Birth Prevalence of Anorectal Malformations for the Western Cape Province, South Africa, 2005 to 2012

Abstract

Introduction Anorectal malformations (ARMs) are a major birth anomaly worldwide. South Africa has ethnically and geologically diverse populations. A recent publication indicated an increased birth prevalence of ARMs in the Witwatersrand referral area between 2005 and 2010. The purpose of this study was to determine the birth prevalence of ARM and its various subtypes in the Western Cape referral district over an 8-year period.

Methods For an 8-year period from January 1, 2005, to December 31, 2012; retrospective data were collected from the Pediatric Surgical Departments of Red Cross War Memorial Children's Hospital, Tygerberg Children's Hospital, as well as the private sector health registries. The number of live births per year for a specific municipal district was obtained from the National Department of Health. The chi-square for trend test was used to determine statistical significance.

Results The birth prevalence for ARM in the Western Cape Province (WCP) in 2012 was shown to be 1:5,572 live births (1.79/10,000 live births). The West Coast municipality district had the highest average birth prevalence rate of 1:3,063 (3.26/10,000) live births for years studied. There was a male predominance (1.6:1), the most common ARM was the vestibular fistula (19.2%) and in 26% of the patients, there was an initial delay in the diagnosis.

Conclusion This study has provided some recent data for ARMs for the WCP. There was no statistical significant change in the prevalence of ARMs over the 8-year period for the WCP as well as in any of the individual six municipal health districts (χ² for trend, p = 0.52). The number of delayed diagnosis of ARM is of concern.

Keywords

anorectal malformation - prevalence - delayed diagnosis - South Africa - Western Cape Province

• References

• 1 Coran AG. , ed. Pediatric Surgery, 7th ed. Vol. 2. Philadelphia: Saunders; 2012: 1289
• 2 Holcomb III GW, Murphy JP. , eds. Ashcraft's Pediatric Surgery, 5th ed. Vol. 1. Philadelphia: Saunders; 2010: 468
• 3 International Clearinghouse Birth Defects Surveillance and Research. Annual Report 2007: with data for 2005. Roma, Italy: The International Centre on Birth Defects – ICBDSR Centre; 2007
• 4 Cuschieri A. ; EUROCAT Working Group. Descriptive epidemiology of isolated anal anomalies: a survey of 4.6 million births in Europe. Am J Med Genet 2001; 103 (03) 207-215
• 5 Lowry RB, Sibbald B, Bedard T. Stability of prevalence rates of anorectal malformations in the Alberta Congenital Anomalies Surveillance System 1990-2004. J Pediatr Surg 2007; 42 (08) 1417-1421
• 6 Lehohla P. Use of Health Facilities and Levels of Selected Health Conditions in South Africa: Findings from the General Household Survey, 2011. South Africa: Printing and Distribution, Statistics South Africa; 2011
• 7 Theron A, Loveland J. Birth prevalence of anorectal malformation in the referral area for the University of the Witwatersrand tertiary hospitals, South Africa. Eur J Pediatr Surg 2015; 25 (02) 220-225
• 8 StatsOnline. P0302 - Mid-year population estimates 2012. This statistical release contains estimations of the population of South Africa and describes the methods used to compile these estimations. Available at: http://www.statssa.gov.za/publications/statspastfuture.asp?PPN=P0302&SCH=4986 . Accessed June 12, 2013
• 9 Tishkoff SA, Reed FA, Friedlaender FR. , et al. The genetic structure and history of Africans and African Americans. Science 2009; 324 (5930): 1035-1044
• 10 Quintana-Murci L, Harmant C, Quach H. , et al. Strong maternal Khoisan contribution to the South African coloured population: a case of gender-biased admixture. Am J Hum Genet 2010; 86 (04) 611-620
• 11 The Local Government Handbook. A complete guide to municipalities in South Africa. Available at: http://www.localgovernment.co.za/provinces/view/9/western-cape . Accessed March 28, 2016.
• 12 Spouge D, Baird PA. Imperforate anus in 700,000 consecutive liveborn infants. Am J Med Genet Suppl 1986; 2: 151-161
• 13 StatsOnline. City of Cape Town Municipality. www.statssa.gov.za 2011. Available at: http://beta2.statssa.gov.za/?page_id=1021&id=city-of-cape-town-municipality. Accessed February 18, 2015
• 14 Seidel H. Primary Care of the Newborn, 4th ed. Philadelphia: Saunders/Elsevier; 2006
• 15 Eltayeb AA. Delayed presentation of anorectal malformations: the possible associated morbidity and mortality. Pediatr Surg Int 2010; 26 (08) 801-806
• 16 Wilson BE, Etheridge CE, Soundappan SV, Holland AJ. Delayed diagnosis of anorectal malformations: are current guidelines sufficient?. J Paediatr Child Health 2010; 46 (05) 268-272
• 17 Turowski C, Dingemann J, Gillick J. Delayed diagnosis of imperforate anus: an unacceptable morbidity. Pediatr Surg Int 2010; 26 (11) 1083-1086
• 18 Haider N, Fisher R. Mortality and morbidity associated with late diagnosis of anorectal malformations in children. Surgeon 2007; 5 (06) 327-330
• 19 Lawal TA, Fatiregun AA, Yusuf OB. Mothers' awareness of anorectal malformations: a pointer to delayed diagnosis in a developing country. Eur J Pediatr Surg 2013; 23 (06) 480-485
• 20 Tareen F, Coyle D, Aworanti OM, Gillick J. Delayed diagnosis of anorectal malformation--a persistent problem. Ir Med J 2013; 106 (08) 238-240
• 21 Liu G, Yuan J, Geng J, Wang C, Li T. The treatment of high and intermediate anorectal malformations: one stage or three procedures?. J Pediatr Surg 2004; 39 (10) 1466-1471
• 22 Tei E, Yamataka A, Segawa O. , et al. Laparoscopically assisted anorectovaginoplasty for selected types of female anorectal malformations. J Pediatr Surg 2003; 38 (12) 1770-1774
• 23 Rintala RJ, Pakarinen MP. Imperforate anus: long- and short-term outcome. Semin Pediatr Surg 2008; 17 (02) 79-89
• 24 Htonl. Map of municipal boundaries in the Western Cape. In: (2011).svg MotWCwmb, editor. 3 ed. Wikimedia Commons 31 March 2011