Paediatric oncology service delivery and outcomes during the COVID-19 pandemic at the National Cancer Institute, Sudan: a retrospective descriptive study

Abstract Background The COVID-19 pandemic disrupted cancer care globally, with disproportionate effects in low- and middle-income countries. Sudan faced compounded challenges from pre-existing healthcare fragility, political instability, and classification as a Level 4 COVID-19 transmission risk zone. Objectives We aimed to describe the pandemic’s impact on pediatric oncology service utilization, treatment delivery, healthcare access, and clinical outcomes at Sudan’s National Cancer Institute. Methods We conducted a retrospective descriptive study of 100 pediatric cancer patients (aged 0–15 years) attending the National Cancer Institute, University of Gezira, between March and September 2020. Data were collected using structured questionnaires and analyzed with multivariable logistic regression. Results Patient volume declined 89% compared to the 2019 baseline. Treatment modifications occurred in 28% of patients, missed appointments in 26%, and in-hospital mortality reached 35%—nearly double pre-pandemic rates and 4–6 times higher than in other low- and middle-income country settings. Low socioeconomic status independently predicted missed appointments (OR 3.2, 95% CI 1.4–7.3) and treatment modification (OR 2.8, 95% CI 1.2–6.6). Conclusions Indirect pandemic effects—service disruption and access barriers—proved more lethal than direct SARS-CoV-2 infection, exacerbating pre-existing health inequities.