The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review
James R. Wester, Joshua P. Weissman, Narainsai K. Reddy, Emily S. Chwa, Arun K. Gosain
Abstract
OBJECTIVE: To identify practices and limitations of cleft care in sub-Saharan Africa (SSA). DESIGN: A retrospective narrative nonsystematic literature review was performed. SETTING: Literature exploring the management practices of cleft lip and/or palate across regions in SSA was included. PARTICIPANTS: Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles written and published in English between 1966 and February 1, 2021, were included in this analysis utilizing PubMed, MEDLINE, EMBASE, and Google scholar databases. MAIN OUTCOME MEASURES: Qualitative themes identified in analysis were clinical practice patterns, current infrastructure and limitations of cleft repair, training and interdisciplinary teams, economic analyses, and international partnerships. RESULTS: Significant barriers to care identified in SSA include lack of hospital resources, craniofacial training, access to multidisciplinary specialists, and public awareness. These problems make the entire care journey difficult for patients. Increasing public education has the power to diminish late presentations to hospitals. Providing adequate hospital resources and craniofacial training through international and organizational partnerships can ensure that more patients will receive care. Increasing the availability and number of multidisciplinary specialists is crucial to follow up care which aims at improving functional outcomes. CONCLUSION: This narrative review highlights current practices and limitations in cleft care, emphasizing the importance of effective and timely repair of clefts in SSA. Targeted efforts aimed at establishing sustainable infrastructure for cleft care in SSA can have significant individual and community health and economic benefits.