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Becker de Oliveira L, Fonseca-Souza G, Rolim TZC, Scariot R, Feltrin-Souza J. Breastfeeding and Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2024; 61:1344-1355. [PMID: 37078146 DOI: 10.1177/10556656231170137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To evaluate the association between cleft lip and/or cleft palate (CL/P) and breastfeeding (BF). DESIGN A systematic review and meta-analysis were performed based on studies published in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, BBO, and Embase databases, and in the gray literature. The search occurred in September 2021 and was updated in March 2022. Observational studies evaluating the association between BF and CL/P were included. Risk of bias was analyzed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted. Certainty of evidence was evaluated using the GRADE approach. MAIN OUTCOME MEASURE(S) Frequency of BF in relation to the presence or absence of CL/P, as well as to the type of CL/P. The association between cleft type and BF challenges was also evaluated. RESULTS From a total of 6863 studies identified, 29 were included in the qualitative review. Risk of bias was moderate and high in most studies (n = 26). There was a significant association between the presence of CL/P and absence of BF (OR = 18.08; 95% CI 7.09-46.09). Individuals with cleft palate with or without cleft lip (CP ± L) had a significantly lower frequency of BF (OR = 5.93; 95% CI 4.30-8.16) and a significantly higher frequency of BF challenges (OR = 13.55; 95% CI 4.91-37.43) compared to individuals with CL. Certainty of the evidence was low or very low in all analyses. CONCLUSION The presence of clefts, especially those with palate involvement, is associated with higher chances of absence of BF.
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Affiliation(s)
- Luiza Becker de Oliveira
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Gabriela Fonseca-Souza
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Tatiane Zahn Cardoso Rolim
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Rafaela Scariot
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Juliana Feltrin-Souza
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
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Rhodes IJ, Zhang A, Arbuiso S, Alston CC, Medina SJ, Liao M, Nthumba J, Chesang P, Hayden G, Rhodes WR, Otterburn DM. Cleft Lip and Palate Surgery at a Rural African Hospital: A 13-Year Experience From Western Kenya. J Craniofac Surg 2024; 35:1471-1474. [PMID: 38830020 DOI: 10.1097/scs.0000000000010341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Most studies on the treatment of cleft lip and palate (CLP) in low-income and middle-income countries have reported on the experience of urban centers or surgical mission trips to rural locations. There is a paucity of literature on the experience of local teams providing orofacial cleft surgery in rural Sub-Saharan Africa. This study reports the efficacy and cost-effectiveness of cleft surgery performed by an all-local team in rural Kenya. METHODS A retrospective chart review was performed on all patients who received CLP repair at Kapsowar Hospital between 2011 and 2023. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. For the most recent year of study (2023), the authors performed a financial audit of all costs related to the performance of unilateral cleft lip surgery. Descriptive statistics were performed. RESULTS The authors identified 381 CLP surgeries performed on 311 patients (197 male, 63.3%). The most common etiology of the cleft was left unilateral (28.3%). The average age of primary lip repair decreased from 46.3 months in 2008 to 2009 to 20.2 months in 2022 to 2023 ( P <0.001). The average age of primary cleft palate repair decreased from 38.0 months in 2008 to 2009 to 25.3 months in 2022 to 2023 ( P <0.001). Patients traveled from 23 districts to receive treatment. Age of treatment was not different when distinguished by sex, county poverty level, or travel time from the hospital. The total costs associated with cleft lip repair was $201.6. CONCLUSIONS Adequately staffed hospitals in rural locations can meaningfully address a regional CLP backlog more cost-effectively than surgical mission trips.
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Affiliation(s)
- Isaiah J Rhodes
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Ashley Zhang
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Sophia Arbuiso
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Chase C Alston
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Samuel J Medina
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Matthew Liao
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | | | | | - Giles Hayden
- Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya
| | | | - David M Otterburn
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
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Rhodes IJ, Alston CC, Zhang A, Arbuiso S, Medina SJ, Liao M, Ng JJ, Romeo D, Dahir S, Rhodes WR, Otterburn DM. The Pattern and Profile of Orofacial Clefts in Somaliland: A Review of 40 Consecutive Cleft Lip and Palate Surgical Camps. J Craniofac Surg 2024; 35:1407-1410. [PMID: 38838366 DOI: 10.1097/scs.0000000000010340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Somaliland is an autonomously run country that is not internationally recognized. As such, it has been largely excluded by global health development programs despite being the world's fourth poorest country. The purpose of this study was to provide the first known description of the pattern and clinical profile of patients with cleft lip and palate from this nation. METHODS The authors performed a retrospective chart review on all patients who received cleft lip and palate repair by a single surgeon in 40 separate surgical camps at Edna Adan University Hospital in Hargeisa, Somaliland, between 2011 and 2024. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. Descriptive statistical analysis was performed. RESULTS A total of 767 patients (495 male, 64.5%) received 787 surgical procedures. The average age of primary surgery was 73.7 months. The most common chief complaint was left cleft lip with cleft palate (316, 41.2%). Males received primary surgery 19.2 months later than did females (73.7 and 54.6 mo, respectively, P <0.001). Patients residing in Hargeisa received their initial procedure an average of 17.8 months younger than those who lived elsewhere in Somaliland (62.9 and 80.7 mo, respectively, P =0.004). CONCLUSIONS In this severely economically depressed region, patients received treatment at ages that lagged far beyond recommended guidelines. Our finding of earlier treatment for females than males is rare in the literature and likely relates to cultural sex expectations. Patients from rural locations were especially vulnerable to receiving delayed treatment. Further efforts to decrease the burden of craniofacial deformities in Somaliland should be pursued in earnest.
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Affiliation(s)
- Isaiah J Rhodes
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Chase C Alston
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Ashley Zhang
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Sophia Arbuiso
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Samuel J Medina
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Matthew Liao
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Jinggang J Ng
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dominic Romeo
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Shugri Dahir
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - William R Rhodes
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - David M Otterburn
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
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Chwa ES, Stoehr JR, Gosain AK. Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data. Cleft Palate Craniofac J 2024; 61:844-853. [PMID: 36594527 DOI: 10.1177/10556656221148901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. DESIGN Multi-institution, retrospective review of Smile Train Express database. SETTING 1110 Smile Train partner hospitals. PATIENTS/PARTICIPANTS 2560 patients. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery. RESULTS The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. CONCLUSIONS Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care.
