Age at Primary Surgery Among Persons Born With Orofacial Clefts in Africa

Orofacial clefts (OFC) are the most common anomalies in the head and neck region, with an overall prevalence of 1 in 700 live births. OFCs can have a lasting, unfavourable effect on the affected individual's health. Timely surgical intervention is critical for optimal outcomes. The age at primary surgery and access to care across African countries remain poorly understood. The main aim of this study was to assess the age at which primary OFC surgeries are performed in African patients born with OFCs, using data from the Smile Train Express Database (STX). A retrospective descriptive study of 161,035 patients with OFCs who received primary surgical treatment at Smile Train partner institutions in 40 African countries between January 2004 and December 2023. Data included age at surgery, sex, type of cleft, type of surgery, and country/region of origin. Descriptive analyses were performed using SPSS version 25. It is estimated that 484,640 African children were born with OFCs during the study period; of these, 33.2% received surgical treatment through Smile Train support during the study period. Most patients (78.5%) received cleft lip surgery. 28.8% of patients received timely primary surgery: cleft lip surgery ≤6 months and cleft palate surgery ≤12 months of age. 71.1% of unilateral cleft lip and 74.6% of palate surgeries were performed after the recommended age. Timeliness improved over time, with significant increases in both surgery volume and early intervention rates in the second half of the study period (2014-2023). Despite an increase in cleft surgeries and improvements in timely intervention over the years, the majority of children in Africa still receive delayed surgical care for OFCs. These findings highlight the urgent need for expanded access to early cleft care, improved health system infrastructure, and targeted community education to overcome barriers to timely surgery.