Congenital malformations (CM), defined as morphological and functional abnormalities present at birth [1] [2] , are a major public health issue. They are the fourth leading cause of neonatal mortality worldwide, accounting for approximately 303,000 newborn deaths each year [2] [3] . In France, they affect between 3% and 4% of births, 2% of which are diagnosed during the neonatal period [4] . In sub-Saharan Africa, although the problem is real, studies remain rare and heterogeneous, with reported prevalences between 2% and 6% [5] . In Côte d’Ivoire, data is limited, often coming from hospitals and being fragmentary in nature. For example, a study conducted at the Cocody University Hospital revealed that CM accounted for 4.9% of neonatal admissions [6] . In 2018, the neonatal unit at Bouaké University Hospital recorded 2098 admissions, including several cases of newborns with malformations. What is the epidemiological and clinical profile of newborns with CM admitted to Bouaké University Hospital? What are the main types of malformations observed, how are they managed, and how do they progress? This study aims to describe the epidemiological, diagnostic, therapeutic, and evolutionary characteristics of newborns with CM at Bouaké University Hospital. It is part of an effort to better document the local situation in order to improve clinical practice, strengthen patient prognosis, and contribute to strategic planning for neonatal health in Côte d’Ivoire.

This was a retrospective descriptive study conducted over a three-year period, from January 1, 2017, to December 31, 2019.

The study was conducted in the neonatal unit of the pediatric department at Bouaké University Hospital, a leading pediatric care facility in the central region of Côte d’Ivoire. The unit has a capacity of nine incubators, three cribs, and three radiant warmers. Newborns are cared for by a multidisciplinary team composed of pediatricians, interns, pediatric residents, midwives, nursing assistants, and students.

The target population is represented by all newborns admitted to the neonatal unit during the study period.

Inclusion criteria:

The following were included:

Non-inclusion criteria:

The following were not included:

Data were extracted from the medical records of hospitalized newborns, using a standardized and anonymous survey form completed for each case. The variables studied were sociodemographic (gender, age, place of residence of the newborn; age, marital status, ethnicity, educational level, and occupation of the mother), diagnostic (maternal medical and obstetric history, number of prenatal consultations (CPN), prenatal assessment, prophylaxis, gestational pathologies, term of pregnancy, place and mode of delivery, amniotic fluid status, Apgar score, weight, height, head circumference, type of malformation), therapeutic (treatments administered) and evolutionary (favorable outcome or death). CM were classified by organ system according to the ICD-10 coding framework. An anomaly was considered isolated when only one organ system was involved, and polymalformative when two or more distinct systems were affected.

Data analysis was exclusively descriptive, using means with standard deviations for quantitative variables and proportions for qualitative variables. Although exploratory bivariate comparisons (between maternal characteristics and neonatal outcomes) were attempted, sample sizes were insufficient to yield statistically robust associations. For this reason, we restricted the analysis to descriptive statistics.

The study was conducted in accordance with current ethical standards, in particular the authorization obtained from the Medical and Scientific Director of the Bouaké University Hospital, as well as the confidentiality ensured by the anonymization of data via a number assigned to each survey form.

During the study period, 5,966 newborns were registered, including 100 newborns with CM, representing a hospital frequency of 1.7% (95% CI: 1.4 - 2.1).

Newborns with malformations were boys in 50% of cases and girls in 50% of cases. They came from the city of Bouaké in 63% of cases. The median age of the mothers was 29 years ± 6 years, with extremes of 14 and 40 years, and 63% were under 30 years of age. They were single mothers in 82% of cases, uneducated or with a primary school education in 89% of cases. They were unemployed in 69% of cases.

The mothers of malformed newborns were primigravida and multiparous in 29% and 35% of cases, respectively. They were primiparous and multiparous in 34% and 35% of cases, respectively ( Table 1 ). They had attended at least four prenatal consultations (CPN) in 32% of cases and had undergone prenatal screening in 21% of cases. Rubella, toxoplasmosis, and syphilis serology tests were performed in 8%, 7%, and 6% of cases, respectively. They were positive in 12.5% and 14.3% of cases, respectively. The rate of obstetric ultrasounds was 13.7%. They were performed in the second and third trimesters of pregnancy in 7 and 4 cases, respectively. The main maternal pathologies during pregnancy were malaria (8%) and cystitis (3%). Folic acid was administered to 25% of mothers of newborns with malformations. Hypertension and consanguinity were found in 3% of mothers. Delivery took place in a hospital setting in 77% of cases and vaginally in 81% of cases. The average birth weight of newborns was 2808.5 g ± 686.3 g, with extremes of 1150 g and 5000 g. The average height was 47.1 cm ± 5.5 cm. The head circumference of malformed newborns was 33.0 cm ± 4.8 cm, with extremes of 14 cm and 70 cm. The Apgar score at 5 minutes was greater than or equal to 7 in 80.5% of cases. Malformations in newborns were discovered on day 0 of life in 57% of cases. CM were isolated in 86.6% of cases. They predominantly affected the limbs (32%) and the abdomen and digestive tract (30%). Clubfoot (22%), omphalocele (15%), and spina bifida (10%) were the most commonly observed CM ( Table 2 ).