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Affiliation(s)
- Emily S Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jenna R Stoehr
- Division of Plastic and Reconstructive Surgery, University of South Florida, Tampa, IL, USA
| | - Arun K Gosain
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Ligot FAC, Bautista PEC, Bunyi KMG. A Qualitative Study on the Feeding Methods of Filipino Mothers of Children with Cleft Lip and Palate Aged 0 to 24 Months: A Pilot Study. ACTA MEDICA PHILIPPINA 2024; 58:23-33. [PMID: 38966839 PMCID: PMC11219549 DOI: 10.47895/amp.vi0.6625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Background One of the early problems that children born with cleft lip and palate encounter is difficulty in feeding. This affects the child's nutritional needs and the timing of the surgical intervention. Information on the appropriate feeding methods for children with cleft lip and palate will enable mothers to feed their babies properly and facilitate the implementation of appropriate interventions. Objectives The study described the feeding problems experienced by children with cleft lip and palate (CLP), and cleft palate (CP) ages 0-24 months, the feeding methods most preferred by Filipino mothers, the methods they found most useful, and the mothers' reactions to the feeding issues their children face. Methods The research is a pilot study which used a quantitative, cross-sectional, descriptive mixed method design. Thirty-two (32) mothers of children with cleft lip and palate, and cleft palate answered an 11-item online survey and participated in focused interviews from January to June 2022. Inferential statistics was used specifically frequency distribution to describe the data, and Fishers' Exact Test and Pearson's Chi-Square Test were used to analyze the data quantitatively to determine the significant association between the variables identified. Results Results showed that the feeding problems encountered by the children included nasal regurgitation, sucking, aspiration of liquids, latching on nipples, and swallowing. Mothers preferred to use regular feeding bottles (24.3%), specialized feeding bottles for children with cleft (21.6%), breast feeding and dropper (17.6%), syringe (9.5%), cup (6.8%), and spoon feeding (2.7%) methods. They also mentioned that they found the following feeding methods to be the most useful, regular feeding bottles (32.7%), specialized feeding bottles for cleft (23.1%), breast feeding (11.5%), spoon and dropper feeding (7.7%), and syringe feeding (1.9%). Conclusion The feeding problems experienced by Filipino children with CLP and CP mirror those that have been reported in other studies. The study revealed that mothers still prefer to use the traditional regular feeding bottles in feeding their babies and found this to be the most useful. Maternal reactions of the participants to the cleft condition and its feeding issues are similar to reported studies in other countries. The internet has been the primary source of information on cleft and feeding of the participants in the study.
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Rafisa A, Sarilita E, Delage B, Munger RG, Mossey PA. Situational analysis of nutritional status among 1899 children presenting with cleft lip and/or palate in Indonesia. J Glob Health 2023; 13:04127. [PMID: 37856736 PMCID: PMC10586796 DOI: 10.7189/jogh.13.04127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Background Given the increased risk of malnutrition in children with cleft lip and/or palate (CLP), determining their nutritional status is critical for preventing adverse surgical risks. However, no such disaggregated, national-level data are available in Indonesia. We aimed to determine the nutritional status of patients with clefts in Indonesia and to identify problems and solutions for malnutrition cases within the population. Methods In this cross-sectional study, we considered records of individuals who underwent primary surgery for CLP in Smile Train-sponsored facilities in Indonesia between 1 January 2016 and 31 December 2021 (n = 18 480). We only included children under the age of five with an evaluation date prior to admission date and excluded subjects with invalid data values. We classified their nutritional status by z-scores according to the World Health Organization Child Growth Standard (2006). Malnutrition cases cover four indicators - stunting, wasting, underweight, and overweight. We compared the prevalence for malnutrition cases in children under the age of five using national health survey data. Results We included 1899 records following data validation. The national prevalence of stunting (24.4%), wasting (12.5%), and overweight cases (12.9%) was high, while underweight cases (6.8%) were comparatively low. Statistical analyses showed significant differences in nutritional status based on length/height-for-age between girls and boys aged 0-5 months (P = 0.008) and 48-60 months (P = 0.001), and based on body mass index-for-age (P = 0.000) between girls and boys aged 0-5 months. Girls in different age groups exhibited a statistically significant difference in nutritional status based on length/height-for-age (P = 0.002) and weight-for-age (P = 0.017). Concurrent stunting and overweight were the most common forms of concurrent malnutrition (8.7%). We found a significant difference in the prevalence of underweight (P = 0.001) and overweight (P = 0.000) cases between children with CLP and those without CLP. Conclusions Our findings highlight the importance of nutritional interventions for children with orofacial clefts in Indonesia, and the importance of age and gender in their design and implementation. Further investigation is necessary to explore the risks of overweight and concurrent malnutrition among this population.
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Affiliation(s)
- Anggun Rafisa
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| | - Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| | | | - Ronald G Munger
- Centre for Epidemiologic Studies, Utah State University, Logan, Utah, USA
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, UK
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Gallego Sobrino R, Iglesia-Altaba I, Moral I, Iso I, Delso E, Rodríguez G. Growth trajectories in children with cleft lip and/or palate. NUTR HOSP 2023; 40:717-723. [PMID: 37334810 DOI: 10.20960/nh.04620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Introduction Introduction: the nutritional status and growth of children with cleft lip and/or palate (CL/P) can be affected due to feeding difficulties caused by their anatomy and the surgical interventions. Objective: this retrospective longitudinal study aims to analyse the growth trajectories of a cohort of children with CL/P and compare them with a healthy representative cohort of children from Aragon (Spain). Methods: type of cleft, surgical technique and sequelae, and weight, length/height and body mass index (BMI) (weight/height2) at different ages (0-6 years) were recorded. Normalized age- and sex-specific anthropometric Z-scores values were calculated by World Health Organization (WHO) charts. Results: forty-one patients (21 male, 20 female) were finally included: 9.75 % cleft lip (n = 4/41), 41.46 % cleft palate (n = 17/41) and 48.78 % cleft lip and palate (n = 20/41). The worst nutritional status Z-scores were achieved at the age of three months (44.44 % and 50 % had a weight and a BMI lower than -1 Z-score, respectively). Mean weight and BMI Z-scores were both significantly lower than controls at one, three and six months of age, recovering from that moment until the age of one year. Conclusions: the highest nutritional risk in CL/P patients takes place at 3-6 months of age, but nutritional status and growth trajectories get recovered from one year of age compared to their counterparts. Nevertheless, the rate of thin subjects among CL/P patients is higher during childhood.
