|Year : 2023 | Volume
| Issue : 1 | Page : 9-13
A retrospective study on clinical and epidemiological profile of nonsyndromic cleft lip and palate patients admitted in a large Comprehensive Cleft Care Centre in West Bengal, India
Nupur Saha, Mainak Das, Shabnam Zahir, Arnab Santra
Department of Pediatric and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
|Date of Submission||04-Aug-2022|
|Date of Acceptance||12-Oct-2022|
|Date of Web Publication||14-Mar-2023|
Dr. Mainak Das
Department of Pediatric and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study is to observe the clinical and epidemiological profile of nonsyndromic cleft lip (CL) and/or palate patients admitted to a cleft care center in West Bengal from May 2021 to April 2022. Materials and Methods: A retrospective epidemiological study had been done by preparing a master data sheet to record the patient's data from a Comprehensive Cleft Care Centre in West Bengal. The study variables included were patient's age reporting at the hospital, type of cleft, sex distribution of patients, residential address of the parents, socioeconomic status through parents' education, occupation, and monthly income, and consanguineous marriage history of the family. Results: A total of 276 nonsyndromic cleft patients during the time period (May 2021 to April 2022) were considered. Among these, 164 were male and 112 were female patients. The mean age of patients reporting to this hospital on average was 13–18 months. CL with palate patients (62%) predominated than any other type and was mostly seen in male patients (69.59%); isolated CL (22%) cases were more in females (56.25%), whereas isolated cleft palate (16%) cases were seen more in males (62.79%); unilateral (77%) and left-sided cleft (67%) were found predominantly than bilateral cases (23%) and seen mostly in females, whereas bilateral cleft cases were more in males. Most of the patients belonged to North 24 Parganas District which is an adjacent district of Kolkata, and most of the families belonged to a low socioeconomic group, and interestingly, most of them had consanguineous marriage history (61%) with at least one generation. Conclusion: The results of this study provided that CL with palate type is more common among all types of clefts and predominantly found in males than females in West Bengal. The unilateral left-sided cleft is predominant among all other varieties. Most of the parents belonged to low socioeconomic status and are having consanguineous marriage history. We need to spread awareness among the public through ads and banners, social media, and medical free camps about the deformity of CL and/or palate and also possible preventive measures, make arrangements for free treatment among the CL and/or CL and palate population for better life of cleft patients and their parents.
Keywords: Cleft lip and palate epidemiology, cleft lip profile, West Bengal
|How to cite this article:|
Saha N, Das M, Zahir S, Santra A. A retrospective study on clinical and epidemiological profile of nonsyndromic cleft lip and palate patients admitted in a large Comprehensive Cleft Care Centre in West Bengal, India. J Cleft Lip Palate Craniofac Anomal 2023;10:9-13
|How to cite this URL:|
Saha N, Das M, Zahir S, Santra A. A retrospective study on clinical and epidemiological profile of nonsyndromic cleft lip and palate patients admitted in a large Comprehensive Cleft Care Centre in West Bengal, India. J Cleft Lip Palate Craniofac Anomal [serial online] 2023 [cited 2023 Jun 5];10:9-13. Available from: https://www.jclpca.org/text.asp?2023/10/1/9/371640
| Introduction|| |
The word “cleft” literally means a split or a fissure. In the current context, the “cleft” refers to a congenital abnormal space or gap in the upper lip, alveolus, or palate. The etiology of cleft lip and palate (CLP) remains largely controversial and unidentified. Evidence-based research shows a strong association with genetics, environmental factors, nutritional deficiency, smoking, alcohol, and drug misuse. According to the Global Burden of Disease 2016 data, the estimated incidence of CLP in India is around 0.25–2.29 per 1000 births with a calculated prevalence rate of 33.27 for males and 31.01 for females per 100,000 population. The etiologies of CLP are multifactorial and occupy both major and minor genetic influences with erratic connections from environmental factors. Among all these etiologies, consanguinity is an important factor. The incidence of CLP is comparatively high in low- and middle-income countries owing to the existence of constrained resources, relatively less affordable health-care infrastructure, lack of awareness, and resulting in a significant unmet need., This study evaluated the clinical and epidemiological profile of nonsyndromic CLP patients admitted at a Comprehensive Cleft Care Centre in West Bengal, India.
| Materials and Methods|| |
This retrospective cohort study has been done in a Comprehensive Cleft Care Centre (ABMSS), Kolkata by recording the clinical data of cleft patients admitted to the hospital from May 2021 to April 2022. This study has been approved by the Institutional Ethics Committee (IEC), G. N. I. D. S. R, Kolkata. The patients were grouped according to the variables such as age at which they reported to the hospital, sex distribution, type of cleft (Veau's classification), residential address, socioeconomic status, and having consanguineous marriage history in the family. The collected data were processed and analyzed using descriptive statistical analysis and the Chi-square test. P < 0.05 was considered statistically significant.
| Results|| |
A total of 276 patients reported to the hospital in the given time period. In 276 patients, 164 were male and 112 were female (P < 0.05) [Table 1]. The mean age of cleft patients reporting to the hospital was 13–18 months (121 out of 276), followed by 7–12 months (64 out of 276). Zero–six months reported the least among all of them (17 out of 276) [Table 2]. Sixty-two percent of patients had CL with palate deformities, which was most predominant among all cleft types (Veau's classification). Isolated CL was found in 22% and isolated cleft palate was found in16% of the study population. Among all the cleft types, unilateral cleft was found in 77% and bilateral cleft was found in 23% of the study population. Left-sided cleft was more common among all, which was 67% and the right-sided cleft was 33% [Figure 1].
