Date Published: May 9, 2019
Publisher: Public Library of Science
Author(s): Phumzile Hlongwa, Jonathan Levin, Laetitia C. Rispel, Kahabi Ganka Isangula.
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.
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.
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%). The study findings should inform the implementation of South Africa’s planned birth defect surveillance system and health service planning for individuals with CLP.
Congenital anomalies, defined as abnormalities of structure, function, or metabolism that are present at birth, are a major public health concern due to their life threatening nature or the potential to result in disability or death. Worldwide, it is estimated that 303 000 new-born infants die within four weeks of birth every year, due to congenital anomalies . Clefting of the lip with or without palate (CLP) is the most common congenital craniofacial anomaly with the global prevalence estimated at 1 in 700 live births . Orofacial clefts can occur on the lip only (CL), alveolar (CA), involve both lip and alveolar, affect the palate (CP) or involve both lip and palate (CLP). A cleft of the lip and/ or palate is serious, as it also affects negatively an individual’s self-esteem, social skills, and behaviour [3–5].
We reviewed 717 CLP records from 10 specialised academic centres, 18 were excluded from the study because of incomplete data, and the final sample was 699 records.
The prevalence rate for CLP in individuals utilising the specialised academic treatment centres in South Africa’s public sector was estimated to be 0.3 per 1000 live births and 0.4 per 1000 when the denominator was adjusted. This prevalence rate could be underestimated, because it excludes stillbirths, abortions and those children who might have died within the first three months of birth, or before seeking care. Nonetheless, this rate is also comparable to those found in Nigeria of 0.5 per 1000 live births  and higher than that of Ethiopia at 0.2 per 1000 live births . In contrast, the prevalence rate reported in our study is lower than the rates reported for a population base birth defects registries from 30 countries from 54 international craniofacial registries during the period 2000 to 2005, where the overall prevalence of CLP was 1.0 per 1000 .
The study has generated new knowledge on the epidemiology and clinical profile of individuals with CLP in the South African public health sector. It is imperative for South Africa to establish an active birth surveillance system on congenital anomalies to enable comprehensive management of CLP individuals and to inform health service planning and policy.