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

  1. Matthew Fell
  2. Michael Goldwasser
  3. B.S. Jayanth
  4. Rui Manuel Rodrigues Pereira
  5. Christian Tshisuz Nawej
  6. Rachel Winer
  7. Neeti Daftari
  8. Hugh Brewster
  9. Karen Goldschmied
  10. Collaborators: Fernando Almas
  11. Mekonen Eshete
  12. George W. Galiwango
  13. Larry H. Hollier
  14. Akhter Hussain
  15. Lun-Jou Lo
  16. Paul Salins
  17. Debbie Sell
  18. Amanuel Tafase
  19. Ronald M. Zuker

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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.

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  1. Version published to 10.1177/10556656211069827
  2. ScreenIT

    SciScore for 10.1101/2021.10.14.21265004: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: The main strength of this piece of work was the collaborative nature of the international working group, which was inclusive of multiple disciplines and affiliation with multiple global cleft organisations. The working group was a good size in terms of productivity, but it was not inclusive of all specialties, organisations or regions and deliberations all took place in English. The consensus recommendations were based on common principles, but this is not an exhaustive document and therefore not a comprehensive guide to delivering cleft care protocols in LMICs during and after COVID-19. It is hoped the efforts of cleft providers in resource-constrained settings will be supported by this work to present a united and coordinated case for the provision of comprehensive cleft care to policy makers and ultimately improve safety and outcomes for patients. Ideally, there should be a focus on local protocols and guidance, therefore the relevance of these recommendations in specific environments may be limited (Truche et al., 2020). Further work: It is hoped that collaborative efforts such as this will galvanise the global cleft community to perform multi-centre international trials to reach a consensus on cleft care protocols and outcomes. Local outcome data collection must be encouraged to drive context-specific guidance. Finally, the efficacy of innovations highlighted by this pandemic should be explored so that they can ultimately help with the provisio...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.10.14.21265004v1 on medRxiv