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Liu RH, Manana W, Tollefson TT, Ntirenganya F, Shaye DA. Perspectives on the state of cleft lip and cleft palate patient care in Africa. Curr Opin Otolaryngol Head Neck Surg 2024; 32:202-208. [PMID: 38695446 PMCID: PMC11340684 DOI: 10.1097/moo.0000000000000979] [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: 07/05/2024]
Abstract
PURPOSE OF REVIEW 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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Affiliation(s)
- Rui Han Liu
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Wayne Manana
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Travis T. Tollefson
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Faustin Ntirenganya
- Department of Surgery, University Teaching Hospital Kigali
- School of Medicine and Pharmacy, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David A. Shaye
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University Teaching Hospital Kigali
- School of Medicine and Pharmacy, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
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Turyasima M, Ahmed FM, Egesa WI, Twesigemukama S, Kyoshabire J. Challenges and lessons learnt in the management of an HIV-exposed neonate with gastroschisis in a resource-limited setting: case report. Ann Med Surg (Lond) 2024; 86:2208-2213. [PMID: 38576955 PMCID: PMC10990413 DOI: 10.1097/ms9.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance The incidence of congenital abdominal wall defects is increasing, but few cases have been reported in the African population. Case presentation The authors report a case of gastroschisis in a term neonate who was delivered through spontaneous vaginal delivery (SVD) in a remote health facility before transfer to a tertiary hospital in Uganda. Although there was no environmental exposure to teratogens, the major risk factor of Gastroschisis, the neonate was low birth weight, HIV-exposed, and the mother had not received folic acid supplementation during the first trimester, known risk factors of gastroschisis. Physical examination revealed intrauterine growth restriction in addition to the findings of the abdominal wall defect. Clinical discussion There were many missed opportunities in the management of this case which was marred by delayed essential care of the newborn, delayed surgical repair, and transfer to the tertiary surgical centre. At the tertiary surgical centre, a modified silo technique with delayed secondary closure was used to repair the defect, but the neonate still met its death before completing day 7 of life. Conclusion This case of gastroschisis shows how the diagnosis and management of neonates born with major congenital structural abnormalities in resource-limited settings is still desirable due to lack of sophisticated medical care services to assist in early detection during pregnancy and early surgical intervention at birth to prevent associated mortality. The authors discuss the lessons learnt and provide recommendations for improvement in the care of neonates born with abdominal wall defects and other congenital birth defects.
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Affiliation(s)
- Munanura Turyasima
- Department of Pediatrics and Child Health, Kampala International University, Faculty of Medicine and Dentistry
- Department of Standards Compliance Accreditation and Patient Protection, Ministry of Health
| | - Fadumo Mohamed Ahmed
- Department of Pediatrics and Child Health, Kampala International University, Faculty of Medicine and Dentistry
| | - Walufu Ivan Egesa
- Department of Pediatrics and Child Health, Nile International Hospital, Jinja City, Uganda
| | - Sabinah Twesigemukama
- Department of Pediatrics and Child Health, Kampala International University, Faculty of Medicine and Dentistry
| | - Joan Kyoshabire
- Department of Management Science, Uganda Management Institute, Kampala
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Borg TM, Solomon S, Alfarrouh R, Barazi W, Abu Sittah G, Sommerlad B, Ghanem A. Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries. Cleft Palate Craniofac J 2024; 61:706-711. [PMID: 36330704 DOI: 10.1177/10556656221136650] [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: 02/17/2024] Open
Abstract
BACKGROUND During periods of civil strife, the need for trauma care and lack of sufficient cleft surgeons causes an increase in children left untreated with cleft lip and palate deformities. During the Syrian war, some cleft care was provided through visiting charities, with surgeries performed both in Syria and neighboring countries. There is a need to increase the number of adequately trained cleft surgeons available in such regions so that care can be achieved beyond mission trips. METHODOLOGY Cleft lip and palate repair workshops were delivered to 50 doctors in Syria. Pre-workshop, trainees received supplementary learning material. During the workshop, attendees received didactic teaching followed by 2 simulation sessions. Pre- and post-workshop, attendees completed questionnaires regarding their confidence and ability to perform cleft lip and palate repair. RESULTS Pre-workshop, 96% of workshop attendees had never independently performed cleft lip repair while 100% of attendees had not previously performed cleft palate repair. The mean pre-workshop confidence score was 2.452. Post-workshop, the mean confidence score was 3.503. Confidence rating scores significantly improved (P < .001). CONCLUSION The workshop delivered in Syria, together with this cleft lip and palate simulator provides an effective training tool that may support surgical training globally, particularly those in low-income countries. Further support is needed by charity organizations to ensure the continued delivery of such training.
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Affiliation(s)
- Tiffanie-Marie Borg
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Sara Solomon
- Department of Surgery, Queen's Hospital, Romford, London, UK
| | - Rik Alfarrouh
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Wael Barazi
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Ghassan Abu Sittah
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
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Zhang Y, Zhang X, Jiang J, Xie W, Xiang D. Factors Associated With Perception of Stigma Among Parents of Children With Cleft Lip and Palate: Cross-Sectional Study. JMIR Form Res 2024; 8:e53353. [PMID: 38437002 PMCID: PMC10949127 DOI: 10.2196/53353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Parents of children with cleft lip with or without cleft palate (CL/P) often face stigmatization, which has a significant impact on their quality of life and mental health. However, to date, there is a lack of comprehensive, multicenter empirical research on parents of children with CL/P in China, particularly those with large-scale samples. OBJECTIVE This study aimed to identify major factors that contribute to the perception of stigma experienced by parents of children with CL/P. METHODS A cross-sectional survey was conducted. A total of 104 parents of children diagnosed with CL/P in 2 hospitals were selected by convenience sampling. Demographics and disease information, the Chinese Perception of Stigma Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Social Anxiety Scale were used in this study. Descriptive statistics, t tests, and one-way ANOVA were used to compare the differences between participants' demographic information and perception of stigma. Multivariable linear regression was performed to assess associations between demographic factors, social anxiety, depression, and perception of stigma. RESULTS The mean scores for the dimensions of perception of stigma, depression, and social anxiety were 22.97 (SD 9.21), 38.34 (SD 8.25), and 22.86 (SD 6.69), respectively. Depression and social anxiety were positively associated with discrimination, while surgery status was a negatively associated variable. Parents with a college education or higher had significantly lower levels of perceived stigma compared to parents with a junior high school education (all P values <.05). These 4 factors explained 40.4% of the total model variance (F8=9.726; P<.001; R2=0.450; adjusted R2=0.404). CONCLUSIONS Our findings highlight a concerning trend of diminished quality of life among parents of children with CL/P. Factors such as parents' education level, surgery status, depression, and social anxiety are shown to influence the level of stigma experienced. Implementing comprehensive nursing care and providing presurgical support are effective strategies for alleviating parents' social anxiety, reducing perceived stigma, and preventing depression.
