Outcomes of Esophageal Atresia at University Tertiary Hospital of Kigali, Rwanda

Abstract Purpose: Mortality associated with EA/TEF has declined in HICs with advances in multidisciplinary care. However, it remains as high as 80% in LMICs. This study examines the current clinical outcomes of neonates with EA/TEF at a tertiary-level hospital in Rwanda following the implementation of care by fellowship-trained pediatric surgeons. Methods: A retrospective cohort study of neonates with EA/TEF from January 2015 to December 2023. Patient data were collected from medical logbooks for all patients who received surgical treatment at Centre Hospitalier Universitaire de Kigali, Rwanda. Univariable logistic regression was used to identify factors associated with higher 30-day mortality. Results: 56 patients were included. All infants were born at term and, on average, arrived 7 days after birth (6.98 ±5.18). Type C was the most common anomaly (68%). Mortality data were only available for 82.1% of patients. Of this subset, the 30-day mortality was 52.2%. Increased odds of mortality were associated with the presence of any congenital anomaly (p <0.05) and specifically a cardiac congenital anomaly (p<0.05). Conclusion: This study provides insights into infants with EA/TEF after implementing specialized surgical care, which has helped reduce mortality compared to other LMICs. Targeted quality improvement initiatives for infants with additional associated congenital anomalies could further improve outcomes.