American Council of Academic Plastic Surgeons
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Current Practices and Challenges in Cleft Care in sub-Saharan Africa
Emily S Chwa, BA1; James R Wester, BA1; Joshua P Weissman, BBA1; Narainsai K Reddy, BA2; Arun K Gosain, MD1,2
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 2Lurie Children's Hospital, Chicago, IL, USA

Background: There is currently a paucity of research on the current practice of cleft care in sub-Saharan Africa (SSA). Understanding the unique burden of cleft lip and palate in SSA will better enable outreach programs and surgical providers to adequately address the needs of the local community
Methods: Current cleft care infrastructure in sub-Saharan Africa was reviewed using PubMed, MEDLINE, EMBASE, and Google Scholar to assess current practices, limitations to cleft management, and international partnerships. Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles written and published in English between 1966 and February 1, 2021 were included. Qualitative themes were explored and analyzed utilizing a retrospective non-systematic narrative review
Results: Significant barriers to care identified in SSA include lack of hospital resources, craniofacial training, access to multidisciplinary specialists, and public awareness with patients often presenting on average at 9.8 years of age. Increasing public education and awareness of surgical care was determined to be the primary method to mitigate late presentations to hospitals. The addition of local training programs in SSA, largely through the College of Surgeons of East, Central, and Southern Africa (COSECSA) program, has enhanced local retention rates of craniofacial cleft surgeons. Common themes in building an international cleft program in SSA include preserving indigenous culture, assisting local surgeons in creating a multidisciplinary and collaborative surgical team, and further focusing on patient safety and awareness
Conclusion: Targeted efforts aimed at establishing sustainable infrastructure for cleft care can have significant individual and community health and economic benefits in sub-Saharan Africa. Efforts should be focused towards additional surgical training programs, concrete practice guidelines specific to SSA, and sustainable international partnerships. Further study into the longitudinal impact of cleft surgical training programs in SSA would provide meaningful data as these programs are new in scope.

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