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Affiliation(s)
- Yanan Zhang
- Ophthalmology and otorhinolaryngology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Xinwen Zhang
- Ophthalmology and otorhinolaryngology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Jinzhuo Jiang
- College of Engineering, South China Agricultural University, Guangzhou, China
| | - Wanhua Xie
- Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Daoman Xiang
- Ophthalmology and otorhinolaryngology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
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Oladayo AM, Odukoya O, Sule V, Molobe I, Busch T, Akodu B, Adeyemo WL, Gowans LJJ, Eshete M, Alade A, Awotoye W, Adeyemo AA, Mossey PA, Prince AER, Murray JC, Butali A. Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research. BMC Public Health 2024; 24:507. [PMID: 38365612 PMCID: PMC10873930 DOI: 10.1186/s12889-024-17987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort. METHODS Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis. RESULTS Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI. CONCLUSIONS Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.
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Affiliation(s)
- Abimbola M Oladayo
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
| | - Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Veronica Sule
- Department of Operative Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Ikenna Molobe
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tamara Busch
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Babatunde Akodu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Wasiu L Adeyemo
- Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - Lord J J Gowans
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mekonen Eshete
- School of Medicine, Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Azeez Alade
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Waheed Awotoye
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | | | - Peter A Mossey
- Department of Orthodontics, University of Dundee, Dundee, UK
| | | | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
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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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Kancherla V, Roos N, Walani SR. Relationship between achieving Sustainable Development Goals and promoting optimal care and prevention of birth defects globally. Birth Defects Res 2022; 114:773-784. [PMID: 35776686 DOI: 10.1002/bdr2.2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/27/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022]
Abstract
Birth defects affect eight million newborns annually worldwide. About 8% of global under-5 mortality is attributable to birth defects. The United Nations (UN) Sustainable Development Goals (SDGs) have set 17 global goals for human growth and development to be achieved by 2030 using multi-sectorial approaches. The third goal (SDG-3) focuses on ensuring healthy lives and promoting well-being; achieving SDG-3 improves birth defects care and prevention. However, we aimed to show how achieving other SDGs also influence optimal care and prevention of birth defects. SDGs focused on poverty reduction, access to nutritious food, universal health coverage, equitable education, gender equality, environment, inclusivity through infrastructure innovation, and strengthening social justice is crucial to addressing social determinants of health for individuals and families affected by birth defects. Understanding birth defects in the context of several relevant SDGs will allow practitioners, researchers, and policymakers to leverage the momentum generated by SDGs and make a case for commitment and allocation of funding and resources for advancing birth defects surveillance, care, and prevention. SDGs are built on principles of equity and social justice and we urge policy-makers to approach birth defects using various SDGs as a catalyst. The synergy between several SDGs helps to optimize birth defect outcomes and prevention. Our effort to present a more comprehensive look at various SDGs and their relationship with birth defects is parallel to several other health advocacy groups conducting a similar mapping exercise, thus bringing to the forefront millions of lives that are impacted by birth defects worldwide.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Saikia A, Muthu M, Orenuga OO, Mossey P, Ousehal L, Yan S, Campodonico M, England R, Taylor S, Sheeran P. Systematic Review of Clinical Practice Guidelines for Oral Health in Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2022; 59:800-814. [PMID: 34159833 PMCID: PMC9121521 DOI: 10.1177/10556656211025189] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) exist to present recommendations and policies aimed at optimizing the oral health of children and adolescents born with cleft lip and/or palate. The aim of this review is to identify and assess the scope, quality, adequacy, and consistency of CPGs related to oral health in children and adolescents with clefts, along with reporting any differences and shortcomings. METHODS A systematic review of the literature of CPGs following Preferred Reporting Items for Systematic Reviews guidelines was conducted. Assessment of selected CPGs was performed using the Appraisal of Guidelines for Research & Evaluation II methodological quality instrument. RESULTS Only 7 CPGs fulfilled the criteria. Of these, 4 were from the American Cleft Palate-Craniofacial Association, and 1 each from the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, and the American Academy of Pediatric Dentistry. The lowest overall mean scores were in the domain "Rigor of Development" (mean 29.58%, SD 17.11), revealing lower quality in methodology of the guideline. The domain "Clarity of Presentation" (mean 73.80%, SD 7.87) revealed the best score. CONCLUSIONS Our review results reveal a lack of integrated high-quality CPGs that can be used as universal guidelines by health workers in a range of disciplines for improving oral health in children and adolescents with cleft problems.
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Affiliation(s)
- Ankita Saikia
- Consulting Pediatric Dental Surgeon, Pedo Planet Children Dental
Centre, Porur, Chennai, Tamilnadu, India
| | - M.S. Muthu
- Centre for Early Childhood Caries Research (CECCRe), Faculty of
Dental Sciences, Department of Pediatric Dentistry, Sri Ramachandra Institute of
Higher Education and Research, Porur, Chennai, Tamilnadu, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman
University, United Arab Emirates
| | - Omolola O. Orenuga
- Department of Child Dental Health, College of Medicine University of
Lagos, University Teaching Hospital, Lagos, Nigeria
| | - Peter Mossey
- School of Dentistry, University of Dundee, Dundee, United
Kingdom
| | - Lahcen Ousehal
- Department of Orthodontics , University of Casablanca, Morocco
| | - Si Yan
- Department of Preventive Dentistry, Peking University, Beijing,
People’s Republic of China
| | | | | | - Sean Taylor
- FDI World Dental Federation, Geneva, Switzerland
| | - Pamela Sheeran
- Strategic Programs and Partnerships, Comprehensive Cleft Care,
Smile Train, NY, USA
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Cleft Lip and Palate Repair Training to Bridge the Gap in Low-Income Countries. J Craniofac Surg 2022; 33:1331-1334. [PMID: 35013070 PMCID: PMC9275852 DOI: 10.1097/scs.0000000000008420] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022] Open
Abstract
There is a significant unmet need for cleft repair in low-income countries. The procedure is challenging due to limited access, small fragile flaps, and the depth at which sutures need to be placed. The aim of this analysis is to review available literature pertaining to cleft lip and palate repair training, with a focus on those applicable to low-income countries.
