Characteristics and outcomes in paediatric patients presenting with congenital colorectal diseases in sub-Saharan Africa

Abstract

In sub-Saharan Africa, there is a high burden of paediatric surgical conditions and a paucity of data regarding outcomes of congenital colorectal anomalies. A retrospective, descriptive analysis utilizing the Kamuzu Central Hospital (Lilongwe, Malawi) paediatric acute care surgery database (age ≤ 18 years) over 44 months was performed. Of the 133 children presenting, 82 had Hirschsprung disease (HD) (2.4 ± 2.7 years) and 51 had anorectal malformations (ARM) (1.8 ± 2.4 years). Of the latter, 51.0% underwent surgery, mainly exploratory laparotomy (n = 15, 57.7%) and posterior sagittal anorectoplasty (n = 7, 26.9%). Of those with HD, 50.0% underwent operative intervention (77.3% boys), including exploratory laparotomy (n = 17, 41.5%) and definitive pull-through (n = 8, 19.5%). A dearth of expert paediatric surgeons and limited exposure to paediatric conditions in general surgeons limits definitive surgery. An emphasis on paediatric surgical training and improvement of referral networks for definitive therapy will improve patient outcomes.

Keywords: Anorectal malformation; Hirschsprung disease; global surgery; paediatric surgery; sub-Saharan Africa.