04.008 Morgan EH, Schoonees A, Sriram U, Faure M, Seguin-Fowler RA. Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors. Cochrane Database Syst Rev. 2020;2020(1):CD012547. https://doi.org/10.1002/14651858.CD012547.pub2 Additional Declarations Competing interest reported. The authors declare no competing interest. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6397628","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453755429,"identity":"5b0ce805-b27b-4817-ac9e-13268dfe388a","order_by":0,"name":"Abubakari Wuni","email":"","orcid":"","institution":"College of Nursing, University of Kentucky, Lexington, United States","correspondingAuthor":false,"prefix":"","firstName":"Abubakari","middleName":"","lastName":"Wuni","suffix":""},{"id":453755433,"identity":"7e511519-2794-4144-8ec3-72fb14323310","order_by":1,"name":"Mudasir Mohammed Ibrahim","email":"","orcid":"","institution":"Department of Internal Medicine(M3), Tamale Teaching Hospital, Tamale","correspondingAuthor":false,"prefix":"","firstName":"Mudasir","middleName":"Mohammed","lastName":"Ibrahim","suffix":""},{"id":453755434,"identity":"4120b1fe-4438-4922-8c9d-78f9017c4663","order_by":2,"name":"Peter Sambian Tonlaar","email":"","orcid":"","institution":"Department of Child Health, Tamale Teaching Hospital, Tamale","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"Sambian","lastName":"Tonlaar","suffix":""},{"id":453755435,"identity":"f1069bf1-5675-4b33-ba3e-6b130fc6369f","order_by":3,"name":"Iddrisu Sisala Mohammed","email":"data:image/png;base64,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","orcid":"","institution":"Department of Nursing, Nurses’ and Midwives’ Training College, Tamale","correspondingAuthor":true,"prefix":"","firstName":"Iddrisu","middleName":"Sisala","lastName":"Mohammed","suffix":""},{"id":453755436,"identity":"6b9daab2-4a9e-4bbd-b2f4-6092d9068cd0","order_by":4,"name":"Issahaku Awal","email":"","orcid":"","institution":"University for Development Studies, School of Nursing and Midwifery, Tamale","correspondingAuthor":false,"prefix":"","firstName":"Issahaku","middleName":"","lastName":"Awal","suffix":""},{"id":453755437,"identity":"3bdfee2b-1823-4475-84eb-1cc530f71f08","order_by":5,"name":"Brenda Abena Nyarko","email":"","orcid":"","institution":"Eliane Marieb College of Nursing, University of Massachusetts, Amherst","correspondingAuthor":false,"prefix":"","firstName":"Brenda","middleName":"Abena","lastName":"Nyarko","suffix":""},{"id":453755438,"identity":"397ad709-f312-4804-a8c4-61ce7f0b048f","order_by":6,"name":"Abdul-Jalil Abdulai","email":"","orcid":"","institution":"College of Nursing, University of Rio Grande, Cincinnati","correspondingAuthor":false,"prefix":"","firstName":"Abdul-Jalil","middleName":"","lastName":"Abdulai","suffix":""},{"id":453755439,"identity":"5bed1764-26a5-4180-b3d4-bb57cdfcd350","order_by":7,"name":"Shamsudeen Mohammed","email":"","orcid":"","institution":"Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene \u0026 Tropical Medicine, London","correspondingAuthor":false,"prefix":"","firstName":"Shamsudeen","middleName":"","lastName":"Mohammed","suffix":""},{"id":453755440,"identity":"924d9256-22f2-4ca1-93bf-7c70400a0e1c","order_by":8,"name":"Waliu Jawula Salisu","email":"","orcid":"","institution":"Cambridge University Hospital, NHS Foundation Trust, Cambridge","correspondingAuthor":false,"prefix":"","firstName":"Waliu","middleName":"Jawula","lastName":"Salisu","suffix":""}],"badges":[],"createdAt":"2025-04-07 22:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6397628/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6397628/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-06141-2","type":"published","date":"2025-10-02T15:57:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82561620,"identity":"5a94187c-c6af-4626-974f-ad742debb412","added_by":"auto","created_at":"2025-05-13 01:39:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":226728,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in childhood cancer admissions by child’s (A) gender and (B) age at diagnsois from 2016 to 2023. The numbers on the bars are percentages.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6397628/v1/cf1aea934e62fac1826c2762.png"},{"id":82561612,"identity":"78ed0716-aec8-465a-8ed0-d25c5f67ad33","added_by":"auto","created_at":"2025-05-13 01:39:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79510,"visible":true,"origin":"","legend":"\u003cp\u003eClinical outcomes of childhood cancer admissions from 2016 to 2023\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6397628/v1/2aeb081c27155609eca4b443.png"},{"id":82562659,"identity":"2c97be5b-dba5-4203-bf6a-9f6a3d447cd3","added_by":"auto","created_at":"2025-05-13 01:47:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":121872,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of childhood cancer admission outcomes by year of admission\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6397628/v1/96b011356dc0b8528487cfbb.png"},{"id":92883787,"identity":"1e7743ec-85a6-4471-9667-a3183f2d3683","added_by":"auto","created_at":"2025-10-06 16:09:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1905139,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6397628/v1/46efea54-893c-41c4-963c-aac8b7e8084c.pdf"}],"financialInterests":"Competing interest reported. The authors declare no competing interest.","formattedTitle":"Patterns and temporal trends in childhood cancer incidence in Northern Ghana: evidence from medical records, 2016 to 2023.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChildhood cancers are a leading cause of morbidity and mortality among children worldwide [1,2,3]. Despite being less common than adult cancers, childhood cancers still pose a substantial global health burden, with nearly 400,000 new cases diagnosed annually [4,5]. They are the ninth leading cause of disease burden in children [6] and contribute substantially to disability-adjusted life years (DALYs) [7], with incidence rates varying across countries [8]. In the United States, approximately 15,000 children are diagnosed with cancer each year [9], whereas in Kenya, 42,116 children were diagnosed in 2022 [10]. Notably, 80% of all childhood cancer cases occur in low- and middle-income countries (LMICs) [11,12] where diagnostic services and treatment options are often limited [13,14], leading to higher mortality than in high-income countries 15].