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Asa GA, Fauk NK, Mwanri L, Ward PR. Understanding Barriers to the Access to Healthcare and Rehabilitation Services: A Qualitative Study with Mothers or Female Caregivers of Children with a Disability in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111546. [PMID: 34770060 PMCID: PMC8583444 DOI: 10.3390/ijerph182111546] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022]
Abstract
Accessibility to healthcare and rehabilitation services for children with a disability (CWD) is essential to improving their health and wellbeing. However, access to the services, especially in many settings in developing countries with scarcity of resources, is still limited. As part of a qualitative study exploring impacts of caring for CWD on mothers or female caregivers and their coping strategies, this paper describes barriers for access to healthcare and rehabilitation services for CWD in Belu district, Indonesia. One-on-one, in-depth interviews were conducted with 22 mothers or female caregivers of CWD. Participants were recruited using a combination of purposive and snowball sampling techniques. These were supplemented with interviews with two staff of disability rehabilitation centers in Belu to understand any additional barriers. Data analysis was guided by a qualitative data analysis framework. Our analysis identified that lack of affordability of healthcare services (high costs and low financial capacity of mothers) was the key barrier for access to healthcare and rehabilitation services CWD. Religious or faith-based factors, such as being a non-Catholic (Belu is predominantly Catholic), converting from Catholic to other religions, and the belief in children’s disability condition as “God’s will”, were also influencing factors for lack of access to the services. Shortage of staff, distrust in the therapy skills of staff at rehabilitation centers, and unavailability of appropriately trained healthcare professionals were structural or system-related barriers. The findings indicate the need for government-owned and run disability rehabilitation centers (not faith-based), the provision of fully subsidised health insurance to provide free services, and the provision of qualified therapists and healthcare professionals (to build trust) in Belu and other similar settings in Indonesia.
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Affiliation(s)
| | - Nelsensius Klau Fauk
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide 5001, Australia; (L.M.); (P.R.W.)
- Institute of Resource Governance and Social Change, Kupang 85221, Indonesia
- Correspondence:
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide 5001, Australia; (L.M.); (P.R.W.)
| | - Paul Russell Ward
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide 5001, Australia; (L.M.); (P.R.W.)
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11
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Alar Base Augmentation Using Vomerine Bone Graft in Patients With Cleft Lip Nasal Deformity. Ann Plast Surg 2021; 85:511-515. [PMID: 33035043 DOI: 10.1097/sap.0000000000002432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although many trials have been made to augment the unilateral alar base depression, the ultimate aesthetic satisfaction has proven difficult to achieve. In our study, we present a novel submucosal dissection technique to harvest the vomer bone and use it as an onlay graft to correct the alar base depression. METHODS We collected a prospective cohort study of 11 patients with unilateral cleft lip nasal deformity. Using CorelDRAW X7 software, we obtained perioperative clinical photographs to analyze the nostril and lateral lip morphometric measurements on the cleft side. Computed tomography scans were used to assess the required graft's volume and to detect resorption. We performed vomerine ostectomy and placed and fixed the bone graft in with a lag screw over the alar base depression. RESULTS The nostril width showed a significant increase, in addition to the height/width ratio. The columellar angle with the lateral lip height increased remarkably, with a general improvement in the nasal tip aesthetics. CONCLUSIONS The vomer bone graft has been shown to correct the lateral and inferior disorientation of the alar base and improve the nostril and nasal tip aesthetic measurements. The vomer bone is therefore a sufficient bone source for grafting with high viability and no resorption.
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12
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daCosta OO, Isiekwe IG, Ogbonna CM. Cleft Care in a Developing Country: An Assessment of Knowledge and Attitudes of Patients/Parents of Children With an Orofacial Cleft to Orthodontic Treatment. Cleft Palate Craniofac J 2021; 59:192-199. [PMID: 33715465 DOI: 10.1177/1055665621998179] [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
OBJECTIVE To assess the knowledge, awareness and attitude to orthodontic treatment of patients and parents of children with orofacial clefts, receiving comprehensive cleft care treatment. DESIGN Cross-sectional survey. SETTING A major tertiary health care facility in Nigeria, the Lagos University Teaching Hospital, Idi-araba, Lagos. PARTICIPANTS Patients and parents of children with orofacial clefts receiving comprehnsive cleft care. INTERVENTION Patients and parents of children with orofacial clefts were asked to complete the survey. Interviewer-administered questionnaires were used. RESULTS A total of 123 patients participated in the study, 55.3% (68) were females and 44.7% (55) were males. The majority (85.3%, 114) of patients were children aged between 0 and 5 years, while only 7.3% (9) were adults, aged 18 years and above. About one-third (41) of the respondents indicated that they felt "their teeth was not straight." Although 43.9% (54) reported that they knew that braces could be used to straighten teeth, only 13.8% of the respondents knew who an orthodontist was. Eighty percent (99) indicated that they would be willing to undergo treatment to straighten their teeth or their children/wards' teeth. CONCLUSION The majority of parents of children with clefts and adult patients attending the institution's cleft clinic had limited knowledge of orthodontics and the orthodontic care required for patients with clefts, although they had a positive attitude toward orthodontic treatment. These findings will guide the center in planning patient-centered orthodontic care for patients with clefts while also highlighting areas of importance for patient counseling and education in the orthodontic care for these patients.
