Predictors of Delayed Cleft Lip and Palate Surgery: A Case-Control Study in Addis Ababa, Ethiopia

Orofacial clefts are common anomalies, and timely treatment is essential for optimal outcomes. In low- and middle-income countries, surgical delays are frequent, yet contributing factors remain understudied. This study aims to identify and quantify these factors at a tertiary medical center in Ethiopia.

An institution-based unmatched case-control study was conducted among 98 patients between January 2023 and December 2024. Cases included patients undergoing surgery after the recommended age (cleft lip >6 mo; cleft palate >12 mo), whereas controls received timely surgery. Data were collected from medical records and telephone interviews. Bivariate analysis and multivariate logistic regression were performed to determine predictors.

Isolated cleft palate (adjusted odds ratio = 21.72; 95% confidence interval [CI], 4.17-113.12; P < 0.001) and greater distance to a cleft center (per kilometer increase: odds ratio = 1.012; 95% CI, 1.003-1.021; P = 0.007) were significantly associated with delayed treatment. Lack of formal education of caregivers showed a strong borderline association (adjusted odds ratio = 8.61; 95% CI, 0.68-108.89; P = 0.096). Post-hoc power exceeded 99.9%. The final model demonstrated good performance, with an area under the receiver operating characteristic curve of 0.875 and acceptable fit (Hosmer-Lemeshow χ² = 11.037; degrees of freedom = 8; P = 0.200).

Cleft type and geographic barriers were the primary determinants of delayed surgery. Patients with isolated cleft palate and those residing farther from specialized centers had higher odds of delayed treatment. Interventions should focus on improving early detection, referral pathways, and access to cleft care.