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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 34-37

Clinico-epidemiological profile of orofacial clefts among children of coastal district of Southern India: A 5 year hospital based study


1 Assistant Professor, Department of Orthodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
2 Intern, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
3 Professor, Department of Forensic Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
4 Professor, Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India

Date of Web Publication5-Feb-2014

Correspondence Address:
Supriya Nambiar
Department of Orthodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka
India
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Source of Support: This study was undertaken as a short term research program Reference Id 2011-01885 with funding from the Indian council of medical research., Conflict of Interest: None


DOI: 10.4103/2348-2125.126554

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  Abstract 

Background: In India with a large multi ethnic population, most of the epidemiological studies on cleft lip/palate (CL/P) have been sporadic. Inequalities exist, both in access to and quality of cleft care with distinct differences in urban versus rural access and over the years the accumulation of unrepaired clefts of the lip and palate make this a significant health care problem in India. Aims and Objectives: The primary aims of this study was to assess the predominant pattern of cleft lip and palate (CLP) cases in Mangalore and secondary aim is to evaluate the role of possible risk factors like previous familial history, maternal diet and nutritional supplementation, consanguinity. Materials and Methods: This was a 5-year hospital based, retrospective study of the birth records, in which all the cases of CL/P up to the age group of 5 years were studied. The data was retrieved from the Medical Records Department of two main hospitals in Mangalore. The data was collected using a semi-structured, pre-tested proforma that was designed based on the review of literature. Results: The cleft occurrence in Mangalore was found to be 2.42/1000 births/year. Cleft lip (CL) along with cleft palate (CP) was found to be the highest in both Hospitals about (64.6%), followed by isolated CL (28.5%), followed by isolated CP (5.1%) and the least being isolated CL with cleft alveolus (1.9%). Conclusions: From the study, it can be concluded that recording of adequate ante-natal history in the birth records hasn't been given critical Importance. Furthermore, there is a lack of parental counseling provided in the government hospital.

Keywords: Birth records, counseling, level of care, management, oro-facial clefts, risk factors


How to cite this article:
Nambiar S, Singhal P, Menon A, Unnikrishnan B. Clinico-epidemiological profile of orofacial clefts among children of coastal district of Southern India: A 5 year hospital based study. J Cleft Lip Palate Craniofac Anomal 2014;1:34-7

How to cite this URL:
Nambiar S, Singhal P, Menon A, Unnikrishnan B. Clinico-epidemiological profile of orofacial clefts among children of coastal district of Southern India: A 5 year hospital based study. J Cleft Lip Palate Craniofac Anomal [serial online] 2014 [cited 2019 Jun 19];1:34-7. Available from: http://www.jclpca.org/text.asp?2014/1/1/34/126554


  Introduction Top


Cleft lip with or without cleft palate (CL/P) is one of the most frequently occurring congenital malformations among live births. The prevalence varies widely, depending on the ethnicity and geographical location of the population ranging from between 1/300 and 1/2500 births for CL/P and around 1/1500 births for cleft palate (CP) alone. [1],[2] A child is born with a cleft, every 2 min according to a World Health Organization study published in 2001. [3] In India, the frequency of occurrence and the number of infants born every year with CL/P is reported to be around 28,600 which means 78 affected infants are born every day, or 3 infants with clefts are born every hour and majority of these defects remain uncorrected. [4] Inequalities exist, both in access to and quality of cleft care with distinct differences in urban versus rural access and over the years the accumulation of non-repaired clefts of the lip and palate make this a significant health care problem in India.

Based on the National Family and Health Survey, 2010 (NFHS), [5] consanguineous marriages are uncommon in the northern, eastern and north eastern states due to the predominance of Hindu population. In comparison, in southern India, the highest rates are reported from the states of Andhra Pradesh, Karnataka and Tamil Nadu and Kerala. In the pursuit of genetic research into cleft lip and palate (CLP) and craniofacial anomalies, it would seem appropriate that an investigation takes into account the influence of consanguineous marriage also on non-syndromic CLP. In addition to this, the order of the child, gender of the child, age of the mother and other factors affecting CLP should also be given due importance so as to understand the role of risk factors in the incidence of CLP. The objective of this study was to determine the profile of CLP cases in Mangalore and to call attention to the possible risk factors such as previous familial history, maternal diet and nutritional supplementation, consanguinity and also post natal care.


