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Blum JD, Benítez DB, Caballero FR, Villavisanis DF, Cho DY, Bartlett SP, Taylor JA, Magee L, Sierra NE, Swanson JW. Disability Caused by Cleft Lip and Palate: A Systematic Review and Critical Valuation Appraisal. Cleft Palate Craniofac J 2024; 61:1356-1368. [PMID: 37403346 DOI: 10.1177/10556656231173478] [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: 07/06/2023] Open
Abstract
OBJECTIVE Measuring disability as a concept of impaired global function enables beneficiaries of treatment, the impact of treatment, and targets of health system investment to be rigorously assessed. Measures of disability are not well established for cleft lip and palate. This study aims to systematically review disability weight (DW) studies pertaining to orofacial clefts (OFCs) and identify methodological strengths and shortcomings of each approach. DESIGN Systematic literature review of studies that met the following criteria: (1) peer-reviewed publication, (2) focus on disability valuation, (3) mention orofacial clefts, and (4) publication January 2001-December 2021. SETTING None. PATIENTS/PARTICIPANTS None. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Disability weight method of valuation and the value itself. RESULTS The final search strategy yielded 1,067 studies. Seven manuscripts were ultimately included for data extraction. The disability weights used in our studies, including those newly generated or taken from the Global Burden of Disease Studies (GBD), ranged widely for isolated cleft lip (0.0-0.100) and cleft palate with or without cleft lip (0.0-0.269). The GBD studies limited their consideration of cleft sequelae informing disability weights to impact on appearance and speech-related concerns, while other studies accounted for comorbidities such as pain and social stigma. CONCLUSIONS Current measures of cleft disability are sparse, inadequately reflect the comprehensive impact of an OFC on function and socialization, and are limited in detail or supporting evidence. Use of a comprehensive health state description in evaluating disability weights offers a realistic means of accurately representing the diverse sequelae of an OFC.
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Affiliation(s)
- Jessica D Blum
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Dillan F Villavisanis
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Y Cho
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leanne Magee
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Reddy NK, Shah ND, Weissman JP, Chwa ES, Gosain AK. Evaluation of Global Cleft Care Initiatives Among the Top Searched Low- and Middle-Income Countries. Cleft Palate Craniofac J 2024; 61:1220-1227. [PMID: 36866656 DOI: 10.1177/10556656231160399] [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: 03/04/2023] Open
Abstract
OBJECTIVE International outreach for cleft lip and/or palate care has traditionally been characterized by foreign groups and individuals holding surgical outreach trips in low- and middle-income countries. However, this "magic bullet" approach has often been criticized for prioritizing short-term results that may disrupt local workflow. The presence and impact of local organizations that support cleft care and take on capacity building initiatives has not been well explored. DESIGN Eight countries previously studied as having the highest Google search demand for CL/P were chosen for the scope of the study. Local NGOs in regions were identified through a web search, and information was collected regarding the location, objectives, partnerships, and work conducted thus far. RESULTS Countries with a strong combination of local and international organizations included Ghana, Philippines, Nepal, Kenya, Pakistan, India, and Nigeria. The country with minimal to no local NGO presence included Zimbabwe. Local NGOs often supported education and research, training of providers and staff, spreading community awareness, offering interdisciplinary care, and opening cleft clinics and hospitals. Unique initiatives included starting the first school for children with CL/P, enrolling patients in the national healthcare to cover CL/P care, and monitoring the referral system to improve efficiencies in the healthcare system. CONCLUSIONS Moving towards a mindset of capacity building not only involves bilateral partnerships between international host sites and visiting organizations, but also collaboration with local NGOs that have a deep understanding of local communities. Successful partnerships may help address the complex challenges regarding CL/P care faced by LMICs.
