To identify practices and limitations of cleft care in sub-Saharan Africa (SSA).
Design
A retrospective narrative nonsystematic literature review was performed.
Setting
Literature exploring the management practices of cleft lip and/or palate across regions in SSA was included.
Participants
Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles written and published in English between 1966 and February 1, 2021, were included in this analysis utilizing PubMed, MEDLINE, EMBASE, and Google scholar databases.
Main Outcome Measures
Qualitative themes identified in analysis were clinical practice patterns, current infrastructure and limitations of cleft repair, training and interdisciplinary teams, economic analyses, and international partnerships.
Results
Significant barriers to care identified in SSA include lack of hospital resources, craniofacial training, access to multidisciplinary specialists, and public awareness. These problems make the entire care journey difficult for patients. Increasing public education has the power to diminish late presentations to hospitals. Providing adequate hospital resources and craniofacial training through international and organizational partnerships can ensure that more patients will receive care. Increasing the availability and number of multidisciplinary specialists is crucial to follow up care which aims at improving functional outcomes.
Conclusion
This narrative review highlights current practices and limitations in cleft care, emphasizing the importance of effective and timely repair of clefts in SSA. Targeted efforts aimed at establishing sustainable infrastructure for cleft care in SSA can have significant individual and community health and economic benefits.
AcheampongAOAddisonWObiri-YeboahSAmuasiAGowansLJJNewman-NarteyMSabbahDKParePSelormeyRBaffourG,et al.The rule of 10’s in the management of unilateral cleft Lip children: the Komfo Anokye teaching hospital experience. J Clin Res Dentistry. 2019;2(1):1-6.
2.
AdebolaRABamgboseBOAdeoyeJB. Community mobilization and awareness creation for orofacial cleft services: a survey of Nigerian cleft service providers. Int Sch Res Notices. 2014;2014:140713.
3.
AdetayoOFordRMartinM. Africa has unique and urgent barriers to cleft care: lessons from practitioners at the Pan-African congress on cleft Lip and palate. Pan Afr Med J. 2012;12:15.
4.
AdeyemoWLOgunleweMODesaluILadeindeALMofikoyaBOAdeyemiMOAdepojuAAHassanOO. Cleft deformities in adults and children aged over six years in Nigeria: reasons for late presentation and management challenges. Clin Cosmet Investig Dent. 2009;1:63-69.
5.
AkadiriOAAmirizeEEOnahII. Challenges to optimal care for orofacial cleft patients in Sub-Saharan Africa - The example of Two Nigerian tertiary hospital. Biomed J Sci &Tech Res. 2018;3(4). BJSTR.MS.ID.000926.
6.
AkinmoladunVAdemolaSOlusanyaA. Management of cleft lip and palate in Nigeria: a survey. Niger J Clin Pract. 2017;20(11):1355-1359.
7.
AkinmoladunVIObimakindeOSOkojeVN. Team approach to management of oro-facial cleft among African practitioners: a survey. Niger J Clin Pract. 2013;16(1):86-90.
8.
AssociationA-C. Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences. Cleft Palate-Craniofacial J. 2018;55(1):137-156.
9.
BelloSABalogunSAOketadeIIghileNUdohNEnebongD. Cleft and facial deformity foundation (CFDF) outreach model: 6 year experience of an indigenous Nigerian mission in the surgical correction of facial clefts. Pan African Medical Journal. 2018;29:109.
10.
BentounsiZLavyCPittalisCClarkeMRizkJLeGBrughaRBorgsteinEGajewskiJ. Which surgical operations should be performed in district hospitals in east, central and Southern Africa? Results of a survey of regional clinicians. World J Surg. 2021;45(2):369-377.
11.
CamilleAEvelyneA-KMartialAEDeniseKMarie-JoséeT-AEmmanuelK. Advantages of early management of facial clefts in Africa. Int J Pediatr Otorhinolaryngol. 2014;78(3):504-506.
12.
CarlsonLCStewartBTHatcherKWKabetuCVanderBurgRMageeWP. A model of the unmet need for cleft Lip and palate surgery in Low- and middle-income countries. World J Surg. 2016;40(12):2857-2867.
13.
ChowIPurnellCAHanwrightPJGosainAK. Evaluating the rule of 10 s in cleft lip repair: does data support dogma?Plast Reconstr Surg. 2016;138(3):670-679.
14.
ChungKYSorouriKWangLSuryavanshiTFisherD. The impact of social stigma for children with cleft Lip and/or palate in Low-resource areas: a systematic review. Plast Reconstr Surg Glob Open. 2019;7(10):e2487.
15.
ConwayJCTaubPJKlingROberoiKDoucetteJJabsEW. Ten-year experience of more than 35,000 orofacial clefts in Africa. BMC Pediatr. 2015;15:8.
16.
CorlewDSAlkireBCPoenaruDMearaJGShrimeMG. Economic valuation of the impact of a large surgical charity using the value of lost welfare approach. BMJ Glob Health. 2016;1(4):e000059.
17.