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Affiliation(s)
| | - Iris Iglesia-Altaba
- Growth, Exercise, Nutrition and Development (GENUD) Research Group. Instituto Agroalimentario de Aragón (IA2). Universidad de Zaragoza
| | | | - Iván Iso
- Hospital Universitario Miguel Servet Zaragoza
| | - Elena Delso
- Hospital Universitario Miguel Servet Zaragoza
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Farshidfar N, Ajami S, Sahmeddini S, Goli A, Foroutan HR. Epidemiological and Spatiotemporal Descriptive Analysis of Patients with Nonsyndromic Cleft Lip and/or Palate: A 12-Year Retrospective Study in Southern Iran. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7624875. [PMID: 37124932 PMCID: PMC10132907 DOI: 10.1155/2023/7624875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023]
Abstract
Objectives The current study is aimed at evaluating epidemiological characteristics and spatiotemporal distribution of cleft lip and/or palate (CL/P) in the south of Iran. Methods Data were extracted from the 1840 medical records of patients who were referred to the Cleft Lip and Palate Center of Shiraz University of Medical Sciences, from January 1, 2011, to September 1, 2022. The collected variables included demographic data (gender, birth date and season, place, birth order, and weight), cleft types and the subtypes, parental information (health status, education level, marital status, and age during the pregnancy), and other basic parameters. The chi-square test at a significance level of 0.05 was used to analyze collected data. The geographic information system (GIS) analysis was also used for analyzing the spatial distribution of CL/P patients. Results Based on our inclusion criteria, 1281 nonsyndromic patients were included in this study. The most common type was cleft lip and palate (CLP) with 48.32%, whereas cleft palate (CP) and cleft lip (CL) accounted for 40.75% and 10.93% of the patients, respectively. There was a progressive increase in the frequency of all types of clefts, and most of them were male (P ≤ 0.001). The urban population outnumbered the rural ones in all provinces. Parents were mostly healthy (>80%) with low educational status (47.5%). Most born CL/P patients were from consanguineous marriages (58.9%), especially between first-degree relatives. A majority of CL/P patients (73.1%) were born in the first two gestations with a birth weight of 2500-4000 g (77.4%). Most infants with CL/P (84.3%) were born from mothers who had at least one of the predisposing factors. Conclusion In this study, the frequency of cleft types and subtypes was similar to the existing literature. However, high rate of consanguineous marriage, especially between first-degree relatives, was the most notable feature of this population.
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Affiliation(s)
- Nima Farshidfar
- Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shabnam Ajami
- Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sarina Sahmeddini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Goli
- Department of Sociology & Social Planning, Shiraz University, Shiraz, Iran
| | - Hamid Reza Foroutan
- Department of Surgery, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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The effect of short-term preoperative nutritional intervention for cleft surgery eligibility. BMC Nutr 2023; 9:47. [PMID: 36918940 PMCID: PMC10012294 DOI: 10.1186/s40795-023-00704-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Children with orofacial clefts are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to receive safe surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for malnutrition; however, the effectiveness has not been demonstrated in this patient population prior to surgery. We studied the effectiveness of short-term RUTF use in transitioning children with malnutrition, who were initially ineligible for surgery, into surgical candidates. METHODS A cohort of patients from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela enrolled in a nutrition program were followed by Operation Smile from June 2017 to January 2020. Age, weight, and length/height were tracked at each visit. Patients were included until they were sufficiently nourished (Z > = -1) with a secondary outcome of receiving surgery. The study was part of a collaborative program between Operation Smile (NGO), Birdsong Peanuts (peanut shellers and distributors), and MANA Nutrition (RUTF producer). RESULTS A total of 556 patients were recruited between June 2017 and January 2020. At baseline 28.2% (n = 157) of patients were diagnosed with severe, 21.0% (n = 117) moderate, and 50.7% (n = 282) mild malnutrition. 324 (58.3%) presented for at least one return visit. Of those, 207 (63.7%) reached optimal nutrition status. By visit two, the mean z-score increased from -2.5 (moderate) to -1.7 (mild) (p < 0·001). The mean time to attain optimal nutrition was 6 weeks. There was a significant difference in the proportion of patients who improved by country(p < 0.001). CONCLUSION Malnutrition prevents many children with orofacial clefts in low- and middle-income countries from receiving surgical care even when provided for free. This creates an even larger disparity in access to surgery. In an average of 6 weeks with an approximate cost of $25 USD per patient, RUTF transitioned over 60% of patients into nutritionally eligible surgical candidates, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, the expansion of cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired orofacial clefts receive timely and safe surgical care.
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Bettens K, Alighieri C, Bruneel L, D'haeseleer E, Luyten A, Sseremba D, Musasizib D, Ojok I, Hodges A, Galiwango G, Vermeersch H, Van Lierde K. Better speech outcomes after very early palatal repair?-A longitudinal case-control study in Ugandan children with cleft palate. JOURNAL OF COMMUNICATION DISORDERS 2022; 96:106198. [PMID: 35217335 DOI: 10.1016/j.jcomdis.2022.106198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/11/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Children born with cleft palate with or without cleft lip (CP±L) tend to use less oral pressure consonants and more glottal sounds in their babbling. The purpose of very early palatal repair (i.e., one-stage palatal closure prior to 6 months of age) is to make the palate functional before the onset of speech acquisition to reduce the anchoring of wrong patterns in the child's developing phonological system. As a result, less compensatory articulation errors are expected to be present. Currently, no detailed longitudinal speech outcomes after very early palatal closure are available. This study aimed to provide longitudinal speech outcomes in Ugandan children with CP±L who received palatal closure prior to the age of 6 months. METHODS Ten children with CP±L were assessed at a mean age of 5 and 10 years old. Speech understandability, speech acceptability, resonance, nasal airflow and articulation were perceptually rated by two experienced speech-language pathologists. Velopharyngeal function was estimated using the velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary (speech) surgery was collected. The outcomes were compared with the longitudinal outcomes of an age- and gender-matched control group of 10 Ugandan children without CP±L. RESULTS Speech understandability and acceptability improved significantly over time in the group with CP±L (all p's ≤ 0.05, all Z's > -2.43). At both test dates, significantly worse judgments were found for the group with CP±L compared to the control group for these variables and variables related to passive speech errors (all p's ≤ 0.05, all Z's > 2.49). A statistically significant difference with the control group was found for the presence of compensatory articulation errors at the age of 5 years but not at the age of 10 years, indicating a catch up by the children with CP±L. CONCLUSION Whether a one-stage palatal closure prior to the age of 6 months is more favorable for speech outcomes compared to one-stage palatal closure at 12 months is still not clear. Speech of the children with CP±L improved over time, but significantly differed from the control group at the age of 5 and 10 years old. Limited access to health care facilities and possible influence of malnutrition on wound healing need to be considered when interpreting the results. Whether palatal closure prior to the age of 6 months is transferable to other countries is subject for further research, including both longitudinal and prospective designs with larger samples.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium.
