

































 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN 

UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR 

Rakotoson M1*, Dally S2, Soanasolo CM2, Ralaiavy HH2, Ratovoarisoa D3, Ranjarisoa LN4 

1Department of Dentofacial Othopedics/  Institute of Tropical Odonto-Stomatology of 

Madagascar (IOSTM) ; Madagascar 

2Department of Periodontics/  Institute of Tropical Odonto-Stomatology of Madagascar 

(IOSTM) ; Madagascar 

3Department of Oral Surgery / Institute of Tropical Odonto-Stomatology of Madagascar 

(IOSTM) ; Madagascar 

4Department of Public Health/  Institute of Tropical Odonto-Stomatology of Madagascar 

(IOSTM) ; Madagascar 

 

 

 

 

 

IJO JOURNALS

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ABSTRACT

Introduction: Cleftlip  and  palate  are  the  most common  facial 

malformations, with prevalence varying between  races  and  ethnic  groups.  They represent  

one  of  the  major public  health problems,  often associated with severe  malformations  at  

high  risk  of  infant mortality.  Hospital  prevalence  in  Madagascar  was  4.66‰  in  2016.  

The  overall  objective  of this study was to describe the epidemiological profile of cleftlip and 

palate in children under 15 years of age in Madagascar from 2015 to 2020.

Methodology:This  was  a  retrospective  descriptive  study reporting epidemiological  data 

of children under  15  years  of  age from  2015  to  2020  at  09  different  sites  in  Madagascar. 

The sample  size  was  exhaustive.  Data  were collected  by  counting,  independent  and 

dependent variables  were analyzed  on  SPPSS  21.0  software  by  the 

chi2  test who se significance threshold was set at a p<0.05.



 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

Results: The epidemiological profile of childrenwithcleftlip and palate in Madagascar 

wasmarked by: apredominance of males, a lowsocio-economiclevel, a riskypre-

gestationalmaternalstatus, and a multiparousfamily. 

Discussion:Male predominance has been observed in similarstudies in Côte d'Ivoire and 

France. Scottish and American studies have demonstratedthat the existence of viral or 

parasitic infections duringpregnancyrepresents a risk of congenital malformation. In 

Madagascar, the birth of an infant with a highlydisfiguringcongenital malformation leads to 

deliberateneglect. 

Conclusion:Cleftlip and palateremains a major public healthproblem in Madagascar. 

Keywords : Child, Cleftpalate, Madagascar. 

 

 

1. Introduction 

Cleftlip and cleftpalate are the mostcommon facial malformations, 

withprevalencevaryingbetween races and ethnic groups [1]. They are a major public 

healthproblem, oftenassociatedwithsevere malformations [2]. Worldwide, an estimated 

303,000 newborns die eachyearwithin four weeks of birth, due to congenital anomalies [2]. 

These malformations disruptseveralfunctions essential to the child's normal development: 

speech, hearing, dentition, as well as aestheticappearance and psychological balance. Future 

sequelae of thiscongenital condition may have an impact on aesthetics and function. The 

psychologicalconsequences of the malformation are veryserious, particularly for the parents, 

and can lead to familytragedy in the face of thismuch-desiredchild, and even for the 

childaftersurgery [3]. It isestimatedthatbetween 1/700 and 1/1000 live birthsworldwide are 

affected byof orofacialclefts for different populations around the world, withconsiderable 

variations linked to geographicalorigins, ethnicity and socio-economic conditions [4].The sex 

ratio is 0.5 (predominantlyfemale) [5]. In Europe, one childin 650 is a cleft carrier [4]. The 

lowestprevalenceisreportedamongAfrican-Americans, at around 0.5 per 1,000 births, and 

amongCaucasians, at around 1 per 1,000 births [5]. In South Africa, earlierstudies on 

IJO JOURNALS

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 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

thisprevalencewerecarried out in Cape Town, Johannesburg and Pretoria in the late 1980s. 

Reportedprevalencerangedfrom 0.1 to 0.4 per 1,000 live births [3]. In Madagascar, according 

to the study made by Rakotoarisonin 2012, the prevalence of cleftlip and palatewas 0.48‰ 

from 1998 to 2007 and washigher in the highlands [6]. A studydone in Mahajanga from 2007 

to 2011 found a hospitalprevalence of 4.66%. The overallaim of thisstudywas to describe the 

epidemiological profile of cleftlip and palate in childrenunder 15 years of age in Madagascar 

from 2015 to 2020. The specific objectives were to describe the socio-epidemiological profile 

of childrenunder 15 and theirparents;Describe the prevalence of clefts in Madagascar; Identify 

the relationshipbetween the epidemiological profile and the type of cleft; Propose suggestions. 

 

 

2. Materials and methods 

This is a retrospective descriptive studyreportingepidemiological data of childrenunder 15 

years of agefrom 2015 to 2020 at 09 different sites in Madagascar. 

This article deals with a site of 200 children. 

The studyranfromJanuary 01, 2015 to December 31, 2020.  

Childrenunder 15 years of agewereincluded in the study.  

Childrenunder 15 years of agewhose records could not beusedwereexcludedfrom the study.  

The sample size was exhaustive. 

The variables were :  

 Patient information 

Age, gender, place of residence, sibling rank, ethnicity, presence of other anomalies, presence 

of allergy. 

 Information on parents (mother, father or guardian) 

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 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

Parents' age, socio-economiclevel, level of education, consanguinity, duration of pregnancy, 

complications duringpregnancy, complications at birth, toxic habits (tobacco, alcohol), 

medicationtakenduringpregnancy, folicacidtaken at birth, presence of cleft in the family, types 

of cleftlip and palate. 

Data werecollectedethically, and independent and dependent variables wereanalyzedusing 

SPPSS 21.0 software, using the chi2 test with a significancethreshold of p<0.05.  

