Management of Anorectal Malformations at a Tertiary Hospital in Tanzania: A Retrospective Cross-Sectional Study.

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.