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Anke Luyten
- Speech Pathology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Daniel Sseremba
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Duncan Musasizib
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Isaac Ojok
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Andrew Hodges
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Hubert Vermeersch
- Department of Head and Skin, Ghent University, Ghent, Belgium; Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South-Africa
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Delage B, Stieber E, Sheeran P. Prevalence of malnutrition among children at primary cleft surgery: A cross-sectional analysis of a global database. J Glob Health 2022; 12:04012. [PMID: 35265326 PMCID: PMC8874895 DOI: 10.7189/jogh.12.04012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Orofacial clefts are common birth defects, affecting one newborn in every 700 live births globally. The condition requires prompt identification, feeding support, and timely surgery. While orofacial clefts benefit from a comprehensive, life-long care management in high-income countries, care provision is often lacking or inadequate in poor-resource settings. Data on the burden of orofacial clefts in children born in limited-resource settings remain scarce. The objective of this study was to estimate the prevalence of malnutrition in children using cleft surgery records collected by one large non-governmental cleft organization in low- and middle-income countries (LMICs). Methods The data set included clinical records of children ≤5 years who underwent primary cleft surgery between 2008 and 2018 in health care facilities across LMICs. Patients’ data included birth date, sex, weight at surgery, ethnicity, country of origin, and date of primary surgery and were analysed using descriptive statistics. The prevalence of malnutrition was estimated using weight-for-age z scores and the distribution described in relation to cleft type, sex, ethnic groups, and geography. Comparisons with prevalence estimates for underweight in children under-5 within countries were conducted using publicly available survey data. Results The analysis included 602 568 children. The prevalence of underweight in children with cleft varies with the epidemiology of cleft and the timing of primary surgery, and between ethnic groups and settings. The overall prevalence of underweight at the time of primary cleft surgery was 28.6% – a figure well above the global underweight prevalence in children under-5 without cleft estimated at 13.5%. We found a positive correlation between the prevalence of underweight among children with cleft and the prevalence of underweight in the DHS program (rs = 0.6305; P < 0.0001). Within-country comparisons showed that, with only few exceptions, the prevalence of underweight was higher in children with clefts than in their peers born without clefts (P < 0.05). Conclusions Although orofacial cleft is not considered to be a life-threatening condition, our findings show a high burden of malnutrition among patients accessing surgeries in LMICs. Interventions prompting early identification and appropriate feeding management of this group of vulnerable children is essential to leave no one behind in the fight against malnutrition.
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Affiliation(s)
- Barbara Delage
- London School of Hygiene and Tropical Medicine, London, UK
- Smile Train, New York City, New York, USA
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12
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Swanson MA, Auslander A, Morales T, Jedrzejewski B, Magee WP, Siu A, Ayala R, Swanson JW. Predictors of Complication Following Cleft Lip and Palate Surgery in a Low-Resource Setting: A Prospective Outcomes Study in Nicaragua. Cleft Palate Craniofac J 2021; 59:1452-1460. [PMID: 34658290 DOI: 10.1177/10556656211046810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Higher rates of postoperative complication following cleft lip or palate repair have been documented in low resource settings, but their causes remain unclear. This study sought to delineate patient, surgeon, and care environment factors in cleft complications in a low-income country. DESIGN Prospective outcomes study. SETTING Comprehensive Cleft Care Center. PATIENTS Candidate patients presenting for cleft lip or palate repair or revision. INTERVENTIONS Patient anthropometric, nutritional, environmental and peri- and post-operative care factors were collected. Post-operative evaluation occurred at standard 1-week and 2-month postoperative intervals. MAIN OUTCOME MEASURES Complication was defined as fistula, dehiscence and/or infection. RESULTS Among 408 patients enrolled, 380 (93%) underwent surgery, of which 208 (55%) underwent lip repair (124) or revision (84), and 178 (47%) underwent palate repair (96) or revision (82). 322 (85%) were evaluated 1 week and 166 (44%) 2 months postoperatively. 50(16%) complications were identified, including: 25(8%) fistulas, 24(7%) dehiscences, 17(5%) infections. Mid-upper arm circumference (MUAC) ≤12.5 cm was associated with dehiscence after primary lip repair (OR = 28, p = 0.02). Leukocytosis ≥11,500 on pre-operative evaluation was associated with dehiscence (OR = 2.51, p = 0.04) or palate revision fistula (OR = 64, p < 0.001). Surgeons who performed fewer previous-year palate repairs had higher likelihood of palate complications, (OR = 3.03, p = 0.01) although there was no difference in complication rate with years of surgeon experience or duration of surgery. CONCLUSIONS Multiple patient, surgeon, and perioperative factors are associated with higher rates of complication in a low-resource setting, and are potentially modifiable to reduce complications following cleft surgery.
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Affiliation(s)
- Marco A Swanson
- School of Medicine, 24575Case Western Reserve University, Cleveland, OH.,20313Operation Smile International, Virginia Beach, VA
| | - Allyn Auslander
- Institute for Global Health, 5116University of Southern California, Los Angeles, CA
| | | | | | - William P Magee
- Institute for Global Health, 5116University of Southern California, Los Angeles, CA.,5150Children's Hospital Los Angeles, Los Angeles, CA
| | - Armando Siu
- 2569Operación Sonrisa Nicaragua, Managua, Nicaragua
| | - Ruben Ayala
- 20313Operation Smile International, Virginia Beach, VA
| | - Jordan W Swanson
- 5150Children's Hospital Los Angeles, Los Angeles, CA.,20313Operation Smile International, Virginia Beach, VA.,Perelman School of Medicine, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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13
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Namchaitaharn S, Pimpiwan N, Saengnipanthkul S. Breastfeeding Promotion and Nursing Care for Infants with Cleft Palate and/or Cleft Lip in Northeastern Craniofacial Center, Thailand. Open Nurs J 2021. [DOI: 10.2174/1874434602115010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process.
Objective:
To evaluate the treatment and breastfeeding rate in infants with CP and CLP.
Methods:
A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected.
Results:
A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively.
Conclusion:
Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.