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Affiliation(s)
- Narainsai K Reddy
- Texas A&M School of Medicine, Engineering Medicine (EnMed), Houston, Texas, USA
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Nikhil D Shah
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Joshua P Weissman
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Emily S Chwa
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
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Taiwo AO, Lehmann U, Scott V, Shafi'u I, Lawal SG, Abdulmajid U, Braimah RO, Ibikunle AA, Abubakar AB, Mujtaba B, Ogbeide ME, Labbo-Jadadi S, Adigun OI, Ile-Ogedengbe BO. Barriers in Cleft Service Access in Sub-Saharan Africa: A Thematic Analysis of Practical Needs of Rural Families. Cleft Palate Craniofac J 2024:10556656241244976. [PMID: 38557293 DOI: 10.1177/10556656241244976] [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: 04/04/2024] Open
Abstract
OBJECTIVE To explore the experiences and perceptions of barriers of parents and family members of patients with cleft lip and palate in accessing cleft services in remote northwest Nigeria. DESIGN Face-to-face semi-structured audio recorded interviews were used to obtained qualitative textual data. Thematic analysis using interpretative descriptive techniques was employed to understand the participants' lived experiences with barriers and accessibility to cleft services. SETTING Participants were from Sokoto, Kebbi and Zamfara states in remote northwest, Nigeria. PARTICIPANTS Consisted of 22 caregivers (17 parents and 5 extended family members) were purposively sampled between 2017 and 2020. MAIN OUTCOME MEASURES Barriers experienced while accessing cleft services were identified during thematic analysis. RESULT Over three quarter of the respondents had patients with both cleft lip and palate and without any previous family history (n = 20). About two-thirds of the participants (n = 15) were females. Most of the interviews were conducted before the surgeries (n = 15). FIVE THEMES EMERGED lack of information, financial difficulty, misrepresentation from health workers, multiple transportation and previous disappointment. CONCLUSIONS Areas of poor awareness, misinformation from primary health care workers, financial hurdles, multiple transportation logistics and others were identified. Aggressive broadcasting of information through radio, timely treatment and collaboration with influential religious leaders were emphasized. Support, grants and subsidies from government and voluntary agencies are encouraged to mitigate the huge out of pocket cost of cleft care in the region.
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Affiliation(s)
- Abdurrazaq Olanrewaju Taiwo
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Resmile Craniofacial Anomaly Foundation Zamfara, Gusau, Zamfara, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Health Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Uta Lehmann
- School of Public Health, University of Western Cape, Cape town, South Africa
| | - Vera Scott
- School of Public Health, University of Western Cape, Cape town, South Africa
| | | | - Suleman Gusau Lawal
- Department of Family Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Usamatu Abdulmajid
- Department of Otolaryngology/ENT, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ramat Oyebummi Braimah
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Health Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Adebayo Aremu Ibikunle
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | - Bala Mujtaba
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Health Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Mike Eghosa Ogbeide
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Suwaiba Labbo-Jadadi
- Department of Dental and Maxillofacial Surgery, Sir Yahyah Memorial Hospital, Birnin-Kebbi, Kebbi, Nigeria
| | - Olufemi Ibrahim Adigun
- Resmile Craniofacial Anomaly Foundation Zamfara, Gusau, Zamfara, Nigeria
- Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Gusau, Zamfara, Nigeria
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Younan RA, Melhem AM, Haddad M, Annan B, Najjar W, Kantar RS, Hamdan US. Global Smile Foundation's Cleft Surgical Outreach Program: Clinical and Economic Impact During the Past 14 Years. J Craniofac Surg 2023; 34:1252-1255. [PMID: 37081641 DOI: 10.1097/scs.0000000000009320] [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: 10/03/2022] [Accepted: 01/28/2023] [Indexed: 04/22/2023] Open
Abstract
Clefts of the lip and/or palate can result in significant morbidity as well as economic and psychosocial distress for patients and families. Global Smile Foundation is a non-profit organization committed to providing comprehensive cleft care to patients with cleft of the lip/palate around the world. Primary cleft lip and primary cleft palate repairs performed by the Global Smile Foundation in the last decade were reviewed. Averted disability-adjusted life years were estimated and assessed for their economic value. A total of 15,310 disability-adjusted life years were averted. The financial gain was estimated between $78,323,624 and $152,906,604, with an average financial benefit of $48,021 to $93,750 per patient.