\u003c/p\u003e \u003cp\u003eIn Ghana, leukemia, lymphoma, retinoblastoma, Wilms\u0026rsquo; tumor, soft tissue sarcoma, and neuroblastoma are among the most prevalent childhood cancers, with an estimated 1,200 children under age 15 diagnosed annually [16]. However, the true burden is likely underestimated due to underdiagnosis and inadequate reporting systems. Recent studies indicate a concerning increase in cases. For instance, Owusu et al. [12] found in two tertiary hospitals an increase in age-specific cancer incidence from 1.6 per 100,000 person-years in 2015 to 2.41 per 100,000 person-years in 2017, followed by a decline in 2019, highlighting fluctuations that require further investigation. Their findings also revealed a higher incidence among male children and those under five. Paintsil et al. [17] also observed a rise in childhood cancer cases from 27.2% in 2012 to 43.0% in 2014 at a tertiary hospital, with the highest prevalence among children aged 5\u0026ndash;9 years and Burkitt\u0026rsquo;s lymphoma as the most common cancer.\u003c/p\u003e \u003cp\u003e The continued rise in childhood cancer cases highlights the need for further investigations and a review of Ghana\u0026rsquo;s national strategy for cancer control to prioritize childhood cancers and the effective allocation of resources [18]. Understanding national trends and high-risk populations is important for developing effective control strategies, ensuring equitable resource distribution, facilitating early diagnosis and treatment, and ultimately reducing childhood cancer mortality. However, existing research is disproportionately concentrated in southern Ghana, leading to a skewed understanding of childhood cancer epidemiology and limiting the effectiveness of national control strategies. The sole study available from northern Ghana was a histopathological review that did not assess patient outcomes [19], thereby limiting its impact on the design of targeted interventions. This lack of nationally representative data limits national estimates and risks excluding northern Ghana from policy and resource allocation decisions. Therefore, in this study, we examined childhood cancer patterns, trends, and admission outcomes in Northern Ghana over a seven-year period using clinical data from the pediatric oncology unit at Tamale Teaching Hospital, the primary referral center for Northern Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy setting and population\u003c/h2\u003e\n\u003cp\u003eThis study is a retrospective analysis of cross-sectional clinical data from the Pediatric Oncology Unit at Tamale Teaching Hospital (TTH), the only tertiary referral and teaching hospital in Northern Ghana. This hospital serves a wide catchment area covering five of Ghana\u0026rsquo;s sixteen administrative regions, representing a geographically and socioeconomically diverse population that is underserved by specialized pediatric oncology services. The unit provides specialized services, including histopathological diagnostics, surgical interventions, chemotherapy, endocrine therapy, and follow-up care. Given its central role in pediatric oncology service delivery across the northern regions, the patient population at TTH can be considered broadly representative of the pediatric cancer burden in Northern Ghana.\u003c/p\u003e\n\u003cp\u003eFor this analysis, we included children under 16 years who were diagnosed with any form of cancer and admitted to the Pediatric Oncology Unit at TTH between January 2016 and December 2023. Cases with inconclusive diagnoses were excluded.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eData abstraction and study variables\u003c/h3\u003e\n\u003cp\u003eThe primary data source for this analysis was the clinical records of children admitted to the pediatric oncology unit. Data abstraction from the records was carried out using a structured, pre-designed form with clear guidelines developed to ensure consistency and completeness. The form was refined in consultation with clinicians at the oncology unit to ensure clinical relevance and contextual appropriateness. Three members of our study team, who have clinical backgrounds and are familiar with the oncology unit, carried out the data extraction. Training sessions were held prior to the commencement of data collection.\u003c/p\u003e\n\u003cp\u003eThe extracted data included clinical and sociodemographic information, such as patient age (classified into 0\u0026ndash;3, 4\u0026ndash;7, and 8\u0026ndash;15 years), gender, date of admission, cancer type, and admission outcome. Cancer diagnoses were classified according to the International Classification of Childhood Cancer (ICCC) [20]. Treatment outcomes at discharge were recorded as \u0026ldquo;treatment completed,\u0026rdquo; \u0026ldquo;referred,\u0026rdquo; or \u0026ldquo;died during admission.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eSociodemographic variables of caregivers were captured including their relationship to the child (mother, father, or other), gender, highest educational attainment (none, primary, secondary, tertiary), occupational status (government-employed, self-employed, unemployed), religious affiliation (Muslim or Christian), and ethnic group (Mole-Dagbani, Gurunsi, Guan, Akan, or other). The caregivers\u0026rsquo; region of residence was also recorded and categorized into three major geographic belts consistent with Ghana\u0026rsquo;s administrative classification: Northern Belt (comprising Northern, North East, Upper East, Upper West, and Savannah regions), Middle Belt (Ashanti, Bono, and Bono East), and Southern Belt (Western, Western North, Central, Greater Accra, Eastern, and Volta).