Foundation-Based Cleft Care in Developing Countries

Abstract

Background: Cleft deformities of the lip and palate affect nearly one in 500 to 700 births, and lead to increased morbidity and mortality if untreated. Nevertheless, significant global disparities in access to timely and appropriate care still exist. The relatively basic infrastructure required to surgically correct these deformities and large unmet disease burden have resulted in a significant number of foundation-based cleft care initiatives focused on developing countries. In this study, the authors evaluate the peer-reviewed literature generated by these foundations in an attempt to assess their clinical, scientific, educational, and economic impact. Methods: A comprehensive review of the literature was performed using key search terms, and the level of evidence of identified articles was determined. Data were then analyzed to determine the different models of foundation-based cleft care in developing countries, and their clinical, scientific, educational, and economic impact. Results: A total of 244 articles were identified through the authors’ search and reviewed. Foundation-based cleft care initiatives in developing countries have significantly contributed to a better understanding of disease epidemiology, barriers to care, safety considerations, complications and outcomes, and international and local cleft surgery education. The cleft care center model is more cost-effective than the surgical mission model and provides more sustainable care. Conclusions: Foundation-based cleft care prevents significant morbidity in developing countries and has provided valuable resources for capacity building. The surgical mission model should be considered as a transitory conduit for establishing the more effective and sustainable cleft care center model of care.

Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education

“…The workshop was well attended and well received by participants who unanimously reported that they would recommend it to others and participate again in a similar activity (Kantar, 2019c). With these points in mind, we sought to reproduce this effort in Latin America, where significant unmet cleft care needs exist (Kantar, 2019a). Relying on strong collaborations between Global Smile Foundation, other cleft care nonprofit foundations, stakeholders from the biomedical industry sector, and international academic leaders in cleft care, we were able to hold our second simulation-based comprehensive cleft care workshop in Lima, Peru, from October 16 to 18, 2019.…”

Optimizing Outcomes in Cleft Surgery

“…Early efforts followed a vertical model of care delivery in which teams are sent to underserved regions for short-periods of time to provide surgical care. This model has often been criticized for its emphasis on patient volume over quality, and for its inherently limited provision for post-surgical follow up [8]. Other criticisms include the marginalization of local providers whose welfare may be threatened by foreign aid, and the use of missions as a training ground for surgeons with little experience in cleft lip and palate repair [17].…”

“…The global response to this problem over the past several decades has been immense. Charitable organizations have provided more than 1 million free cleft repair surgeries and trained local surgeons to perform these procedures [8]. Historically, the success of these outreach efforts has been measured by the number of patients served, and little emphasis has been placed on the quality of care delivered.…”

“…What little data that exists indicates that cleft mission work in low and middleincome countries (LMICs) has at times been associated with poor outcomes [8]. Complication rates following cleft palate repair in these settings often approach 30% and follow up rates are understandably much lower than at tertiary care centers in developed nations [13,14].…”

Extracellular Matrix Composition and Remodeling: Current Perspectives on Secondary Palate Formation, Cleft Lip/Palate, and Palatal Reconstruction

“…CL/P is the most common craniofacial anomaly occurring in approximately 1 in 700 live births, and representing a substantial burden worldwide (Shaw, 2004;Massenburg et al, 2016). The treatment of this disorder is complex and demands a multiplicity of health professionals to perform numerous interventions throughout the patient's life (Kantar et al, 2019). Besides the high cost of treatment, CL/P imposes a significant impact on the quality of life of affected children and their families (Macho et al, 2017;Sundell et al, 2017).…”