{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:56:04Z","timestamp":1791665764454,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2016,7,14]],"date-time":"2016-07-14T00:00:00Z","timestamp":1468454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2016,7,14]],"date-time":"2016-07-14T00:00:00Z","timestamp":1468454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2016,7,14]],"date-time":"2016-07-14T00:00:00Z","timestamp":1468454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["R25-TW009345"],"award-info":[{"award-number":["R25-TW009345"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["R25\u2010TW009345"],"award-info":[{"award-number":["R25\u2010TW009345"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is a significant unmet need for the cleft lip and\/or palate (CL\/P) care in low\u2010 and middle\u2010income countries (LMICs)\n; however, country\u2010level estimates that can be used to inform local and international cleft care program strategies are lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using data from Operation Smile surgical programs in twelve LMICs and country\u2010level indicators from the World Health Organization and World Bank, we developed a model to estimate the proportion of individuals with CL\/Ps older than respective surgery age targets for cleft lip and cleft palate surgery (1 and 2 years, respectively). After extrapolating this model to other LMICs with available indicator data, we combined these findings with estimates of CL\/P prevalence among live births to estimate the total number of unrepaired CL\/P cases in LMICs worldwide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The models were constructed from a total of 887 cases of cleft palate and 576 cases of cleft lip across the twelve countries. From these, we estimated that there are 616,655 cases of unrepaired CL\/P (95 % CI 564,893\u2013678,503) in the 113 countries with available data for extrapolation. The rate of unrepaired CL\/Ps ranged from 2.5 per 100,000 population in Romania to 28.5 per 100,000\u00a0in Cambodia, respectively (median rate 10.7 per 100,000 population).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our model provides marked insight into the global surgical backlog due to cleft lip and palate. While the most populated LMICs have the largest number of unrepaired CL\/Ps, low\u2010income countries with relatively less healthcare infrastructure have exceptionally high rates (e.g., Cambodia, Afghanistan, and Nepal). These estimates can be used by local and international cleft care organizations to set program priorities, estimate resource requirements, and inform strategies to support cleft care.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-016-3637-4","type":"journal-article","created":{"date-parts":[[2016,7,14]],"date-time":"2016-07-14T20:40:22Z","timestamp":1468528822000},"page":"2857-2867","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["A Model of the Unmet Need for Cleft Lip and Palate Surgery in Low\u2010 and Middle\u2010Income Countries"],"prefix":"10.1002","volume":"40","author":[{"given":"Lucas C.","family":"Carlson","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women\u2019s Hospital 10 Vining St., Neville House\u20102nd Floor 02115 Boston MA USA"},{"name":"Department of Emergency Medicine Massachusetts General Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barclay T.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Washington Seattle WA USA"},{"name":"School of Medical Sciences Kwame Nkrumah University of Science and Technology Kumasi Ghana"},{"name":"Department of Interdisciplinary Health Sciences Stellenbosch University Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin W.","family":"Hatcher","sequence":"additional","affiliation":[{"name":"Operation Smile Inc. Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Kabetu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Kenyatta National Hospital Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"VanderBurg","sequence":"additional","affiliation":[{"name":"Operation Smile Inc. Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"William P.","family":"Magee","sequence":"additional","affiliation":[{"name":"Operation Smile Inc. Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,7,14]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(09)60695\u20104"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.2001.3618"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460\u20109592.2008.02839.x"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild\u20102014\u2010306175"},{"key":"e_1_2_6_6_2","first-page":"5","article-title":"Epidemiology of orofacial clefts in Africa: methodological challenges in ascertainment","volume":"2","author":"Butali A","year":"2009","journal-title":"Pan Afr Med J"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010011\u20101010\u20101"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010015\u20103168\u20104"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.01.021"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31829ad109"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e318192801b"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e318199669b"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2010.10.002"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2014.02.012"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2014.12.015"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010014\u20102628\u20106"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010012\u20101876\u20106"},{"key":"e_1_2_6_18_2","first-page":"185725","article-title":"Effectiveness of international surgical program model to build local sustainability","volume":"2012","author":"Magee WP","year":"2012","journal-title":"Plast Surg Int"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000001687"},{"key":"e_1_2_6_20_2","volume-title":"Global Health Observatory Data Repository","year":"2015"},{"key":"e_1_2_6_21_2","unstructured":"World DataBank(2015) The World Bank Group. Washington DChttp:\/\/databank.worldbank.org\/data\/home.aspx. Accessed 24 Oct 2015"},{"key":"e_1_2_6_22_2","volume-title":"The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage","author":"Gibbons L","year":"2015"},{"issue":"3","key":"e_1_2_6_23_2","first-page":"216","article-title":"Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review","volume":"24","author":"Vanderas AP","year":"1987","journal-title":"Cleft Palate J"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182402dd1"},{"key":"e_1_2_6_25_2","doi-asserted-by":"publisher","DOI":"10.1597\/09\u2010217"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006254\u2010197807000\u201000001"},{"key":"e_1_2_6_27_2","volume-title":"Global registry and database on craniofacial anomalies","author":"Mossey P","year":"2003"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2006.10.011"},{"key":"e_1_2_6_29_2","unstructured":"Operation Smile(2015) Operation smile standards of care.Virginia Beach.https:\/\/www.operationsmile.org\/sites\/default\/files\/Operation%20Smile%20Global%20Standards%20of%20Care.pdf. Accessed 24 Oct 2015"},{"key":"e_1_2_6_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0031\u20103955(16)38191\u20103"},{"key":"e_1_2_6_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(15)70115\u20104"},{"key":"e_1_2_6_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00238\u2010010\u20100513\u20106"},{"key":"e_1_2_6_33_2","doi-asserted-by":"publisher","DOI":"10.4314\/cajm.v46i11.8572"},{"key":"e_1_2_6_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u2010263X.2005.00626.x"},{"key":"e_1_2_6_35_2","unstructured":"World Health Organization(2002)Global strategies to reduce the health\u2010care burden of craniofacial anomalies: report of WHO meetings on International Collaborative Research on Craniofacial Anomalies. Geveva.http:\/\/apps.who.int\/iris\/bitstream\/10665\/42594\/1\/9241590386.pdf. Accessed 24 Oct 2015"},{"key":"e_1_2_6_36_2","volume-title":"Global burden of disease cause patterns","author":"GBD Data Visualizations","year":"2013"},{"key":"e_1_2_6_37_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132362"},{"key":"e_1_2_6_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010012\u20101794\u20107"},{"key":"e_1_2_6_39_2","article-title":"An analysis of cesarean section and emergency hernia ratios as markers of surgical capacity in low\u2010income countries affected by humanitarian emergencies from 2008\u20102014 at M\u00e9decins sans Fronti\u00e8res Operations Centre Brussels Projects","volume":"7","author":"Stewart B","year":"2015","journal-title":"PLoS Curr"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-016-3637-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-016-3637-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-016-3637-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-016-3637-4","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T16:38:07Z","timestamp":1703608687000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-016-3637-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,14]]},"references-count":38,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2016,12]]}},"alternative-id":["10.1007\/s00268-016-3637-4"],"URL":"https:\/\/doi.org\/10.1007\/s00268-016-3637-4","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,14]]},"assertion":[{"value":"14 July 2016","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}