title: Ten-year experience of more than 35,000 orofacial clefts in Africa.
abstract: BACKGROUND
  Surgical correction of orofacial clefts greatly mitigates negative outcomes. However, access to reconstructive surgery is limited in developing countries. The present study reviews epidemiological data from a single charitable organization, Smile Train, with a database of surgical cases from 33 African countries from 2001-2011.
  
  
  METHODS
  Demographic and clinical patient data were collected from questionnaires completed by the participating surgeons. These data were recorded in Excel, analyzed using SPSS and compared with previously reported data.
  
  
  RESULTS
  Questionnaires were completed for 36,384 patients by 389 African surgeons. The distribution of clefts was: 34.44% clefts of the lip (CL), 58.87% clefts of the lip and palate (CLP), and 6.69% clefts of the palate only (CP). The male to female ratio was 1.46:1, and the unilateral: bilateral ratio 2.93:1, with left-sided predominance 1.69:1. Associated anomalies were found in 4.18% of patients. The most frequent surgeries included primary lip/nose repairs, unilateral (68.36%) and bilateral (11.84%). There was seasonal variation in the frequency of oral cleft births with the highest in January and lowest by December. The average age at surgery was 9.34 years and increased in countries with lower gross domestic products. The average hospital stay was 4.5 days. The reported complication rate was 1.92%.
  
  
  CONCLUSIONS
  With the exception of cleft palates, results follow trends of worldwide epidemiologic reports of 25% CL, 50% CLP, and 25% CP, 2:1 unilateral:bilateral and left:right ratios, and male predominance. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting that limitations in economic resources and cultural aesthetics of the obvious lip deformity may outweigh functional concerns and access to treatment for females. A fewer than expected associated anomalies suggests either true ethnic variation, or that more severely-affected patients are not presenting for treatment. The epidemiology of orofacial clefting in Africa has been difficult to assess due to the diversity of the continent and the considerable variation among study designs. The large sample size of the data collected provides a basis for further study of the epidemiology of orofacial clefting in Africa.
authors.affiliation: Department of Pediatrics at Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1497, New York, NY, 10029, USA. juliaclaireconway@gmail.com.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Conway
authors.affiliation: Department of Pediatrics at Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1497, New York, NY, 10029, USA. peter.taub@mountsinai.org.|Department of Surgery at Icahn School of Medicine at Mount Sinai, New York, NY, USA. peter.taub@mountsinai.org.|Department of Dentistry at Icahn School of Medicine at Mount Sinai, New York, NY, USA. peter.taub@mountsinai.org.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taub
authors.affiliation: State University of New York Downstate Medical School, Brooklyn, NY, USA. rochelle.kling@gmail.com.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Kling
authors.affiliation: Johns Hopkins University Medical School, Baltimore, MD, USA. oberoik@umich.edu.
authors.forename: Kurun
authors.initials: K
authors.lastname: Oberoi
authors.affiliation: Department of Preventive Medicine at Icahn School of Medicine at Mount Sinai, New York, NY, USA. john.doucette@mssm.edu.
authors.forename: John
authors.initials: J
authors.lastname: Doucette
authors.affiliation: Department of Pediatrics at Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1497, New York, NY, 10029, USA. ethylin.jabs@mssm.edu.|Department of Genetics and Genomic Sciences at Icahn School of Medicine at Mount Sinai, New York, NY, USA. ethylin.jabs@mssm.edu.|Developmental and Regenerative Biology at Icahn School of Medicine at Mount Sinai, New York, New York, USA, New York, NY, USA. ethylin.jabs@mssm.edu.
authors.forename: Ethylin Wang
authors.initials: EW
authors.lastname: Jabs
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology / Q000601:surgery; D000349:Africa / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000453:epidemiology* / Q000601:surgery*; D002972:Cleft Palate / Q000453:epidemiology* / Q000601:surgery*; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012621:Seasons; D017678:Sex Distribution; D011795:Surveys and Questionnaires