  Materials and Methods Top


This was a 5-year hospital based retrospective study of the birth records archived in the medical records, in which all the cases of CLP up to the age group of 5 years were studied. All the subjects born between December 2005 and December 2010 with cleft lip (CL), cleft palate (CP) or CLP were included in the study. The data was collected using a semi-structured, pre-tested proforma that was designed based on the review of literature. Prior to the study, approval of the Institutional Ethics Committee was obtained from Manipal College of Dental Sciences, Mangalore. The data was retrieved from the archived medical Records of Lady Goschen Hospital, a Tertiary Health Care Center that receives patients predominantly from the lower socioeconomic status and Unity Health Center, one of the largest private hospitals in Mangalore that receives a large number of patients from both the lower and upper socioeconomic status. The characteristics of these two hospitals made them appropriate for conducting this study.

Statistical analysis

The data collected was subjected to descriptive statistical analysis using SPSS version 11.5 (SPSS Inc.). Frequency analysis of the collected data with respect to parameters such as gender variation, type of cleft, unilateral or bilateral, left sided or right sided, syndromic or non syndromic, treatment provided, parental counseling provided and possible risk factors was done. In addition, a Chi-square analysis was performed to demonstrate the comparison between both the hospitals with respect to the above mentioned parameters.


  Results and Observations Top


A total number of orofacial clefts encountered in the two hospitals between December 2005 and December 2010, were 158 out of which 78 were from the public sector hospital and 80 belonged to the private hospital. The proportion of Oro-facial clefts in the public sector public sector hospital was found to be 78 among 32,155 live births. Hence, the incidence of cleft in this hospital is 2.42/1000 births/year. The proportion of cleft cases in private center was 80 out of 950 subjects, which included clefts patients from Mangalore as well as from adjoining areas. This was due to the fact that the hospital was a referral center for orofacial clefts associated with smile train project [Table 1], [Table 2] and [Table 3].{Table 1}{Table 2}{Table 3}


  Discussion Top


This study was based in an urban setting but involved a large section of rural population also, since the hospital is a tertiary health care center for Mangalore and adjoining areas. It did not present any significant variation in the epidemiological occurrence of cleft when compared with other significant studies conducted in this field. The number of cleft cases in Mangalore was found to be 2.42/1000 births per year, which was slightly higher than that demonstrated by Devi et al. [6] As observed in this study, cleft shows a slight predilection for males over females [Table 1]. In both public sector hospital and private health center, males were seen to be more commonly affected by cleft than the females with the ratio being 57.7:42.3 and 60:40 respectively. This result was consistent with the studies conducted by Sridhar et al. [7] and Devi et al. [6] This result however contrasted with the study conducted by Jamilian et al. [8] which observed a higher incidence of cleft in females (52%) than males (48%). In this study, it was also observed that all the patients belonged to the lower socio-economic status. The pattern of clefts showed that, CL along with CP was found to be the highest in both Hospitals amounting to 64.6%, followed by isolated CL followed by isolated CP and the least being isolated CL with cleft alveolus the data in % is already mentioned in the result. Hence this may be deleted [Table 3]. Unilateral clefts were seen to be much higher than that of bilateral clefts. Midline clefts were seen to be low [Table 3]. Among the unilateral Clefts, the left side was seen to be more commonly involved than the right side [Table 2]. These results were found to be consistent with the findings of Devi et al. [6] The treatment modalities adopted by the patients were also assessed as a part of this study. A total number of cases that underwent surgery were 146 whereas; the remaining 12 patients remained unoperated [Table 3]. In the public sector hospital, 84.62% patients had surgical treatment for repair of cleft and whereas, unity health center reports 100% surgical treatment [Table 3]. This was in contrast to the study conducted by Agbenorku et al. [9] in 2006 which reports a surgical treatment in only 8% of the patients.

An important observation was that the parental counseling was better at the private hospital, lack of which could be observed at the government hospital, which indicates the need for the formation of proper cleft clinics at government sponsored establishments. Folate deficiency occurring during the pregnancy period has been shown to be linked to higher susceptibility of orofacial clefts in the infants as shown by the studies conducted by Iregbulem et al. [10] and Sridhar et al. [7] Even the administration of certain drugs during the pregnancy period have been shown to increase the risk of orofacial clefts. [10],[11] Due to lack of adequate recording of ante-natal history, complete list of possible risk factors for every patient could not be assessed. All the patients treated in unity health center were referred patients; and hence ample ante-natal history wasn't recorded. In the lady goschen hospital, 6 mothers presented with a history of folate Deficiency and 5 mothers presented with a deficiency of iron during the pregnancy period [Table 3]. Thus, it was inferred that folate or iron deficiency during gestation period may act as a predisposing factors for the development of CL/P. Orofacial clefts have been shown to follow a genetic Predisposition and hence; the risk increases in the case of familial occurrence. [11]

