WOFAPS 2025 8th World Congress of Pediatric Surgery

Florian Friedmacher ¹, Doris Klingelhöfer ², Udo Rolle ¹, David Groneberg ²

¹ Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
² Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany

Purpose: Anorectal malformations (ARMs) are one of the most frequent structural birth defects treated by pediatric surgeons worldwide. However, significant morbidity and socioeconomic challenges persist, particularly in low-resource settings. This study aimed to evaluate the global ARM research landscape in relation to epidemiological and socioeconomic factors, using scientometric methodologies, big data analytics and density-equalizing visualization.

Methods: The “New Quality and Quantity Indices in Science” platform was used to assess all ARM-related articles indexed in the Web of Science^™ Core Collection since 1900. A comprehensive scientometric analysis was performed, combining results with epidemiological and socioeconomic data. Density-equalizing map projections (DEMPs) were generated to visualize geographical disparities.

Results: A total of 2,280 ARM publications were identified, originating from 90 countries. The USA led in absolute numbers, followed by Japan and China. When adjusted for population size, Finland, the Netherlands and Sweden ranked highest. A similar ranking was observed in relation to the countries’ gross expenditure on research and development (R&D). DEMPs revealed that much of Africa, South America and Southeast Asia contributed minimally to global ARM research. India had the largest estimated annual ARM caseload, followed by China and Nigeria. India also exhibited the most ARM cases in relation to the country’s annual health expenditure, followed by the Democratic Republic of Congo and Pakistan. Somalia showed the largest number of annual ARM cases relative to its workforce of medical doctors, followed by Niger and Tanzania.

Conclusion: Worldwide ARM research activity is increasing but remains highly imbalanced from a global point of view. Shortcomings in R&D and health-care funding most likely contribute to these results. Significant investment in public health is required in low- and middle-income countries to improve ARM outcomes; specifically, coordinated neonatal surgical care, international collaborations and partnership programs between local surgeons and ARM experts from other countries.