"Barriers to Care Associated with Pediatric Orofacial Clefts Global Disease Burden".

Abstract

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. 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. 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. 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.