Adapting cleft care protocols in low- and middle-income countries during and
after COVID-19: a process-driven review with recommendations
Authors names:
Matthew Fell MRCS
1
,
2
Michael Goldwasser MD
3
,
4
B.S Jayanth MD
5
Rui Manuel Rodrigues Pereira MD
6
,
7
Christian Tshisuz Nawej MMED
8
Rachel Winer BA
9
Neeti Daftari MA, MSc
9
Hugh Brewster MEd
9
Karen Goldschmied SLT
10
Collaborating authors names:
Fernando Almas MD
11
Mekonen Eshete MD
12
George W. Galiwango MD
13
Larry H. Hollier Jr. MD
14
,
15
Lun-Jou Lo MD
16
,
17
Debbie Sell FRCSLT
18
Amanuel Tafase MD
11
Ronald M. Zucker MD
19
,
20
1
CLEFT Charity, Chelmsford, United Kingdom
2
Cleft Collective, University of Bristol, Bristol, United Kingdom
3
Operation Smile, Virginia Beach, USA
4
Craniofacial and Surgical Care, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
5
ABMSS, Bengaluru, India
6
Faculdade de Medicina da Universidade de Sao Paulo, Sau Paulo, Brazil
7
Instituto de Medicina Integral Prof Fernando Figueira, Recife, Brazil
8
Cliniques Universitaires de Lubumbashi, Democratic Republic of Congo
9
Transforming Faces, Toronto, Canada
10
Hospital Dr Luis Calvo Mackenna, Santiago de Chile, Chile
11
Project Harar Ethiopia, Henfield, United Kingdom
12
Cleft Lip and Palate Program, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
13
CORSU Rehabilitation Hospital, Kisubi, Uganda
14
Smile Train Global Medical Advisory Board, New York, USA
15
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine,
Department of Surgery, Texas Children’s Hospital, Houston, Texas, USA
16
Noordhoff Craniofacial Foundation, Taipei, Taiwan
17
Craniofacial Center, Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
18
Great Ormond Street Hospital for Children, London, United Kingdom
19
Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto Canada
20
The University of Toronto, Toronto, Canada
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perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted October 19, 2021. ; https://doi.org/10.1101/2021.10.14.21265004doi: medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
Corresponding author:
Matthew Fell
The Cleft Collective
Bristol Dental School
University of Bristol
Oakfield House
Oakfield Grove
Bristol
BS8 2BN
United Kingdom
Mobile: 0044 (0)1179505050
Mattfell@doctors.org.uk
Running title: Adapting cleft protocols in LMICs following COVID
Financial support:
MF is supported by the VTCT Foundation for a research fellowship with the Cleft Collective
at the University of Bristol
ACKNOWLEDGEMENTS
The authors would like to thank the Circle of Cleft professionals and the multiple
organisations that support it for facilitating this work.
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted October 19, 2021. ; https://doi.org/10.1101/2021.10.14.21265004doi: medRxiv preprint
Adapting cleft care protocols in low- and middle-income countries during and
after COVID-19: a process-driven review with recommendations
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted October 19, 2021. ; https://doi.org/10.1101/2021.10.14.21265004doi: medRxiv preprint
2
ABSTRACT
Objective: A consortium of global cleft professionals, predominantly from low- and middle-
income countries, identified adaptions to cleft care protocols during and after COVID as a
priority learning area of need.
Design: A multidisciplinary international working group met on a videoconferencing
platform in a multi-staged process to make consensus recommendations for adaptions to
cleft protocols within resource-constrained settings. Feedback was sought from a
roundtable discussion forum and global organisations involved in comprehensive cleft care.
Results: 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 scrutinised and COVID adaptions, specifically in the
pre and peri-operative periods, were highlighted. Second, surgical operations and access to
services were prioritized according to their relationship to functional outcomes and time-
sensitivity. The operations assigned the highest priority were emergent interventions for
breathing and nutritional requirements and primary palatoplasty. The cleft services assigned
the highest priority were new-born assessments, paediatric support for children with
syndromes, management of acute dental or auditory infections and speech pathology
intervention.
Conclusions: 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
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted October 19, 2021. ; https://doi.org/10.1101/2021.10.14.21265004doi: medRxiv preprint
3
amongst global cleft care providers will be advantageous to advocate for children born with
cleft lip and palate in resource-constrained settings.
Keywords: comprehensive cleft care, low- and middle-income countries, COVID-19, Circle of
Cleft Professionals
All rights reserved. No reuse allowed without permission.
perpetuity.
preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in
The copyright holder for thisthis version posted October 19, 2021. ; https://doi.org/10.1101/2021.10.14.21265004doi: medRxiv preprint
