SummaryA project to perform surgical correction of cleft lips and palates was carried out in Uganda in 1998. Twenty centres were visited and 336 cleft lips and 41 cleft palates were repaired. The age of the patients ranged from 2 weeks to 60 years. Many of the centres visited were remote and lacked even the most basic equipment. Patients were anaesthetised using ketamine, ether or halothane according to a protocol that we developed. There was no anaesthetic mortality and only one case of significant morbidity. We report our experience and discuss recommendations regarding the provision of anaesthesia in remote circumstances based on our outcome. An additional benefit of the project was that we provided training to local medical personnel in anaesthesia and surgery for cleft lips and palates.
BackgroundTo determine the prevalence and factors associated with malnutrition among infants with Cleft palate and/or cleft lip (CP+/-L) at Comprehensive Rehabilitation for Uganda Hospital (CoRSU) in Uganda.MethodsThis was a cross-sectional study done on infants with CP+/-L and their caretakers admitted between November 2013 and October 2014 at CoRSU hospital which was the study setting. A questionnaire was answered by the infants’ caretakers. The main outcome measure, malnutrition was defined and classified based on Z-scores obtained using the W.H.O Z-calculator in which weights of the infants in kilograms and lengths in centimeters respectively were placed. The values obtained were expressed as a proportion using all enrolled infants with CP+/-L as denominator. Multivariable analysis was used to determine the risk factors.ResultsA total of 44 infants with CP+/-L were enrolled. Of these, 77% were below 4 months of age and 97.7% were immunized. The male-to-female ratio was 1.06:1. About 59% had unilateral CP+/-L. A total of 93.2% were delivered at term with 69.4% having a birth weight greater than 3 kg. Generally, 68% were malnourished, with the highest burden among females (71.4%), infants below 4 months (73.5%) and those with unilateral CP+/-L (77%). About 57% had moderate-to-severe malnutrition. There was delayed supplementation to breast milk, with cow-milk as the main supplemental feed for all the infants. In the multivariable analysis, factors associated with malnutrition included, having caretakers lacking nutritional information post-delivery (OR = 3.8, p = 0.17), low birth weight (OR = 3.4, p = 0.20), and having less than 10 feeds/day (OR = 4.9, p = 0.09).ConclusionCP+/-L infants born in Uganda suffer a high-burden of malnutrition. Preventional strategies are needed with focus on proper feeding information. Research on cost-effective feeds, feeding methods and reasons behind gender disparities in these infants is also required.
The distribution of sex and laterality broadly correlates with findings of other studies; however, a large discrepancy in the proportions of CL, CLP, and CP is apparent. Much higher numbers of CLs and much lower numbers of CLP and CP presented than would be expected in comparison with worldwide literature (2% of patients had an isolated CP). It is hypothesized that the low numbers of patients presenting with combined CLP and CP are due to high mortality among this cohort. If this hypothesis is correct, then in this series of 1304 cleft patients, as many as 3526 CP patients (91% of all CPs) are missing and probably died before undergoing surgical correction.
We describe our experience of working in plastic and reconstructive surgery in Uganda over the last 10 years. There is a high burden of disease, a health system that is under resourced, and few qualified physicians to provide healthcare for a principally rural population. Training the physicians of the future is essential. Prevention and early wound management needs to be emphasized for traumatic injuries including burns. Subsidized up-country visits by trained specialists with the appropriate equipment are required to provide a service for the rural poor. There appears to be a high mortality rate in babies with unrepaired cleft palate, probably due to feeding difficulties in an environment where intercurrent illness is common. We now offer nutritional support with early combined cleft lip and palate repair in these babies, a practice that has a high success rate and may be suited to other specialist units in the developing world.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.