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Affiliation(s)
| | | | | | | | | | - Rami S Kantar
- Global Smile Foundation, Norwood, MA
- Department of Plastic and Reconstructive Surgery, The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York City, NY
- Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
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Weissman JP, Reddy NK, Shah ND, Gosain AK. Global Cleft Lip and Palate Outreach: A Google Trends Analysis. Cleft Palate Craniofac J 2023; 60:474-481. [PMID: 34930059 DOI: 10.1177/10556656211069823] [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
Understanding patient awareness of cleft lip and/or palate (CL/P) and evaluating demand for necessary procedures may serve to better target future efforts in global outreach. We utilized internet search query data from Google Trends for the terms: "cleft lip," "cleft palate," "cleft lip and palate," "cleft surgery," and "cleft repair" from January 2004 to January 2021. Relative search volumes (RSV) recorded for the top 5 highest displaying countries and top 3 available regions within those countries were compared against global outreach by Operation Smile and Smile Train, as measured by the number of patients treated. World Health Organization (WHO) indicators were used to validate the RSV values for each country and better understand the current infrastructure and need for cleft care in those countries. Globally, there was an increase in RSV for the terms "cleft lip," "cleft palate," "cleft repair," and "cleft surgery" between 2004 and 2021. For "cleft lip," the countries with the highest displaying RSVs included: Ghana (100%), Zimbabwe (97%), Nepal (78%), the Philippines (64%), and Kenya (52%). Countries with high RSVs and moderate to high WHO indicators included Ghana, Kenya, India, Nigeria, and Zimbabwe. Countries with high RSVs and poor WHO indicators included Nepal and Pakistan. Some countries had specific regions with high search demand that are not currently targeted for global outreach. Using Google Trends' data may help find more feasible locations and targeted care for efforts in global outreach with better patient awareness and turnout where demand for CL/P is increasing.
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Affiliation(s)
- Joshua P Weissman
- Division of Plastic and Reconstructive Surgery, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Narainsai K Reddy
- Division of Plastic Surgery, 2429Lurie Children's Hospital, Chicago, IL, USA
| | - Nikhil D Shah
- Division of Plastic and Reconstructive Surgery, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic and Reconstructive Surgery, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Plastic Surgery, 2429Lurie Children's Hospital, Chicago, IL, USA
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Al Abyad OS, Annan B, Melhem A, Chahine EM, Ramly EP, Vyas RM, Hamdan US. Application of Safety Protocols for International Cleft Outreach Programs During the COVID-19 Pandemic: Global Smile Foundation Precaution Guidelines and Implications. Cleft Palate Craniofac J 2023; 60:344-351. [PMID: 34919450 PMCID: PMC9902902 DOI: 10.1177/10556656211066435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Since COVID-19 was declared a worldwide pandemic by the World Health Organization (WHO) in March of 2020, foundation-based cleft outreach programs to Low- and Middle-Income Countries (LMICs) were halted considering global public health challenges, scarcity of capacity and resources, and travel restrictions. This led to an increase in the backlog of untreated patients with cleft lip and/or palate, with new challenges to providing comprehensive care in those regions. Resumption of international outreach programs requires an updated course of action to incorporate necessary safety measures in the face of the ongoing pandemic. In this manuscript, the authors outline safety protocols, guidelines, and recommendations implemented in Global Smile Foundation's (GSF) most recent outreach trip to Beirut, Lebanon. METHODS COVID-19 safety protocols for outreach cleft care and an Action Response Plan were developed by the GSF team based on the published literature and recommendations from leading international organizations. RESULTS GSF conducted a 1-week surgical outreach program in Beirut, Lebanon, performing 13 primary cleft lip repairs, 7 cleft palate repairs, and 1 alveolar bone grafting procedure. Safety protocols were implemented at all stages of the outreach program, including patient preselection and education, hospital admission and screening, intraoperative care, and postoperative monitoring and follow-up. CONCLUSIONS Organizing outreach programs in the setting of infectious diseases outbreaks should prioritize the safety and welfare of patients and team members within the program's local community. The COVID-19 protocols and guidelines described may represent a reproducible framework for planning future similar outreach initiatives in high-risk conditions.
