The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review

Wester, James R.; Weissman, Joshua P.; Reddy, Narainsai K.; Chwa, Emily S.; Gosain, Arun K.

doi:10.1177/10556656211038183

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…Given the elective nature of these procedures, remote digital assessments have also proven a reliable way to preoperatively diagnose cleft lip and palate in the context of short‐term plastic surgical missions in low‐ and middle‐income countries [47]. Numerous long‐term global partnerships by non‐governmental organizations in collaboration with local partners have supported training and service delivery for cleft care in LMIC for decades and is rapidly helping to reduce the unmet burden of disease from cleft lip and palate [48].…”

Section: Resultsmentioning

confidence: 99%

Surgically Correctable Congenital Anomalies: Reducing Morbidity and Mortality in the First 8000 Days of Life

et al. 2023

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Background Congenital anomalies are a leading cause of morbidity and mortality worldwide. We aimed to review the common surgically correctable congenital anomalies with recent updates on the global disease burden and identify the factors affecting morbidity and mortality. Method A literature review was done to assess the burden of surgical congenital anomalies with emphasis on those that present within the first 8000 days of life. The various patterns of diseases were analyzed in both low-and middleincome countries (LMIC) and high-income countries (HIC).Results Surgical problems such as digestive congenital anomalies, congenital heart disease and neural tube defects are now seen more frequently. The burden of disease weighs more heavily on LMIC. Cleft lip and palate has gained attention and appropriate treatment within many countries, and its care has been strengthened by global surgical partnerships. Antenatal scans and timely diagnosis are important factors affecting morbidity and mortality. The frequency of pregnancy termination following prenatal diagnosis of a congenital anomaly is lower in many LMIC than in HIC. Conclusion Congenital heart disease and neural tube defects are the most common congenital surgical diseases; however, easily treatable gastrointestinal anomalies are underdiagnosed due to the invisible nature of the condition. Current healthcare systems in most LMICs are still unprepared to tackle the burden of disease caused by congenital anomalies. Increased investment in surgical services is needed.

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Section: Resultsmentioning

confidence: 99%

Surgically Correctable Congenital Anomalies: Reducing Morbidity and Mortality in the First 8000 Days of Life

et al. 2023

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“…The path to comprehensive and accessible cleft care in SSA is fraught with patient and systemic barriers [38 ▪ ]. Fundamentally, there is a lack of awareness in the population of why CLP occurs.…”

Section: Cleft Care Barriers and Solutionsmentioning

confidence: 99%

Perspectives on the state of cleft lip and cleft palate patient care in Africa

Liu,

Manana,

Tollefson

et al. 2024

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review As the most common congenital craniofacial defect, patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa. Recent findings To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources. Summary The replacement of CLP ‘missions’ with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.

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Surgical Tray Optimization in the Setting of Cleft Lip and Palate Reconstruction: Implications for Operative Cost and Efficiency

Laspro,

Groysman,

Perez Rivera

et al. 2024

The Cleft Palate Craniofacial Journal

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Objectives To assess surgical instrument usage in cleft lip (CL) and cleft palate (CP) surgery and create an optimized surgical tray with an associated cost-savings analysis. Design Prospective, observational study. Setting Single institution, 6-month prospective review. Patients/Participants A total of 10 primary CL surgeries and 10 primary CP surgeries were included in this study. Intervention Complete lists of surgical instruments utilized in CL and CP surgeries were collected. Utilization fractions (UFs) were calculated as the percentages of average used instruments to averaged opened instruments per case. New optimized CL and CP surgical trays were idealized by removing instruments not used in at least 20% of cases, and a cost analysis was performed to identify potential savings. Calculation of annual potential savings was also conducted based on institutional caseload. Results The average instrument UFs were 26.0% for CL and 22.6% for CP. The estimated costs were $33.15 to $290.29 for the original CL surgical tray and $10.20 to $63.80 for the optimized tray. For CP, the original tray's cost was estimated at $38.25 to $319.00, and the optimized tray at $9.18 to $57.42. This demonstrates a cost reduction of $22.95 to $226.49 for CL and $29.07 to 261.58 for CP. Conclusions The idealized surgical instrument tray could contribute to reducing healthcare expenditures and promoting operating room efficiency, patient safety, and environmentally friendlier operating theaters.

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The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review

Cited by 5 publications

References 36 publications

Surgically Correctable Congenital Anomalies: Reducing Morbidity and Mortality in the First 8000 Days of Life

Surgically Correctable Congenital Anomalies: Reducing Morbidity and Mortality in the First 8000 Days of Life

Perspectives on the state of cleft lip and cleft palate patient care in Africa

Surgical Tray Optimization in the Setting of Cleft Lip and Palate Reconstruction: Implications for Operative Cost and Efficiency

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