A Continental Survey of the Diagnostic Capacity and Fellowship Training Priorities for Childhood Cancer Pathology Across Africa

BACKGROUND: Accurate pathological diagnosis is essential for effective childhood cancer management, yet paediatric oncology pathology capacity across Africa remains inadequately characterised. This study aimed to establish a baseline assessment of pathology service capacity, workforce composition, diagnostic infrastructure, quality systems, and training needs across the continent. METHODS: A cross-sectional online survey was conducted among pathologists within the SIOP Africa professional network between September 2025 and April 2026, assessing five domains: respondent characteristics, pathology infrastructure, diagnostic capabilities, quality indicators and fellowship training needs. Quantitative data were analysed descriptively, while free-text responses underwent thematic content analysis. RESULTS: Eighty-five pathologists from 19 African countries participated. Most respondents were early- to mid-career anatomical pathologists (81%) working in university or national referral hospitals (75%). Although histopathology was widely available (99%), access to advanced diagnostics was limited, with immunohistochemistry available in 47% of facilities and flow cytometry and molecular diagnostics in only 15%. Routine histopathology turnaround times exceeded 7 days in 76% of centres, and only 48% reported participation in external quality assurance programmes. Interest in further training was high (88%), with paediatric pathology (65%), molecular pathology (52%) and cytopathology (39%) identified as priority areas. Major challenges included limited diagnostic capacity, infrastructure and equipment shortages, workforce gaps, and inadequate specialist training opportunities. CONCLUSIONS: This study highlights substantial gaps in paediatric oncology pathology capacity across Africa, spanning from limited access to advanced diagnostics to shortages of subspecialist expertise. The strong demand for fellowship training presents an opportunity for investment in sustainable, context-specific capacity-building strategies to strengthen paediatric cancer care across the continent.