Nationwide Spatial Analysis of Orofacial Cleft Prevalence in Ecuador: Geographic Variations and Clustering Across the Andean Region

Abstract

Objective

To determine the estimated birth prevalence of orofacial clefts in Ecuador, describe the demographic characteristics of these children, evaluate temporal trends, assess regional and provincial disparities, and perform spatial analyses to identify geographic clusters.

Design

Cross-sectional study.

Setting

Ecuador; national hospital discharge and live birth registries maintained by the National Institute of Statistics and Census, 2018-2024.

Patients, participants

Children diagnosed with cleft lip (CL), cleft palate (CP), or cleft lip and palate (CLP) between 2018 and 2024 (ICD-10 codes Q35-Q37).

Interventions

None; observational study.

Main Outcome Measure

The estimated birth prevalence of cleft lip and/or cleft palate (CL/P) was defined as the number of cases per 10,000 live births.

Results

A total of 3970 children were identified with CL/P between 2018 and 2024, corresponding to an estimated birth prevalence of 21.94 per 10,000 live births. The lowest estimated birth prevalence occurred in 2020, and only CP diagnosis demonstrated a significant temporal change, with a decline from 2018 to 2020 followed by an increase from 2020 to 2024. The Highlands region exhibited the highest estimated birth prevalence. Provincial estimated birth prevalence ranged from 11.04 to 43.56 per 10,000, with Carchi and Napo showing the highest burdens. Flexible and circular spatial scan statistics consistently identified high-risk clusters concentrated in the central and northern Highlands, confirming robust geographic clustering.

Conclusion

Orofacial clefts in Ecuador demonstrate one of the highest estimated births prevalences reported worldwide, with substantial regional and provincial variation. High-prevalence clusters were concentrated in the Highlands.