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González Jara M, Norambuena Norambuena S, Inostroza Allende F, Lennon Zaninovic L, Quezada Gaponov C, Cornejo Farías J. Caracterización de la alimentación en bebés chilenos con fisura de paladar entre 0 y 6 meses. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2021. [DOI: 10.5209/rlog.72154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Los bebés con fisura de paladar manifiestan problemas en las dinámicas de succión, debido a la comunicación entre la cavidad nasal y oral. El objetivo del estudio fue caracterizar y comparar antecedentes generales y de alimentación en bebés de entre 0 y 6 meses portadores de fisura post-foramen (FPF) y trans-foramen (FTF). Se revisaron registros de atenciones de 36 bebés portadores de FPF y FTF de un hospital público de Chile. Se compararon los datos obtenidos entre los tipos de fisura FPF y FTF usando el software estadístico R. Los días de alimentación por lactancia materna directa fueron en promedio 13.5 días en bebés con FPF y 16.6 días en bebés con FTF. Se constató desnutrición en el 72.7% de los bebés con FPF y 40% de los bebés con FTF. La fórmula láctea y el uso de biberón se presentó más del 96% de los participantes. La extracción de leche materna alcanzó los 25.2 días en FPF y 48.1 días en FTF. La indicación de métodos de extracción de leche materna, tipo de fórmula y tipo de utensilio para la alimentación fue entregada en su mayoría por un profesional. Se observó que el tiempo de lactancia materna directa fue inferior a otros centros nacionales e internacionales. En tanto, el utensilio más usado fue el biberón y las indicaciones para alimentar fueron otorgadas mayormente por profesionales. Se concluye que no existen diferencias significativas al comparar la alimentación entre ambos tipos de fisura.
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Auslander A, McKean-Cowdin R, Feigelson D, Brindopke F, DiBona M, Magee K, Arakaki L, Kapoor R, Ly S, Conti DV, Rakotoarison S, Mahmoudi F, McGregor A, Giron M, Hernandez AR, Nguyen THD, Mwepu A, Sanchez-Lara PA, Magee W. The International Family Study of Nonsyndromic Orofacial Clefts: Design and Methods. Cleft Palate Craniofac J 2021; 59:S37-S47. [PMID: 34056937 DOI: 10.1177/10556656211018956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The majority of research to understand the risk factors of nonsyndromic orofacial clefts (NSOFCs) has been conducted in high-income populations. Although patients with NSOFCs in low- and middle-income countries (LMICs) are at the highest risk of not receiving care, global health infrastructure allows innovative partnerships to explore the etiologic mechanisms of cleft and targets for prevention unique to these populations. METHODS The International Family Study (IFS) is an ongoing case-control study with supplemental parental trio data designed to examine genetic, environmental, lifestyle, and sociodemographic risk factors for NSOFCs in 8 LMICs (through August 2020). Interview and biological samples are collected for each family. The interview includes demographics, family history of cleft, diet and water sources, maternal pregnancy history, and other lifestyle and environmental factors. RESULTS Seven of 8 countries are currently summarized (2012-2017) for a total of 2955 case and 2774 control families with 11 946 unique biological samples from Vietnam, Philippines, Honduras, Madagascar, Morocco, Democratic Republic of the Congo, and Nicaragua. The phenotype distribution was 1641 (55.5%) cases with cleft lip and palate, 782 (26.5%) with cleft lip (CL), and 432 (14.6%) with cleft palate (CP). DISCUSSION The International Family Study is the largest case set of NSOFCs with an associated biobank in LMICs currently assembled. The biobank, family, and case-control study now include samples from 8 LMICs where local health care infrastructure cannot address the surgical burden of cleft or investigate causal mechanisms. The International Family Study can be a source of information and may collaborate with local public health institutions regarding education and interventions to potentially prevent NSOFCs.
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Affiliation(s)
- Allyn Auslander
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA.,Children's Hospital Los Angeles, CA, USA.,Operation Smile, Inc, Virginia Beach, VA, USA
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Eye Institute, CA, USA
| | - Devin Feigelson
- Children's Hospital Los Angeles, CA, USA.,Operation Smile, Inc, Virginia Beach, VA, USA
| | | | | | - Kathy Magee
- Operation Smile, Inc, Virginia Beach, VA, USA
| | | | - Rijuta Kapoor
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA
| | - Stephanie Ly
- Department of Public Health, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA
| | | | | | | | | | | | | | - Anselme Mwepu
- University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pedro A Sanchez-Lara
- Operation Smile, Inc, Virginia Beach, VA, USA.,Department of Pediatrics, Cedars-Sinai Medical Center & David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - William Magee
- Children's Hospital Los Angeles, CA, USA.,Operation Smile, Inc, Virginia Beach, VA, USA
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16
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Nabatanzi M, Seruwagi GK, Tushemerirwe FB, Atuyambe L, Lubogo D. "Mine did not breastfeed", mothers' experiences in breastfeeding children aged 0 to 24 months with oral clefts in Uganda. BMC Pregnancy Childbirth 2021; 21:100. [PMID: 33516176 PMCID: PMC7847043 DOI: 10.1186/s12884-021-03581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Appropriate breastfeeding is vital for infant and young child nutrition. Annually, oral clefts affect 0.73 per 1000 children in Uganda. Despite this low incidence, children with a cleft face breastfeeding difficulty which affect their nutrition status. In addition, knowledge on maternal experiences with breastfeeding and support is limited. We explored maternal perceptions, experiences with breastfeeding and support received for their children 0 to 24 months with a cleft attending Comprehensive Rehabilitative Services of Uganda (CoRSU) Hospital. METHODS This cross-sectional study combined quantitative and qualitative methods. We consecutively recruited 32 mothers of children with a cleft aged 0 to 24 months attending CoRSU hospital between April and May 2018. A structured questionnaire collected data on breastfeeding practices and device use (n = 32). To gain a broad understanding of mothers' perceptions and experiences with breastfeeding and support received, we conducted two Focus Group Discussions (in each, n = 5), and 15 In Depth Interviews. Descriptive statistics were analyzed using SPSS software. Qualitative data were analyzed thematically. RESULTS Of the 32 children with a cleft, 23(72%) had ever breastfed, 14(44%) were currently breastfeeding, and among those under 6 months, 7(35%) exclusively breastfed. Of 25 mothers interviewed in IDIs and FGDs, 17(68%; IDIs = 8/15, FGD1 = 5/5 and FGD2 = 4/5) reported the child's failure to latch and suckle as barriers to breastfeeding. All ten mothers who used the soft squeezable bottle reported improved feeding. Nineteen (76%) mothers experienced anxiety and 14(56%), social stigma. Family members, communities and hospitals supported mothers with feeding guidance, money, child's feeds and psycho-social counselling. Appropriate feeding and psycho-social support were only available at a specialized hospital which delayed access. CONCLUSIONS Breastfeeding practices were sub-optimal. Mothers experienced breastfeeding difficulties, anxiety and social stigma. Although delayed, feeding, social and psycho-social support helped mothers cope. Routine health care for mothers and their children with a cleft should include timely support.
