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"Barriers to Care Associated with Pediatric Orofacial Clefts Global Disease Burden"
Erin K O'Connor1, Adee J Heiman2, Kexin Li3
1Medical Student, University of Michigan Medical School, Ann Arbor, MI.
Insights
Barriers like limited internet access, poor roads, and fewer doctors increase cleft disease burden globally. Improving surgical workforce and using telehealth can enhance cleft repair rates, especially in low-income countries.
Area of Science:
- Global Health
- Pediatric Surgery
- Public Health Policy
Background:
- Orofacial clefts present a significant health burden, disproportionately impacting low- and middle-income countries (LMICs).
- Understanding barriers to cleft care is crucial for reducing pediatric disease burden and improving repair rates worldwide.
Purpose of the Study:
- To identify global barriers to seeking, accessing, and receiving cleft care.
- To analyze associations between developmental indicators and pediatric cleft disease burden and repair rates.
Main Methods:
- Extracted 2021 Global Burden of Disease data on orofacial clefts (incidence, prevalence, DALYs, mortality).
- Estimated cleft repair rates and used multivariable linear regression to link DALYs and repair rates with global developmental indicators.
Main Results:
- LMICs exhibit higher unrepaired cleft prevalence, DALYs, and mortality; incidence is similar across income levels.
- Decreased physician workforce, limited internet use, and lower road density correlate with increased cleft burden.
- Higher surgeon volume, internet use, and health expenditure correlate with increased cleft repair rates.
Conclusions:
- Limited internet, poor road infrastructure, and a smaller physician workforce are linked to higher cleft burden.
- A lower surgical workforce is associated with reduced cleft repair rates.
- Strategies include alternative information dissemination, telehealth expansion, and strengthening healthcare workforces.
Background:
Orofacial clefts disproportionately affect low- and middle-income countries. This study aims to identify barriers to seeking, accessing, and receiving cleft care that are associated with increased pediatric cleft disease burden and repair rates globally.
Methods:
Live birth, incidence, prevalence, disability-adjusted life year (DALY), and mortality rates of pediatric orofacial clefts were extracted from the 2021 Global Burden of Disease database for each country. Cleft repair rates were estimated based on this data. Multivariable linear regression was used to determine associations between log-transformed DALYs and cleft repair rates with several global developmental indicators.
Results:
Unrepaired cleft prevalence, DALYs, and mortality were highest in LMICs, although incidence per live birth was not statistically different across income groups. Compared to 2019, global prevalence remained unchanged and DALYs decreased as a result of lower mortality rates across all income groups. LogDALYs were associated most closely with fewer doctors, decreased internet use, and lower road density. Repair rates were closely associated with greater surgeon volume, mobile phone (or internet) use, and health expenditure. NGO presence was not significantly associated with repair rates after adjustment for other variables.
Conclusion:
Decreased internet use, lower road density, and decreased physician workforce were independently associated with increased cleft burden. Lower surgical workforce was associated with decreased rates of cleft repair. Efforts to address these barriers to care include using alternative methods of information dissemination, spreading telehealth efforts in areas with adequate technological infrastructure, and bolstering surgical and physician workforce.
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