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Affiliation(s)
- Oluranti Olatokunbo daCosta
- Faculty of Dental Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Ikenna Gerald Isiekwe
- Faculty of Dental Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
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NAM-help or burden? Intercultural evaluation of parental stress caused by nasoalveolar molding: a retrospective multi-center study. Clin Oral Investig 2021; 25:5421-5430. [PMID: 33665684 PMCID: PMC8370945 DOI: 10.1007/s00784-021-03850-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/18/2021] [Indexed: 11/14/2022]
Abstract
Objectives Nasoalveolar molding (NAM) was developed to facilitate easier treatment and better outcomes for cleft lip and palate (CLP) patients. The aim of this study was to investigate the parental burden and possible intercultural differences of this treatment modality, which is often argued to burden parents to an extraordinary amount. Materials and methods Standardized questionnaires (available in English, Mandarin, and German) with 15 non-specific and 14 NAM-specific items to be retrospectively answered by Likert scales by parents of unilateral CLP patients with completed NAM treatment. Results The parents of 117 patients from two treatment centers in Taiwan and Germany were included. A very high level of overall satisfaction was found in both countries with significant intercultural differences in prenatal parent information, feeding problems, dealing with 3rd party’s perception, and experienced personal effort. Conclusion NAM is an effective treatment tool for children’s CLP deformities and their caregivers in overcoming the feeling of helplessness. Intercultural differences may be due to infrastructural reasons, cultural attitudes and habits, or different public medical education. Clinical relevance In addition to facilitating easier surgical treatment, NAM can be seen as a powerful coping strategy for parents dealing with a CLP deformity of their child and does not seem to burden them extraordinarily.
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14
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Kara İ, Dumbak AB, Kayıkcı MEK. Perceptions Regarding the Academic and Cognitive Performance of Individuals With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2021; 59:32-39. [PMID: 33622048 DOI: 10.1177/1055665621995308] [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
INTRODUCTION Factors such as teachers' appropriate support and social interactions have an impact on the academic performance of children with cleft lip and/or palate (CL/P). This study was designed to investigate the perceptions of the teachers and the general public about the academic and cognitive performance of individuals with CL/P. METHODS This study was included 360 (male/female = 102/258) teachers and 640 (male/female = 259/381) participants that represent the general public. Anonymized web-based and paper-and-pencil self-administered questionnaire that included multiple-choice and yes/no questions were administered. Within-group differences and intergroup differences were analyzed in terms of academic and cognitive performance. RESULTS Most of the teachers and the general public indicated that the academic and cognitive performance of individuals with CL/P is the same as their unaffected peers. A significantly higher proportion of the teachers indicated that the academic performance of children with CL/P is the same as their unaffected peers than the general public. CONCLUSION Considering that the general public's attitudes and appropriate teacher support are crucial to prevent adverse impacts on the lives of individuals with CL/P, it is important to support teachers with the appropriate information and to encourage the public to recognize that everybody with a facial difference should be treated as an individual rather than a disability.
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Affiliation(s)
- İlkem Kara
- Speech and Language Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Aydan Baştuğ Dumbak
- Speech and Language Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Maviş Emel Kulak Kayıkcı
- Speech and Language Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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15
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James O, Adekunle AA, Adeyemo WL. How Does Octyl-2-Cyanoacrylate Tissue Adhesive Compare With Prolene Sutures in Cleft Lip Repair? J Oral Maxillofac Surg 2021; 79:1540-1548. [PMID: 33621479 DOI: 10.1016/j.joms.2021.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Comparative evidence of the usefulness of octyl-2-cyanoacrylate tissue adhesive in cleft lip epidermal skin closure especially in Africans is still lacking. This study aimed to compare the outcome of wound healing after the use of Dermabond tissue adhesive and 5/0 Prolene sutures in cleft lip repair. METHODS This was a prospective randomized controlled clinical study. The sampled population was patients undergoing cleft lip repair at a tertiary health facility in Lagos, Nigeria. Study patients were randomly allocated to either group A (Dermabond) or group B (suture). The predictor variable was the type of material used in skin closure; the primary outcome variable was the esthetics of the resulting scar, and secondary outcome variables were wound healing complications. Assessment of the 3-month postoperative wound scar was performed using the cosmetic visual analog scale (CVAS) and the Hollander Wound Evaluation scale (HWES). Calculated sample size was 14 participants per group. Descriptive and comparative statistics were computed, and the P value was set at <0.05. RESULTS Analysis of result included 38 participants. Median age was 4 months and 52.6% were women. Two cases (5.3%) of wound healing complications were recorded (1 in each group). Blinded evaluation of the 3-month postoperative photographs yielded a mean CVAS score of 86.0 (±11.2) and HWES score of 5.0 (±0.9) for group A and a mean CVAS score of 76.5 (±14.5) and HWES score of 4.5 (±1.1) for group B. There was no statistically significant difference between these 2 groups based on the CVAS (P = .052) and HWES (P = .152). CONCLUSIONS The results of this study suggest Dermabond offers a comparable cosmetic outcome as 5/0 Prolene suture in epidermal closure of cleft lip. There was no statistically significant difference in wound complications and wound cosmetic scores between the 2 groups.
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Affiliation(s)
- Olutayo James
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi - Araba, Lagos, Nigeria
| | - Adegbayi Adeola Adekunle
- Senior Resident, Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi - Araba, Lagos, Nigeria.
