Do social circumstances dictate a change in the setup of an ANORECTAL malformation clinic

Abstract Background/Purpose To assess the number of patients seen at the colorectal clinic of a low-to-middleincome-country with emphasis on their social circumstances. Methods Between January 2013 and December 2018 we recorded the number of visits to colorectal clinic. From February 2019 prospective data on patients with anorectal malformations (ARM) focusing on their social conditions (type of housing and sanitation) and HIV-exposure was collected. Results At the clinic 452 visits were recorded in 2013, 608 in 2014, 904 in 2016, 1392 in 2017, and 1968 in 2018. The ARM cohort included 100 patients: at the time of delivery the HIV status of 74 mothers was negative, positive in 21, and unknown in 5. None of the HIV-exposed patients seroconverted to HIVpositive(average follow-up:39 months). Seventy-four patients live in formal settlements, 23 in informal, and 3 in unknown type. Forty-six patients have inside toilets, 39 outside flushing toilets, 10 outside pit latrines, 2 community toilets, and 3 an unknown sanitation. Conclusions The clinic work-load has increased during the past years. A significant proportion of our patients are HIV-exposed, do not live in formal houses and do not have inside toilets. Tailored strategies for a successful surgical plan and bowel management need to be implemented. Level of evidence II