Adapting Elements of Cleft Care Protocols in Low- and Middle-income Countries During and After COVID-19: A Process-driven Review With Recommendations

Authors

Matthew Fell
Michael Goldwasser
B S Jayanth
Rui Manuel Rodrigues Pereira
Christian Tshisuz Nawej
Rachel Winer
Neeti Daftari
Hugh Brewster
Karen Goldschmied
Collaborators Fernando Almas
Mekonen Eshete
George W Galiwango
Larry H Hollier
Akhter Hussain
Lun-Jou Lo
Paul Salins
Debbie Sell
Amanuel Tafase
Ronald M Zuker

Publication Date

5-1-2023

DOI

10.1177/10556656211069827

PMID

34982012

PMCID

PMC10102820

PubMedCentral® Posted Date

1-4-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Child, Humans, Cleft Palate, Cleft Lip, Developing Countries, COVID-19, comprehensive cleft care, low- and middle-income countries, COVID-19, circle of cleft professionals

Abstract

A consortium of global cleft professionals, predominantly from low- and middle-income countries, identified adaptations to cleft care protocols during and after COVID-19 as a priority learning area of need. A multidisciplinary international working group met on a videoconferencing platform in a multi-staged process to make consensus recommendations for adaptations to cleft protocols within resource-constrained settings. Feedback was sought from a roundtable discussion forum and global organizations involved in comprehensive cleft care. Foundational principles were agreed to enable recommendations to be globally relevant and two areas of focus within the specified topic were identified. First the safety aspects of cleft surgery protocols were scrutinized and COVID-19 adaptations, specifically in the pre- and perioperative periods, were highlighted. Second, surgical procedures and cleft care services were prioritized according to their relationship to functional outcomes and time-sensitivity. The surgical procedures assigned the highest priority were emergent interventions for breathing and nutritional requirements and primary palatoplasty. The cleft care services assigned the highest priority were new-born assessments, pediatric support for children with syndromes, management of acute dental or auditory infections and speech pathology intervention. A collaborative, interdisciplinary and international working group delivered consensus recommendations to assist with the provision of cleft care in low- and middle-income countries. At a time of global cleft care delays due to COVID-19, a united approach amongst global cleft care providers will be advantageous to advocate for children born with cleft lip and palate in resource-constrained settings.