| | - Wasiu Lanre Adeyemo
- Professor, Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi - Araba, Lagos, Nigeria
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James O, Adekunle AA, Adamson OO, Agbogidi OF, Adeyemo WL, Butali A, Ladeinde AL, Ogunlewe MO. Management of Orofacial Cleft in Nigeria - A Retrospective Study. Ann Maxillofac Surg 2020; 10:434-438. [PMID: 33708591 PMCID: PMC7943976 DOI: 10.4103/ams.ams_104_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Orofacial clefts (OFCs) are among the most common craniofacial developmental abnormalities worldwide and a significant cause of childhood morbidity and mortality. This study aimed to identify patterns of patient presentation, treatment approaches, and changes in our overall cleft care service between 2007 and 2019. Methods and Methodology A retrospective review of patients managed at a tertiary health facility in Nigeria of all OFC cases operated between 2007 and 2019 was done using the postintervention data retrieved from the Smile Train database. Data of all OFC cases operated within the period were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed using the Statistical Package for the Social Sciences version 20.0. Results A total number of 740 OFC surgeries were performed in 565 patients, consisting of 269 females (48.2%) and 289 males (51.8%). The majority (63%) of the patients presented before the age of 2 years. Thirty-seven percent presented with cleft lip and alveolus, 27.1% with cleft palate only, and 36.7% with cleft lip, alveolus, and palate. Primary cleft lip repair was the most performed surgery (n = 320, 43.2%), the mean age at repair was 2.1 years. Since 2017, additional services such as speech therapy, mixed dentition orthodontics, and nutritional support were added to services provided to our cleft patients. Fifteen patients have undergone speech assessment and three have completed speech treatment. Eight patients have undergone mixed dentition stage orthodontic treatment. Discussion Our services have evolved from simply providing surgical care to comprehensive care with a multidisciplinary team approach and provision of a wide range of services including nutritional counseling, pediatric care, orthodontic services, and speech therapy. We believe these will improve the overall well-being of our patients while we continue to improve on services based on clinical research outcomes.
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Affiliation(s)
- Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olawale Olatubosun Adamson
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olushola Failat Agbogidi
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
| | - Akinola L Ladeinde
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Smith ER, Concepcion TL, Shrime M, Niemeier K, Mohamed M, Dahir S, Ismail EA, Poenaru D, Rice HE. Waiting Too Long: The Contribution of Delayed Surgical Access to Pediatric Disease Burden in Somaliland. World J Surg 2020; 44:656-664. [PMID: 31654200 DOI: 10.1007/s00268-019-05239-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Delayed access to surgical care for congenital conditions in low- and middle-income countries is associated with increased risk of death and life-long disabilities, although the actual burden of delayed access to care is unknown. Our goal was to quantify the burden of disease related to delays to surgical care for children with congenital surgical conditions in Somaliland. METHODS We collected data from medical records on all children (n = 280) receiving surgery for a proxy set of congenital conditions over a 12-month time period across all 15 surgically equipped hospitals in Somaliland. We defined delay to surgical care for each condition as the difference between the ideal and the actual ages at the time of surgery. Disability-adjusted life years (DALYs) attributable to these delays were calculated and compared by the type of condition, travel distance to care, and demographic characteristics. RESULTS We found long delays in surgical care for these 280 children with congenital conditions, translating to a total of 2970 attributable delayed DALYs, or 8.4 avertable delayed DALYs per child, with the greatest burden among children with neurosurgical and anorectal conditions. Over half of the families seeking surgical care had to travel over 2 h to a surgically equipped hospital in the capital city of Hargeisa. CONCLUSIONS Children with congenital conditions in Somaliland experience substantial delays to surgical care and travel long distances to obtain care. Estimating the burden of delayed surgical care with avertable delayed DALYs offers a powerful tool for estimating the costs and benefits of interventions to improve the quality of surgical care.
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Affiliation(s)
- Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, MMGYM Room 218, One Bear Place #97313, Waco, TX, 76798-7313, USA.
| | | | - Mark Shrime
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Kelli Niemeier
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, MMGYM Room 218, One Bear Place #97313, Waco, TX, 76798-7313, USA
| | - Mubarak Mohamed
- Edna Adan University Hospital, Hargeisa, Somaliland, Somalia
| | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland, Somalia
| | | | | | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
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18
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Alfwaress F, Alomari M. Social and religious attitudes of Jordanian parents toward children born with orofacial clefts. Int J Pediatr Otorhinolaryngol 2020; 137:110222. [PMID: 32658804 DOI: 10.1016/j.ijporl.2020.110222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND GOALS Parental attitudes towards orofacial clefts (OFC) can be influenced by culture. Interestingly, there are no studies up to date examined parental attitudes towards these congenital anomalies in Jordan. The objectives of this study were to 1) explore the social and religious attitudes of Jordanian parents toward their children born with OFCs, and 2) determine the predictors of social and religious beliefs and behaviors. METHODS AND SETTINGS A descriptive study conducted at a tertiary care teaching hospital. Hundred and fifty-three parents participated in the study. All the participants completed the questionnaire were the biological either father or mother; (61) and (92) respectively. The patients with OFC were 95 males and 58 females ranged in age from 0.1 to 20 years (M = 8.2 years, SD = 6.4). The prevalence of OFC was characterized by 40 CL, 24 CP and 89 CLP. Patients' gender and age, residence, other family incidences, and receiving health education about the cleft were the independent variables used in the binary regression to predict the social and religious beliefs. RESULTS The majority of the parental responses denied any social negativity in regard to the ability of their children to establish friendships, being hidden from the public, facing social difficulties. However, substantial parental concerns were found in regard to teasing and bullying (102 = 76.8%; p < 0.0001). No negative religious beliefs were observed. None of the independent variables showed significant relationships with the social beliefs except for "receiving health education about the cleft" which predicted the possibility of encountering "social difficulties" (B = 2.9; CI 3.2-100.5; p < 0.001; OR = 18.1). Regression model showed that parent with no education tended to hide the child (2.0%; St. Res = 3.4). Difficulty making friends was related to cleft lip type (Chi2 = 6.05; p < 0.05). Believing the deformity is because of an evil spirit" was related to cleft lip type (Chi2 = 6.6; p < 0.04). CONCLUSIONS Irrespective to particular negative viewpoints observed among the parents towards OFCs, the majority of families tend to have positive social and religious beliefs. These affirmative constructs towards the cleft deformity may reflect positively on the provision of health care services. The establishment of an in depth family counseling and health education routine programs concerning the attributes of OFCs at a wider scale to maintain the integrity of parents' beliefs of the OFC deformity may be warranted.