EfunkoyaAAOmejeKUAmoleIOOsundeODAkpasaIO. A review of cleft lip and palate management: experience of a Nigerian teaching hospital. Afr J Paediatr Surg. 2015;12(4):257-260.
18.
EkenzeSOJac-OkerekeCANwankwoEP. Funding paediatric surgery procedures in sub-Saharan Africa. Malawi Med J. 2019;31(3):233-240.
FreitasDMMunthaliJMusowoyaJIsmailHHerbstAChikoyaLDhageSHopkinsMA. Surgical registrars’ perceptions of surgical training and capacity in Zambia: results from three COSECSA affiliated training hospitals. Am J Surg. 2018;215(4):744-751.
21.
HamzeHMengisteACarterJ. The impact and cost-effectiveness of the amref health Africa-smile train cleft Lip and palate surgical repair programme in eastern and Central Africa. Pan Afr Med J. 2017;28:35.
22.
HutchABekeleAO’FlynnE, Ndonga A, Tierney S, Fualal J, Samkange C, Erzingatsian K. The brain drain myth: retention of specialist surgical graduates in east, central and Southern Africa, 1974-2013. World J Surg. 2017;41(12):3046-3053.
23.
KatusabeJLHodgesAGaliwangoGWMulogoEM. Challenges to achieving low palatal fistula rates following primary cleft palate repair: experience of an institution in Uganda. BMC Res Notes. 2018;11(1):358.
24.
MadareeA. Two-Stage repair of bilateral cleft Lip: indications for this treatment strategy. J Craniofac Surg. 2020;31(8):2222-2225.
25.
MartiniukALCManouchehrianMNeginJAZwiAB. Brain gains: a literature review of medical missions to low and middle-income countries. BMC Health Serv Res. 2012;12:134.
26.
MassenburgBBJennyHESalujaSMearaJGShrimeMGAlonsoN. Barriers to cleft lip and palate repair around the world. J Craniofac Surg. 2016;27(7):1741-1745.
27.
Mbuyi-MusanzayiSTshilombo KatombeFLukusa TshiloboPKalenga Mwenze KayambaPDevriendtKReychlerH. Anthropometric and aesthetic outcomes for the nasolabial region in 101 consecutive African children with unilateral cleft lip one year after repair using the anatomical subunit approximation technique. Int J Oral Maxillofac Surg. 2017;46(10):1338-1345.
28.
McCulloughMBradshawAGetachewDEshetuYRaghuramAStoneburnerJArianiRMageeWPHallPN. A traveling fellowship to build surgical capacity in Ethiopia. Int J Surg: Global Health. 2020;3(2):e17.
29.
McCulloughMCampbellASiuADurnwaldLKumarSMageeWPSwansonJ. Competency-Based education in Low resource settings: development of a novel surgical training program. World J Surg. 2018;42(3):646-651.
30.
MillardDRJr. The optimum time for cleft lip surgery. In: Cleft Craft. Philadelphia, PA: Lippincott Williams and Wilkins; 1976:69-74.
31.
OginniFOAdeyemoWL. Cleft palate treatment in developing countries of Africa. In: BerkowitzS, ed. Cleft Lip and Palate. Berlin, Heidelberg: Springer Berlin Heidelberg; 2013:855-870.
32.
PanamontaVPradubwongSPanamontaMChowchuenB. Global birth prevalence of orofacial clefts: a systematic review. J Med Assoc Thai. 2015;98(Suppl 7):S11-S21.
33.
PhamAMTollefsonTT. Cleft deformities in Zimbabwe, Africa: socioeconomic factors, epidemiology, and surgical reconstruction. Arch Facial Plast Surg. 2007;9(6):385-391.
34.
PoenaruD. Getting the job done: analysis of the impact and effectiveness of the SmileTrain program in alleviating the global burden of cleft disease. World J Surg. 2013;37(7):1562-1570.
35.
ShayeDAMuchemwaFCGongaATollefsonTT. Blast SMS text messaging to facilitate enrollment for cleft lip and palate surgery in Zimbabwe. JAMA Facial Plast Surg. 2018;20(3):254-256.
36.
TindlundRSHolmefjordAErikssonJCHJohnsonGEVindenesH. Interdisciplinary evaluation of consecutive patients with unilateral cleft lip and palate at age 6, 15, and 25 years: a concurrent standardized procedure and documentation by plastic surgeon; speech and language pathologist; ear, nose, and throat specialist; and orthodontist. J Craniofacial Surg. 2009;20(8):1687-1698.
37.
VenkateshR. Syndromes and anomalies associated with cleft. Indian J Plast Surg. 2009;42(S 01):S51-S55.
38.
WilhelmsenHRMusgraveRH. Complications of cleft lip surgery. Cleft Palate J. 1966;3:223-231.
39.
YoungWGWorshamMJJosephCLMDivineGWJonesLRD. Incidence of keloid and risk factors following head and neck surgery. JAMA Facial Plast Surg. 2014;16(5):379-380.
40.
ZbarRISRaiSMDingmanDL. Establishing cleft malformation surgery in developing nations: a model for the New millennium. Plast Reconstr Surg. 2000;106(4):886-889.
