Management is dependent on the type of anomaly with low ARM typically being managed with a primary anoplasty and higher anomalies requiring a primary colostomy followed by a posterior sagittal anorectoplasty (PSARP) within the first year of life, and subsequent colostomy closure. Divided sigmoid colostomy is preferred to avoid overspill of stool from the proximal limb into the distal pouch, however some centres in SSA undertake loop colostomies. Lukong et al highlighted their improvement in outcome following a change in practice from a transverse loop colostomy to divided sigmoid colostomy with delayed PSARP. In some centres local anaesthesia is utilised to undertake the colostomy, reducing the risks associated with general anaesthesia where resources are limited.