Epidemiology and risk factors of congenital anomalies managed by the Paediatric surgery unit at Greater Accra Regional Hospital: a three‑year review

Purpose Congenital anomalies contribute substantially to neonatal morbidity and mortality in low‑ and middle‑income countries. Contemporary data on surgically managed anomalies in Ghana are limited. We aimed to quantify the prevalence, spectrum, outcomes and maternal risk factors of congenital anomalies managed by the paediatric surgery unit at Greater Accra Regional Hospital (GARH). Methods NICU admissions at GARH between 1 June 2022 and 30 June 2025 were retrospectively reviewed. Neonates with congenital anomalies who were managed surgically were included. Demographics, anomaly types, outcomes and maternal factors were extracted. Prevalence was summarised descriptively, and logistic regression was used to identify maternal risk factors, reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results Among 8 015 NICU admissions, 104 neonates (1.3%) required surgical management. Gastrointestinal anomalies predominated (67.3%), notably Hirschsprung’s disease or meconium plug syndrome (21.2%), anterior abdominal wall defects (19.2%) and anorectal malformations (11.5%). Overall mortality was 19.2%. Maternal age > 35 years, absent periconceptional folic acid supplementation and non‑facility births were significant risk factors. Conclusion Surgically managed congenital anomalies at GARH were mainly gastrointestinal and carried high mortality. Promoting periconceptional folic acid use, antenatal screening, facility‑based deliveries and strengthening paediatric surgical capacity may reduce preventable neonatal deaths in Ghana.