Background: Febrile neutropenia (FN) is a frequent and serious complication in children with cancer. In resource-constrained cancer centres, infectious complications pose a significant risk to patient health and survival. The aim of the study was to evaluate the clinical characteristics and outcomes of FN in children with cancer treated at Jimma University Medical Center (JUMC) Pediatric Hemato–oncology Unit.

Methods: A prospective, longitudinal observational study was done over 12-month, from 1 December 2023, to 30 November 2024. Children with cancer who developed FN were enrolled and followed throughout their FN episodes. Clinical characteristics, microbiological findings, treatment practices and outcomes were assessed. Blood cultures and antimicrobial susceptibility testing were performed according to standard operating procedures. Descriptive statistics were used to summarise socio-demographic, clinical, microbiological and outcome data.

Results: During the study period, 110 children with cancer admitted to the JUMC Pediatric Hemato–oncology Unit were followed, among whom 32 (29.1%) experienced 67 episodes of FN. Leukaemia was the most common underlying malignancy (17/32, 53.1%). The mean age of patients with at least one FN episode was 7.3 ± 4.5 years, and the mean absolute neutrophil count at FN diagnosis was 257 ± 222 cells/µL. Blood cultures were positive in 7 (10.5%) FN episodes. The mean time from physician prescription to administration of the first dose of antibiotics was 2.57 ± 1.91 hours. Overall, 14 (43.8%) of the 32 patients with FN experienced a poor outcome, including in-hospital death in 8 (25.0%) and discharge against medical advice in 6 (18.8%).

Conclusion: FN was common and associated with poor outcomes. Delayed administration of empirical antibiotics highlights the need to strengthen early diagnosis, standardised management and infection prevention to improve outcomes in resource-limited settings.