Cleft lip and/or palate and associated risks in lowermiddle-income countries : a systematic review

Abstract

Background: Cleft lip and/or palate (CL/P) is a complex, heterogeneous disorder which occurs due to the interplay between environmental and biological risk factors. Individuals in lower-middle-income countries (LMICs) are exposed to a multitude of risk factors resulting in a greater occurrence of CL/P. Research and knowledge of which risk factors are associated with CL/P in LMICs may aid health care professionals such as speech-language therapists in low-income countries in the early identification of at-risk infants.

Objective: To identify and review published data on the risks associated with CL/P in LMICs.

Design: A systematic review of literature was performed on electronic databases using the PRISMA-P. Literature on risks associated with CL/P in LMICs, from 2010 to 2020 was included.

Results: Seventeen studies met the inclusion criteria. All studies adopted an observational study design. Biological and environmental risks were identified. Maternal and paternal age (n=7) and low socioeconomic status (n=5) were the most prominently associated environmental risk factors. Regarding biological risk factors, a strong association was identified between family history of cleft (n=7) and CL/P occurrence.

Conclusion: Environmental risk factors are now being investigated more than biological risk factors in LMICs, hindering health care workers in the early identification (EI) of the possible cumulative effects of risks in CL/P. Contextually-relevant tools are recommended to promote the EI of at-risk infants.