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Affiliation(s)
- Firas Alfwaress
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Mahmoud Alomari
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Kalisya LM, Bake JF, Elisee B, Nyavandu K, Perry R, Rothstein DH, Cairo SB. Surgical Repair of Orofacial Clefts in North Kivu Province of Eastern Democratic Republic of Congo (DRC). Cleft Palate Craniofac J 2020; 57:1314-1319. [PMID: 32787585 DOI: 10.1177/1055665620947604] [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 There is a high prevalence of orofacial clefts in low- and middle-income countries with significant unmet need, despite having 50% of the population younger than 18 years in countries such as the Democratic Republic of Congo (DRC). The purpose of this article is to report on the experience of general surgeons with orofacial clefts at a single institution. METHODS This is a retrospective study of patients treated for cleft lip/palate in the province of North Kivu, DRC between 2008 and 2017. RESULTS A total of 1112 procedures (122/year) were performed. All procedures were performed by general surgeons following training by an international nongovernmental aid organization. A total of 59.2% of patients were male and the median age was 3.4 years (interquartile range: 0.7-13 years). Average distance from surgical center to patient location was 242.6 km (range: 2-1375 km) with outreach performed for distances >200 kms. A majority (82.1%) of patients received general anesthesia (GA) with significant differences in use of GA, age, weight, and length of stay by major orofacial cleft category. Of the 1112 patients, 86.1% were reported to have cleft lip alone, 10.5% had cleft lip and palate, and 3.4% cleft palate alone. Despite this, only 5.3% of patients underwent surgical repair of cleft palate. CONCLUSIONS Multiple factors including malnutrition, risk of bleeding, procedural complexity, and cosmetic results may contribute to the distribution of procedures performed where most cleft palates are not treated. Based on previously published estimates, unmet needs and social burden of cleft lip and palate are high in the DRC.
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Affiliation(s)
| | | | - Bake Elisee
- HEAL Africa Hospital, COSECSA Training Program, Buffalo, NY, USA
| | - Kavira Nyavandu
- HEAL Africa Hospital, COSECSA Training Program, Buffalo, NY, USA
| | - Robert Perry
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA.,Division of Pediatric Plastic Surgery, 23561John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA.,Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY, USA
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20
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de Vries J, Landouré G, Wonkam A. Stigma in African genomics research: Gendered blame, polygamy, ancestry and disease causal beliefs impact on the risk of harm. Soc Sci Med 2020; 258:113091. [PMID: 32521416 PMCID: PMC7396479 DOI: 10.1016/j.socscimed.2020.113091] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022]
Abstract
A recurring concern in genomics research is the possibility that it could lead to stigma for participants, their families and the population groups they belong to. Little evidence exists to explain how and when this ought to be a concern in genomics research in Africa whilst there is growing international evidence drawing into question the direct link between stigma and genetics. In this paper, we interrogate practical instances from African genomics research where stigma was identified as a concern in an attempt to nuance and refine accounts of when stigma should be considered as an ethical issue. The paper describes examples involving gendered blame, polygamy, beliefs in supernatural disease causation and sensitive information about group lineage. We propose that the concern may not be about stigma so much as broader research-related harm, including for instance reputational harm to population groups. Furthermore, we propose to shift the analytical gaze from establishing causal relationships to exploring the intersection of genomics with pre-existing stigma. Finally, we emphasize the importance of ensuring genomics researchers are culturally competent, meaning able to recognise when cultural factors impact on the possibility that genomics research could cause harm.
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Affiliation(s)
- Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Guida Landouré
- Faculté de Médecine et d'Odontostomatologie, USTTB, Bamako, Mali; Service de Neurologie, CHU du Point "G", Bamako, Mali
| | - Ambroise Wonkam
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa
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21
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Kerr AM, Thompson CM, Rubinsky V. Memorable Messages Parents of Children with Vascular Birthmarks Receive from Others: Implications for Stigma and Identity. HEALTH COMMUNICATION 2020; 35:685-695. [PMID: 30793957 DOI: 10.1080/10410236.2019.1582314] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Parents of children with visible illnesses and physical differences, such as vascular birthmarks (VBs), often fear that their child will be stigmatized by others. Despite their use of various strategies to minimize this stigma, parents still frequently receive comments and questions from others about their child's condition. In the current study, we explore the source, content, and valence of these messages using a memorable messages framework. We also examine how parents react to messages from others and why those messages are considered memorable. To collect data, we administered a cross-sectional online survey through the website and social media pages of a national support group for parents of children with vascular birthmarks. A total of 70 parents completed the survey and, altogether, recalled 92 memorable messages. Our analyses revealed that the significance of the memorable messages coalesced around identity. Specifically, the messages described carried implications for a) participants in terms of their identities as parents, and b) participants' children in terms of their identities as stigmatized individuals. When messages were directed at parents, parents appraised them negatively or positively to the extent that they made parents feel judged or validated as parents of children with VBs. When messages were directed at children, parents appraised them negatively or positively to the extent that they labeled children and their VB as abnormal, unattractive, and undesirable, or accepted and complimented children as unique, special, and beautiful. The current research extends previous research exploring the role of memorable messages in negotiating identity.
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Affiliation(s)
- Anna M Kerr
- Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University
| | - Charee M Thompson
- Department of Communication, College of Liberal Arts and Sciences, University of Illinois Urbana Champaign
| | - Valerie Rubinsky
- School of Communication Studies, Scripps College of Communication, Ohio University
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Manyumwa P, Chimhundu-Sithole T, Marange-Chikuni D, Evans FM. Adaptations in pediatric anesthesia care and airway management in the resource-poor setting. Paediatr Anaesth 2020; 30:241-247. [PMID: 31910309 DOI: 10.1111/pan.13824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
The need for safe and quality pediatric anesthesia care in low- and middle-income countries (LMICs) is huge. An estimated 1.7 billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. Surgery is usually performed at three levels of facilities: district, provincial, and national referral hospitals. Unfortunately, the manpower, equipment, and other resources available to provide surgical care for children vary greatly at the different level facilities. The majority of district level hospitals are staffed solely by non-physician anesthesia providers with variable training and little support to manage complicated pediatric patients. Airway and respiratory complications are known to account for a large portion of pediatric perioperative complications. Management of the difficult pediatric airway pathology is a challenge for anesthesia providers regardless of setting. However, in the low-resource setting poor infrastructure, lack of transportation systems, and crippled referral systems lead to late presentation. There is often a lack of pediatric-sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low-fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.
