Global Variation in Cleft Palate Repairs: An Analysis of 352,191 Primary Cleft Repairs in Low- to Higher-Middle-Income Countries

Abstract

Objectives : Resources for repair of cleft lip and palate may be lacking in low- and middle-income countries. The Smile Train is a registered charity that supports cleft repair in resource-poor settings. In the global health care challenge, it has been suggested that many babies born with cleft palates are not repaired. This study aims to determine whether any variation exists in the proportion of cleft lip and cleft palate repairs undertaken in low- and middle-income countries. Methods : Data were obtained from the Smile Train database of 352,191 consecutive cleft operations performed between 2008 and 2011 in low- to higher-middle-income countries. The ratio of cleft lip to palate repair was analyzed as a function of geographic region and by country income (gross national income). Results : A significant correlation exists between both the income of a country and its geographical region to the ratio of lip and palate repair procedures undertaken. Higher-income countries had a higher ratio of cleft palate repairs. Countries in sub-Saharan Africa have the lowest proportion of cleft palate repairs. Conclusion : This study emphasizes that many babies born with cleft palates in resource-poor regions do not have their palates repaired. This finding may be explained by an increased neonatal mortality in cleft palate babies. Furthermore, fewer isolated palatal clefts may present to an appropriate health care facility or there may be a reluctance to treat cleft palate due to concerns regarding higher perioperative risks or the lack of available surgical and anesthetic expertise.

Assessment of Mothers’ Needs for their Infants who have Cleft Lip and/or Palate

“…In relation to mothers' needs regarding underweight infants, the current study indicated that three fifth of the infants were underweight when comparing their age to the current weight through the assessment done by the researchers and this finding was in the same line with [13] who emphasized that babies with a cleft palate significantly malnourished and require perioperative nutritional support, also [19] found that infants with cleft lip and palate were highly susceptible to weight loss and gastroenteritis. These results may be due to the feeding difficulties arisen, and the recurrent opportunistic infections like pneumonia and gastro-entritis.…”

“…These results were supported by [13] who emphasized that babies with a cleft palate have a higher incidence of intercurrent infections, particularly lower respiratory tract infections. Also, these results were in accordance with [14] who studied "perceived barriers to care among children with orofacial clefts in North Carolina" and concluded that…”

Epidemiological Study of Cleft Palate in the State of Bahia, Brazil

“…In the majority of the cases, such a surgical procedure was performed in the own reference centre (data not reported). A study performed by Cubitt et al 13 used data from the Smile Train Organisation, which provides free surgical treatment for orofacial clefts across several countries in the world, and found a variation in the percentage of individuals who had access to treatment, particularly depending on the country's income. Specifically in the case of cleft palate repair, low-income countries had only 22 percent of individuals operated, whereas highincome countries had 52 percent.…”

“…The ideal age recommended by the American Cleft PalateCraniofacial Association 14 for this treatment is up to 12 months of life. Cubitt et al 13 reported that the mean age for such surgery varies depending on the geographic site as well as on each country's income. For cleft palates, individuals from countries of Europe and Central Asia had a mean age of 3 years old when they sought treatment, whereas those from Sub-Saharan Africa had a mean age of 6.7 years old.…”

Impact of short-term reconstructive surgical missions: a systematic review

“…Specialty hospitals provide continuous care all year round in a LMIC. The cleft care centre of Operation Smile in India,39 or Smile Train’s model are examples of this approach 69–78…”