Comprehensive Cleft Care Delivery in Developing Countries: Impact of Geographic and Demographic Factors

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Objective Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. Design Cross-sectional survey-based evaluation. Setting International comprehensive cleft care workshop. Participants Total of 489 participants. Interventions Three-day simulation-based hybrid comprehensive cleft care workshop. Main Outcome Measures Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. Results The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). Conclusion Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The First Hybrid International Educational Comprehensive Cleft Care Workshop

Kantar

Esenlik

Abyad

et al. 2022

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“…International global outreach organizations have had a tremendous impact on cleft care in LMICs (Moon et al, 2012; Rousso et al, 2019; Kantar et al, 2021). When assessing countries based on needs-based requirements for care, resources are often devoted to vetting particular countries and regions within those countries before embarking on outreach trips (Chahine et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…Many CL/P international organizations embark on outreach trips primarily for direct cleft repairs or to establish infrastructure for cleft care training (Chahine et al, 2020; Volk et al, 2020; Kantar et al, 2021; Espinosa et al, 2021). The goal of these organizations is to establish a longitudinal capacity building that sustainably benefits the local host sites and patient populations (Yao et al, 2016; Sommer et al, 2020; Espinosa et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Global Cleft Lip and Palate Outreach: A Google Trends Analysis

Weissman

Reddy

Shah

et al. 2021

Understanding patient awareness of cleft lip and/or palate (CL/P) and evaluating demand for necessary procedures may serve to better target future efforts in global outreach. We utilized internet search query data from Google Trends for the terms: “cleft lip,” “cleft palate,” “cleft lip and palate,” “cleft surgery,” and “cleft repair” from January 2004 to January 2021. Relative search volumes (RSV) recorded for the top 5 highest displaying countries and top 3 available regions within those countries were compared against global outreach by Operation Smile and Smile Train, as measured by the number of patients treated. World Health Organization (WHO) indicators were used to validate the RSV values for each country and better understand the current infrastructure and need for cleft care in those countries. Globally, there was an increase in RSV for the terms “cleft lip,” “cleft palate,” “cleft repair,” and “cleft surgery” between 2004 and 2021. For “cleft lip,” the countries with the highest displaying RSVs included: Ghana (100%), Zimbabwe (97%), Nepal (78%), the Philippines (64%), and Kenya (52%). Countries with high RSVs and moderate to high WHO indicators included Ghana, Kenya, India, Nigeria, and Zimbabwe. Countries with high RSVs and poor WHO indicators included Nepal and Pakistan. Some countries had specific regions with high search demand that are not currently targeted for global outreach. Using Google Trends’ data may help find more feasible locations and targeted care for efforts in global outreach with better patient awareness and turnout where demand for CL/P is increasing.

“…3 Timely surgical correction at an adequate early age, coupled with multidisciplinary care, is critical to achieving optimal functional and facial esthetic outcomes ( Shkoukani et al, 2013 ; Worley et al, 2018 ). Nevertheless, comprehensive cleft care delivery is not equitable throughout the world and has been found to be especially deficient in LMICs, where barriers to comprehensive medical and surgical cleft care are numerous and multifaceted ( Massenburg et al, 2016 ; Kantar et al, 2021 ). For decades, international cleft practitioners have attempted to alleviate the burden of disease facing those regions, most notably via outreach cleft programs to LMICs ( Kantar et al, 2019 ; Chahine et al, 2021a ).…”

Section: Introductionmentioning

confidence: 99%

Application of Safety Protocols for International Cleft Outreach Programs During the COVID-19 Pandemic: Global Smile Foundation Precaution Guidelines and Implications

Abyad

Annan

Melhem

et al. 2021

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Background Since COVID-19 was declared a worldwide pandemic by the World Health Organization (WHO) in March of 2020, foundation-based cleft outreach programs to Low- and Middle-Income Countries (LMICs) were halted considering global public health challenges, scarcity of capacity and resources, and travel restrictions. This led to an increase in the backlog of untreated patients with cleft lip and/or palate, with new challenges to providing comprehensive care in those regions. Resumption of international outreach programs requires an updated course of action to incorporate necessary safety measures in the face of the ongoing pandemic. In this manuscript, the authors outline safety protocols, guidelines, and recommendations implemented in Global Smile Foundation's (GSF) most recent outreach trip to Beirut, Lebanon. Methods COVID-19 safety protocols for outreach cleft care and an Action Response Plan were developed by the GSF team based on the published literature and recommendations from leading international organizations. Results GSF conducted a 1-week surgical outreach program in Beirut, Lebanon, performing 13 primary cleft lip repairs, 7 cleft palate repairs, and 1 alveolar bone grafting procedure. Safety protocols were implemented at all stages of the outreach program, including patient preselection and education, hospital admission and screening, intraoperative care, and postoperative monitoring and follow-up. Conclusions Organizing outreach programs in the setting of infectious diseases outbreaks should prioritize the safety and welfare of patients and team members within the program's local community. The COVID-19 protocols and guidelines described may represent a reproducible framework for planning future similar outreach initiatives in high-risk conditions.