Orofacial clefts are the most common malformations of the head and neck. In Africa, orofacial clefts are underascertained, with little or no surveillance system in most parts for clefts and other birth defects. A Nigerian craniofacial anomalies study, NigeriaCRAN, was established in 2006 to support cleft research specifically for epidemiological studies, treatment outcomes, and studies into etiology and prevention.
We pooled data from seven of the largest Smile Train treatment centers in the six geopolitical zones in Nigeria. Data from September 2006 to June 2011 were analyzed and clefts compared between sides and genders using the Fisher exact test.
A total of 2197 cases were identified during the study period, with an estimated prevalence rate of 0.5 per 1000. Of the total number of orofacial clefts, 54.4% occur in males and 45.6% in females. There was a significant difference (P=.0001) between unilateral left clefts and unilateral right clefts, and there was a significant difference (P=.0001) between bilateral clefts and clefts on either the left or right side. A significant gender difference (P=.03) was also observed for cleft palate, with more females than males. A total of 103 (4.7%) associated anomalies were identified. There were nine syndromic cleft cases, and 10.4% of the total number of individuals with clefts have an affected relative.
The significant difference between unilateral clefts and the gender differences in the proportion of cleft palate only are consistent with the literature. The present study emphasizes the need for birth defects registries in developing countries in order to estimate the exact prevalence of birth defects including orofacial clefts.
AkinmoladunV.I., ObimakindeO.S.Team approach concept in management of oro-facial clefts: a survey of Nigerian practitioners. Head Face Med.2009; 10: 5–11.
4.
Bermejo-SánchezE., CuevasL., AmarE., BakkerM.K., BiancaS., BianchiF., CanfieldM.A, CastillaE.E., ClementiM., CocchiG.. Amelia: a multi-center descriptive epidemiologic study in a large dataset from the International Clearinghouse for Birth Defects Surveillance and Research, and overview of the literature. Am J Med Genet C Semin Med Genet.2011; 157: 288–304.
5.
BowerC., RudyE., CallaghanA., QuickJ., NassarN.Age at diagnosis of birth defects. Birth Defects Res A Clin Mol Teratol.2010; 88: 251–255.
6.
ButaliA., AdeyemoW.L.An overview of cleft care in Nigeria. Niger Postgrad Med J.2011; 18: 151–153.
7.
ButaliA., MosseyP.A.Epidemiology of orofacial clefts in Africa: methodological challenges in ascertainment. Pan Afr Med J.2009; 2: 2–5.
8.
ButaliA., MosseyP.A., AdeyemoW.L., JezewskiP.A., OnwuamahC.K., OgunleweM.O., UgbokoV.I., AdejuyigbeO., AdigunA.I., Abdur-RahmanL.O.. Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders. Cleft Palate Craniofac J.2011; 48: 646–653.
9.
CalzolariE., PieriniA., AstolfiG., BianchiF., NevilleA.J., RivieriF.Associated anomalies in multimalformed infants with cleft lip and palate: an epidemiologic study of nearly six million births in twenty-three Eurocat registries. Am J Med Genet A.2007; 143: 528–537.
10.
CarneiroP.M., MassaweE.R.Pattern of cleft lip and palate in Dar-es-Salaam. Cent Afr J Med.2009; 55: 10–14.
11.
DixonM.J., MarazitaM.L., BeatyT.H., MurrayJ.C.Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet.2011; 12: 167–178.
12.
EsheteM., GravenmP.E., TopstadT., BefikaduS.The incidence of cleft lip and palate in Addis Ababa, Ethiopia. Ethiop Med J.2011; 49: 1–5.
13.
Federal Ministry of Health.Saving newborn lives in Nigeria: Newborn health in the context of the Integrated Maternal, Newborn and Child Health Strategy.2nd ed.Abuja: Federal Ministry of Health, Save the Children, Jhpiego.2011.
14.
GeniscaA.E., FríasJ.L., BroussardC.S., HoneinM.A., LammerE.J., MooreC.A., ShawG.M., MurrayJ.C., YangW., RasmussenS.A.; National Birth Defects Prevention Study. Orofacial clefts in the National Birth Defects Prevention Study, 1997–2004. Am J Med Genet A.2009; 149: 1149–1158.
15.
GundlachK.K., MausC.Epidemiological studies on the frequency of clefts in Europe and world-wide. J Craniomaxillofac Surg.2006; 34: 1–2.
16.
International Clearinghouse for Birth Defects Surveillance and Research.Annual Report.Rome: Carlo Mirabello; 2009.
17.
IregbulemL.M.The incidence of cleft lip and cleft palate in Nigeria. Cleft Palate J.1982; 19: 201–205.
18.
