Epidemiology of Orofacial Clefts in East Africa: a Systematic Review

This research project is a systematic review designed to provide an epidemiological mapping of Orofacial Clefts (OFCs) across eleven East African nations: Uganda, Rwanda, Burundi, Tanzania, Kenya, South Sudan, Democratic Republic of the Congo, Ethiopia, Eritrea, Djibouti, and Somalia. Its primary purpose is to address the critical "data gap" regarding the prevalence and etiology of cleft lip and palate in East Africa. While surgical interventions have increased across the region, public health policy remains hampered by fragmented data. Currently, estimates of OFC prevalence vary wildly due to inconsistent reporting methods, ranging from community-based surveillance to localized hospital registries. This project seeks to synthesize literature published between 2011 and 2025 to achieve three core objectives: 1. To determine the pooled prevalence of OFCs, distinguishing between birth incidence and the "surgical backlog" of untreated cases. 2. To evaluate how these anomalies are distributed by sex, phenotype (isolated vs. syndromic), and laterality. 3. To investigate the correlation between OFCs and regional specificities, such as consanguinity, nutritional deficiencies (folic acid), and environmental exposures like biomass fuel smoke. To ensure the highest level of academic rigor, the project will utilize a multifaceted search strategy across six major databases (PubMed, Scopus, Web of Science, Google Scholar, AJOL, and WHO Global Index Medicus). The study will employ a unique "Tiered Evidence Approach," stratifying data into population-based, hospital-based, and service-based categories. This methodology will allow the research to account for selection bias and provide a more nuanced understanding of the regional burden. Data synthesis will be performed using STATA (v17.0), utilizing a random-effects model to manage the anticipated heterogeneity of the East African healthcare landscape. The findings of this systematic review are expected to serve as a foundational evidence base for several key stakeholders: 1. Public Health Policy: By identifying high-risk regions and specific environmental triggers, the study will provide a roadmap for primary prevention strategies and maternal-fetal health interventions. 2. Healthcare Planning: Accurate prevalence data will assist Ministries of Health and NGOs in optimizing resource allocation for surgical missions and multidisciplinary cleft care centers. 3. Clinical Counseling: Identifying the prevalence of associated malformations will improve the diagnostic accuracy and prenatal counseling provided to families. 4. Scientific Contribution: This study will be registered with Open Science Frame, contributing a standardized, peer-reviewed dataset to the global body of epidemiological research, specifically highlighting the unique challenges faced by the East African population.