Pattern and Factors Associated with Congenital Anomalies among Young Infants Admitted at Bugando Medical Centre, Mwanza, Tanzania.

Congenital anomalies or birth defects are among the leading causes of infant mortality and morbidity around the world. The impact of congenital anomalies is particularly severe in middle- and low-income countries where health care resources are limited. The prevalence of congenital anomalies varies in different parts of the world, which could reflect different aetiological factors in different geographical regions. Between October 2012 and January 2013, a cross-sectional study was conducted involving young infants below 2 months of age, admitted at a university teaching hospital in Tanzania. Face-to-face interviews with parents/caretakers of young infants were carried out to collect socio-demographic and clinical information. Physical examinations were performed on all young infants. Echocardiography, X-ray, cranial as well as abdominal ultrasonographies were performed when indicated. Analysis of the data showed that among 445 young infants enrolled in the study, the prevalence of congenital anomalies was 29%, with the Central Nervous System (CNS) as the most commonly affected organ system. Maternal factors that were significantly associated with congenital anomalies included the lack of peri-conceptional use of folic acid (OR = 3.1; 95% CI = 1.4-6.7; p = 0.005), a maternal age of above 35 years (OR = 2.2; 95% CI = 1.1-4.3; p = 0.024) and an inadequate attendance to antenatal clinic (OR = 2.1; 95% CI = 1.4-3.3; p < 0.001). Infant factors that were significantly associated with congenital anomalies were female sex, a birth weight of 2.5 kg or more, singleton pregnancy and a birth order above 4. Due to the high prevalence of congenital anomalies observed in this particular context, the hospital should mobilize additional resources for an optimal and timely management of the patients with congenital anomalies. In this study, the proportion of women taking folic acid supplements during early pregnancy was very low. Efforts should be made to ensure that more women use folic acid during the peri-conceptional period, as the use of folic acid supplement has been linked by several authors to a reduced occurrence of some congenital anomalies

Patterns and outcome of surgical management of anorectal malformations at a tertiary care hospital in resource limited setting: a Tanzanian experience

 Background: Anorectal malformations (ARM) are common congenital abnormalities in most parts of the world and its management remains a challenge to surgeons practicing in resource-limited setting such as Tanzania. This study aimed to determine the patterns and outcome of surgical management of ARM at a Tanzanian tertiary care hospital. Methods and Patients: This was a cross sectional study (with a follow up component) of patients with ARMs admitted to Bugando Medical Centre between May 2014 and April 2017.Results: A total of 109 patients (M: F ratio= 1:1.4) were studied. The median age at diagnosis was 50 days. The majority of patients, 78(71.6%) were less than a year old. Most of patients, 91(83.5%) had major clinical type of ARMs. Associated congenital anomalies were recorded in 18 (16.5%) patients. The majority of patients, 64(58.7%) reported to hospital late in acute intestinal obstruction. Most of patients in this study, 107(98.2%) were initially managed by a preliminary colostomy before definitive treatment. Out of 109 patients with ARMs, only 39 (33.0%) underwent definitive operations. Of the 107 patients who had preliminary colostomy, only 28(26.2%) had their colostomies closed at the end of study period. The overall complication and mortality rates were 47.7% and 16.0% respectively. Delayed presentation (&gt; 48 hours), associated congenital anomalies, prolonged duration of operation (&gt; 3 hours) and surgical site infections were the main predictors of mortality (p &lt; 0.001). The follow up of patients in this study was generally good as only 3(8.3%) patients were lost to follow up. Good results using Kelly’s scoring system were obtained in 83.3% of surviving patients.Conclusion: Anorectal malformations are common in our setting. The major type of ARMs is commoner than the minor type. The outcome of surgery is good when the patients present early at birth. Therefore there is need for increasing community awareness and among all healthcare workers who handle neonates to effect early presentation and therefore prompt management