\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eThe extracted data were cleaned and validated prior to the analysis to ensure completeness and internal consistency. Records were examined for duplication, missingness, and logical inconsistencies. No duplicate or ambiguous entries were identified. Descriptive analyses were performed to summarize the distribution of cancer cases by patient demographics and clinical characteristics. Categorical variables were presented as frequencies and percentages. Childhood cancer types were classified based on the International Classification of Childhood Cancer (ICCC), with case counts reported overall and stratified by gender and age at diagnosis.\u003c/p\u003e\n\u003cp\u003eWe examined trends in cancer distribution over the seven-year study period, stratified by gender and age at diagnosis to identify potential changes in diagnostic patterns or the burden of disease over time. Clinical outcomes at discharge, defined as completion of treatment, referral to another facility, or in-hospital death, were analyzed in relation to child-level variables (such as age at diagnosis, sex, and cancer type), in addition to the year of admission and caregiver characteristics, to investigate potential variations in outcomes. The results are presented in cross-tabulation tables, clustered bar charts, and pie charts. All data management and statistical analysis were conducted using SAS JMP Pro, version 17.\u003c/p\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003eEthical approval\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003efor this study was obtained from the Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication and Ethics (reference number: \u003cstrong\u003eCHRPF/AP /1047 /24)\u003c/strong\u003e. Permission to access medical records was granted by the management of Tamale Teaching Hospital (reference number: \u003cstrong\u003eTTH/R\u0026amp;D/SR/24/303).\u003c/strong\u003e Data were anonymized to protect patient confidentiality by removing identifiable information. Consent to participate was not applicable, as the study was based solely on the analysis of existing medical records and did not involve any direct interaction with participants or primary data collection. However, the study adhered strictly to ethical principles regarding the secondary use of health data. All procedures were conducted in accordance with the principles of the Declaration of Helsinki, ensuring respect for patient rights, data integrity, and confidentiality.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e \u003cp\u003eOverall, 216 children diagnosed with cancer and admitted to the pediatric oncology unit between January 2016 and December 2023 were included in the analysis. The sociodemographic characteristics of the children and their caregivers are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of the children were male (62.5%), and nearly half (48.1%) were 0 to 3 years at the time of diagnosis. Two-thirds of the caregivers were mothers (67.6%). Among the caregivers, 59.7% had no formal education, 74.5% were self-employed, 66.2% identified as Muslim, 52.8% belonged to the Mole-Dagomba ethnic group, and 94.3% lived in the Northern belt of Ghana.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of children with cancer and their caregivers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild characteristics:\u003c/p\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;15 years\u003c/p\u003e \u003cp\u003e\u003cb\u003eCaregiver characteristics\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship with child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnic group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAkan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGurunsi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMole-Dagbani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegional belt\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern belt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle belt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern belt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNote: \u003csup\u003e1\u003c/sup\u003eNorthern belt (Northern, Upper East, Upper West, North East, and Savannah region); Middle belt (Ashanti, Bono, and Bono East); Southern belt (Western, Western North, Central, Greater Accra, Eastern, and Volta region). Missing values\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrends in childhood cancer admissions by gender and age at diagnosis\u003c/h3\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates trends in childhood cancer admissions from January 2016 to December 2023, stratified by gender and age at diagnosis. Male admissions consistently exceeded female admissions across all periods, increasing from 53.3% in 2016/17 to 67.1% in 2022/23. In contrast, female cancer admissions declined from 46.7\u0026ndash;32.9% over the same period. The distribution of cancer admissions by age indicates that these admissions were increasingly dominated by children aged 0\u0026ndash;3 at diagnosis, rising from 40.0% in 2016/17 to 58.5% in 2022/23. Conversely, the proportion of children aged 4\u0026ndash;7 years declined from 46.7\u0026ndash;23.2%, while those aged 8\u0026ndash;15 years remained relatively stable, showing minor fluctuations between 13.3% and 18.3%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eChildhood cancer classifications according to the International Classification of Childhood Cancer\u003c/h3\u003e\n\u003cp\u003eOf the 216 pediatric cancer cases (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the most prevalent childhood cancer was retinoblastoma (30.1%). This was followed by lymphomas and reticuloendothelial neoplasms (23.1%), renal tumors (15.7%), and leukemias, myeloproliferative diseases, and myelodysplastic diseases (14.4%). Other cancers included neuroblastoma and other peripheral nervous cell tumors (6.9%), soft tissue and other extraosseous sarcomas (5.1%), and hepatic tumors (1.9%). Less common types were malignant bone tumors (1.4%), germ cell tumors, trophoblastic tumors, and neoplasms of the gonads (0.9%). Other and unspecified malignant neoplasms represented just 0.5% of cases.