Diagnosis of anorectal malformations in Sub-Saharan Africa: a scoping review and analysis of impact of the gross domestic product

Abstract

Abstract Introduction Diagnosis of ARM in SSA has some particularities linked to delayed diagnosis, different proportions of ARM types, and lower frequencies of associated anomalies. With this review, we aimed to summarize diagnostic aspects of ARM in SSA and analyze its impact on the GDP. Methods Using PubMed, we conducted a scoping review by screening published reports from SSA institutions from 2006 to 2023. Statistical tests were used to compare variables according to three GDP groups (LICs, LMICs, UMICs), with significance set at p < 0.05. Results Twenty-three studies reporting 3344 patients were included. The male to female ratio was 1.3:1. The median age at diagnosis was 0.9 years. The Krickenbeck classification was used in 14 studies (60.8%). Rectovestibular fistulae were reported with higher frequency in LICs vs UMICs (95% CI [4.872, 29.818], p = 0.013). The existence of a screening protocol for AA increased with GDP (1/7 vs 4/9 vs 7/7; p = 0.005). The reported frequency of AA was lower in LICs vs UMICs ([-64.016, − 23.470], p < 0.001) and in LMICs vs UMICs ([− 61.878, − 30.872], p < 0.001). Urogenital malformations were reported with lower frequency in LICs vs UMICs ([-33.459, − 3.802], p = 0.026) and in LMICs vs UMICs ([− 28.697, − 4.678], p = 0.041). Cardiovascular anomalies had lower frequency in LICs vs UMICs ([− 31.954, − 5.504], p = 0.011) and in LMICs vs UMICs ([− 29.410, − 2.965], p = 0.021). Conclusion Diagnosis of ARM in SSA is often delayed, with non-systematic use of the Krickenbeck classification. Lower GDP group results in higher reports of rectovestibular fistula, fewer existences of screening protocol for AA, and their lower reports in LICs and LMICs compared to UMICs, especially urogenital and cardiovascular ones.