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Affiliation(s)
- Maureen Nabatanzi
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - Gloria Kimuli Seruwagi
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - Florence Basiimwa Tushemerirwe
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - Lynn Atuyambe
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - David Lubogo
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
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Long-term growth patterns in children born with cleft lip and/or palate. A systematic review. NUTR HOSP 2021; 38:410-417. [PMID: 33624504 DOI: 10.20960/nh.03426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: in children with cleft lip and/or palate nutritional status and growth may be impaired due to early life feeding difficulties. Objective: to review the existing literature on the nutritional prognosis during childhood of patients undergoing surgery for cleft lip and/or palate (CLP), their body composition and growth patterns from 2 to 10 years of age, and the possible effects of their early nutritional status on the long-term onset of overweight. Methods: a systematic search of growth and body composition parameters in 2-10 year-old CLP children, including cross-sectional and longitudinal studies, and using the Pubmed and Scopus databases. From the 2,983 retrieved articles, 6 were finally included. Results: two studies out of 6 were longitudinal and the other 4 were cross-sectional, including very heterogeneous samples. Weight and height were used as growth parameters in 2 studies; 2 studies used body mass index (BMI); and the remaining 2 used indexes of nutritional status derived from anthropometric measures. The studies showed discrepancies among results: 3 of them found growth differences between children with CLP and their counterparts, whereas the other 3 did not. The two longitudinal studies did not show any significant differences between the mean BMI z-scores or growth curves of cleft patients and their counterparts. When differences existed, the most affected group was that under 5 years, syndromic children, and adopted children with CL/P. Conclusions: the literature is scarce comparing growth patterns between children with CLP and controls, and results cannot confirm that children with CLP aged 2-10 years, excluding those with syndromes or belonging to vulnerable populations, have different growth patterns or a worse nutritional status than their counterparts.
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18
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Murthy PS, Deshmukh S, Murthy S. Assisted breastfeeding technique to improve knowledge, attitude, and practices of mothers with cleft lip- and palate-affected infants: A randomized trial. SPECIAL CARE IN DENTISTRY 2020; 40:273-279. [PMID: 32388857 DOI: 10.1111/scd.12464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cleft lip and palate is one of the most common developmental anomalies affecting the craniofacial region leading to an array of problems including the inability to feed properly. OBJECTIVES This study aimed to compare the effectiveness of specially designed audio-visual module over traditional instructional module in improving the assisted breastfeeding habits. METHODOLOGY Sixteen patients received training regarding the feeding practices through the traditional instructional method, and 16 subjects received training through audio-visual module. Infants in both the groups received the standard care. These infants were followed up longitudinally for 6 months. During the follow up period, the growth parameters were recorded monthly. The knowledge, attitude, and practices of the mothers regarding feeding practices were assessed using KAP questionnaire. RESULTS There was significant improvement in the knowledge of the mothers from baseline to 6 months, however, the practices indicated that the mothers belonging to the audio-visual module group showed better understating of the condition and earlier adaptation of the breastfeeding practices. Correspondingly, the growth parameters also showed significant difference. CONCLUSION The custom-made audio-visual module would help the mothers adapt better to the stressful situation following the birth of the infant affected with cleft lip and palate.
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Affiliation(s)
- Prashanth Sadashiva Murthy
- Department of Pediatric and Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Seema Deshmukh
- Department of Pediatric and Preventive Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Srinivasa Murthy
- Department of Pediatrics, JSS Hospital, JSS Academy of Higher Education & Research, Mysuru, India
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Diniz CM, Lopes MVDO, Nunes MM, Menezes APD, Silva VMD, Leal LP. A Content Analysis of Clinical Indicators and Etiological Factors of Ineffective Infant Feeding Patterns. J Pediatr Nurs 2020; 52:e70-e76. [PMID: 32008831 DOI: 10.1016/j.pedn.2020.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To analyze the content of the concepts present in the nursing diagnosis of Ineffective infant feeding pattern. DESIGN AND METHODS Content validation of nursing diagnosis based on the predictive diversity model. A methodological study of the content validation of a nursing diagnosis was based on the predictive diversity model and performed in the following three stages: conceptual definition of the phenomenon of interest; organization of the phenomenon of interest; and analysis by judges of the concepts of the phenomenon of interest. RESULTS The first two stages identified 13 clinical indicators and 12 etiological factors, which were evaluated by 23 judges. The analyses of judgments were performed according to the level of expertise of the judges. All the clinical indicators were relevant to nursing diagnosis under study. Nine causal factors were analyzed, including the level of importance to the occurrence of Ineffective infant feeding pattern. CONCLUSIONS This study analyzed the diagnostic structure of Ineffective infant feeding pattern, which were considered representative of the phenomenon of interest after evaluation by the judges. PRACTICE IMPLICATIONS The use of nursing diagnosis with accurate elements facilitates clinical reasoning and favors the development of an adequate care plan.
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Affiliation(s)
- Camila Maciel Diniz
- Federal University of Ceará, 1115 Alexandre Barauna, Fortaleza, Ceará 60430160, Brazil.
| | | | - Marília Mendes Nunes
- Federal University of Ceará, 1115 Alexandre Barauna, Fortaleza, Ceará 60430160, Brazil
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Adekunle AA, Adamson O, James O, Ogunlewe OM, Butali A, Adeyemo WL. Breastfeeding Practices Among Mothers of Children With Orofacial Clefts in an African Cohort. Cleft Palate Craniofac J 2020; 57:1018-1023. [PMID: 32295412 DOI: 10.1177/1055665620919312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To carry out a survey of breastfeeding practices and related challenges among mothers with orofacial cleft babies attending the cleft clinic of a tertiary health institution. METHODOLOGY This was a cross-sectional descriptive study using an interviewer-administered questionnaire. Sample population was all mothers of babies aged between 1 and 18 months with nonsyndromic orofacial clefts attending the cleft clinic of a tertiary health institution in Nigeria. RESULT A total of 65 mothers participated in the study. Initiation of breastfeeding was reported by the majority (83%, n = 54) of the mothers, and only 18.5% (n = 10) of this proportion continued exclusive breastfeeding. Inability of the babies to suck was reported by 46% (n = 30) of the mothers as being the most important challenge in breastfeeding. There was a significant correlation between the type of cleft and challenge in breastfeeding (Fisher exact P = .001). Sixty-three percent (n = 41) of the mothers reported they received no counseling on overcoming challenges associated with feeding their babies with a cleft at the facility where they delivered. Sixty-nine percent (n = 45) reported they first received nutritional information from the cleft clinic at presentation. The most adopted substitute for breastfeeding was the use of regular feeding bottles (n = 24, 43.6%). CONCLUSION Rate of initiation of breastfeeding for children with orofacial clefts in this African cohort is higher than reported in other populations despite the low level of nutritional counseling of the mothers after delivery.