\u003c/p\u003e \u003cp\u003eRetinoblastoma showed a steady increase over time, with cases rising from 26.7% in 2016/17 to 32.9% in 2022/23. The highest incidence was observed in children aged 0\u0026ndash;3 years (45.2%), and among females (34.6%). Lymphomas and reticuloendothelial neoplasms followed a consistent pattern, peaking at 41.7% in 2018/19 and declining to 18.3% in 2022/23. This type was more prevalent in males (27.4%) compared to females (16.0%) and was distributed relatively evenly across age groups, with a higher incidence in children aged 8\u0026ndash;15 years (42.9%). Leukemias, myeloproliferative diseases, and myelodysplastic diseases surged in later years, from 0% in 2016/17 to 22.0% in 2022/23. These conditions were more prevalent in older children, particularly those aged 4\u0026ndash;7 years (20.0%) and 8\u0026ndash;15 years (26.2%). Males (17.0%) had a higher incidence of these diseases compared to females (9.9%).\u003c/p\u003e \u003cp\u003eRenal tumors also showed an increasing trend, rising from 6.7% in 2016/17 to 15.9% in 2022/23. These tumors were most common in children aged 0\u0026ndash;3 years (21.2%), with a higher prevalence in males (18.5%) than in females (14.1%). Other cancer types, such as neuroblastoma and peripheral nervous cell tumors, increased from 2.8% in 2018/19 to 9.6% in 2020/21, with a higher incidence in males (6.7%) and children aged 4\u0026ndash;7 years (11.4%). Soft tissue sarcomas and hepatic tumors remained relatively rare but were more prevalent among children aged 0\u0026ndash;3 years (4.8%) and 4\u0026ndash;7 years (7.1%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of childhood cancer types by year of admission, child\u0026rsquo;s gender, and age Cancer types were classified based on the International Childhood Cancer Classification (Steliarova-Foucher et al., 2005).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;216)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eYear of admission\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eChild\u0026rsquo;s gender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eChild age\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer types\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016/17\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2018/19\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2020/21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2022/23\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u0026ndash;3 years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4\u0026ndash;7 years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8\u0026ndash;15 years\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;135)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetinoblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e47 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGerm cell tumors, trophoblastic tumors, and neoplasms of gonads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphomas and reticuloendothelial neoplasms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18 (42.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatic tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukemias, myeloproliferative diseases, and myelodysplastic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11 (26.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignant bone tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuroblastoma and other peripheral nervous cell tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 (11.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e22 (21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 (9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft tissue and other extraosseous sarcomas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther and unspecified malignant neoplasms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCase counts of pediatric cancer subtypes\u003c/h2\u003e \u003cp\u003eThe cancer subtypes within each major category are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Retinoblastoma (n\u0026thinsp;=\u0026thinsp;65) was the single most common individual diagnosis. Among lymphomas and reticuloendothelial neoplasms, Burkitt lymphoma was the predominant subtype (n\u0026thinsp;=\u0026thinsp;22). In the leukemias category, acute lymphoblastic leukemia accounted for the majority of cases (n\u0026thinsp;=\u0026thinsp;22). Other notable subtype distributions included nephroblastoma (n\u0026thinsp;=\u0026thinsp;34) as the leading renal tumor, rhabdomyosarcoma (n\u0026thinsp;=\u0026thinsp;11) among soft tissue sarcomas, and neuroblastoma (n\u0026thinsp;=\u0026thinsp;15) among tumors of the peripheral nervous system. Hepatic tumors were exclusively hepatoblastoma (n\u0026thinsp;=\u0026thinsp;4), while osteosarcoma (n\u0026thinsp;=\u0026thinsp;2) represented all malignant bone tumors. Germ cell tumors (n\u0026thinsp;=\u0026thinsp;2) were the only tumours observed in the Germ cell tumors, trophoblastic tumors, and neoplasms of gonads category.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCase count of childhood cancer subgroups admitted from 2016 to 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer subtypes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetinoblastoma\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetinoblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGerm cell tumors, trophoblastic tumors, and neoplasms of gonads\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGerm cell tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLymphomas and reticuloendothelial neoplasms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurkitt lymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHodgkin lymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hodgkin lymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHepatic tumors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatoblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeukemias, myeloproliferative diseases, and myelodysplastic