Distribution of Orofacial Clefts and Frequent Occurrence of an Unusual Cleft Variant in the Rift Valley of Kenya

Spritz, Richard A.; Arnold, Thomas; Buonocore, Samuel; Carter, David; Fingerlin, Tasha E.; Odero, Wilson; Wambani, John; Tenge, Robert K; Weatherley-White, Christopher

doi:10.1597/06-136

Cited by 6 publications

(7 citation statements)

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“…About a third (n = 7) of the mothers admitted having relatives with cleft lip and cleft palate (Table 2), which was also echoed by some medical staff members (n = 5) who stated that oro-facial clefts are inherited conditions (Table 3) suggestive of the role of heredity [19,20]. Similar findings had previously been reported [1,3,18,21] (Table 4).…”

Section: Discussionsupporting

confidence: 70%

Prevalence, pattern and perceptions of cleft lip and cleft palate among children born in two hospitals in Kisoro District, Uganda

et al. 2014

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BackgroundCleft lip with or without cleft palate is one of the most common congenital anomalies that affect the oro-facial region. The aim of the study was to determine the period prevalence, pattern and perceptions of cleft lip and cleft palate in children born between 2005 and 2010 in two hospitals in Kisoro District, Uganda.MethodsThe study involved a retrospective review of medical records of mothers who delivered live babies between January 2005 and December 2010 in Kisoro Hospital and St. Francis Hospital, Mutolere in Kisoro District. Key informant interviews of mothers (n = 20) of the children with cleft lip and/or clip palate and selected medical staff (n = 24) of the two hospitals were carried out. The data were analysed using descriptive statistics.ResultsOver the 6 year period, 25,985 mothers delivered live babies in Kisoro Hospital (n = 13,199) and St. Francis Hospital, Mutolere (n = 12,786) with 20 babies having oro-facial clefts. The overall period prevalence of the clefts was 0.77/1,000 live births. Sixty percent (n = 12) of children had combined cleft lip and palate and the same proportion had clefts on the left side of the face. More boys were affected than girls: 13 versus 7. About 45% of mothers were hurt on realizing that they had delivered a child with an oro-facial cleft. Forty percent of mothers indicated that a child with oro-facial cleft was regarded as an outcast. About 91.7% (n = 22) of the medical staff reported that these children were not accepted in their communities. Surgical intervention and psychosocial support were the management modalities advocated for by most respondents.Conclusion/recommendationsThe period prevalence of combined cleft lip and palate in two hospitals in Kisoro District was comparable to some findings elsewhere. Cleft lip and cleft palate are a medical and psychosocial problem in Kisoro District that calls for sensitization and counseling of the families and communities of the affected children. The policy makers need to strategically plan for provision of rehabilitation with feeding obturators to facilitate easy feeding to gain weight before surgical intervention of the affected children.

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Section: Discussionsupporting

confidence: 70%

Prevalence, pattern and perceptions of cleft lip and cleft palate among children born in two hospitals in Kisoro District, Uganda

et al. 2014

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“…In Ethiopia, a rate of 1.4 in 1000 live births was reported in a hospital-based study (Eshete et al, 2011). A retrospective study in Tanzania reported higher proportions of individuals with cleft lip only (Manyama et al, 2011); this is similar to reports from another study in Kenya (Spritz et al, 2007). A significant difference in cleft side (more unilateral left-sided clefts than unilateral right-sided clefts) was reported in studies in Ghana, Nigeria, and Tanzania (Carneiro and Massawe, 2009; Agbenorku et al, 2011; Butali et al, 2011).…”

