Tackling rising cases of cleft lip, palate with free surgical repairs

For every pregnant woman, there are possibilities of having a child with one form of birth defect or the other.

One of the most common birth defects is the cleft lip and cleft palate, which occur in every one in 700 live births globally. Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside the mother.

Cleft lip results when there is not enough tissue in the mouth or lip area, while the tissue that is available does not join together properly, causing a split of the two sides of the upper lip that extends beyond the base of the nose, which include the bones of the upper jaw and/or the upper gum, as well as a gap in the roof of the mouth that connects to the nose.

However, studies reveal that pregnant women, mostly the low-income earners, stand a risk of giving birth to babies with cleft lip and cleft palate.

Such is the case of Fausa Teslim, 29, who gave birth to her first child having cleft lip. The young mother, who resides in Ibeju-Lekki area of Lagos state, said during her pregnancy, she attended antenatal and also visited traditional birth attendant for herbal concussions to ensure her baby stays safe, while in the womb.

On the day of delivery, December 24, 2017, Fausa delivered of her baby girl at home because it was too late for her to get to the hospital as there was no means of getting there, while she was in great labour, which she could no longer bear.

She and her husband were scared when they saw the face of their baby, which had the opening. The first time parents took their baby to the health centre where the mother registered for antenatal and were referred to Ikeja general hospital.

Fausa said the doctors asked her if she took all her medicines at the right time or took other medicines aside from the ones given to her at the clinic. She replied that she followed the doctor’s advice strictly, forgetting that she combined traditional herbs.

Another mother with a cleft palate child is Kafilat Ayoola, 23, who resides in Ikorodu area of Lagos state.

Like Fausa, Kafilat attended antenatal and visited the traditional birth attendant for herbal concussions to make her baby healthy and to also have safe delivery.
“I went for antenatal at a health centre, and then visited the traditional birth attendant for herbal medicine while I was pregnant.

Kafila, who was surprised on the outcome of her baby said: “I started antenatal three months to my pregnancy and I went regularly, received my drugs and at the end I gave birth to a child with cleft palate.”

She continued: “I gave birth at the traditional birth attendant’s place because it was close by. I was in heavy labour and couldn’t go to the health centre, which was a bit far from where I reside.”

Just like the two mothers, experts have revealed that cleft lip and cleft palate are associated with specific factors, which are being investigated.

According to a Plastic and Laser Surgeon, Dr. Aranmolate Rasheed Ayobami, the causes of cleft lip and cleft palate are not new, but are linked to folic acids deficiency during pregnancy, alcohol intake and delay in antenatal, among other predisposing factors.

“We noticed that some of the mothers, when they were pregnant, probably didn’t start their antenatal on time. Also the drugs used during pregnancy – some women use unprescribed drugs during pregnancy and that can cause cleft lip, other things will include, alcohol, which has being associated with a lot of problems during pregnancy, so if the mother is taking alcohol during pregnancy, they can end up with a child that has cleft lip and palate,” he stressed.

Dr. Ayobami, who is also the Medical Director, Grandville Medical and Laser, said in his observation, cleft lip and cleft palate occur in the Nigerian environment among low income earners, which tend to supports the fact that deficiency of the essential nutrients needed during pregnancy results to these birth defects.

He explained that cleft lip and cleft palate occur usually before seven to 13 weeks of the pregnancy, which is when the face is actually being slit, noting that ” if the mother who is suppose to be attending antenatal doesn’t do so, then, definitely, she has the possibility of having a child with cleft lip and palate.”

Although, there are no physical data on the incidence of cleft lip and cleft palate in Nigeria, globally data shows that there is one in every 700 babies born with a cleft lip, a cleft palate, or both—making it one of the most common birth defects globally

According to studies carried out in Nigeria, there are more than 100, 000 cases of cleft lip and cleft palate per year in the country. Albeit, Ayobami is of the view that, since there are no local data available, it is difficult to know the incidence of these birth defects in Nigeria, but says cases treated shows that the birth defects are also in the country, the low income earners presenting mostly.

“For now, I don’t think we have local data. The incidence of cleft lip and palate in African-American is one in 1000. There are specific statistics we have to follow. Until we have a national data or study we can specifically give the accurate number of incidence of cleft lip and palate in Nigeria,” he said.

Abayomi explained that there are congenital anomalies associated with the birth defects, which requires that when examining a child with cleft lip and cleft palate, certain things to look out for include, spinal cord problem, such as spina bifida, (a birth defect where there is incomplete closing of the backbone and membranes around the spinal cord), and other associated heart conditions.

Other problems he noted include, hearing loss, breathing, upper air wave infections, which should be taken care of in children with cleft lip and cleft palate.

“There is what we call the inner ear or the middle ear, so they don’t drain well and with that they tend to have hearing problem and there are some degree of hearing loss. What is often time done, is what we call myringotomy, (a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear),” he maintained.

While the causes of cleft palate and cleft lip are still being investigated, the medical director said some of these birth defects are not preventable as hereditary factors sometimes play a small role.

About one in three babies born with a cleft palate or a cleft lip may have a relative with the same or similar condition, or an associated chromosomal or genetic condition, which means that a parent that has cleft lip has about four to seven per cent chances of having a child with similar problem.

“For those we know are due to deficiency, we ensue that people start antenatal on time, which is one of the many ways of preventing cleft lip and palate, rather than wait until when there is a problem,” he added.

According to the plastic and laser surgeon, cleft lip and cleft palate are treatable, although not while the baby is still in the womb, which is called fetal repair, but can be done through surgical repair.

To enable Nigerians access treatment of these birth defects, Grandville Medical and Laser is providing free surgical procedures to enable those who can’t afford treatment get their children treated, in order to reduce the burden of the birth defects in the country.

“We do more or less a charity work where we have children born with cleft lip and palate come to the clinic and we attend to them and do free surgeries for them. We help indigent patients that cannot afford to do this kind of surgery. We admit them, educate them, do the surgery for them and give them before and after care treatment,”Abayomi noted.

He said most people are unaware of the birth defects, which can be treated, there is however, need to increase awareness and advocacy, educating the communities about cleft lip and cleft palate as well as its treatment, especially as it is free.

He, however, advised parents not be scared or worried whenever they have children with similar cases but rather bring them to their facilities in Lagos for free surgical repair.

Meanwhile, the medical facility’s Aftercare Manager, Horsfall Tamunomiete stressed the need for aftercare in helping patients recovery.

She said the hospital has a facility where it offers aftercare services to patients undergoing treatment or after their procedures to enable them recuperate properly without any relapse due to the inconveniences or phobia for hospital environment.