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Affiliation(s)
| | - Tsitsi Chimhundu-Sithole
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Danai Marange-Chikuni
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Faye M Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, USA
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23
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Zhou Y, Mao X, Zhou H, Qin Z, Wang L, Cai Z, Yu B. Epidemiology of birth defects based on a birth defect surveillance system in Southern Jiangsu, China, 2014-2018. J Matern Fetal Neonatal Med 2020; 35:745-751. [PMID: 32098533 DOI: 10.1080/14767058.2020.1731459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Changzhou has been confronted with great challenges in birth defects (BDs) prevention, as the prevalence rates of BDs in Changzhou increased rapidly. The aims of this study were to describe the epidemiology of BDs in perinatal infants (PIs, including dead fetus, stillbirth, or live birth between 28 weeks of gestation and 7 days after birth) in Changzhou during the period from 2014 to 2018.Methods: The BD surveillance data of PIs were collected from 56 hospitals of Changzhou. The prevalence rate of BDs with 95% confidence interval (CI) were calculated by Poisson distribution. Univariate and multivariate Poisson regression was performed to identify the changing trends of prevalence rates of BDs by year and the association of regarding BD characteristics including year, infant gender, maternal age, and season with BDs successively.Results: From 2014 to 2018, there were a total of 238,712 PIs of which 1707 had BDs, with the average prevalence of 71.509 per 10,000 PIs, showing a remarkable uptrend (aPRR = 1.133, 95%CI: 1.094-1.173). The ten leading BDs were polydactyly, congenital heart defects (CHD), syndactyly, microtia, cleft lip and palate (CLP), hypospadias, cleft palate, other malformation of external ear (OMEE), congenital atresia of rectum and anus, and congenital talipes equinovarus (CTE). During the study period, the prevalence rates of polydactyly, CHD and syndactyly increased significantly (PRR = 1.195, 95%CI: 1.109-1.288, PRR = 1.194, 95%CI: 1.105-1.291, and PRR = 1.143, 95%CI: 1.007-1.297, respectively); the prevalence rates of congenital esophageal atresia decreased significantly (PRR = 0.571, 95%CI: 0.395-0.826). The risk of BDs was higher in male PIs versus female PIs (aPRR = 1.235, 95%CI: 1.123-1.358).Conclusions: A significant increase in the prevalence of BDs was detected from 2014 to 2018 in Changzhou. CHD, polydactyly, and syndactyly increased much and congenital esophageal atresia declined much. Male PIs was risk factor for occurrence of BDs. Collecting information on factors associated with BDs, setting the report time of BDs system at smaller gestational age so as to get an exact prevalence and make better prevention strategy, strengthening the publicity and education, improving the ability of monitoring, and wider use of new diagnosis technology are important to reduce the prevalence of BDs in PIs.
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Affiliation(s)
- Ying Zhou
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
| | - Xueqin Mao
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
| | - Hua Zhou
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
| | - Zhiqiang Qin
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
| | - Li Wang
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
| | - Zhengmao Cai
- Changzhou Commission of Health, Changzhou, China
| | - Bin Yu
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, China
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Iskandar RPD, Alida, Triwardhani A, Narmada IB, Hanum F, Kusumo AH, Nidom CA, Sudjarwo SA. Soluble Human Leukocyte Antigen Molecules Detected in Orofacial Cleft Patients: A Case-Control Study. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Alida
- Universitas Airlangga, Indonesia
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Deol R, Chattopadhyay D, Das A, Thakur V. Is cleft still a taboo? Beliefs and expectations of parents of cleft lip and palate patients: A study from an institute in North India. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2020. [DOI: 10.4103/jclpca.jclpca_13_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Adekunle AA, James O, Adeyemo WL. Health Information Seeking Through Social Media and Search Engines by Parents of Children With Orofacial Cleft in Nigeria. Cleft Palate Craniofac J 2019; 57:444-447. [DOI: 10.1177/1055665619884447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To ascertain the level of utilization of social media platforms and search engines by parents of children with orofacial cleft presenting to our clinic, with respect to information seeking about the condition and its treatment. Materials and Methods: All consenting parents of children attending the cleft outpatient clinic of the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, within the study period were included in the sample population. Data collection was done using a 17-item interviewer-administered questionnaire. Results: A total of 50 parents participated in the study. Eighty-eight percent first sought information about their child’s condition from hospital medical staff. Sixty-eight percent of the parents are active users of social media for general purposes, with Facebook being the most used platform (62%). Forty percent of the total respondents have used search engines/social media to seek information on their child’s condition, with majority of those (80%) using Google to search for such information, 35% of the search was in relation to diagnosis, and 75% of the parents considered the information obtained very useful. Only 3 parents reported being part of a social media support group based on their child’s condition. Conclusion: The use of Internet resources for information seeking among the population studied is low. There is need to leverage on social media to provide support groups for families with children who have cleft.
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Affiliation(s)
- Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Iskandar RPD, Proboningrat A, Fadholly A, Narmada IB, Nidom CA, Sudjarwo SA. The Densitometric Analysis of Protein Pattern in Cleft Lip and Palate Patients. J Int Soc Prev Community Dent 2019; 9:240-244. [PMID: 31198695 PMCID: PMC6559042 DOI: 10.4103/jispcd.jispcd_388_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/05/2019] [Indexed: 01/15/2023] Open
Abstract
Objectives Cleft lip and palate (CLP) belongs to the congenital anomaly that is clinically seen as cleft in lip, alveolar bone, palate, and nasal septum. The patients suffer from esthetic and various functional defects. CLP is resulted from impaired palatogenesis during the embryonic phase. The etiology of CLP is influenced by genetic, environmental, and combination of both. According to the literature, CLP is highly associated with defect in interferon regulatory factor 6 (IRF6) and poliovirus receptor-like (PVRL1) genes. The present study aimed to investigate the total protein profile and to identify protein IRF6 and PVRL1 in plasma of CLP patients. Materials and Methods Dot-Blot analysis was performed to identify protein target of IRF6 and PVRL1. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was performed in gel concentration 12% using plasma of CLP patients, their parents, and control population. The gels were stained by Coomassie blue afterward. Gels were analyzed through ImageLab 5.2.1 software. Results The intensity of major bands in CLP patients was darker than control group, but remains similar to the parents group. The target protein IRF6 and PVRL1 were positively identified through Dot-Blot. Retardation factor value was significantly different in major bands of CLP patients compared to control group. Conclusion There pattern of protein profile in CLP patients was different compared to non-CLP.
