Factors associated with in-hospital mortality of neonates with anorectal malformations managed at a tertiary centre in uganda: a retrospective cohort study.

BACKGROUND

Anorectal malformations (ARM) are common congenital anomalies among neonates presenting to paediatric surgical units in Uganda. Optimal care is often hindered by significant health system gaps. However, factors influencing mortality among neonates with ARM in Uganda have not been formally evaluated.

OBJECTIVE

To determine factors associated with in-hospital mortality among neonates admitted with anorectal malformations at a tertiary hospital in Uganda.

METHODS

This retrospective cohort study included consecutive neonates with ARM managed at a single teaching hospital in Uganda from 2015 to 2023. Socio-demographic and clinical data were extracted and analysed. Modified Poisson regression was used to identify factors independently associated with in-hospital mortality. All analyses were two-sided (p < 0.05). Results are presented as incidence risk ratios (IRRs) with 95% confidence intervals (CIs).

RESULTS

A total of 226 neonates with ARM were included. The median age at presentation was 3 days (IQR: 2-7). Males accounted for 139 (61.5%) cases. Most neonates presented with intestinal obstruction (60.2%), while 27.4% developed sepsis. The overall in-hospital mortality rate was 20.8% (95% CI: 15.7-26.7). Sepsis and the presence of one or more associated congenital anomalies were independently associated with increased mortality.

CONCLUSION

In-hospital mortality among neonates with ARM in Uganda remains high. Sepsis and associated congenital anomalies are significant predictors of mortality in this population.