Surgically correctable congenital anomalies: Prospective analysis of management problems and outcome in a developing country

Congenital anomalies exist all over the world. The management and outcome, however, vary considerably between the developed and the developing countries. This study looks at the impediments to the management of surgically correctable anomalies in South-east Nigeria. A prospective study was undertaken on 223 children with surgically correctable anomalies managed at the Federal Medical Center Owerri, South-east Nigeria. Most of the children (40.8 per cent) presented during infancy with overall mean age of 2.5 years (range 3 days-13 years). The anomalies encountered include: hernia (71), undescended testes (15), anorectal malformation (11), Hirschsprung's disease (9), hypospadias (8), ankyloglossia (8), thyroglossal duct remnants (7), omphalocele (6), posterior urethral valve (5), jejuno-ileal atresia (4), cystic hygroma (4), intersex (3), oesophageal atresia (2) and orthopaedic anomalies (70). 148 of these children had operative procedure as part of their management. Procedure-related complications occurred in 41 children (27.7 per cent) with haematoma (21) and surgical site infection (10) being the most common. The overall mortality was 1.8 per cent. Septicaemia, respiratory failure, pneumonia and anaesthetic complication were the cause of death. Delay in presentation, shortage of personnel and inadequate facilities were the major limitations in the management of these children. The wide range of congenital anomalies among children in the developing world poses a significant healthcare problem. This calls for provision of adequate manpower and facilities to improve outcome.