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Affiliation(s)
- Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Olawale Adamson
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Nigeria
| | - Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Nigeria
| | - Omobolanle M Ogunlewe
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Nigeria
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, University of Iowa, IA, USA
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Nigeria
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Madhoun LL, Crerand CE, Keim S, Baylis AL. Breast Milk Feeding Practices and Barriers and Supports Experienced by Mother–Infant Dyads With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2019; 57:477-486. [DOI: 10.1177/1055665619878972] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine trends in breast milk provision and to characterize the breast milk feeding practices experienced by mother–infant dyads with cleft lip and/or palate (CL/P) in a large US sample. Design: Cross-sectional study. Methods: An online survey was distributed through cleft-related social media sites in the United States and in a single cleft lip and palate clinic. Statistical analyses included Kruskal-Wallis H tests and post hoc Mann-Whitney tests to examine group differences based on cleft type and prenatal versus postnatal cleft diagnosis. Linear regression was used to estimate associations between obtained variables. Participants: One hundred fifty biological mothers of infants (8-14 months of age) with CL/P (15% cleft lip, 29% cleft palate, 56% cleft lip and palate). Results: Forty-six percent of mothers of infants with CL/P provided breast milk to their infant for at least 6 months. Five percent of infants ever fed at breast, and 43% received pumped breast milk via bottle. The most commonly reported supports included lactation consultants, nurses, feeding therapists, and online support groups. Feeding therapy was received by 48% of infants. Conclusions: A lower percentage of mothers of infants with CL/P reported providing breast milk compared to national estimates of the general population of infants without clefting. Results suggested there are multiple barriers, as well as numerous medical and psychosocial supports that facilitated breast milk feeding success. Implications for care are discussed.
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Affiliation(s)
- Lauren L. Madhoun
- Division of Clinical Therapies, Nationwide Children’s Hospital, Columbus, OH, USA
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
| | - Canice E. Crerand
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University College of Medicine, OH, USA
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Sarah Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Adriane L. Baylis
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University College of Medicine, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
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22
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Bruneel L, Alighieri C, Bettens K, Musasizi D, Ojok I, D'haeseleer E, Van Lierde K. Assessing health-related quality of life in patients with cleft palate in resource-limited countries: A preliminary evaluation of the VELO questionnaire in Uganda. Int J Pediatr Otorhinolaryngol 2019; 124:39-46. [PMID: 31158570 DOI: 10.1016/j.ijporl.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Studies evaluating health-related quality of life (HRQoL) in patients with cleft palate living in resource-limited countries such as Uganda are scarce. The VELO questionnaire evaluates the impact of speech (and swallowing) difficulties on the patient's HRQoL. The aim was to evaluate an adapted English version of the VELO questionnaire with reduced response options in Ugandan patients with a cleft lip and palate in order to identify influencing factors and future perspectives to implement HRQoL assessement in this population. METHODS Based on the responses of 16 parents of patients with cleft palate, 6 adolescent/adult patients with cleft palate and 12 control participants without cleft palate, observations regarding linguistic and cultural difficulties were noted and the discriminant validity and internal consistency of this adapted version of the questionnaire were evaluated. Additionally, the relationship between these responses and perceptually assessed speech parameters was assessed. RESULTS Half of the participants (11/22) completed the questionnaire independently, frequently resulting in incomplete responses (8/11). Difficulties with wording and cultural aspects influencing the responses were identified. The subscales showed excellent internal consistency, with the exception of the subscale 'swallowing problems'. The score on the subscale 'perception by others' of the parent report showed no significant difference with the score of the control group. The total score on the parent report and the youth report was (borderline) significantly related to the speech variables speech understandability, speech acceptability and the VPC-SUM. DISCUSSION AND CONCLUSION Promising results regarding the validity and internal consistency of the adapted instrument were found, indicating the potential of the VELO questionnaire for HRQoL assessment at the CoRSU hospital in Uganda. However, results should be interpreted cautiously, given that all participants had a primary language other than English, the small sample size with skewed distribution of speech characteristics, and the bias induced by socially desirable responses. In future studies, adaptations based on qualitative research to account for linguistic and cultural aspects, followed by a rigorous forward-backward translation of the questionnaire to English and Luganda are needed.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium.
| | - Cassandra Alighieri
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Duncan Musasizi
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Isaac Ojok
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Evelien D'haeseleer
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
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Bekele KK, Ekanem PE, Meberate B. Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact. BMC Pediatr 2019; 19:254. [PMID: 31340768 PMCID: PMC6657112 DOI: 10.1186/s12887-019-1624-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cleft lip and palate deformities are considered one of the most common birth defects of the head and neck that pose significant medical, psychosocial and financial burdens on the affected individuals and families, especially in low income communities. The etiology and pathogenesis of cleft lip and palate is complex and is known to involve genetic and/or environmental factors. Objective To assess the patterns of anatomical cleft lip and palate deformities among neonates in Mekelle and Ayder Comprehensive Specialized hospitals, Tigray, Northern Ethiopia. Methods A hospital-based retrospective study was conducted from May 2017 to June 2017 at Mekelle and Ayder Comprehensive Specialized hospitals, both in Mekelle city. Data was collected from all medical charts of neonates registered from 2011 to 2016 and analyzed using SPSS version 21.0 and OpenEpi software. Results were presented using tables and graphs; Chi-square test was used to look for an association between variables, odds ratio to determine the strength of association of selected variables using multinomial logistic regression model, while Fisher Exact (Clopper-Pearson) was used to compare yearly prevalence. Results Of 37,152 neonatal charts analyzed, 119 (0.32%) cases were identified as having cleft deformities. 38.7, 17.6, and 43.7% of this figure had cleft lips, cleft palates and both cleft lip and palate respectively. 46 (38.7%) neonates had lateral patterns of cleft lip deformities with 56.5% located unilaterally on the right and 43.5% unilaterally on the left. Of 52 (43.7%) neonates with cleft lip and palate deformities, 40.4% were located bilaterally while 38.5 and 21.2% were located unilaterally on the left and right, respectively. Associated malformations were: cardiac (3.4%), central nervous system (1.7%) and limb deformities (5.9%). The overall prevalence of cleft deformities was found to be 3.11 per 1000 live births. Conclusion The study showed a higher prevalence of cleft deformities than that reported in Addis Ababa and some other African countries. A higher occurrence of left unilateral pattern of cleft lip and palate was observed whereas a higher right unilateral pattern of cleft lip was identified. The higher prevalence of cleft lip and palate recorded in this region of Ethiopia may reflect an environmental impact.
