Incidence Of Various Types Of Cleft Lip And Palate In Southern Kp, Pakistan

Authors

  • Asif Aziz
  • Tauseef ul Hassan
  • Manzoor Ahmad

Keywords:

Cleft Lip and Palate (CLP), Consanguineous Marriages, Maternal Education, Socioeconomic Factors, Epidemiology, Congenital Anomalies, Unilateral pattern

Abstract

Cleft lip and palate (CLP) is among the most frequent congenital malformations in the world and its incidence and its etiological factors are notable among different regions. The objective of this study was to study the patterns, socioeconomic and risk factors of CLP occurring in Southern KPK, Pakistan, in which consanguinity and maternal education were hypothesized to be the important risk factors for CLP. This study was conducted from July 2017 to June 2024 over 7 years. The retrospective cross sectional study analyzed 223 confirmed CLP cases in two Tertiary Care Hospitals in districts of Bannu and Dera Ismail Khan. Cleft types, laterality, gender distribution, parental consanguinity, maternal education, family history, among other predisposing factors, were meticulously collected on a data base. Of these CLP, 1.83 per 1,000 live births were encountered, with a predominance of cleft lip with palate (46.6%), cleft lip (34.9%) and cleft palate (18.5%). Most affected patients were males (61.6%), and the majority of clefts were left sided (57.5%). Notably, consanguinity emerged as a significant risk factor, present in 83% of cases, alongside a positive family history in 14.4%. Furthermore, in 21.2% of the patients there were associated congenital anomalies, mainly congenital heart defects, and almost 19% of the children were presented to hospitals later than the infancy. These findings emphasize the multifaceted nature of CLP in this region, which includes both genetic predisposition, maternal education, and socio-economic inequality. The study recommends targeted public health strategies like avoiding consanguineous marriages, and increased access to prenatal care to reduce CLP risk. For healthcare policy and optimization of outcomes of affected children in Southern KPK, region specific insights are very critical.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Ahmed, R., Gul, S., & Malik, T. (2024). Maternal nutrition and congenital anomalies in South Asia: A review of current evidence. Journal of Maternal-Fetal & Neonatal Medicine, 37(2), 334–341. https://doi.org/10.1080/14767058.2023.2189989

Alade, A., Thomas, N., & Bello, H. (2023). Genetic burden of cleft lip and palate in high-consanguinity regions. Human Genetics, 142(3), 401–410. https://doi.org/10.1007/s00439-023-02516-8

Berkowitz, S., Shetye, P., & Grayson, B. (2021). Advances in cleft lip and palate management: Multidisciplinary perspectives. Seminars in Plastic Surgery, 35(3), 125–132. https://doi.org/10.1055/s-0041-1731358

Blencowe, H., Kancherla, V., Moorthie, S., & Lawn, J. E. (2023). Global impact of folic acid supplementation on congenital anomalies. The Lancet Global Health, 11(1), e34–e42. https://doi.org/10.1016/S2214-109X(22)00398-4

Butali, A., & Mossey, P. (2022). Epidemiology of orofacial clefts in low-resource settings. The Lancet Global Health, 10(4), e482–e490. https://doi.org/10.1016/S2214-109X(21)00582-0

Harville, E. W., Li, Y., & Misra, D. P. (2022). Maternal education and pregnancy outcomes: A systematic review. Maternal and Child Health Journal, 26(4), 523–531. https://doi.org/10.1007/s10995-022-03456-9

Iqbal, N., Tariq, M., & Hussain, F. (2024). Congenital anomalies and healthcare disparities in Pakistan: A provincial analysis. Pakistan Journal of Public Health, 14(1), 22–29. https://doi.org/10.32413/pjph.v14i1.1032

Javed, M., Alam, S., & Rehman, M. (2024). Barriers to early diagnosis of cleft lip and palate in Pakistan. BMC Pediatrics, 24(1), 45. https://doi.org/10.1186/s12887-024-04233-9

Kancherla, V., Oakley, G. P., & Brent, R. L. (2023). Health literacy and its role in congenital defect prevention. Journal of Public Health Policy, 44(2), 157–168. https://doi.org/10.1057/s41271-023-00380-5

Khan, A., Saeed, F., & Shah, M. (2023). Rural-urban disparities in maternal and child health in Pakistan. International Journal of Environmental Research and Public Health, 20(15), 6265. https://doi.org/10.3390/ijerph20156265

Khan, M. A., Siddiqui, N., & Ahmad, M. (2023). Socioeconomic determinants of congenital anomalies in Pakistan. Journal of Pediatric Surgery, 58(2), 274–281. https://doi.org/10.1016/j.jpedsurg.2022.12.004

Lee, Y. H., Kim, H. J., & Park, E. C. (2023). Family history and risk of cleft lip and palate: A meta-analysis. Oral Diseases, 29(3), 837–845. https://doi.org/10.1111/odi.14321

