OA/TOF in Tanzania: 105 of 114 died before surgery or within 14 postoperative days

A 10-year referral-center review found 62 preoperative deaths and 43 deaths among 52 operated infants within 14 days. The median birth-to-diagnosis interval was 5 days, but 16 records lacked survival outcomes and nonrandom timing cannot prove that earlier surgery alone changes survival.

THE HOT TAKE

The mortality signal ran across the whole pathway. A seven-day surgical cutoff does not explain it.

A 2026 PLOS Global Public Health report reviewed a decade of care at Tanzania's national referral hospital. Of 130 assessed records, 16 were excluded because survival status could not be determined. Among 114 analyzed infants with radiologically confirmed oesophageal atresia with or without tracheo-oesophageal fistula, 62 died before surgery. Of 52 operated infants, 43 died in hospital within 14 postoperative days; nine were alive at day 14.

THE DELAY WAS MEASURABLE

The median birth-to-diagnosis interval was 5 days (IQR 3 to 9.25), and only 18/114 infants were diagnosed within 24 hours. Ninety-three percent were referred from lower-level facilities. At diagnosis, 48 had moderate pneumonia and 26 had severe pneumonia, based on radiographic infiltrates and oxygen need. The records establish late recognition and substantial respiratory illness; they do not measure aspiration exposure or prove its cause.