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Original Investigation |

Estimate of Unmet Need for Cleft Lip and/or Palate Surgery in India

Barclay T. Stewart, MD, MScPH1,2,3; Lucas Carlson, MD, MPH4; Kristin Ward Hatcher, MPH5; Abhishek Sengupta, MSc6; Richard Vander Burg, RN5
[+] Author Affiliations
1Department of Surgery, University of Washington, Seattle
2School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
3Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
4Harvard Affiliated Emergency Medicine Residency, Brigham & Women's Hospital, Boston, Massachusetts
5Operation Smile, Virginia Beach, Virginia
6Operation Smile, Mumbai, India
JAMA Facial Plast Surg. 2016;18(5):354-361. doi:10.1001/jamafacial.2016.0474.
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Importance  The unmet need for cleft lip and/or palate (CL/P) care in India is significant. However, estimates required for CL/P care program planning are lacking.

Objective  To estimate the unmet need for CL/P surgery in India at the state level.

Design, Setting, and Participants  To determine the proportion of individuals with CL/P who presented for care in India, data were used from patients who received care at Operation Smile programs in 12 low- and middle-income countries from June 1, 2013, to May 31, 2014. The resulting model describes the prevalent unmet need for cleft surgery in India by state and includes patients older than the surgery target ages of 1 and 2 years for cleft lip and cleft palate repair, respectively. Next, the total number of unrepaired CL/P cases in each state was estimated using state-level economic and health system indicators.

Main Outcomes and Measures  Prevalent unmet need for CL/P repair.

Results  In the 28 states with available data, an estimated 72 637 cases of unrepaired CL/P (uncertainty interval, 58 644-97 870 cases) were detected. The percentage of individuals with unrepaired CL/P who were older than the respective target ages ranged from 37.0% (95% CI, 30.6%-43.8%) in Goa to 65.8% (95% CI, 60.3%-70.9%) in Bihar (median, 57.9%; interquartile range, 52.6%-63.4%). The rate of unrepaired CL/Ps ranged from less than 3.5 per 100 000 population in Kerala and Goa to 10.9 per 100 000 population in Bihar (median rate, 5.9 [interquartile range, 4.6-7.3] per 100 000 population).

Conclusions and Relevance  An estimated 72 000 cases of unrepaired CL/P are found in India. Poor states with less health care infrastructure have exceptionally high rates (eg, Bihar). These estimates are useful for informing international and national CL/P care strategies, allocating resources, and advocating for individuals and families affected by CL/P more broadly.

Level of Evidence  NA.

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Figure.
Rate of Unmet Need for Cleft Lip and/or Palate Surgery in Each State in India

Rates are estimated per 100 000 population.

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