Leslie, E. J., Koboldt, D. C., & Marazita, M. L. (2023). Genomic architecture of nonsyndromic cleft lip and palate. Nature Genetics, 55(1), 12–22. https://doi.org/10.1038/s41588-022-01100-0

Lin, S. W., Chen, Y. C., & Tsai, M. C. (2023). Sex differences and laterality patterns in cleft lip and palate: A population-based study. Birth Defects Research, 115(8), 745–752. https://doi.org/10.1002/bdr2.2153

Marazita, M. L. (2023). Embryology of orofacial clefts: Current insights. Clinical Genetics, 103(4), 345–356. https://doi.org/10.1111/cge.14256

Mirza, T., Khan, A. A., & Yousafzai, A. (2023). Genetic and environmental determinants of orofacial clefts in Pakistan: An integrative review. Asian Pacific Journal of Medical Genetics, 4(2), 66–73. https://doi.org/10.4103/apjmg.apjmg_8_23

Mossey, P. A., Little, J., & Munger, R. G. (2022). Global epidemiology of cleft lip and palate. Plastic and Reconstructive Surgery, 150(4S), 15S–22S. https://doi.org/10.1097/PRS.0000000000009402

Mossey, P., Modell, B., & Dixon, M. J. (2022). Sex differences in the prevalence of cleft lip and palate: A global review. Journal of Craniofacial Surgery, 33(5), 1427–1433. https://doi.org/10.1097/SCS.0000000000008473

Mwanga, J., Otieno, J., & Muteshi, J. (2022). Geographical disparities in CLP incidence in sub-Saharan Africa. African Journal of Medical Sciences, 39(2), 199–208. https://doi.org/10.4314/ajms.v39i2.7

Rahimov, F., Jugessur, A., & Murray, J. C. (2022). Consanguinity and risk of congenital malformations: A meta-analysis. Genetic Epidemiology, 46(3), 245–254. https://doi.org/10.1002/gepi.22412

Sabbagh, H. J., Hassan, M. H., & Alamoudi, N. (2023). Orofacial clefts: Prevention strategies and future directions. Clinical Oral Investigations, 27(1), 193–204. https://doi.org/10.1007/s00784-022-04615-3

Shah, N., Khan, M., & Akhtar, T. (2022). Consanguinity and its impact on birth defects in Pakistan: An evidence-based review. Genetics Research, 104, e14. https://doi.org/10.1017/S0016672322000146

Singh, R., Chawla, H. S., & Goyal, A. (2024). Congenital heart diseases in children with cleft lip and palate: A cross-sectional study. Journal of Clinical Pediatric Dentistry, 48(1), 12–18. https://doi.org/10.17796/1053-4628-48.1.2

Singh, V., Sharma, N., & Prasad, C. (2023). Barriers to prenatal care in rural South Asia: Implications for congenital anomalies. Asian Pacific Journal of Public Health, 35(1), 72–81. https://doi.org/10.1177/10105395221150854

Sitkin, N. A., Ozgediz, D., & Farmer, D. L. (2023). Poverty and congenital anomalies: A global perspective. Global Health Science and Practice, 11(1), e2200200. https://doi.org/10.9745/GHSP-D-22-00200

Wilcox, A. J., Lie, R. T., & Taylor, J. A. (2022). Maternal folate status and cleft risk: Evidence from a multicenter cohort. American Journal of Epidemiology, 191(5), 844–852. https://doi.org/10.1093/aje/kwac017

Yassin, H., Farag, A., & El-Shafie, O. (2023). Impact of consanguinity on orofacial clefts in Middle Eastern populations. Middle East Journal of Medical Genetics, 12(3), 178–185. https://doi.org/10.1097/MEG.0000000000000123

Yu, Y., Wang, X., & Chen, H. (2024). Genome-wide association study of cleft lip and palate in diverse populations. PLoS Genetics, 20(2), e1010823. https://doi.org/10.1371/journal.pgen.1010823

Zahid, F., Ali, S., & Malik, R. (2024). Educational disparities in maternal nutrition and pregnancy outcomes in Pakistan. Pakistan Journal of Nutrition, 23(1), 45–52. https://doi.org/10.3923/pjn.2024.45.52

Zhou, Q., Zhang, Y., & Liu, W. (2023). Preventive role of folic acid in cleft lip and palate: A meta-analysis. BMJ, 381, e070839. https://doi.org/10.1136/bmj-2023-070839

Downloads

Published

2025-04-28

How to Cite

1.
Aziz A, Hassan T ul, Ahmad M. Incidence Of Various Types Of Cleft Lip And Palate In Southern Kp, Pakistan. J Neonatal Surg [Internet]. 2025Apr.28 [cited 2025Oct.3];14(19S):463-74. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/4799

Issue

Vol. 14 No. 19S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.