Ten-year experience of more than 35,000 orofacial clefts in Africa

BMC Pediatrics, Feb 2015

Background Surgical correction of orofacial clefts greatly mitigates negative outcomes. However, access to reconstructive surgery is limited in developing countries. The present study reviews epidemiological data from a single charitable organization, Smile Train, with a database of surgical cases from 33 African countries from 2001–2011. Methods Demographic and clinical patient data were collected from questionnaires completed by the participating surgeons. These data were recorded in Excel, analyzed using SPSS and compared with previously reported data. Results Questionnaires were completed for 36,384 patients by 389 African surgeons. The distribution of clefts was: 34.44% clefts of the lip (CL), 58.87% clefts of the lip and palate (CLP), and 6.69% clefts of the palate only (CP). The male to female ratio was 1.46:1, and the unilateral: bilateral ratio 2.93:1, with left-sided predominance 1.69:1. Associated anomalies were found in 4.18% of patients. The most frequent surgeries included primary lip/nose repairs, unilateral (68.36%) and bilateral (11.84%). There was seasonal variation in the frequency of oral cleft births with the highest in January and lowest by December. The average age at surgery was 9.34 years and increased in countries with lower gross domestic products. The average hospital stay was 4.5 days. The reported complication rate was 1.92%. Conclusions With the exception of cleft palates, results follow trends of worldwide epidemiologic reports of 25% CL, 50% CLP, and 25% CP, 2:1 unilateral:bilateral and left:right ratios, and male predominance. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting that limitations in economic resources and cultural aesthetics of the obvious lip deformity may outweigh functional concerns and access to treatment for females. A fewer than expected associated anomalies suggests either true ethnic variation, or that more severely-affected patients are not presenting for treatment. The epidemiology of orofacial clefting in Africa has been difficult to assess due to the diversity of the continent and the considerable variation among study designs. The large sample size of the data collected provides a basis for further study of the epidemiology of orofacial clefting in Africa.

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Ten-year experience of more than 35,000 orofacial clefts in Africa

Conway et al. BMC Pediatrics Ten-year experience of more than 35,000 orofacial clefts in Africa Julia C Conway 0 2 3 Peter J Taub 0 2 3 4 5 Rochelle Kling 2 3 6 Kurun Oberoi 2 3 9 John Doucette 2 3 8 Ethylin Wang Jabs 0 1 2 3 7 0 Department of Pediatrics at Icahn School of Medicine at Mount Sinai , One Gustave L Levy Place, Box 1497, New York, NY 10029 , USA 1 Department of Genetics and Genomic Sciences at Icahn School of Medicine at Mount Sinai , New York, NY , USA 2 Burundi , Djibouti, Ethiopia, Kenya, Madagascar, Rwanda, Somalia, Tanzania , Uganda 3 Benin , Burkina Faso, Cote D'Ivoire, Gambia, Ghana, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone , Togo 4 Department of Dentistry at Icahn School of Medicine at Mount Sinai , New York, NY , USA 5 Department of Surgery at Icahn School of Medicine at Mount Sinai , New York, NY , USA 6 State University of New York Downstate Medical School , Brooklyn, NY , USA 7 Developmental and Regenerative Biology at Icahn School of Medicine at Mount Sinai , New York, New York , USA , New York, NY , USA 8 Department of Preventive Medicine at Icahn School of Medicine at Mount Sinai , New York, NY , USA 9 Johns Hopkins University Medical School , Baltimore, MD , USA Background: Surgical correction of orofacial clefts greatly mitigates negative outcomes. However, access to reconstructive surgery is limited in developing countries. The present study reviews epidemiological data from a single charitable organization, Smile Train, with a database of surgical cases from 33 African countries from 2001-2011. Methods: Demographic and clinical patient data were collected from questionnaires completed by the participating surgeons. These data were recorded in Excel, analyzed using SPSS and compared with previously reported data. Results: Questionnaires were completed for 36,384 patients by 389 African surgeons. The distribution of clefts was: 34.44% clefts of the lip (CL), 58.87% clefts of the lip and palate (CLP), and 6.69% clefts of the palate only (CP). The male to female ratio was 1.46:1, and the unilateral: bilateral ratio 2.93:1, with left-sided predominance 1.69:1. Associated anomalies were found in 4.18% of patients. The most frequent surgeries included primary lip/nose repairs, unilateral (68.36%) and bilateral (11.84%). There was seasonal variation in the frequency of oral cleft births with the highest in January and lowest by December. The average age at surgery was 9.34 years and increased in countries with lower gross domestic products. The average hospital stay was 4.5 days. The reported complication rate was 1.92%. Conclusions: With the exception of cleft palates, results follow trends of worldwide epidemiologic reports of 25% CL, 50% CLP, and 25% CP, 2:1 unilateral:bilateral and left:right ratios, and male predominance. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting that limitations in economic resources and cultural aesthetics of the obvious lip deformity may outweigh functional concerns and access to treatment for females. A fewer than expected associated anomalies suggests either true ethnic variation, or that more severely-affected patients are not presenting for treatment. The epidemiology of orofacial clefting in Africa has been difficult to assess due to the diversity of the continent and the considerable variation among study designs. The large sample size of the data collected provides a basis for further study of the epidemiology of orofacial clefting in Africa. Cleft; Lip; Palate; Epidemiology; Africa - Background Limited access to reconstructive surgery in developing countries has led to the involvement of international organizations that provide surgical correction for patients with orofacial clefts. Based in New York City, the Smile Train organization offers training and financial support for physicians and institutions to provide surgical procedures for patients with clefts of the lip and/or palate. Its goal is to enhance care by local physicians and build infrastructure in developing countries rather than conduct missions. In 15 years of operation, the Smile Train organization enabled repair of over 1,000,000 clefts in 87 countries, and many of these repairs have been in the African continent [1]. Orofacial clefting is associated with elevated infant mortality and significant morbidity in many developing nations where barriers to ensuring multidisciplinary treatment still remain. A cleft of the palate is associated with feeding difficulties in infancy, chronic otitis media due to eustachian tube dysfunction, midface hypoplasia, hypernasality of speech and difficulties with articulation and language development. The possible sequelae of undetected hearing loss can be socially isolating and compound challenges with communication. Another problem of clefts of the lip (CL) is the physical deformity and the associated social and psychiatric morbidity [2,3]. The stigma of an u (...truncated)


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Julia C Conway, Peter J Taub, Rochelle Kling, Kurun Oberoi, John Doucette, Ethylin Jabs. Ten-year experience of more than 35,000 orofacial clefts in Africa, BMC Pediatrics, 2015, pp. 8, 15, DOI: 10.1186/s12887-015-0328-5