{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T03:10:41Z","timestamp":1782443441808,"version":"3.54.5"},"reference-count":27,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    To assess the nutritional status and feeding difficulties of infants with cleft lip and\/or palate (CL\/P) in Karachi, Pakistan, and explore barriers in accessing healthcare.\n                    <jats:bold>Design:<\/jats:bold>\n                    Mixed-methods convergent study.\n                    <jats:bold>Setting:<\/jats:bold>\n                    A centrally located clinic in Karachi, Pakistan.\n                    <jats:bold>Participants:<\/jats:bold>\n                    Between July 2023 and February 2024, 22 infants were identified with CL\/P through the Congenital Anomalies Registry project. Of these, seven caregivers provided consent and participated in the study with their infants.\n                    <jats:bold>Interventions:<\/jats:bold>\n                    A single-day study was conducted, comprising both quantitative and qualitative components. Quantitative assessments included a caregiver survey and anthropometric measurements. A qualitative focus group discussion was held to explore feeding challenges and access to care.\n                    <jats:bold>Main Outcome Measures:<\/jats:bold>\n                    Proportion of infants with malnutrition (wasting, stunting, underweight), reported feeding practices, caregiver-reported barriers to feeding and healthcare access.\n                    <jats:bold>Results:<\/jats:bold>\n                    All data was anonymized before reporting of results. Five of the seven infants exhibited poor nutritional indicators. A variety of feeding practices were reported including breastfeeding along with bottle and syringe feeding. Feeding difficulties were reported by almost all caregivers (n\u2009=\u20096). Specialist care was only accessed by four participants; barriers were identified across the various dimensions of access to care.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Infants with CL\/P in this urban low- and middle-income country setting face high rates of malnutrition and significant barriers to care. Nutritional assessment, feeding support, and holistic patient-centered care are critically important in improving surgical outcomes in children with CL\/P. Moreover, context-specific care pathways must be made available that address the identified barriers.\n                  <\/jats:p>","DOI":"10.1177\/10556656251369662","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T06:23:36Z","timestamp":1755671016000},"page":"2132-2140","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Documenting Nutritional Status and Access to Care for Infants with Cleft Lip and\/or Palate in Karachi, Pakistan: A Mixed-Methods Study"],"prefix":"10.1177","volume":"63","author":[{"given":"Mahnoor","family":"Nawab","sequence":"first","affiliation":[{"name":"Department of Global Surgery, Interactive Research and Development (IRD) Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0925-1848","authenticated-orcid":false,"given":"Maryam","family":"Sherwani","sequence":"additional","affiliation":[{"name":"Department of Global Surgery, Interactive Research and Development (IRD) Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hameeda A.","family":"Arain","sequence":"additional","affiliation":[{"name":"Department of Global Surgery, Interactive Research and Development (IRD) Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3591-5027","authenticated-orcid":false,"given":"Mahwish","family":"Fatima","sequence":"additional","affiliation":[{"name":"Department of Global Surgery, Interactive Research and Development (IRD) Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5246-5104","authenticated-orcid":false,"given":"Ammar","family":"Ali Muhammad","sequence":"additional","affiliation":[{"name":"Department of Global Surgery, Interactive Research and Development (IRD) Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8279-6246","authenticated-orcid":false,"given":"Shazia","family":"Junejo","sequence":"additional","affiliation":[{"name":"Department of Global Surgery, Interactive Research and Development (IRD) Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9716-8162","authenticated-orcid":false,"given":"Felicity","family":"Mehendale","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, Usher Institute, The University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6365-8796","authenticated-orcid":false,"given":"Lubna","family":"Samad","sequence":"additional","affiliation":[{"name":"Director Global Surgery, Interactive Research and Development (IRD) Global"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665618820754"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1597\/05-185"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1277714"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1597\/05-172"},{"issue":"2","key":"e_1_3_2_6_2","first-page":"113","article-title":"Clinical research in cleft lip and cleft palate: the state of the art","volume":"10","author":"Spriestersbach DC","year":"1973","unstructured":"Spriestersbach DC, Dickson DR, Fraser FC, Horowitz SL, McWilliams BJ, Paradise JL, Randall P. 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