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confidence: 86%

Prevalence of Orofacial Clefts in Nigeria

Butali

Adeyemo

Mossey

et al. 2014

The Cleft Palate-Craniofacial Journal

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Orofacial clefts (OFC) are the most common malformations of the head and neck. In Africa, OFC is under-ascertained with little or no surveillance system in most parts for clefts and other birth defects. A Nigerian craniofacial anomalies study “NigeriaCRAN” was established in 2006 to support cleft research specifically for epidemiological studies, treatment outcomes and; studies into etiology and prevention. We pooled data from seven of the largest Smile Train treatment centers in the six geopolitical zones in Nigeria. Data from September 2006 to June 2011 were analyzed and clefts compared between sides and gender using the Fisher’s exact test. A total of 2197 cases were identified during the study period with an estimated prevalence rate of 0.5/1000. Of the total number of OFC, 53.3% are males and 47%.7 are females. There was a significant difference (p=0.0001) between unilateral left clefts and unilateral right clefts and; significant difference (p=0.0001) between bilateral clefts and either clefts on the left or right side. A significant gender difference (p=0.03) with more females than males was also observed for CP. A total of 103 (4.7 %) associated anomalies were identified, nine syndromic cleft cases and 10.4 % of the total number of clefts individuals have an affected relative. The significant difference between unilateral clefts and gender differences in the proportion of cleft palate only are consistent with the literature. The present study emphasizes the need for birth defects registries in developing countries in order to estimate the exact prevalence of birth defects including OFC.

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“…10 Given the contrast in the prevalence of sincipital EC between our population and that reported from several centers in Nigeria, we hypothesized a possible ethnic difference in this regard between children of Bantu and non-Bantu origin. In a similar way, it is recognized that Nilotes have a higher incidence of oral-facial clefts, 26 an anomaly known to be associated with sincipital EC. 4,21 We found that infants of Bantu origin had a signifi- cantly higher proportion of occipital lesions than did those of Nilotic origin.…”

Section: Encephalocele Location and Ethnic Predispositionmentioning

confidence: 90%

Encephalocele in Uganda: ethnic distinctions in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children

Warf

Stagno

Mugamba

2011

PED

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Object This study characterizes the first clinical series of encephalocele (EC) from East or Central Africa, and is the largest reported from the African continent. The authors explored survival, the efficacy of primary endoscopic management of associated hydrocephalus, and ethnic differences in EC location. Methods One hundred ten consecutive children presented to CURE Children's Hospital of Uganda for treatment of EC over a 9-year period. Clinical data, including patient demographic information, birth date, lesion type (sincipital, parietal, or occipital), operative data, and subsequent course had been entered prospectively into a clinical database. Home visits to update the status of those lost to follow-up were done when possible. With appropriate institutional approvals, the database was reviewed for this retrospective study. Two-tailed probability values calculated using the Fisher exact test were used to assess the significance of differences among groups, with p < 0.05 being considered significant. The Kaplan-Meier method was used for analysis of survival and treatment success probabilities. Results There were 53 (48%) occipital, 33 (30%) sincipital, and 24 (22%) parietal lesions. Occipital lesions were significantly more common among children of Bantu origin (p = 0.02). Nilotes demonstrated a roughly equal distribution among sincipital, parietal, and occipital locations. The female/male ratio was 1.2, with no difference between EC types (range 1.0–1.4, p = 0.6–0.8). Of 110 patients, 108 (98%) underwent surgical repair at a median age of 1 month (mean 15.7 months), whereas 2 had treatment for hydrocephalus only. Wound revision was required in 13% of cases. Surgery-related mortality was 3%. One-year and 5-year survival rates were 87% (95% CI 0.79–0.93) and 61% (95% CI 0.51–0.70), respectively. Hydrocephalus required treatment in 32%, and was equally common among the 3 EC types. Thirteen patients were treated with combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC) and 2 with ETV alone, whereas 18 patients received primary shunt placement. Predicted treatment success at 1 year was 79% for ETV or ETV/CPC (95% CI 0.50–0.94) and 47% for shunt placement (95% CI 0.24–0.71). Conclusions Analysis of this first EC series from this region suggests that sincipital lesions are 3 times more common in East than in West Africa. Occipital lesions predominate in patients of Bantu origin, but not among those of Nilotic descent. Hydrocephalus incidence was equally common among different EC types, and endoscopic treatment was more successful (79%) than shunting (47%) at 1 year. The 5-year mortality rate was similar to that for infants with myelomeningocele in Uganda, and more than twice that for their unaffected peers.

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Distribution of Orofacial Clefts and Frequent Occurrence of an Unusual Cleft Variant in the Rift Valley of Kenya

Cited by 6 publications

References 0 publications

Prevalence, pattern and perceptions of cleft lip and cleft palate among children born in two hospitals in Kisoro District, Uganda

Prevalence, pattern and perceptions of cleft lip and cleft palate among children born in two hospitals in Kisoro District, Uganda

Prevalence of Orofacial Clefts in Nigeria

Encephalocele in Uganda: ethnic distinctions in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children

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