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Management of Anorectal Malformations at a Tertiary Hospital in Tanzania: A Retrospective Cross-Sectional Study
Mohamed Ibrahim1, Ahmed Salman2, Elkhider Babiker3
1Urology, Queen Elizabeth Hospital Birmingham, Birmingham, GBR.
Insights
Anorectal malformations (ARMs) in Tanzania show standard surgical care but face prolonged treatment and low completion rates. Early diagnosis and improved follow-up are crucial for better outcomes in pediatric surgical anomalies.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Surgery
Background:
- Anorectal malformations (ARMs) are common congenital gastrointestinal defects requiring complex surgical management.
- Challenges in low- and middle-income countries include delayed diagnosis, limited specialist access, and poor follow-up.
- Limited published data exists on ARM presentation and management in Tanzania.
Purpose of the Study:
- To describe demographic characteristics, presentation patterns, and anatomical subtypes of ARMs in Tanzanian children.
- To analyze surgical management strategies and treatment completion rates for ARMs at Muhimbili National Hospital (MNH).
- To identify factors influencing treatment completion in pediatric patients with ARMs.
Main Methods:
- Retrospective review of 100 pediatric Anorectal Malformation cases managed at MNH over a 12-month period in 2023.
- Data collected included patient demographics, ARM type, diagnosis timing, surgical procedures (colostomy, posterior sagittal anorectoplasty), and treatment completion.
- Statistical analysis was performed to determine associations between ARM type and treatment completion.
Main Results:
- The mean age at presentation was 52.4 weeks, with 56% of patients being female.
- Most patients (84%) were diagnosed within the first two weeks of life; imperforate anus without fistula (38%) and vestibular fistula (37%) were most common.
- High rates of colostomy (88%) and posterior sagittal anorectoplasty (60%) were observed, but only 49% completed all management stages, with ARM type being a significant factor (p = 0.049).
Conclusions:
- Management at MNH aligns with standard practices, yet prolonged treatment duration and low completion rates indicate significant challenges.
- The complexity of ARMs necessitates strengthened follow-up systems and emphasis on adequate, early diagnosis.
- Improving treatment completion requires addressing systemic issues related to follow-up and timely diagnosis in pediatric surgical care.
Abstract:
Background Anorectal malformations (ARMs) are among the most common congenital gastrointestinal anomalies and encompass a spectrum of defects requiring individualized, often staged, surgical management. Delayed diagnosis, limited access to specialist paediatric surgical services, and loss to follow-up remain significant challenges in low- and middle-income countries. Despite being a major tertiary referral centre, published data describing the presentation and management of ARMs in Tanzania are limited. This study aimed to describe the demographic characteristics, patterns of presentation, anatomical subtypes, surgical management, and treatment completion of children with ARMs managed at Muhimbili National Hospital (MNH), Tanzania. Methods A retrospective review of 100 ARM cases managed at MNH in 2023 was conducted. This study featured a 12-month study period. Data included demographics, ARM type, timing of diagnosis, surgical procedures, and treatment completion. Results The mean age at presentation was 52.4 weeks; 56% were female. The mean management time was 113 weeks. Most patients (84%) were diagnosed within the first two weeks of life. Imperforate anus without fistula (38%) and vestibular fistula (37%) were the most common types. Colostomy was performed in 88% of patients, mainly divided colostomy (86%). Posterior sagittal anorectoplasty (PSARP) was the predominant definitive repair (60%). Only 49% completed all stages of management, with ARM type significantly associated with completion (p = 0.049). Conclusion Management practices at MNH follow standard approaches, but prolonged treatment duration and low completion rates highlight the complexity of the malformations, along with the need for stronger follow-up systems and adequate, early diagnosis.
