The Panorama of Cleft Lip and Palate Live Birth in Brazil: Follow-up of a 10-Year Period and Inequalities in the Health System

Abstract

Objective To provide the prevalence and an overview of cleft lip and palate (CL/P) in the period of 2008 to 2017, as well as the profile of care provided for this condition in Brazil. Design Cross-sectional study of epidemiological character. Setting Brazilian government website. Participants National Live Birth and Hospital Information System. Intervention Organization of the end databases and performance-based statistical analysis. Main Outcome Measure(s) Analysis of the prevalence of CL/P in newborns, sociodemographic condition of the mothers, surgical procedures and hospitalizations, and specialized hospitals in Brazil within a 10-year period. Results The average prevalence of CL/P in Brazil was ∼52 children per 100 000 live births in the covered period, corresponding to 1 per 1924 newborns. The presence of cleft was associated with preterm birth, being underweight, and the male gender. The highest prevalence was found in the South region, while the lowest was found in the Northeast region, with increasing rates in the North region of Brazil. The states with the highest prevalence were not those with a great number of hospitalizations and surgical procedures for live births with CL/P. Conclusion In the 10-year study period, the prevalence of CL/P was 0.52 newborns per 1000 live births, a result which differs among the states of Brazil. The need to reinforce the national monitoring of the prevalence and surgical procedures of cleft patients have also emphasized the need to improve public medical care for CL/P subjects.

Epidemiologic profile and prevalence of live births with orofacial cleft in Brazil: a descriptive study

“…In all of these studies the prevalence of OC showed differences between the Federative Units and the regions. The overall prevalence of OC in Brazil found in this present study is in accordance with what was found in the literature regarding the country; 6 – 8 , 28 , 29 however, the Brazilian prevalence of this malformation is lower than the global, which is about 1–1.5/1,000 live births. 3 Some reasons that could explain it are the underestimation of reported cases of OC in the national system, and the misdiagnosis of clefs in some Brazilian regions, especially those with the lowest reports.…”

“…Studies done involving the years between 2009 and 2013 found prevalences ranging from 4.85/10,000 live births 29 to 5.86/10,000 live births. 28 The most recent ones 7 , 8 found prevalences near 5.1/10,000 live births for the 2005–2017 period. In all of these studies the prevalence of OC showed differences between the Federative Units and the regions.…”

“…Only five 6 – 8 , 28 , 29 studies were found in the literature regarding the prevalence of OC using SINASC data for the entire country, but none of them covered the entire time period selected for the present analysis. For the period between 1998 and 2002, Rodrigues et al 6 found a prevalence of 3.6/10,000 live births.…”

“…Analyzing the regions most and least affected by clefts, the results were also consistent with other studies. 6 , 7 , 28 , 29 This difference between regions can be explained by the greater probability of underreporting of cases in the economically poorer regions, 8 since, when the OC were evaluated by state, an absence of OC records was found for some years, especially in the Northern states.…”

“… 5 In Brazil, few studies have been carried out on the national prevalence of OC, mainly due to reporting and recording difficulties. 6 The most recent studies 7 , 8 found prevalences near 5.1/10,000 live births for the country.…”