Similarly, consanguinity also has some deal to play in the predisposition of orofacial clefts. [1],[7],[10] Based on the NFHS, 1992-1993, [6] consanguineous marriages are uncommon in the northern, eastern and north eastern states of India because of the predominance of Hindu population. By comparison, in southern India, consanguineous unions between biological kin have a long tradition. The highest rates are reported in the states of Andhra Pradesh, Karnataka, Tamil Nadu and Kerala. Many such typographical and grammatical corrections are required. The only exception is the strict avoidance of consanguineous marriage amongst the large Christian population. In this study however; due to lack of adequate information from the birth records, every case with Familial occurrence and a history of consanguineous marriage could not be assessed. These sporadic incidences are not enough to conclude that consanguinity is responsible for causation of cleft.

Recording of adequate ante-natal history in the birth records need to be given critical Importance. Identification of the risk factors causing cleft can be crucial for the prevention and/or treatment of orofacial clefts. Furthermore, there is a lack of parental counseling provided in the government hospital. Along with post-surgical care, psychological treatment in the form of parental counseling forms an important aspect of the treatment modality.


  Summary Top


The epidemiology of CLP cases was shown in a 5 year sample size from December 2005 to December 2010. A clear and accurate knowledge regarding the role of risk Factors such as consanguinity, familial occurrence and folate deficiency could not be assessed due to lack of adequate information from the birth records. Such a study would be crucial and serve as baseline information for the prevention and/or treatment of orofacial clefts.


  Acknowledgments Top


This study was undertaken as a short term research program Reference Id 2011-01885 with funding from the Indian council of medical research. Our acknowledgements to the Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, a constituent college of Manipal university, District medical officer of Government Wenlock hospital, the Medical Superintendent, Unity Hospital and Dr. Mustafa, Oral and Maxillo Facial Surgeon, Unity Hospital.

 
  References Top

1.Stanier P, Moore GE. Genetics of cleft lip and palate: Syndromic genes contribute to the incidence of non-syndromic clefts. Hum Mol Genet 2004;13 Spec No 1:R73-81.  Back to cited text no. 1
    
2.Murray JC. Gene/environment causes of cleft lip and/or palate. Clin Genet 2002;61:248-56.  Back to cited text no. 2
    
3.Global strategies to reduce the health care burden of craniofacial anomalies: Report of WHO meetings on international collaborative research on craniofacial anomalies. Cleft Palate Craniofac J 2004;41:238-43.  Back to cited text no. 3
    
4.Mossey P, Little J. Addressing the challenges of cleft lip and palate research in India. Indian J Plast Surg 2009;42 Suppl:S9-S18.  Back to cited text no. 4
    
5.IIIPS National Family and Health Survey, India, 2010. Mumbai: International Institute for Population Sciences; 2010.  Back to cited text no. 5
    
6.Devi AR, Rao NA, Bittles AH. Inbreeding and the incidence of childhood genetic disorders in Karnataka, South India. J Med Genet 1987;24:362-5.  Back to cited text no. 6
    
7.Sridhar K. A community-based survey of visible congenital anomalies in rural Tamil Nadu. Indian J Plast Surg 2009;42 Suppl:S184-91.  Back to cited text no. 7
    
8.Jamilian A, Nayeri F, Babayan A. Incidence of cleft lip and palate in Tehran. J Indian Soc Pedod Prev Dent 2007;25:174-6.  Back to cited text no. 8
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9.Agbenorku P, Agbenorku M, Iddi A, Abude F, Sefenu R, Matondo P, et al. A study of cleft lip/palate in a community in the South East of Ghana. Eur J Plast Surg 2011;34:267-72.  Back to cited text no. 9
    
10.Iregbulem LM. The incidence of cleft lip and palate in Nigeria. Cleft Palate J 1982;19:201-5.  Back to cited text no. 10
    
11.Suleiman AM, Hamzah ST, Abusalab MA, Samaan KT. Prevalence of cleft lip and palate in a hospital-based population in the Sudan. Int J Paediatr Dent 2005;15:185-9.  Back to cited text no. 11
    



 
 
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  [Table 1]JCleftLipPalateCraniofacAnomal_2014_1_1_34_126554_t1.jpg, [Table 2]JCleftLipPalateCraniofacAnomal_2014_1_1_34_126554_t2.jpg, [Table 3]JCleftLipPalateCraniofacAnomal_2014_1_1_34_126554_t3.jpg



 

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