JaruratanasirikulS., ChichareonV., PattanapreechawongN., SangsupavanichP.Cleft lip and/or palate: 10 years experience at a pediatric cleft center in Southern Thailand. Cleft Palate Craniofac J.2008; 45: 597–602.
19.
KrombergJ.G.R., JenkinsT.Common birth defects in South African blacks. S Afr Med J.1982; 62: 599–602.
20.
LetraA., MenezesR., GranjeiroJ.M., VieiraA.R.Defining subphenotypes for oral clefts based on dental development. J Dent Res.2007; 86: 986–991.
21.
LopooJ.B., HedrickM.H., ChasenS., MontgomeryL., ChervenakF.A., GoldsteinR., HoffmanW.Y., HarrisonM.R., LongakerM.T.Natural history of fetuses with cleft lip. Plast Reconstr Surg.1999; 103: 34–38.
22.
ManyamaM., RolianC., GilyomaJ., MagoriC.C., MjemaK., MazyalaE., KimwagaE., HallgrimssonB.An assessment of orofacial clefts in Tanzania. BMC Oral Health.2011; 2: 11–15.
23.
MartelliD., BonanP., SoaresM., ParanaíbaL., Martelli-JúniorH.Analysis of familial incidence of non-syndromic cleft lip and palate in a Brazilian population. Med Oral Patol Oral Cir Bucal.2010; 15: 898–901.
24.
MenezesR., VieiraA.R.Dental anomalies as part of the cleft spectrum. Cleft Palate Craniofac J.2008; 45: 414–419.
25.
MosseyP.A., LittleJ.Epidemiology of oral clefts: an international perspective. In: WyszynskiD.F., ed. Cleft lip and palate. From origin to treatment.New York: Oxford University Press; 2002: 127–158.
NeiswangerK., WeinbergS.M., RogersC.R., BrandonC.A., CooperM.E., BardiK.M., DeleyiannisF.W., ResickJ.M., BowenA., MooneyM.P.. Orbicularis oris muscle defects as an expanded phenotypic feature in nonsyndromic cleft lip with or without cleft palate. Am J Med Genet A.2007; 143: 1143–1149.
28.
OgleO.E.Incidence of cleft lip and palate in a newborn Zairian sample. Cleft Palate Craniofac J.1993; 30: 250–251.
29.
PeterkaM., PeterkováR., HalaskováM., TvrdekM., FáraM., LikovskýZ.Sex differences in the incidence of cleft and question of primary prevention in families with genetic risk. Acta Chir Plast.1996; 38: 57–60.
30.
RajabianM.H., SherkatM.An epidemiologic study of oral clefts in Iran: analysis of 1,669 cases. Cleft Palate Craniofac J.2000; 37: 191–196.
31.
RittlerM., CosentinoV., Lopez-CameloJ.S., MurrayJ.C., WehbyG., CastillaE.E.Associated anomalies among infants with oral clefts at birth and during a 1-year follow-up. Am J Med Genet A.2011; 155: 1588–1596.
32.
ShafiT., KhanM.R., AtiqM.Congenital heart disease and associated malformations in children with cleft lip and palate in Pakistan. Br J Plast Surg.2003; 56: 106–109.
SpritzR.A., ArnoldT.D., BuonocoreS., CarterD., FingerlinT., OderoW.W., WambaniJ.O., TengeR.K., Weatherley-WhiteR.C.Distribution of orofacial clefts and frequent occurrence of an unusual cleft variant in the Rift Valley of Kenya. Cleft Palate Craniofac J.2007; 44: 374–377.
35.
StraussR.P.The American Cleft Palate–Craniofacial Association (ACPA) Team Standards Committee. Cleft palate and craniofacial teams in the United States and Canada: a national survey of team organization and in standards of care. Cleft Palate Craniofac J.1998; 35: 473–480.
36.
StraussR.P.The organization and delivery of craniofacial health services: the state of the art. Cleft Palate Craniofac J.1999; 36: 189–195.
37.
SuzukiS., MarazitaM.L., CooperM.E., MiwaN., HingA., JugessurA., NatsumeN., ShimozatoK., OhbayashiN., SuzukiY.. Mutations in BMP4 are associated with subepithelial, microform, and overt cleft lip. Am J Hum Genet.2009; 84: 406–411.
38.
United Nations, Department of Economic and Social Affairs, Population Division.World Population Prospects: The 2010 Revision United Nations.New York: 2011.
39.
World Health Organization (WHO).Addressing the global challenges of craniofacial anomalies: report of a WHO meeting on International Research on Craniofacial Anomalies, Geneva, 2–4 December, 2004.Geneva: WHO;2004.
40.
WHO.2nd International Conference on Birth Defects and Disabilities in the Developing World. Hospital-based registries for monitoring birth defects: The National Collaborative Perinatal Neonatal Network; 11–15 September 2005. Beijing, China. WHO; 2005.
