The Near‐Absence of Isolated Cleft Palate in a Surgical Mission Cohort in Ethiopia: Implications for Infant Mortality and Disease Recognition

ABSTRACT

In Ethiopia, cleft lip and/or palate is a major public health concern. In this study, we compiled clinical statistics on patients who presented during 7 years of surgical medical aid missions and examined possible background factors underlying the striking imbalance in cleft types (i.e., the apparent absence of isolated cleft palate) compared with those in developed countries. All 150 patients examined during surgical medical aid missions conducted between 2013 and 2019 were included. Age, sex, cleft type, surgery performed, and reasons for cancellation were analyzed retrospectively. The mean age of the 150 patients was 4.9 years. Most cases were cleft lip (unilateral cleft lip with or without cleft alveolus) and cleft lip and palate, whereas only two cases (1.3%) were isolated cleft palate. Surgery was performed in 93 cases (62.0%); however, all procedures were cheiloplasty, and palatoplasty was not performed for safety‐related reasons. The surgical cancellation rate was high (38.0%), mainly due to infection and malnutrition. The extreme paucity of patients with isolated cleft palate suggests an “unobserved mortality” in the region. Early death (natural selection) due to feeding difficulties and lack of disease recognition may be the contributing factors. This “cleft‐type imbalance” indicates an urgent need not only to provide surgery, but also to implement early screening and nutritional interventions at the community level.