Prevalence and Factors Associated with the Delay in Diagnosis of Anorectal Malformations in Pediatric Surgery Patients Attended Muhimbili National Hospital, 2022–2023

Background and Objective: Anorectal malformations (ARMs) are congenital anomalies of the anus, rectum, and often the urinary or reproductive systems. They vary in severity and, if not diagnosed early, can cause serious morbidity and mortality. Despite advances in neonatal care, delayed diagnosis remains common, often due to inadequate perineal examinations or prolonged referral pathways. This study aimed to determine the prevalence of delayed diagnosis and its associated factors among pediatric surgery patients with ARMs at Muhimbili National Hospital, Tanzania. Methods: This retrospective study reviewed medical records of pediatric patients with ARMs admitted between January 2022 and December 2023. A total of 152 patients were included. Data were extracted using structured forms, and statistical analysis identified factors linked with delayed diagnosis. Results: Of 152 patients, 118 (77.6%) had delayed diagnosis, with a mean delay of 46.3 days (median 5.5). Mothers detected most abnormalities (104, 68.4%), while healthcare workers identified 48 (31.6%). Imperforate anus without fistula was the most frequent anomaly (33.6%). By gender, rectovestibular fistula predominated in females (40.2%) and imperforate anus without fistula in males (55.7%). Logistic regression showed that birth in a regional/district hospital significantly reduced the odds of delay (Exp(B) = 0.210, p = 0.018) compared with home births. Conclusion: Delayed diagnosis of ARMs was frequent, with most cases first identified by mothers rather than healthcare workers. Prematurity and place of birth were significantly associated with delay, underscoring the need for vigilant neonatal perineal examinations and stronger referral systems for timely detection and management.