Public Release: 

Estimating unmet need for cleft lip and palate surgery in India

The JAMA Network Journals

An estimated more than 72,000 cases of unrepaired cleft lip and/or palate exist in 28 of India's 29 states and poor states with less health infrastructure had higher rates, according to an article published online by JAMA Facial Plastic Surgery.

Cleft lip and/or palate (CL/P) disproportionately affect newborns in low- and middle-income countries because of substandard nutrition and a lack of prenatal care. Infants in these countries face significant barriers to treatment and that can lead to prolonged disfigurement, social stigma, speech impairment and feeding trouble that can result in malnutrition and death. Safe, timely and effective surgery can result in successful outcomes.

Barclay T. Stewart, M.D., M.Sc.P.H., of the University of Washington, Seattle, and coauthors used data from Operation Smile programs in 12 low- and middle-income countries to estimate the unmet need for CL/P surgery in India at the state level.

The authors estimate 72,637 cases of unrepaired CL/P in 28 of the 29 states in India with available data. The rate of unrepaired CL/Ps ranged from less than 3.5 per 100,000 population in Kerala and Goa to 10.9 per 100,000 population in Bihar, according to the results.

The authors acknowledge study limitations that include using data from 11 countries in addition to India in building their statistical models.

"With more than 72,000 cases of unrepaired CL/P in India, significant efforts must be made to relieve the prevalent unmet need and strengthen health care services to meet the demand of new cases so that the surgical backlog does not grow," the study concludes.


(JAMA Facial Plast Surg. Published June 9, 2016. doi:10.1001/jamafacial.2016.0474. Available pre-embargo to the media at

Editor's Note: The article contains conflict of interest and funding/support disclosures. Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media advisory: To contact study corresponding author Barclay T. Stewart, M.D., M.Sc.P.H., call Bobbi Nodell at 206-543-7129 or email

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