Surgical Tribune Asia Pacific

Barriers to cleft lip and palate surgery persist in Vietnam

By Surgical Tribune
November 10, 2016

LOS ANGELES, USA: Charitable organisations perform more than 80 per cent of cleft lip and cleft palate surgeries in Vietnam, a new study by US researchers has found. According to the scientists, this reflects the complex and persistent barriers to surgical care in low- to middle-income countries (LMICs) and shows that charitable missions remain a critical source of access to surgical care for these states.

Cleft lip and palate are the most common craniofacial birth defects, occurring in between one in 500 to one in 2,500 infants worldwide. “The defect not only results in physical obstacles to feeding and language development, but patients are often subjected to significant social stigma,” the researchers stated.

They surveyed approximately 450 Vietnamese families seeking cleft lip and/or palate repair surgery for their affected child. Some of the children had already undergone surgery for their condition previously (54 per cent) and 46 per cent of them were seeking surgical care for the first time. The families were seen at four medical missions sponsored by the international charity Operation Smile. Parents were asked in-depth questions about their perceptions of the barriers to surgical and medical care for their child’s condition.

Facing structural, financial and cultural barriers to cleft lip and palate surgery, patients in LMICs rely on charitable care outside the centralised health care system, the study report pointed out. “As a result, surgical treatment of cleft lip and palate is delayed beyond the standard optimal window compared to more developed countries,” the researchers wrote. At the time of initial cleft surgery, the children’s average age was 3.25 years. By comparison, in developed countries, the recommended age for cleft lip and palate repair surgery is between 3 and 18 months of age.

Nearly three-quarters of the families had health insurance coverage. Nevertheless, 83 per cent had their surgery performed by a charitable organisation outside of the national health care system. While most parents had a local hospital that was more accessible than the charitable mission was, many said that they could not obtain cleft treatment there, mainly owing to cost. About 40 per cent stated that, without the charitable mission, they would not have had access to any surgical or medical treatment for their child’s condition.

The survey found a wide range of structural, financial and cultural barriers to cleft care. Structural barriers included lack of trained medical staff, equipment and medicine. Financial barriers were identified as not only the cost of the surgery, but also the cost of travel to obtain care. Cultural barriers included family members’ opinions and permission, as well as lack of trust in the medical system and staff.

According to the researchers, these barriers need to be better understood in order to design more effective programmes for both missions-based and locally sustainable surgical care in LMICs. On the basis of their findings, they proposed a new surgical LMIC model that accounts for the unique barriers and specific challenges to accessing surgery in resource-poor countries—especially for conditions that require multiple operations, such as cleft lip and palate.

Improving access to surgical care has become a major global health priority, the researchers said. However, the current knowledge gap on providing surgery in LMICs—including the need for specialised facilities, physicians and follow-up care—has only begun to be studied. Thus, even in countries with near-universal health insurance, charitable missions remain a critical source of access to surgical care, they concluded.

The study, titled “Barriers to reconstructive surgery in low- and middle-income countries: A cross-sectional study of 453 cleft lip and cleft palate patients in Vietnam”, was conducted by scientists from the University of Southern California in Los Angeles. It was published in the November issue of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons.

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