What this study adds. This evaluation of 150 children in Yaoundé reveals a preserved left ventricular function in 99.4% of patients, yet a concerning 34.6% prevalence of subclinical structural cardiac abnormalities, dominated by pericardial effusions. The study identifies a cumulative dose ≥250 mg/m² and dyspnoea as major independent risk factors for these abnormalities. Implications for practice, policy, or future research. These findings have a dual implication. For clinical practice, they justify and reinforce the absolute necessity for accessible echocardiographic screening for all children on anthracyclines, independent of LVEF. For public health, they call for integrating long-term cardiac surveillance protocols into national paediatric cancer programmes to prevent late complications. This publication is available in full in Health Research in Africa.