Increasing access to treatment for cleft victims in Nigeria

Cleft lip and palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. These birth defects are commonly known as “Orofacial Clefts”.

Cleft is caused by a combination of genes and other environmental factors that an expectant the mother comes in contact with, including what she eats or drinks, or certain medications she uses during pregnancy.

Other factors may include diseases like diabetes, obesity, and excessive consumption of cigarettes or alcohol, as well as poor mother’s nutrition level.

The World Health Organisation (WHO) stated that globally, one in every 700 children is born with the condition.

WHO added that one in 1,200 children estimated cleft incidences, are of African descent. 19,000 cleft children are born every year in Africa, out of which 12,000 are in West Africa and 6,000 in Nigeria.

Dr Akintunde Akintayo, a Consultant Surgeon with the Plastic and Reconstruction Unit, Department of Surgery, Jos University Teaching (JUTH), had told the News Agency of Nigeria (NAN), in an interview that cleft often occurred when certain body parts and structures did not properly fuse together during fetal development.

According to Akintayo, cleft lip is a congenital opening on the lip, while the palate is an opening in the throat.

“As a baby develops during pregnancy, body tissue and special cells from each side of the head grow towards the center of the face, and join together to make the face.

“A cleft lip happens if the tissue that makes up the lip does not join completely before birth and this results in an opening in the upper lip.

“The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose.

“A cleft lip can be on one or both sides of the lip, or in the middle of the lip, which occurs very rarely. Children with cleft lip also can have cleft palate,’’

Akintayo, who said that the abnormality could be hereditary, added that the mother’s lifestyle during pregnancy could increase her chances of having a child with cleft.

He, however, assured that cleft was treatable.

The surgeon explained that anyone born with cleft might likely have other abnormalities, and therefore, advised mothers to be wary of their lifestyles during pregnancy.

“Cleft is hereditary; it can be transferred from parents to children. But it is a treatable condition.

“It is not possible to have a society that’s totally free of cleft because it is genetic, and it is difficult to correct genes, but the cases can be reduced.

“When both parents have cleft, it increases the chances of their children coming up with the condition.

“But specifically, mothers must take good care of themselves and avoid indiscriminate consumption of medicines during pregnancy.

“We also advice intending couples, who both have cleft, against getting married; this will automatically reduce the number of cleft victims in our society,”

How enlightened are people about this condition? But how can access to treatment be increased for victims of cleft? Whose responsibility is it to ensure such access? What is the government’s role in tackling the menace? These and more are the questions that readily come to mind in a bid to understand the condition and curb it.

In the light of the above, and worried by the situation, Smile Train, a non-profit organisation, founded in 1999, with its headquarters in New York City, has been providing corrective surgery for children with clefts.

Currently, it provides free corrective cleft surgery in 87 countries, training local doctors and providing hospital funding for the procedures, with the sole aim of supporting 100 per cent free cleft repair surgery and comprehensive cleft care for children globally.

In Nigeria for instance, Smile Train has sponsored more than 25,000 free cleft treatments since 2002.

Beyond the surgeries, its sustainable model empowers local medical professionals to provide other cleft care in their own communities such as orthodontics, speech therapy and nutritional support.

Commending smile train for providing free treatment for cleft victims, Akintayo said that the organisation had sponsored more than 300 free surgeries in JUTH since 2007.

According to him, the free treatment introduced by Smile Train and other similar organisations has increased access to treatment for victims.

“But we need to do more in creating awareness, particularly in rural communities.

“Smile Train is doing well in this regard, but a lot of victims are still not aware of the existing free treatment.

“In JUTH, surgery for cleft costs between N75,000 to N100,000. These figures may look small, but it is big for a family with a lean income.

“Inhabitants of urban cities like Jos may not know how and where to access free cleft treatment, but the people in rural communities must be adequately sensitised in this regard.”

Prof. Emmanuel Ameh, of the Department of Paediatrics Surgery, National Hospital, Abuja, who also threw more light on the condition, called on federal and state governments to commit more funds towards improving surgical treatment and care for cleft victims.

According to Ameh, the spate of deaths due to unavailability of surgical procedures for those with medical conditions such as cleft, keep going higher, and that the policymakers, who should consider the issue as critical, usually view surgical care as too expensive.

He noted that the government often placed more emphasis on treating infectious diseases over other health conditions.

“Over the years, policymakers believe surgical care is very expensive and tend to neglect that aspect of medicine.

“Government at all levels lay more emphasis on infectious diseases over other medical conditions and one classical example is the outbreak of COVID-19 pandemic.

“Currently, nine out of 10 people in Low-Income Countries such as Nigeria lack access to basic surgical care.

“So, there is a need for the government to invest more funds into surgical and anaesthetic care.”

He further advised the government to expand surgical care to cover 75 per cent of the population and 50 per cent of children less than 15 years of age.

The surgeon further called on the government to ensure that the National Health Insurance Scheme (NHIS), removed restrictions on the treatment of surgical conditions.

Ameh also called on the government to train more experts in providing surgical care, particularly in the aspect of life support.

Rhoda Ajiji, a beneficiary of the free treatment offered by smile train, narrated her ordeal before she could access treatment.

Ajiji, a resident of Maijuju community, in Jos East Local Government Area of Plateau, said that some people from her community did everything to prevent her from getting treated.

“In 2009, I heard of the free treatment offered in JUTH by Smile Train. It was at the village market that someone told me about it.

“But when people in my community, including members of my family, heard of it, they refused me going for the treatment.

“They warned those with motorcycles or cars not to pick me, so, I had to trek for two days to go to JUTH for treatment,”

Dismissing the claim in some quarters that cleft could be a spiritual attack on the victims, Rev. Ayuba Asheshe, the Secretary General of Evangelical Church Winning All (ECWA), agreed with Akintayo that it was a genetic condition.

According to Asheshe, the Church does not discriminate against anyone on the basis of their health condition, but supports people, irrespective of religious background, to seek medical help when in need of one.

“Most Churches today have established hospitals and these facilities cater for the health needs of not just its members, but the general public, irrespective of religious or cultural affiliations.

“So, the Church does not discriminate on basis of health condition, but we support our members to seek medical attention alongside prayers when passing through any health challenge,”

Asheshe promised to create awareness on the availability of free treatment for people with cleft lip and palate.

Da Samuel Jok, the District Head of Riyom, promised to support the efforts of Smile Train, and other relevant agencies in providing succor to all cleft victims in rural communities.

Therefore with concerted efforts by critical stakeholders in the health sector, it is believed that cases of cleft in Nigeria, particularly in rural communities, would drastically reduce, as those who are currently suffering from the condition would access the free treatment courtesy of Smile Train.

Source: News Agency of Nigeria