Isolated CL cases were more in female population (56.25%), left-sided cleft was also found more in females (64.67%), but the isolated cleft palate was predominant in the male population (62.79%), CL with palate was found more in males (69.59%) as compared to females. If we look gender distribution of different cleft variety we found that, bilateral and right sided cleft both were found more in males (60.94% and 55.43%) respectively [Figure 2].
We found that patients came to the hospital from different parts of West Bengal including Burdwan, Medinipur, North 24 Parganas, Howrah, etc., However, most of the patients resided at North 24 Parganas which is an adjacent district of Kolkata [Figure 3]. We grouped the patient's socioeconomic status by the Kuppuswamy socioeconomic status (SES) scale 2019 which is based on the occupation, education, and monthly income of the head of the family, and we found that most of the patients belonged to upper–lower SES group according to the Kuppuswamy SES scale 2019 [Figure 3].
In consanguineous marriage history, we found 61% family had history of consanguineous marriage in at least one generation [Figure 4].
| Discussion|| |
CLP malformation constitutes nearly one-third of all congenital anomalies accounting for 65% of all craniofacial anomalies. A significant variation in the occurrence of CLP has been observed across all the continents as well as the countries. Immediately after birth, individuals with CLP have facial deformation, feeding problems, and recurrent middle ear infections. Beyond the physical effects on the patient, CL and cleft palate also have significant psychological and socioeconomic effects on both patient and family, including disruption of psychosocial functioning and decreased quality of life. It is associated with increased mortality due to various causes, including suicide as well as substantial health-care costs. In our study, we found that clefts occurred more in males than females. Desai et al. presented similar findings in the Gujarat population, whereas Kumar et al. got a greater number of female clefts patients in the Karnataka population., In Upadhyaya et al.'s study of the Indian population, the male and female sex ratio of patients undergoing surgery was found to be 2.3:1. Male children were more predominant in the patient population than female children which can be explained simply by the sex ratio in Uttar Pradesh state (912 females for every 1000 males). Furthermore, a possible explanation for this could be the still widely prevalent practice of female feticide and also a gender bias whereby the girl child is only reluctantly brought to the hospital for treatment of such defects. In our study, we found that unilateral left-sided cleft cases were predominant among other cleft types, this finding is similar to Reddy et al. Furthermore, in our study, CL with palate patients was found more in number than all other cleft types, which is nearly similar with Reddy et al. study, which showed a prevalence of CL to be 33%, CLP 64%, and CP 3% in India. Parihar et al. in a study of the Gujarat population showed a higher incidence of combined CLP followed by cleft palate. Even Khajanchi et al. found that CL cases were highest followed by combined clefts in the Gujarat population.
In our study, we found that most of the patients reported to the hospital at an average age of 13–18 months, which is quite late for the ideal surgery age of patients. Kharbanda and Monga found in India that the majority of cleft patients are unable to follow the protocol of cleft care due to a lack of proper feeding advice which leads to feeding difficulties and poor nutrition, resulting in delayed primary surgeries since most of them are unfit for surgery. Illiteracy, superstitions, lack of awareness of free treatment, and travel cost from the hospital can be various causes of delayed reporting to the hospital. We need to spread awareness, educate the general population about the deformity, and promote free treatments, through media, social media platforms, and free camps in rural and peripheries of different parts of the state.
In our study, we found that most of the families having cleft children belonged to lower socioeconomic status and 61% of families of cleft cases had consanguineous marriage history in the family in at least one generation. Sah and Powar reported that consanguineous marriages were noted in 48.9% of the parents.
The shortfalls of our study are single-centered, small sample size, and limited time period of the whole study. To know the cleft profile of West Bengal, we need to study with a multicentered approach, with a longer time span.
| Conclusion|| |
Males are more affected by cleft deformity than females and CL with the palate is the most common type we found in West Bengal cleft profile, which is similar to the worldwide prevalence of cleft. Similarly, we found that most of the families with cleft children belonged to low socioeconomic groups and had consanguineous marriage history. Only proper education can change the world. We recommend the organization of mass awareness camps to educate the people and spread awareness about the causes, treatment, and prevention of CLP. These measures may help to counter the negative beliefs and attitudes toward the condition and even reduce the incidence of cleft cases. Media campaigns on radio, TV, and newspaper as well as the establishment of cleft support groups by the relevant governmental and professional organizations should be embarked upon. Now, it is the era of information technology. We can design apps, send messages, and play short videos for the correct feeding technique of these children. Advertise through motivational messages from prominent persons in public life. We can share short videos or presentations on the importance of early reporting to the hospital and the care of children right after birth. To know the cleft profile of West Bengal, we need to longer study and spread education among the population so that we can not only change the smile of cleft patients but also we can raise them to a normal or near-normal life.
Requisite ethical clearance was taken from the Institutional Ethical Committee of Gurunanak Institute of Dental sciences and Research, Kolkata for our main study in the title of comparative evaluation quality of life of parents and growth parameter of their children before and after primary surgery. The ethical no is GNIDSR/IEC/2020-23/04. This study is preliminary part of our main study so no need for separate ethical approval.
We sincerely thank all the staff and administration of ABMSS Comprehensive Cleft Care Centre Kolkata.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]