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Affiliation(s)
- Konjit K Bekele
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia
| | - Peter E Ekanem
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia.
| | - Berhanu Meberate
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia
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24
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Karaçam Z, Sağlık M. Breastfeeding problems and interventions performed on problems: systematic review based on studies made in Turkey. TURK PEDIATRI ARSIVI 2018; 53:134-148. [PMID: 30459512 PMCID: PMC6239069 DOI: 10.5152/turkpediatriars.2018.6350] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/19/2018] [Indexed: 01/17/2023]
Abstract
To determine the breastfeeding problems encountered in the postpartum period and effect of interventions done in relation to the problems based on breastfeeding studies in Turkey. This study is a systematic review and was conducted by performing a scan of the Turkish and English literature over the period October 2016-February 2017. The study included 27 articles and seven theses, which were published in 2000-2015 in Turkey and published in 2008-2017. Data are presented tabulating and the aggregate percentages were calculated for some data showing common characteristics. A total of 6736 parents and 592 babies were included in these studies. As a result of the combined percentage calculation based on the data of cross-sectional and case-control studies, the most frequently reported problems were having breastfeeding problem (24.5%), mother's milk deficiency/worry about milk deficiency/thinking her baby is not satisfied/baby's inadequate weight gain (15.7%), lack of knowledge and experience about breastfeeding/need for education and support (17.8%). Again, these studies showed that women stated the problems about have flat/depressed/small nipple (7.7%), pain/sensitivity (3.9%), swelling/fullness/engorgement (10.8%), redness (28.8%), crack/wound/bleeding (26.1%) and mastitis (5.6%). Methods of prenatal education/counselling/motivation/follow-up, strong motivation, proactive lactation management and social support, moist warm application, using of breast milk and olive oil and using of breast shield and feeding with container and pacifier using have been reported to be effective in the experimental/quasi-experimental and case report studies included in this systematic review. This study showed that women experienced a lot problem with breastfeeding and that more prenatal education/counselling/monitoring was used in reducing problems.
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Affiliation(s)
- Zekiye Karaçam
- Division of Midwifery, Adnan Menderes University School of Health Sciences, Aydın, Turkey
| | - Müge Sağlık
- Department of Midwifery, Adnan Menderes University, Health Sciences Institute, Aydın, Turkey
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25
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Katusabe JL, Hodges A, Galiwango GW, Mulogo EM. Challenges to achieving low palatal fistula rates following primary cleft palate repair: experience of an institution in Uganda. BMC Res Notes 2018; 11:358. [PMID: 29880044 PMCID: PMC5992877 DOI: 10.1186/s13104-018-3459-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/31/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To determine frequency of palatal fistula following primary cleft palate repair and the associated factors as a measure of cleft palate repair outcome and its challenges at a cleft centre in Uganda. Results Between May and December 2016, 54 children with cleft palate were followed up at Comprehensive Rehabilitation services of Uganda (CoRSU) hospital, from time of primary cleft palate repair until at least 3 months postoperative to determine whether they developed palatal fistula or not. Frequency of palatal fistula was 35%. Factors associated with increased fistula formation were cleft width wider than 12 mm (p = 0.006), palatal index greater than 0.4 (p = 0.046), presence of malnutrition at initial outpatient assessment (p = 0.0057) and at time of surgery (p = 0.008), two-stage palate repair (p = 0.005) and postoperative infection (p = 0.003). Severe clefting (palatal index greater than 0.4) was seen in 74% of patients and malnutrition (Low weight for age) seen in 48% of patients. Palatal fistula rates at our institution were high compared to reports in literature. The high proportions of severe clefting and malnutrition observed in our population that was also poor and unable to afford feeding supplements increased likelihood of fistula formation and posed challenges to achieving low fistula rates in our setting. Electronic supplementary material The online version of this article (10.1186/s13104-018-3459-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Andrew Hodges
- Comprehensive Rehabilitation Services Uganda (CoRSU) Hospital, P.O.Box 46, Kisubi, Uganda
| | | | - Edgar M Mulogo
- Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda
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26
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Fan D, Wu S, Liu L, Xia Q, Tian G, Wang W, Ye S, Wang L, Rao J, Yang X, Yu Z, Xin L, Li S, Duan Z, Zhang T, Wu S, Guo X, Liu Z. Prevalence of non-syndromic orofacial clefts: based on 15,094,978 Chinese perinatal infants. Oncotarget 2018; 9:13981-13990. [PMID: 29568410 PMCID: PMC5862631 DOI: 10.18632/oncotarget.24238] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022] Open
Abstract
Non-syndromic orofacial clefts (NSOFC), which include cleft lip and palate (CLP), cleft lip only (CLO), and cleft palate only (CPO), contains a range of disorders affecting the lips and oral cavity. No systematic review and meta-analysis has been carried out to synthesize the prevalence of NSOFC in Chinese perinatal infants. We aimed to quantify and understand the variation of prevalence national and regional levels. Four English databases and four Chinese databases were searched using a comprehensive search strategy from inception to April 2017. The random effect model was used for this meta-analysis. To determine the sources of heterogeneity, subgroup analyses and meta-regression were conducted based on different categories. The protocol has been pre-registered in the PROSPERO, number CRD42017062293. 110 studies, including 15,094,978 Chinese perinatal infants, were eligible for inclusion. The pooled prevalence rate for NSOFC was 1.67‰ (95% CI 1.53–1.82), varying with provinces. The pooled prevalence estimate was 0.56‰ (0.50–0.63) for CLO, 0.82‰ (0.73–0.90) for CLP, and 0.27‰ (0.24–0.30) for CPO. Significant associations were found between overall prevalence estimates and survey year and study region. The prevalence of NSOFC was severe in Chinese perinatal infants, varying with provinces. The results will serve as a baseline for future assessment of the overall effectiveness of NSOFC control, and will also support and inform health policy for planning and helping health debates.
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Affiliation(s)
- Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Obstetrics, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Shuzhen Wu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Obstetrics, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China.,Department of Library, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Qing Xia
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China.,Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia
| | - Guo Tian
- Department of Library, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Wen Wang
- Department of Obstetrics, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Shaoxin Ye
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Obstetrics, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Lijuan Wang
- Department of Obstetrics, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Jiaming Rao
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Epidemiology, Medical College of Jinan University, Guangzhou, Guangdong, 510632, China
| | - Xiao Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China.,Changzhou Center for Disease Control and Prevention, Changzhou, Jiangsu, 213003, China
| | - Zhen Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Lihong Xin
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Song Li
- Chaohu Hospital Affiliated Anhui Medical University, Chaohu, Anhui, 238000, China
| | - Zhenghua Duan
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, 610041, China
| | - Tianchen Zhang
- Department of Communicable Diseases Control, Jiangxi Provincial Center for Disease Control and Prevention, Nanchang 330000, Jiangxi, China
| | - Song Wu
- School of Integrated Traditional and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Obstetrics, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.,Department of Obstetrics, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
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