diseases\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute lymphoblastic leukemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute myeloid leukemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMalignant bone tumors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEwing\u0026rsquo;s sarcoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteosarcoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeuroblastoma and other peripheral nervous cell tumors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuroblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRenal tumors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephroblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSoft tissue and other extraosseous sarcomas\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRhabdomyosarcoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther and unspecified malignant neoplasms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParanasal sinus tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcome on discharge\u003c/h2\u003e \u003cp\u003eOf the 216 patients, outcome data were available for 184 (85.2%). As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, over half of these children (56.5%) died during their admission. Referrals to other facilities were recorded for 30.4%, while only 13.0% completed treatment and were discharged.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes on discharge by child and caregiver characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents discharge outcomes by sociodemographic characteristics. Mortality (67.3%) and referrals (57.1%) were higher in males (67.3%) than in females (32.7%), but treatment completion did not differ between the sexes. Children aged 0\u0026ndash;3 had the highest mortality (45.2%), referral (48.2%), and treatment completion (58.3%). Children diagnosed with retinoblastoma had the highest treatment completion (58.3%), those with leukemias had the highest referrals (23.2%), while those with lymphomas and reticuloendothelial neoplasms had the highest mortality (29.8%).\u003c/p\u003e \u003cp\u003eChildren of caregivers without formal education had higher mortality (66.3%) and referral rates (55.4%) than those with educated caregivers. However, treatment completion was higher among children of educated caregivers (62.5%). Children of employed caregivers had higher mortality (80.8%), referral (80.4%), and treatment completion (87.5%) than those of unemployed caregivers. As expected, almost all the children who were referred, died, or completed treatment lived in the Northern belt.\u003c/p\u003e \u003cp\u003eTemporal patterns in discharge outcomes are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Cancer-related mortality decreased from 71.4% in 2016/17 to 44.4% in 2022/23, while referrals rose steadily from 21.4% in 2016/17 to 39.7% in 2022/23. Treatment completion also increased from 7.1% in 2016/17 to 15.9% in 2022/23, albeit with some fluctuations between 2018 and 2021.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of child and caregiver characteristics by childhood cancer admission outcomes (N\u0026thinsp;=\u0026thinsp;184)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompleted treatment\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReferred\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild characteristics:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (67.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (32.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (45.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (20.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregiver characteristics\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUneducated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (66.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (33.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (19.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (80.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegional belt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern belt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98 (98.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle belt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern belt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of childhood cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetinoblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (28.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGerm cell tumors, trophoblastic\u003c/p\u003e \u003cp\u003etumors, and neoplasms of gonads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphomas and reticuloendothelial\u003c/p\u003e \u003cp\u003eneoplasms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (29.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatic tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukemias, myeloproliferative\u003c/p\u003e \u003cp\u003ediseases, and myelodysplastic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignant bone tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuroblastoma and other peripheral\u003c/p\u003e \u003cp\u003enervous cell tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (13.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft tissue and other extraosseous\u003c/p\u003e \u003cp\u003esarcomas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther and unspecified malignant\u003c/p\u003e \u003cp\u003eNeoplasms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNote: Categories recorded: Caregiver\u0026rsquo;s educational level [Uneducated (No formal education), Educated (Primary Secondary, and Tertiary)] and Caregiver\u0026rsquo;s occupation [Unemployed, Employed (Government employee, Self-employed)]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined patterns and temporal trends in childhood cancer incidence at the Tamale Teaching Hospital in Northern Ghana from 2016 to 2023. The results of this study indicate a higher incidence of childhood cancer among male children compared to their female counterparts. This trend aligns with previous research by Williams et al. [21], Endalamaw et al. [22], and Williams et al.