{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:10:36Z","timestamp":1789567836858,"version":"build-2803163510"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the likelihood of families with a child with orofacial cleft falling into catastrophic healthcare expenditure (CHE) due to financial burden of caring for the child.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional descriptive study using a 35-item interviewer administered proforma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A tertiary health institution in Lagos, Nigeria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All consenting caregivers attending the orofacial cleft clinic within the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measure<\/jats:title>\n                    <jats:p>The primary outcome was the capacity of families to make out-of-pocket payment (CTP) for treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study enrolled 84 respondents, with CHE analysis based on 83 participants with complete income data. The approximate combined family monthly income of 77.4% was below \u20a6300,000(\u223c$222), supporting a median of five family members. A single government-subsidized surgical intervention can cost as much as \u20a6600,000(\u223c$444) out-of-pocket. Applying the WHO threshold of out-of-pocket expenditure exceeding 40% of household's capacity to pay(CTP), and using phenotype-specific cost pathways, an estimated 53.0% to 59.0% of families would face CHE from direct treatment costs, with no statistically significant difference across cleft phenotypes. For unilateral and bilateral cleft lip and palate, the 10-year direct cost of comprehensive cleft care at our center ranges from \u20a62,975,000 to \u20a63,980,000 (\u223c$2204-$2948), which exceeds the total annual income of many participating families.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The result of this study reveals the frailty of the current healthcare financing model for orofacial cleft management in Nigeria and the urgent need for policy intervention to extend insurance coverage to the full multidisciplinary care pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261470526","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:19:01Z","timestamp":1789445941000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Potential Catastrophic Health Expenditure Related to Treatment Cost for Families of Children With Orofacial Cleft in a Low-Middle-Income Country"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5679-4469","authenticated-orcid":false,"given":"Adegbayi Adeola","family":"Adekunle","sequence":"first","affiliation":[{"name":"College of Medicine, University of Lagos\/Lagos University Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul-Kabir Adegoke","family":"Yahya-Imam","sequence":"additional","affiliation":[{"name":"Lagos University Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0904-6772","authenticated-orcid":false,"given":"Olawale Olatubosun","family":"Adamson","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos\/Lagos University Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olutayo","family":"James","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos\/Lagos University Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mobolanle Olugbemiga","family":"Ogunlewe","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos\/Lagos University Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1229-5964","authenticated-orcid":false,"given":"Azeez","family":"Butali","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos, Lagos University Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasiu Lanre","family":"Adeyemo","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos\/Lagos University Teaching Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60695-4"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003474"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/562892"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/J.1601-0825.2009.01588.X"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/S-0039-3402353"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0B013E318268A960"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002146"},{"issue":"2","key":"e_1_3_4_9_2","first-page":"188","article-title":"Estimates of the economic costs of birth defects","volume":"31","author":"Waitzman NJ","year":"1994","unstructured":"Waitzman NJ, Romano PS, Schefflern RM. 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