title: Comparison in the incidence of anorectal malformations between a first- and third-world referral center.
abstract: OBJECTIVE
  Aim of study was to evaluate the differences in incidence and presentation of anorectal malformations (ARMs) between selected Pediatric Surgery Divisions in the Republic of South Africa (ZAR) and Italy.
  
  
  METHODS
  A retrospective cohort study involved analysis of clinical records of patients with ARM born between 2005 and 2012. Type of ARM, maternal age, birth weight, gestational age, presence of associated anomalies and delayed diagnosis were analyzed.
  
  
  RESULTS
  335 patients were included in this study. Of note, statistically significant differences between the African and European patient groups were observed in a male predominance in the ZAR patient population. In addition, female recto-perineal fistulas were diagnosed in significantly more Italian patients than in ZAR. Furthermore, a more advanced maternal age and a lower gestational age was noted in the European cohort with a minimal delay in initial diagnosis as opposed to the African counterpart. Both centers reported recto-perineal fistula as the most common malformation in male patients.
  
  
  CONCLUSIONS
  With the exception of perineal fistulas in females, the incidence of specific subtypes of ARMs was similar in the two groups. This may be of importance when extrapolating European study conclusion to the South African setting.
authors.affiliation: Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 6th Floor ICH Building, Klipfontein Road, Rondebosch, 7700, Cape Town, Republic of South Africa, andre.theron@gmail.com.
authors.forename: Andre P
authors.initials: AP
authors.lastname: Theron
authors.forename: Giulia
authors.initials: G
authors.lastname: Brisighelli
authors.forename: Anne E
authors.initials: AE
authors.lastname: Theron
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
authors.forename: Alp
authors.initials: A
authors.lastname: Numanoglu
mesh_terms: D001003:Anal Canal / Q000002:abnormalities*; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007558:Italy; D008297:Male; D010865:Pilot Projects; D012007:Rectum / Q000002:abnormalities*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013019:South Africa