[23], which consistently reported a greater prevalence of childhood cancer among males. While the reasons for this disparity remain an area of ongoing research, several biological factors have been proposed as potential contributors. Studies suggest that a combination of immune-related, genetic, and hormone-related mechanisms may play a role in the higher incidence observed in males [24]. These findings highlight the need for further investigation into sex-based differences in childhood cancer to support the development of targeted public health interventions. The study also revealed that the highest number of childhood cancer cases occurred in children aged 0\u0026ndash;3 years. This finding is comparable with studies by Owusu et al. [12] and Siegel [25], which reported that pediatric cancer rates are highest within this age group. This could be due to congenital genetic mutations, prenatal environmental exposures, or early-life susceptibility to carcinogens. Certain cancers, such as neuroblastoma, retinoblastoma, and Wilms' tumor, predominantly occur in infancy and early childhood [5], further supporting this observation. The immaturity of the immune system during this critical developmental phase may also contribute to the increased vulnerability of younger children to malignancies [26]. Hence, public health initiatives should focus on raising awareness about the early signs and symptoms of childhood cancers, promoting genetic screening for high-risk families, and reducing prenatal and early-life exposure to known carcinogens.\u003c/p\u003e \u003cp\u003eThe current study showed that the most prevalent childhood cancer was retinoblastoma. Retinoblastoma is a malignant tumor of the retina that primarily affects young children, with both hereditary and non-hereditary forms linked to mutations in the RB1 gene [27,28]. The high prevalence of retinoblastoma in this study suggests that genetic factors may be contributing to the disease burden in the studied population. In contrast, a study by Owusu et al. [12] found lymphomas as the most prevalent childhood cancer. Moreover, other studies by Ward et al. [15], Lu et al. [29], and Wu et al. [30] identified leukemia as the most common cancer in children. The variation in findings could be due to differences in geographic distribution and genetic predisposition.\u003c/p\u003e \u003cp\u003eThe mortality rate for childhood cancer in this study was high, with more than half of the affected children dying during the course of treatment. This finding is concerning and highlights significant challenges in childhood cancer management within the studied population. This was similarly observed in the study by Slone et al. [31]. However, the observed mortality rate is higher than reported in studies by Loeffen et al. [32] and Horn et al.[33], indicating a discrepancy in findings. These studies revealed that childhood cancer mortality was relatively low. The disparity in findings may be attributed to differences in healthcare infrastructure, access to specialized pediatric oncology care, and the availability of advanced treatment options and supportive care services. This highlights the urgent need for strengthened healthcare policies to improve childhood cancer management.\u003c/p\u003e \u003cp\u003eEfforts should prioritize early detection programs, timely referral systems, expanded access to chemotherapy and radiotherapy, and enhanced supportive care, including infection control and nutritional support. In addition, this study found that mortality rates among childhood cancer patients were higher in males compared to females. A possible explanation for this trend is that males have poorer survival outcomes for childhood cancer [24]. The increased risk of childhood cancer among males may have a genetic basis, as hormonal differences between males and females during childhood are minimal [21]. This means that factors beyond hormonal influence, such as genetic susceptibility, immune response differences, and variations in tumor biology, could contribute to the observed disparity in survival rates. This result is consistent with previous studies by Curado et al. [34], Gupta et al. [35], Williams and Spector [36], and Siegel et al.[37], all of which reported higher mortality rates among male childhood cancer patients compared to females. This highlights the need for targeted interventions aimed at improving survival outcomes among male children with cancer.\u003c/p\u003e \u003cp\u003e According to the study results, higher mortality and referral rates were predominant among children whose caregivers had no formal education. This finding emphasizes the significant role of caregiver education in determining childhood cancer outcomes. Caregivers with lower educational levels may have limited awareness of early cancer symptoms, delayed healthcare-seeking behavior, and reduced understanding of treatment protocols which can contribute to poor prognosis [38,39]. This result aligns with previous research by Moore et al. [40] and Garc\u0026iacute;a-Quintero et al.[41] indicating that caregiver literacy and health knowledge play a crucial role in disease management and survival outcomes in pediatric oncology. Therefore, public health interventions should focus on caregiver education programs to enhance awareness of childhood cancer signs, the importance of early diagnosis, and adherence to treatment.\u003c/p\u003e \u003cp\u003eFurthermore, the study found that cancer treatment completion was higher among children of employed caregivers compared to those of unemployed caregivers. This discovery suggests that the economic stability associated with caregiver employment plays a crucial role in ensuring adherence to cancer treatment. Employed caregivers are more likely to have financial resources which contribute to a higher likelihood of treatment completion [42]. This result is in accordance with studies by Jones [43], Bekui et al. [44], and Tran et al. [45] that have highlighted the influence of socioeconomic status on pediatric cancer treatment outcomes. This underscores the need for government policies and healthcare programs that provide financial assistance, subsidized treatments, and transportation support for unemployed caregivers. This will ultimately improve treatment adherence and outcomes for children with cancer.