The Ponsety method was the most commonly used surgical treatment in 20% of cases, with death (10%) occurring during hospitalization.

This study aims to describe the epidemiological, diagnostic, therapeutic, and evolutionary characteristics of newborns with CM at Bouaké University Hospital. The results reveal a high frequency of these anomalies in the unit, associated with often delayed diagnosis, a determining factor in their high mortality rate. However, these findings should be interpreted with caution given the inherent methodological limitations. This is a retrospective study with risks of selection and information bias. In addition, the single-center approach did not allow the results to be extrapolated to the entire Gbêkê region, and the lack of counter-references limited access to post-referral data. Despite these methodological limitations, these results raise the following points for discussion in terms of epidemiology, diagnosis, treatment, and progression.

The prevalence of CM observed is 1.7%, which is lower than the data reported elsewhere in Africa (2% - 6%) or in Western countries (3% - 4%) [7] - [9] . This disparity can be explained by heterogeneous study methodologies, differences in technical facilities and diagnostic capabilities, and sociocultural, genetic, and environmental influences.

The majority of newborns with malformations were born to mothers under the age of 30, a profile similar to that observed at the Yopougon University Hospital in 2006 [10] and at the Cocody University Hospital in 1997 [11] in Côte d’Ivoire. A study conducted at the Brazzaville University Hospital in Congo [12] reported advanced maternal age (>35 years). The literature highlights the association between advanced maternal age and chromosomal malformations [7] [13] [14] , but in the local context, early marriages could explain the young age of pregnant women. The high prevalence of abnormalities in primiparous and pauciparous women (69%) and primigravid/paucigravid women (64%) corroborates the results reported at the Bouaké University Hospital [15] and in Yaoundé [16] in Cameroon. The study reveals a notable lack of prenatal care, with fewer than four prenatal visits for 68% of mothers, no prenatal check-ups for 79%, and an obstetric ultrasound rate of 13.7%. In our cohort, only 25% of mothers received periconceptional folic acid prophylaxis, a rate that falls far short of the WHO 2022 recommendation that all women take 400 µg daily from preconception through the first trimester to prevent neural tube defects [17] . This low uptake is consistent with regional findings: Moges et al. [18] reported that not taking folic acid was associated with a more than twofold increased risk of congenital anomalies (pooled OR = 2.67; 95% CI: 1.42 - 5.00), while Chaulo et al. [19] found that missed periconceptional supplementation increased the risk of hydrocephalus by 83% (aPR = 1.83; 95% CI: 1.11 - 1.96) and congenital heart disease by 78% (aPR = 1.78; 95% CI: 1.31 - 1.94). This insufficient coverage is also linked to socioeconomic vulnerability and the widespread use of traditional medicine and African pharmacopoeia, underscoring the urgent need to strengthen folate supplementation programs. Regarding the types of malformations, the detection of anomalies on day 0 of life in 57% of cases reflects a late diagnosis, likely linked to home births and the absence of obstetric monitoring. The majority of cases involved isolated malformations (86.6%) versus polymalformative syndromes (14%), which is consistent with data from the African literature [10] [12] . The most common malformations were in the lower limbs (clubfoot, 22%), the abdominal wall (omphalocele, 15%) ( Figure 1 ), the nervous system (spina bifida, 10%) ( Figure 2 ), the face (cleft lip and palate, 9%) and laparoschisis (6%) ( Figure 3 ). This profile is similar to that reported in the university hospitals of Abidjan [11] [20] , in southwestern Nigeria [21] , and in Morocco, albeit in different proportions.

The study shows that treatment is mainly medical, supplemented by specific surgical procedures such as the Ponseti method for clubfoot (20%) ( Figure 4 ), colostomy for anorectal malformations (6%), and tanning in cases of omphalocele (6%). The low rate of surgical intervention for conditions other than clubfoot highlights the limitations of the technical facilities, as reported in a study in Burkina Faso [22] . However, the lack of counter-referrals may explain why it was not possible to determine the outcome for the child once admitted to pediatric surgery. Regarding outcomes, the neonatal mortality rate for malformations is 10% in the study. This rate is much lower than the data reported in the literature [23] [24] . This difference could be related to the predominance of “benign” malformations in this series, particularly those of the limbs.

This retrospective study conducted in the neonatal unit of Bouaké University Hospital highlighted the high prevalence of CM, with a predominance of limb and abdominal wall abnormalities. Late diagnosis, the limitations of prenatal care, and technical and socioeconomic constraints negatively influence the neonatal prognosis. It highlights the need to strengthen prenatal diagnosis, develop protocols adapted to the local context, and structure referral systems. These recommendations aim to improve the quality of care while supporting medical training with contextualized educational tools.

All authors participated intellectually in the preparation and revision of the manuscript prior to submission.