The connection between cleft palate and malnutrition | Think global health

In 2022, the world faces unprecedented food crises driven by conflict conflict, climate change and COVID-19. Russia’s invasion of Ukraine drastically reduced the global sourcing cereals and restricts farmers’ access to fertilizers, driving up food prices. Global fluctuations in climate exert direct effects on crop yields, animal production, and fisheries and aquaculture systems, while also influencing the pillars of food safety— availability, access, use and stability. Meanwhile, COVID-19-related disruptions continue, with declining incomes and rising poverty threatening access To food. In this context, it is more urgent than ever to tackle the health consequences of food insecurity.

In communities experiencing food crises, children with orofacial clefts (cleft lip and/or palate) are among the most vulnerable. According to a new global analysis from Institute of Health Metrics and Evaluation and smile train, the largest slot-focused non-profit organization in the world. Almost half of malnutrition-related deaths in people with orofacial clefts could potentially be prevented with access to adequate treatment and support.

Children with a cleft lip or cleft palate are more prone to infectious diseases than children without a cleft

The Relationship Between Cleft and Malnutrition

Cleft lip and cleft palate occur when a baby’s lip or the roof of the mouth not forming properly in the womb. Cleft conditions increase children’s risk of developing health problems. They struggle to receive adequate nutrition due to their condition, which subsequently weakens their immune response. Children with a cleft lip and/or palate are more prone to infectious diseases than children without a cleft. Cleft abnormalities impair the function of the nasal cavity, increasing the likelihood of developing ear infections. Children with clefts are also at higher risk of aspiration pneumonia, which can occur when food or liquid gets lodged in the lungs.

Because cleft conditions make feeding difficult, children with these conditions are predisposed to stunting and being underweight. Breastfeeding and bottle-feeding take longer for children with clefts; it is common for them to regurgitate food through their nose and mouth when nursing.

Sharon Wumocha, a mother from Kenya who has a baby with an orofacial cleft, described in an interview with Devex the difficulties encountered by her infant son during breastfeeding. She said her son’s mouth would overflow with milk and it would “almost choke him”.

Malnutrition is not only a consequence of orofacial clefts, it can also be the cause. Children are more likely to be born with clefts when their mother or parents are sick or malnourished during pregnancy, or lack essential micronutrients, such as folic acid and zinc. Clefts are more likely to occur when a parent does not gain enough weight during pregnancy. Smoking tobacco during pregnancy or being exposed to high levels of air pollution are also risk factors for cleft.

In children under five years of age who have orofacial clefts, the regions South Asia and parts of Africa are the most affected by malnutrition. African countries stretching from Mali to Somalia have the highest rates of death from cleft-related malnutrition. Many countries with higher rates of orofacial clefts also appear in the world food program ten countries with the highest number of people in food crisis. These countries include Afghanistan, Democratic Republic of Congo, Ethiopia, Nigeria, Pakistan, South Sudan and Sudan. By targeting food security program interventions to children with clefts in these areas, policy makers could maximize humanitarian assistance.

Total prevalence of children under 5 years of age who are underweight with a cleft

Total prevalence of underweight children (per 1,000 people) among those with a cleft, under 5, both sexes, 2020

Cleft palate and lip surgery

Surgery to repair a cleft palate and/or lip is not possible immediately after birth due to the risks associated with anesthesia of a very small baby. Also, doing the surgery too soon increases the likelihood that it will not be effective. Most cleft surgeries occur in children between the ages of three months and two years. In addition, children must be strong enough to undergo surgery. If the child is malnourished or fighting an infection, they cannot have surgery until their body is healthy enough to withstand the procedure. When a child undergoes corrective surgery under deteriorating health conditions, there is a greater chance that the repair will fail and postoperative complications will arise.

Early intervention to identify children with orofacial clefts and provide support to their parents and caregivers can reduce the risk of children dying from malnutrition or other health complications. Ensuring that children with clefts are diagnosed by a medical professional and receive treatment as soon as possible can save lives. From 2000 to 2020, there has been a marked improvement in the general population in terms of reducing the prevalence of underweight. However, for children with clefts, the improvements were much slower.

Without early diagnosis and intervention, children with clefts often fall further and further behind on the growth curve. Providing support and education to parents or caregivers is essential to ensure that children with clefts receive adequate nutrition, prompt treatment for any infection that occurs, and surgery to repair their cleft as soon as possible.

In Ethiopia, Getaw Alamnia is a Plastic and Reconstructive Surgeon at Yekatit 12 Medical College Hospital in Addis Ababa, a Smile Train Hospital. Alamnie strives to make cleft surgeries safer. “There is a higher risk of complications with surgery in children than in adults, and when it comes to patients with clefts, the majority of whom are children, because they have difficulties eating, they tend to be underweight and have compromised nutrition,” he said. said in a interview with SmileTrain in May 2022.

“Part of this job is to address these issues as much as possible to strengthen the child before surgery,” he added.

In Peru, nutrition consultant Adriana Zavalaga started a program to help children with clefts grow stronger before having surgery. Zavalaga volunteers with Misión Caritas Felices, a partner organization of Smile Train. In a March 2021 interview, Zavalaga describes which motivated her to start the cleft surgery preparation program.

“We noticed a pattern of malnutrition and anemia in many of these patients that would temporarily disqualify them from cleft surgery,” she said. Through this program, Zavalaga provides nutrition education to families of children scheduled for cleft surgery and distributes healthy food to families in need.

Much remains to be done to respect the fundamental human right to food. As aid workers grapple with the challenge, focusing on children with clefts can reduce the burden of malnutrition. By providing healthy foods, such as protein, whole grains, fruits and vegetables, nutritional counseling and medical support to families of children with clefts, and implementing a treatment plan that includes follow-up care, up to half of the malnutrition-associated deaths that occur each year are potentially preventable.

People carry sacks of rice, humanitarian aid sent by China to Afghanistan, at a distribution center in Kabul, Afghanistan, April 7, 2022.
REUTERS/Ali Khara

EDITOR’S NOTE: The authors are employed by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which produced the research described in this article. IHME collaborates with the Council on Foreign Relations on Think Global Health. All statements and opinions expressed in this article are solely those of the individual author and are not necessarily shared by his or her institution.

Nicholas J. Kassebaum, MD, is Adjunct Associate Professor of Health Metrics and Global Health in the Institute for Health Metrics and Evaluation and Associate Professor in the Department of Anesthesiology and Pain Medicine at the University from Washington.

Theresa A. McHugh, PhD, is a science writer at the Institute for Health Metrics and Evaluation, where she focuses on neonatal and child health research and disease-related expenditures.

Katherine Leach-Kemon is a policy translation manager at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Christine E. Phillips