\u003c/p\u003e \u003cp\u003eLastly, among childhood cancers, retinoblastoma had the highest treatment completion rate. This may be attributed to its distinct and visible symptoms, such as leukocoria (white pupil) and strabismus (misaligned eyes) [46,47], which may prompt caregivers to seek medical attention earlier than for other childhood cancers with more subtle presentations [48]. A key factor influencing treatment completion is caregiver awareness and knowledge about childhood cancers [39], as caregivers play a crucial role in ensuring that children receive timely medical attention and adhere to prescribed treatment plans [49]. To improve early recognition, reduce delays in seeking care, and enhance treatment adherence, community outreach initiatives should be implemented to equip caregivers with essential knowledge about childhood cancer symptoms and management.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite the valuable insights provided, this study has some limitations. The reliance on hospital electronic records may introduce selection bias, as only children who sought care at the facility were included, potentially underrepresenting cases managed elsewhere or undiagnosed cases in the region. Also, data completeness and accuracy were dependent on the quality of medical record entry, which may have led to missing or misclassified information. The retrospective nature of the study also limited the ability to assess causality between demographic factors and clinical outcomes. Moreover, socioeconomic variables such as household income and healthcare accessibility, which could influence treatment adherence and outcomes, were not captured. Lastly, while the classification of cancer types followed the International Childhood Cancer Classification (ICCC), potential inconsistencies in diagnostic coding could have impacted the categorization of certain cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eChildhood cancer is increasingly prevalent in Northern Ghana, particularly among males and younger children, highlighting an urgent need for improved early detection and treatment strategies. High mortality rates, especially for retinoblastoma and lymphomas, suggest gaps in access to timely diagnosis, specialized pediatric oncology care, and supportive therapies. Though a decline in cancer-related deaths indicates some progress, further investments in healthcare infrastructure, capacity building for early diagnosis, and enhanced treatment protocols are crucial to improving survival outcomes for affected children.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study presents significant trends and patterns in childhood cancers in Northern Ghana between 2016 and 2023. Retinoblastoma is the most prevalent cancer type, followed by lymphomas and renal tumors. Demographically, male children, particularly those under 3 years of age, were more frequently diagnosed. A concerning trend emerged in the clinical outcomes, where the majority of children either died during treatment or were referred to other facilities, especially in the Northern belt. Mortality rates were notably higher among children of uneducated caregivers and those with employed caregivers. Geographically, the Northern belt had the highest mortality and referral rates. Furthermore, retinoblastoma demonstrated relatively better treatment completion rates compared to other cancer types. The results of the study highlight the need for improved healthcare infrastructure, caregiver education, and regional support to address childhood cancer care disparities in Northern Ghana.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDALYs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003edisability-adjusted life years\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elow- and middle-income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTTH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTamale Teaching Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Childhood Cancer Classification\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The study received ethical approval from the Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication, and Ethics. Permission to access medical records was granted by Tamale Teaching Hospital, with data anonymized to protect confidentiality. Consent to participate was not applicable, as the study was based solely on the analysis of existing medical records and did not involve any direct interaction with participants or primary data collection. All procedures adhered to the Declaration of Helsinki, ensuring patient rights, data integrity, and confidentiality\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Statement\u003c/h2\u003e \u003cp\u003eThis study did not receive any funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAW, MMI, ISM, and PST conceived the study. The design of the work was carried out by AW, MMI, ISM, PST, IA, BAN, AA, SM, and WJS. The acquisition and analysis of data were handled by AW, MMI, ISM, SM, WJS, and PST. The interpretation of the data was done by AW, MMI, ISM, SM, WJS, PST, and IA. AW, MMI, ISM, PST, IA, BAN, AA, SM, and WJS drafted the manuscript or substantively revised it. All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors express their gratitude to the Tamale Teaching Hospital and its Pediatric Oncology Unit for granting access to medical records and supporting this research. Special thanks to the hospital staff for their assistance in data collection and validation. We also acknowledge the caregivers and families whose data contributed to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data used to support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med. 2018;379(25):246875. https://doi.org/10.1056/NEJMsa1806938\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Mullen CJ, Barr RD, Franco EL. Timeliness of diagnosis and treatment: the challenge of childhood cancers. 