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Prevalence and Factors Associated With Preoperative Malnutrition Among Nonsyndromic Cleft Lip and Palate in Rwanda
Thierry Cyuzuzo1,2, Joel Nshumuyiki1, Chaste Dominique Niyihuza1
1From the College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Insights
Nearly half of Rwandan infants with cleft lip and/or palate (CL±P) were malnourished before surgery. Cow's milk consumption and cleft type were significant factors, highlighting the need for improved preoperative nutritional support.
Area of Science:
- Pediatric Surgery
- Nutritional Science
- Craniofacial Anomalies
Background:
- Cleft lip and/or palate (CL±P) is a common congenital craniofacial anomaly.
- Affected children face high malnutrition risk due to feeding difficulties.
- Preoperative malnutrition is a significant concern in nonsyndromic CL±P patients.
Purpose of the Study:
- To determine the prevalence of preoperative malnutrition in Rwandan children with nonsyndromic CL±P.
- To identify factors associated with malnutrition in this population.
Main Methods:
- A multicenter cross-sectional study involving children under 5 years undergoing primary cleft repair.
- Nutritional status assessed using WHO growth standards; malnutrition defined by stunting or wasting.
- Data analyzed using descriptive statistics, bivariate analysis, and logistic regression.
Main Results:
- Overall malnutrition prevalence was 47% (stunting 41%, wasting 9%) among 116 infants.
- Malnutrition associated with older age, lack of nutrition education, non-breastfeeding, early complementary feeding, cow's milk, and cleft type.
- Multivariate analysis identified cow's milk consumption and cleft type (palate or lip and palate) as significant factors.
Conclusions:
- Almost half of operated cleft patients were malnourished preoperatively.
- Strengthening preoperative nutritional support is crucial to mitigate malnutrition burden.
- Targeted interventions addressing cow's milk consumption and cleft type may improve outcomes.
Background:
Cleft lip and/or palate (CL±P) is among the most common congenital craniofacial anomalies, with affected children at high risk of malnutrition due to feeding difficulties. This study aimed to determine the prevalence and factors associated with preoperative malnutrition among patients with nonsyndromic CL±P in Rwanda.
Methods:
A multicenter cross-sectional study was conducted over a 1 year period among children younger than 5 years undergoing primary cleft repair. Nutritional status was assessed using the World Health Organization growth standards. Malnutrition was defined as stunting (height-for-age z score ≤ -2) or wasting (weight-for-length z score ≤ -2). The data were analyzed using descriptive statistics, bivariate analysis, and logistic regression.
Results:
Of 116 infants, the median age was 6.5 months (interquartile range: 3-10 mo), and 64% were male. The overall prevalence of malnutrition was 47% (95% confidence interval: 38-56). Stunting was observed in 41% (19% moderate, 22% severe) and wasting in 9% of the patients. Malnutrition was significantly associated with older infant age (P = 0.0099), lack of postnatal nutrition education (P = 0.0232), nonbreastfeeding at the time of surgery (P = 0.0088), early introduction of complementary feeding (P = 0.0034), cow's milk consumption (P < 0.001), and having both cleft lip and palate (P = 0.0101). On multivariate analysis, the consumption of cow's milk (P = 0.001) and cleft type (palate or lip and palate) (P = 0.028) remained significant factors.
Conclusions:
Nearly half of the cleft patients operated on were malnourished preoperatively. Strengthening preoperative nutritional support is essential to reduce this burden.
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