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Affiliation(s)
| | | | | | | | - Elie P Ramly
- 6684Oregon Health & Science University, Portland, OR, USA
| | - Raj M Vyas
- 8788University of California Irvine, Irvine, CA, USA
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Association of Patient Factors and Follow-Up in an International Volunteer Cleft Lip and Palate Repair Clinic in El Salvador. J Craniofac Surg 2022; 33:2477-2481. [PMID: 35859268 DOI: 10.1097/scs.0000000000008715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In countries which lack robust health care systems, congenital conditions such as cleft lip and/or palate deformities are often untreated in certain individuals. Many volunteer organizations have stepped in to fill this gap but certain factors, such as continuity of care, are yet to be studied for these clinics. METHODS This is a retrospective cohort study of 167 pediatric patients with cleft lip and/or palate residing in El Salvador treated by a nongovernmental organizations between 2011 and 2020. This data was used in univariate and multivariable models to associate particular patient factors to their likelihood of following up to their annual clinic visits. RESULTS Each 1-year increase in duration of follow-up was associated with a 27% decrease in the odds of attending a visit. In addition, 33.7% of cleft lip and 49.7% of cleft palate/cleft lip and palate patients returned at least once. Males had 36% higher odds of attending a return visit compared with females but this difference was not statistically significant. Time spent travelling to the clinic had no effect on follow-up rates. CONCLUSION Nongovernmental organizations utilizing a diagonal care model should consider using more strategies to maximize continuity of care by increasing communication with patients and emphasizing the need of following up during clinic visits. Continued and increased collaboration with the local team is also of great importance.
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Chahine EM, Ramly EP, Marston AP, Teng SN, Nader M, Kassam SN, Kantar RS, Hamdan US. Quality Assurance Standards for Outreach Cleft Lip and Cleft Palate Repair Programs in Low-Resource Settings. Cleft Palate Craniofac J 2022; 60:773-779. [PMID: 35179415 DOI: 10.1177/10556656221074883] [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: 11/15/2022] Open
Abstract
BACKGROUND Comprehensive cleft care is a multidisciplinary team endeavor. While untreated craniofacial conditions have multiple undue repercussions, cleft care in outreach settings can be fraught with significant perioperative morbidity risks. AIM Propose updated quality assurance standards addressing logistic and operational considerations essential for the delivery of safe and effective cleft lip and /or palate (CL/P) care in low and middle-income countries (LMICs) settings. METHODS Based on American Cleft Palate-Craniofacial Association (ACPA) quality standards, published literature, published protocols by Global Smile Foundation (GSF), and the senior author's three-decade experience, updated standards for outreach cleft care were synthesized. RESULTS Ten axes for safe, effective, and sustainable cleft lip and palate care delivery in underserved settings were generated: 1) site assessment, 2) establishment of community partnerships, 3) team composition and credentialing, 4) team training and mission preparation, 5) implementation of quality assurance guidelines, operative safety checklists, and emergency response protocols, 6) immediate and long-term postoperative care, 7) medical record keeping, 8) outcomes evaluation, 9) education, and 10) capacity building and sustainability. Subsequent analysis further characterized essential components of each of those ten axes to delineate experience derived and evidence-based recommendations. DISCUSSION Quality assurance guidelines are essential for the safe delivery of comprehensive cleft care to patients with CL/P in any setting. Properly designed surgical outreach programs relying on honest community partnerships can be effectively used as vehicles for local capacity building and the establishment of sustainable cleft care ecosystems.
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Affiliation(s)
| | - Elie P Ramly
- Global Smile Foundation, Norwood, MA, USA.,6684Oregon Health & Science University, Portland, OR, USA
| | | | | | - Marie Nader
- Global Smile Foundation, Norwood, MA, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Serena N Kassam
- Global Smile Foundation, Norwood, MA, USA.,New York University College of Dentistry, New York, NY, USA.,21668The University of Maryland Medical System, Baltimore, MD, USA
| | - Rami S Kantar
- Global Smile Foundation, Norwood, MA, USA.,21668The University of Maryland Medical System, Baltimore, MD, USA
| | - Usama S Hamdan
- Global Smile Foundation, Norwood, MA, USA.,12261Tufts University School of Medicine, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
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