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Pediatr Blood Cancer. 2022;69(5):e29546. https://doi.org/10.1002/pbc.29546\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e O'Brien JM. Retinoblastoma: Clinical Presentation and the Role of Neuroimaging. AJNR Am J Neuroradiol. 2001;22(3):427-9. PMID: 11237964\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Balmer A, Munier F. Differential diagnosis of leukocoria and strabismus, first presenting signs of retinoblastoma. Clin Ophthalmol. 2007;1(4):431-9. https://doi.org/10.2147/OPTH.S1369\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Nazemi KJ, Malempati S. Emergency department presentation of childhood cancer. Emerg Med Clin North Am. 2009;27(3):477\u0026thinsp;\u0026minus;\u0026thinsp;95. https://doi.org/10.1016/j.emc.2009.04.008\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Morgan EH, Schoonees A, Sriram U, Faure M, Seguin-Fowler RA. Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors. Cochrane Database Syst Rev. 2020;2020(1):CD012547. https://doi.org/10.1002/14651858.CD012547.pub2\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Childhood, cancer, incidence, treatment outcome, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-6397628/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6397628/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eChildhood cancers contribute significantly to child morbidity and mortality worldwide, with an even greater burden in resource-limited settings. However, there is limited research documenting the incidence and patterns of childhood cancers in Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eWe aimed to examine the trends and patterns of childhood cancers in Northern Ghana over a seven-year period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a retrospective descriptive analysis of medical records from the regional pediatric oncology unit at Tamale Teaching Hospital in Northern Ghana. The study included children diagnosed with cancer and admitted to the oncology unit between January 2016 and December 2023. We classified cancers based on the International Classification of Childhood Cancer and quantified the number of cases of each type, both overall and stratified by time and child characteristics. \u0026nbsp;SAS JMP Professional Software (version 17.1) was used to analyze the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 216 child medical records were analyzed. Most (62.5%) children were male, with 48.1% aged 0 to 3 years. The number of children admitted with cancer increased progressively over time, from 15 cases in 2016/2017 to 82 in 2022/2023. Males and those 0 to 7 years were more likely to be admitted with cancer. Ten cancer types were identified, with retinoblastoma being the most commonly diagnosed cancer (30.1%), followed by lymphomas (23.1%) and renal tumors (15.7%). Of the 184 children with admission outcome data, 56.5% died. Cancer-related deaths were highest among those diagnosed with lymphomas (28.8%) and retinoblastoma (58.3%), as well as those aged 0–3 years (45.2%) and among males (67.3%). Overall, cancer deaths declined steadily from 71.4% in 2016/2017 to 44.4% in 2022/2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eOur findings suggest a rise in childhood cancers in Northern Ghana, with a greater proportion of cases occurring in children between 0-7 years and among males.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number: Not applicable\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Patterns and temporal trends in childhood cancer incidence in Northern Ghana: evidence from medical records, 2016 to 2023.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 01:39:26","doi":"10.21203/rs.3.rs-6397628/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-05T06:35:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T08:45:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-25T14:41:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203559615244395933515783364272752077406","date":"2025-05-23T16:45:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337567998249362455419333628945781869356","date":"2025-05-20T08:58:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206559184811933279981039001880660397298","date":"2025-05-17T13:29:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270008815030837749243994027337013166258","date":"2025-05-16T09:37:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53861847959189367770475620227926107235","date":"2025-05-12T08:01:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250299340723124335362456831088325434453","date":"2025-05-11T08:27:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333889549963419779260910100345443759656","date":"2025-05-06T14:12:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98267634045186205912122831358284456934","date":"2025-05-06T08:44:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-06T08:33:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T09:15:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-15T04:40:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-14T19:40:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-04-14T19:39:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b532541-b77d-4010-9df9-f8a960a2f2bb","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:03:15+00:00","versionOfRecord":{"articleIdentity":"rs-6397628","link":"https://doi.org/10.1186/s12887-025-06141-2","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-10-02 15:57:54","publishedOnDateReadable":"October 2nd, 2025"},"versionCreatedAt":"2025-05-13 01:39:26","video":"","vorDoi":"10.1186/s12887-025-06141-2","vorDoiUrl":"https://doi.org/10.1186/s12887-025-06141-2","workflowStages":[]},"version":"v1","identity":"rs-6397628","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6397628","identity":"rs-6397628","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}