Malnutrition in cleft lip and palate children in Uganda

Abstract

The objective of this study is to investigate the nutritional status of patients with cleft lip and/or palate when compared to non-cleft lip or palate patients. A retrospective analysis was carried out of all patients aged less than 1 year who were operated on in the Comprehensive Rehabilitation Services in Uganda hospital since opening in April 2009 to November 2010. The data was divided into three groups: cleft lip patients; cleft lip and palate patients and non-cleft patients. The WHO anthropometric calculator was used to calculate weight-for-age Z scores on each patient for the initial outpatient appointment and the operation. The demographic data and Z scores were compared using independent T tests. Three hundred and twenty-one patients were identified, 131 patients had cleft lip alone, 112 patients had cleft lip and palate and 78 patients had no cleft. The cleft lip and palate group had significantly lower Z scores for both the outpatient appointment and operation (i.e. were more malnourished) than either the cleft lip group or the non-cleft group. Malnutrition is a well-documented problem associated with cleft lip and palate. Our research confirms this malnutrition but also highlights the severity of the malnutrition. The patients with cleft lip and palate are unable to feed adequately and therefore need intervention. We operate on these patients once they reach a target weight of 3 kg and repair both lip and palate in one operation to enable patients to feed and improve their nutritional status.

The prevalence and factors associated with malnutrition among infants with cleft palate and/or lip at a hospital in Uganda: a cross-sectional study

“…Children with CP+/-L are more prone to malnutrition compared to those with only Cleft Lip (CL) [3]. The prevalence of malnutrition among infants with CP+/-L in the literature varies between 30 and 50% [4, 5].…”

Impact of Early Synchronous Lip and Palatal Repair on Speech

“…The synchronous repair is advocated as failure to complete palatoplasty after lip repair is highly frequent in African patients with CLP due to operation costs, traveling costs, traveling distance and recovered aesthetics [13,14] - in black African societies, clefts are often associated with evil spirits, curses and punishment for ancestral wrongdoings [15]. Moreover, very early closure of the CP is advised as babies with unrepaired CP frequently lose weight in their first few months of life due to the inability to adequately breast-feed [16], resulting in a great risk for malnutrition [17]. Consequently, synchronous CLP repair is performed once the patient has reached a target weight of 3 kg, what is often prior to the age of 6 months, in order to improve nutrition and survival [17].…”

“…Moreover, very early closure of the CP is advised as babies with unrepaired CP frequently lose weight in their first few months of life due to the inability to adequately breast-feed [16], resulting in a great risk for malnutrition [17]. Consequently, synchronous CLP repair is performed once the patient has reached a target weight of 3 kg, what is often prior to the age of 6 months, in order to improve nutrition and survival [17]. Given that this cleft surgery is performed in safe circumstances by one experienced surgeon (A.H.) using the Sommerlad technique for palatal repair, this setting provides an excellent opportunity to assess the normality of speech characteristics after palatal repair prior to 6 months of age.…”

What If the Cleft Child is Yours?

“…Studies also show that malnutrition is a well-documented problem associated with cleft lip and palate. It is mainly because of partial starvation because cleft children often get fatigue easily and their inability to create negative pressure inside the mouth and the lack of a hard palate to press the nipple against to initiate lactation (Foote, 1925;Cubitt et al, 2011). Thus briefing about the feeding method and how to care for the cleft child is necessary for the parents because their cleft child cannot eat like the other children.…”