Comparative analysis of healthcare provision to individuals with cleft lip and/or palate at specialised academic centres in South Africa

Abstract

Background. Cleft lip and/or palate (CLP) is the most common congenital anomaly of the craniofacial complex, with an estimated worldwide prevalence of 1/500-700 live births. Affected children require immediate medical treatment and prolonged management by a multidisciplinary team of health professionals. Objectives. To describe and compare healthcare provision to individuals with CLP at specialised care centres in South Africa (SA). Methods. The study was conducted at all CLP care centres in 6 of SA’s 9 provinces that provide specialised treatment and care to individuals with CLP. At each centre, the team leader was interviewed using a semi-structured questionnaire that focused on the point-of-care entry for CLP patients; type of services provided; whether treatment protocols were used, which treatment protocols were used and internal referral systems; and members of the healthcare team. Stata 13 (StataCorp., USA) was used to analyse the data. Results. Eleven CLP team leaders participated in the study, of whom 5 were from Gauteng Province. The point-of-care for CLP patients in the majority of centres was plastic surgery (n=9/11; 81.8%). The majority of centres (n=10/11; 90.9%) followed similar treatment protocols and only 1 centre performed lip surgery at 12-18 months. Although all centres reported a multidisciplinary team approach for CLP care provision, there were gaps in the health professions categories, which influenced the type of treatment provided. Hence, surgical repair of the lip and palate (n=10/11; 90.9%) and speech therapy (n=7/11; 63.6%) dominated the type of treatment provided, and patients were referred to other provinces or to the private health sector for other types of treatment. Conclusions. The gaps in services at the CLP care centres in SA need to be addressed to ensure integrated, holistic care provision.