Background <p>Colorectal cancer (CRC) is one of the leading malignancies globally and chemotherapy forms the bulk of its management. Oxaliplatin is one of the standard drugs used for management of colorectal cancer. Oxaliplatin induced peripheral neuropathy (OIPN) is one of the most debilitating toxicities encountered which can lead to dose modification and premature treatment discontinuation with a great impact on quality of life. Therefore, we aimed to determine the prevalence, severity and factors associated with OIPN among colorectal cancer patients treated in Tanzania.</p> Methods <p>This retrospective cohort study conducted at Ocean Road Cancer Institute (ORCI) of histologically confirmed CRC patients who were on oxaliplatin-based chemotherapy regimens. Data was collected using EORT-QLQ CIPN20 questionnaire and analysis was done using SPSS version 23 and <i>p</i> value &lt; 0.05 was considered statistically significant.</p> Results <p>A total of 62 patients were recruited, the prevalence of OIPN was 71% and 59.7% for acute and chronic symptoms respectively. Obese patients were 21.66 times higher at risk of suffering from chronic OIPN compared to individuals who have normal body weight (<i>p</i> &lt; 0.05). Cumulative Dose ≤ 780 showed a protective effect (<i>p</i> &lt; 0.005) in development of OIPN. For the severity of acute OIPN, it was found that 4.8% had grade 4 symptoms, while 8.1% had grade 3 symptoms, and 69.4% had grade 2 symptoms, and 17.7% of the patients had grade 1. In patients with chronic OIPN, 13.5% had grade 3 neuropathies, 24.3% had grade 2 and 62.2% had grade 1 neuropathy.</p> Conclusion <p>The prevalence of acute and chronic OIPN among colorectal cancer patients managed at ORCI was 71.0% and 59.7% respectively, with most patients developing grade 1 and 2 neuropathy for both acute and chronic symptoms. Number of cycles, cumulative dose and BMI were the major factors associated with the neuropathy.</p>