American Council of Academic Plastic Surgeons
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Combining Search Query Data with Operation Smile and Smile Train Outreach to Better Understand Global Cleft Surgical Care
Joshua P. Weissman, BBA1; Narainsai K. Reddy, BA2; Nikhil D. Shah, BS1; Arun K. Gosain, MD1,2
1Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 2Lurie Children's Hospital, Chicago, IL, USA

Background: Understanding patient awareness of cleft lip and/or palate (CL/P) and evaluating demand for necessary procedures may serve to better target future efforts in global outreach. One potential solution to help understand patient demand for cleft care is assessing the density of cleft-related internet search terms in developing countries.
Methods: We utilized internet search query data from Google Trends for the terms: “cleft lip”, “cleft palate”, “cleft lip and palate”, “cleft surgery”, and “cleft repair” from January 2004 to January 2021. Relative search volumes (RSV) recorded for the top 5 highest displaying countries and top three available regions within those countries were compared against global outreach by Operation Smile, as measured by the number of patients treated. World Health Organization (WHO) indicators were used to validate the RSV values for each country and better understand the current infrastructure and need for cleft care in those countries.
Results: Globally, there was an increase in RSV for the terms “cleft lip,” “cleft palate,” “cleft repair,” and “cleft surgery” between 2004 and 2021. For “cleft lip,” the countries with the highest displaying RSVs included: Ghana (100%), Zimbabwe (97%), Nepal (78%), the Philippines (64%), and Kenya (52%). Countries with high RSVs and moderate to high WHO indicators included Ghana, Kenya, India, Nigeria, and Zimbabwe. Countries with high RSVs and poor WHO indicators included Nepal and Pakistan. Some countries had specific regions with high search demand that are not currently targeted for global outreach.
Conclusion: Using Google Trends’ longitudinal data may help find more feasible locations and targeted care for efforts in global outreach with better patient awareness and turnout where demand for CL/P is increasing. We describe a strategy that may be used to improve global outreach for patients, providers, and international organizations such as Operation Smile. By enhancing our understanding of patient demand based on relative search interest by country and subregion, global health organizations can better direct their efforts in providing care to those populations that express a high interest in cleft care but may not have the provision to provide this care.

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