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Affiliation(s)
- Regina Purnama Dewi Iskandar
- Doctoral Student, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Orthodontics, Faculty of Dentistry, Airlangga University, Surabaya, Indonesia
| | - Annise Proboningrat
- Doctoral Student, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
| | - Amaq Fadholly
- Doctoral Student, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
| | - Ida Bagus Narmada
- Department of Orthodontics, Faculty of Dentistry, Airlangga University, Surabaya, Indonesia
| | - Chairul Anwar Nidom
- Department of Veterinary Basic Medicine, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
| | - Sri Agus Sudjarwo
- Department of Veterinary Basic Medicine, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
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Hlongwa P, Levin J, Rispel LC. Epidemiology and clinical profile of individuals with cleft lip and palate utilising specialised academic treatment centres in South Africa. PLoS One 2019; 14:e0215931. [PMID: 31071123 PMCID: PMC6508722 DOI: 10.1371/journal.pone.0215931] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/10/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The study was conducted to determine the epidemiology and clinical profile of individuals with cleft lip and/or palate (CLP) utilizing specialized academic treatment centres in South Africa's public health sector. MATERIALS AND METHODS The Human Research Ethics Committee of the University of the Witwatersrand in Johannesburg provided ethical approval for the study. We conducted a retrospective record review of all cases of CLP treated at the specialised academic centres for the two-year period from 1 January 2013 until 31 December 2014. We used a structured, pre-tested record review form to obtain demographic, clinical and treatment information on each CLP case. We used Stata 13 to analyse the data and conducted statistical tests at 5% significance level. RESULTS We analysed 699 records of individuals with CLP. The estimated prevalence of CLP in the South African public health sector was 0.3 per 1000 live births, with provincial variation of 0.1/1000 to 1.2/1000. The distribution of clefts was: 35.3% cleft palate; 34.6% cleft lip and palate; 19.0% cleft lip and other cleft anomalies at 2%. Of the total number of CLP, 47.5% were male and 52.5% female, and this difference was statistically significant (p<0.001). The majority of clefts occurred on the left for males (35.5%) and palate for females (43.4%), with a male predominance of unilateral cleft lip and palate (53.3%). CONCLUSION The study findings should inform the implementation of South Africa's planned birth defect surveillance system and health service planning for individuals with CLP.
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Affiliation(s)
- Phumzile Hlongwa
- School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Laetitia C. Rispel
- Centre for Health Policy & DST/NRF SARChI Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
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Parents' Knowledge, Attitude and Behaviour toward Cleft Lips and Cleft palate in Kencana Hospital, Serang, Banten. J Craniofac Surg 2019; 30:1105-1108. [PMID: 30817518 DOI: 10.1097/scs.0000000000005352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cleft lips (CL) and cleft palate (CP) are common congenital diseases caused by gene mutation in embriology development of the lips and mouth at 4 weeks of gestation. CL and CP can cause several problems such as difficulty in eating, speaking, abnormality in teeth and mouth development and ear iritation. Adequate treatment is needed to improve patients' quality of life. MATERIAL AND METHOD This cross sectional study take samples purposively from all parents who joined in cleft charity surgery in Kencana Hospital, Serang, Banten on October 24th 2018. This study identify parents' knowledge, attitude and behaviour towards CL and CP and analyzed the relationship of parents' knowledge and attitude towards CL and CP. Statistical analysis used in this study is Fisher method. RESULT Ten patients undergo labioplasty surgery, 1 patient undergo labioplasty revision, 5 patients undergo palatoplasty surgery and 10 patients undergo labioandpalatoplasty surgery. The majority of parents' education background have income < 3,5 million a month 84.6% (22 people), do not have any social insurance 88.5% (23 people) and joined in because of they cannot pay for medical treatment 96,2% (25 people). 6.2% (25 people) have under knowledge, 69.2% (18 people) have good attitude and 84.6% (22 people) have good behaviour toward CL and CP. There is no significant relationship between parents' knowledge and attitude toward CL and CP P value = 1,00 (P > 0,05). DISCUSSION Parent's under knowledge is caused by their low educational background and inaccurate information and education provided by medical professional. But, they had a good attitude and behaviour toward CL and CP because they had initiative to look for medical help and treat their children same as other normal one. Although they received inaccurate information and education about cleft disease, all parents looked for medical help and did what they were told by medical professionals. CONCLUSION The majority of parents in this study have under knowledge about cleft lips and cleft palate but they are still looking for medical help to treat their children. This charity significantly helps parents whose children have cleft lips, with or without cleft palate, to get treated in that area.
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Feragen KB, Stock NM. Factors affecting subjective appearance evaluations among patients with congenital craniofacial conditions: An application of Cash's cognitive-behavioural model of body image development. Body Image 2018; 24:124-136. [PMID: 29414145 DOI: 10.1016/j.bodyim.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
Satisfaction with appearance is of central importance for psychological well-being and health. For individuals with an unusual appearance, such as congenital craniofacial anomalies (CFA), appearance evaluations could be especially important. However, few, if any papers have presented a comprehensive synthesis of the factors found to affect subjective satisfaction with appearance among children, adolescents, and adults born with a CFA. Further, only a handful of craniofacial studies have applied psychological theories or models to their findings, resulting in an overall lack of guidance for researchers in the field. This paper summarises the literature pertaining to satisfaction with appearance among those affected by CFAs, and examines the extent to which Cash's cognitive-behavioural model of body image development (2012) fits with this literature. Given the overlap between factors of interest in the field of CFAs, and in the area of body image more broadly, a closer collaboration between the two research fields is suggested.
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Affiliation(s)
| | - Nicola Marie Stock
- 'Scar Free Foundation Research Fellow' at the 'Centre for Appearance Research and The Cleft Collective', University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom.
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