Management and Outcomes of Anorectal Malformations at University Teaching Hospital of Kigali, Rwanda from 2015 to 2023

Abstract Purpose: ARMs are common congenital disorders, including LMICs, where limited neonatal and surgical care leads to worse outcomes compared to HICs. Recent efforts to improve health systems in LMICs focus on training healthcare workers. This study assesses the clinical care of infants with ARMs at the University Teaching Hospital of Kigali (CHUK), a tertiary-level hospital in Rwanda, provided by pediatric surgeons and other fellowship-trained pediatric specialists. Methods: A retrospective study of patients who presented with ARMs at CHUK, Rwanda, from January 2015 to December 2023. All patients who underwent their definitive anorectoplasty at the CHUK and had retrievable data in operative logbooks were included. Regression analysis was performed to determine predictors of 30-day mortality. Results: 62 patients were included. The most common fistula type was a rectovestibular fistula (48%) in females and a rectoperineal fistula (18.9%) in males. 43.5% underwent a three-stage repair. 30-day mortality was 17.9%. Low weight (<3000g) at surgery was significantly associated with 94% higher odds of mortality. Conclusion: Although mortality was higher than that encountered in HICs, it was lower than what has generally been reported in LMICs. This could be attributed to the improved care provided by fellowship-trained pediatric specialists.