Perspectives on the state of cleft lip and cleft palate patient care in Africa.

PURPOSE OF REVIEW: Patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa. RECENT FINDINGS: To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources. SUMMARY: The replacement of CLP 'missions' with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.

Cost Burden of Rigid Internal Fixation in Craniomaxillofacial Trauma Care in Low- and Middle-Income Countries.

Fractures of the craniomaxillofacial (CMF) skeleton cause significant morbidity and mortality in low- and middle-income countries (LMICs). Despite this, quality CMF trauma care is lacking for the majority of the world's population. There is a paucity of literature describing the costs of standard-of-care open reduction internal fixation (ORIF) for CMF fractures in LMICs. We consider the cost of a six-hole plate with six screws (SHPS), standard materials used in ORIF for CMF fractures, as a percentage of gross domestic product (GDP) per capita to ascertain the cost burden to patients. Hospital pricing catalog data at 14 LMIC institutions were queried. On average, the SHPS cost represented 10.2% of the GDP per capita in sampled LMICs. We highlight manufacturing costs, import taxes, and lack of subsidized health care as factors contributing to the significant cost burden of ORIF in these areas. Future work should characterize additional financial and socioeconomic barriers to optimal CMF care.

The Pattern of Orbital Fractures Managed at Two Referral Centers in Nairobi, Kenya.

Orbital fractures are one of the commonest injuries in mid-face trauma and can lead to significant functional and cosmetic defects. This study was aimed at analyzing the pattern of orbital fractures at 2 referral centers in Nairobi. It was a descriptive prospective hospital-based study of the demographics, etiology, clinico-radiological features, and management modalities among patients presenting with orbital fractures at the University of Nairobi Dental Hospital and Kenyatta National Referral Hospital in Nairobi, Kenya. A total of 60 patients (52 males, 8 females; P <0.05) with confirmed orbital fractures were recruited during the 6-months study period. Orbital fractures occurred most frequently in the 21 to 40-year-old age group (80%, P<0.05). The principal etiological factors were motor cycle crashes; 30%, interpersonal violence 23.3%, public vehicle crushes 20%, private vehicle crushes; 10%, injury from flying objects 10% and falls 8.3%. The most commonly affected anatomical sites were the floor (75%), the lateral wall (71.7%), infra-orbital rim (66.7%), zygomatico-frontal suture (63.3%). There were 5 (8.3%) cases of total blindnessThe impure orbital fractures that involve the satellite bones especially the zygomatic complex predominate.