Three-fourths of global pediatric cancer diagnoses are made in low- and middle-income countries (LMICs). Children with cancer in LMICs have an eightfold higher risk of death compared to those in high-income settings, with infectious complications serving as a major cause of mortality.  In Africa, there is a critical shortage of data on the burden and outcomes of infectious complications in pediatric oncology patients, contributing to an absence of tailored clinical pathways that address local epidemiology and endemic pathogens. This gap results in frequent misdiagnosis, inappropriate therapeutic regimens, and inefficient resource utilization, further compounding the risk of poor outcomes for these vulnerable patients.

This study aims to pilot and iteratively refine a clinical pathway to enhance the diagnosis of infectious complications among pediatric oncology patients in Botswana, where no standardized approach currently exists. Leveraging a quality improvement framework, we will develop a provisional pathway informed by retrospective microbiology data, expert consensus, and existing international guidelines. The pathway will be piloted among pediatric oncology patients (aged 0–18 years) at Princess Marina Hospital and Sir Ketumile Masire Teaching Hospital in Gaborone, Botswana.

A multidisciplinary pathway committee, including subject matter experts, and other local stakeholders, will meet quarterly to review process metrics tracking adherence to the diagnostic pathway. These metrics will guide iterative revisions to optimize the pathway’s applicability and effectiveness in the local context.

Concurrently, we will enroll a prospective cohort of pediatric oncology patients to capture comprehensive clinical, diagnostic, and therapeutic data, enabling us to describe the incidence, spectrum, and outcomes of infectious complications. Nested case-control analyses will identify clinical risk factors associated with ICU referral and mortality.

By combining real-time data collection with pathway refinement, this study will not only bridge a critical knowledge gap but also establish a scalable tool to improve care for pediatric oncology patients in LMICs.