Factors associated with in-hospital mortality of neonates with anorectal malformations at Mulago National Referral Hospital

Abstract

Background Anorectal malformation is a common disease entity among neonates presenting to pediatric surgery units in Uganda. The optimal care for these babies is compromised by gaps in several of the pillars of the health-care system in the country. Despite all these, the factors associated with the mortality of neonates managed for anorectal malformations in Uganda are yet to be formally evaluated. Objective: To determine factors associated with in-hospital mortality of neonates admitted with anorectal malformations in Mulago National Referral Hospital, Uganda. Methods: This was a retrospective study of neonates with anorectal malformation managed at Mulago National Referral Hospital from January 2015 to December 2023. Socio-demographic and clinical data of patients were retrieved and analyzed. A logistic regression model was used to identify factors independently associated with in-hospital mortality of neonates with anorectal malformation. All analyses were 2-sided (p<0.05) using Epi-info (version 7.2.6.0). Results were reported as percentage proportions as well as odds ratios and their 95% confidence intervals. Results: A total of 226 files of neonates with anorectal malformations were assessed. Median age at presentation was 3 days (IQR: 2 to 7days). 87 (38.5%) were female and 139 (61.5%) male. Majority of the neonates, 136 (60.2%) presented with features of intestinal obstruction and 62 (27.4%) developed sepsis. Overall in-hospital mortality was 50 cases, 22.1% (95% CI: 17.0% - 28.2%). Multivariate logistic regression showed the factors: Occurrence of sepsis, none placement of colostomy and presence of at least one other associated congenital anomaly to be significantly associated with mortality of neonates with anorectal malformation in Mulago National Referral Hospital. ARM occurring with tracheoesophageal atresia/fistula carried 100% mortality. Conclusion: In-hospital mortality of neonates with anorectal malformation managed in Mulago National Referral hospital was high (22.1%). Developing sepsis, failure to give indicated colostomy and presence of other associated congenital anomalies are factors significantly associated with mortality of neonates with anorectal malformation