EN
TÜRKÇE
Oral Presentation - 38
CORRELATION BETWEEN LONG-TERM FOLLOW-UP ADHERENCE AND FUNCTIONAL OUTCOMES IN CHILDREN WITH ANORECTAL MALFORMATIONS: A RETROSPECTIVE-PROSPECTIVE STUDY AT A RURAL TERTIARY CENTER
Muma Nyagetuba
AIC KIJABE HOSPITAL
Purpose: Anorectal malformations (ARMs) require specialised surgical correction. It usually requires multidisciplinary care and long-term follow up in order to achieve optimal functional outcomes. Despite this, there is paucity of data pertaining to long-term follow up in in low- and middle-income countries (LMICs). To correlate long-term adherence to follow-up with long-term outcomes in children treated for ARM at a rural tertiary facility in Kenya.
Methods: A mixed-methods retrospective-prospective study evaluated ARM cases managed between 2004 and 2022. Quantitative chart reviews (n = 179) were corroborated by caregiver interviews (n = 136). Outcomes of interest that were evaluated were faecal incontinence, constipation, and urinary incontinence. Adherence was classified as complete, partial, or non-adherence. Data were analysed using descriptive statistics, chi-square tests, and logistic regression models (STATA v18.0).
Results: Full adherence was documented in 28.7% of patients, while 43.4% showed partial and 27.9% non-adherence. Constipation was the most prevalent long-term outcome (57.4%) [4,24], followed by faecal incontinence (41.2%) [13,36] and urinary incontinence (21.3%) [14]. Fully adherent children had significantly lower odds of faecal incontinence compared to their non-adherent peers (OR 0.33, 95% CI 0.14–0.78, p=0.011). Adherence was independently associated with both bowel function (χ²=13.92, p=0.001) and urinary continence (χ²=6.01, p=0.049). Key predictors of non-adherence included lack of insurance, single-guardian care, and lower parental education.
Conclusion: High complication rates and suboptimal adherence underscore the need for structured follow-up models tailored to the realities of rural LMICs. The disparity between documented clinic visits and patient-reported care underscores the need for proactive, protocolized follow-up systems that ensure structured transitions and minimize loss to follow-up—especially in low-resource settings.