 

3. Results 

Table 1:Distribution of children by gender(N = 200) 

Gender 
Number 

(n = 173) 

Percent 

         (%) 

Male 95 54,9 

Female 78 45,1 

Total 173 100 

 

Table 2 : Distribution of children by parental consanguinity(N = 200) 

Consanguinity Number 

(n =173) 

Percent 

(%) 

Yes 31 17,9 

No 142 82,1 

Total 173 100 

 

 

 

IJO JOURNALS

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 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

Table 3 : Distribution of childrenaccording to theirmother's cigarette 

consumptionduringpregnancy(N = 200) 

Consumptionduringpregnancy Nombre 

(n = 173) 

Pourcentage 

(%) 

Yes 5 2,9 

No 158 91,3 

Unknown 10 5,8 

Total 173 100 

Table 4 : Distribution of childrenaccording to 

theirmother'salcoholconsumptionduringpregnancy(N = 200) 

Consumptionduringpregnancy Number 

(n = 173) 

Percent 

(%) 

No 160 92,5 

Unknown 13 7,5 

Total 173 100 

 

Table 5 : Distribution of childrenaccording to the existence of cleftfamilymembers(N = 

200) 

Cleft Family members 

 

Number 

(n = 173) 

Percent 

(%) 

Yes 20 11,6 

No 146 84,4 

Unknown 7 4,0 

Total 173 100 

 

 

 

 

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 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

Table 6 : Distribution of childrenaccording to the existence of associatedcraniofacial 

malformations (N = 200) 

Existence of associatedcraniofacial 

malformations 

 

Number 

 (n =173) 

Percent 

(%) 

Yes 4 2,3 

No 115 66,5 

Unknown 54 31,2 

Total 173 100 

 

Table 7 : Distribution of children by cleft type (N = 200) 

Type of cleft Number 

(n = 173) 

Percent 

(%) 

Labial cleft 42 24,3 

Alveolar cleft 15 8,7 

Palate cleft 38 22,0 

Labio-alveolar cleft 16 9,2 

Labio-palate cleft 34 19,7 

Alveolo-palate cleft 3 1,7 

Labio-alveolo-palate cleft 25 14,5 

Total 173 100 

 

4. Discussion 

Males accounted for 54.9% of the population. Our studycorrelateswiththat of Colemann JR in 

2001, whostatedthat “cleftlip and palate are twice as frequent in boys” [7].  The majority of 

childrenhadunilateralclefts. Studies by Anderson P in 1942 and Jensen BL in 1976-1981 

confirmourstudythat “cleftlip tends to beunilateral (about 90%) and about two-thirdsoccur on 

the leftsideregardless of gender, ethnicity and severity of defect” [8]. 

Consanguinityisalsopresent. A study by Al-Johar A in 2008 in Saudi Arabia reportedthat: “the 

reportedprevalence of consanguinity in familieswithcleftlip and palate in Saudi Arabia ranges 

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 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

from 6.7% to 83%, with a high prevalence of marriagesbetween first cousins” [9].  Some of 

the motherswerealcoholics. In 2007, Honein MA assertedthat “alcoholconsumption 

(particularly for cleftpalates) and/or smoking during the first threemonths of pregnancy are 

environmentalfactors in the development of cleftlip and palate” [10]. Rakotoarison RA in 

2011 states that: “A particularityisobserved in the Vakinankaratra region, 

wherethisprevalenceis double that of otherregions. This wouldbe due to the existence of very 

high doses of radioactivity in certain areas of thisregion” [6]. The dysmorphologicalseverity 

of cleftlip and palateisassociatedwith the severity of the phenotype in terms of other 

malformations, with a striking trend. Bilateralcleftlip and palate cases are three times more 

likely to have anothersevere malformation thanunilateral cases” [11]. 

 

5. Conclusion 

Cleftlip and palateremains one of the major public healthproblems in Madagascar.  

The epidemiological profile of childrenwithcleftlip and palate in Madagascar wasmarked by 

male predominance, lowsocio-economicstatus, riskypre-gestationalmaternalstatus, and 

multiparousfamilies. According to ourresults, relationshipsbetweenepidemiological profile 

and types of cleftexisted. 

However, the etiology of cleftlip and palateremainspoorlyknown in Madagascar, henceour 

plan to broadenourresearch by conducting an analyticalstudy of cleftlip and palate in 

Madagascar. 

 

 

References 

1.Bonaiti C. Briard M.L., Freingold J. An epidemiological and genetic study of facial cleft in 

France: epidemiology and frequency in relative. J Med Genet, 1982; 19:8-18. 

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 IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                                           Rakotoson M1* * 

https://ijojournals.com/                                                                               Volume 08 || Issue 03 || March, 2025 || 

“ EPIDEMIOLOGICAL PROFILE OF CLEFT LIP AND PALATE IN CHILDREN UNDER 15 FROM 2015 TO 2020 IN MADAGASCAR." 

 

 

 

2.PLo S One. Epidemiology and clinical profile of people withcleftlip and 

palateusingspecializeduniversitytreatment centers in South Africa. 2019;14(5). 

3.Francannet C. Facial cleft and nutritionalfactors. Symposium of the EuropeanGenomutation 

Institute Groupama Foundation. Lyon. 2002. 

4.Mange M, Campbell R, Gilyoma J, Magori CC, Kilalo M, Mazyala E et al. An assessment 

of orofacial clefts in Tanzania, Published online 2011, doi: 10.1186/1472-6831-11-5. 

5.Omo-Aghoja VW, Omo-Aghoja LO, Ugboko VI, Obuekwe ON, Saheeb BDO, Feyi-

Waboso P et al. Antenatal determinants of oro-facial clefts in Southern Nigeria. Afr Health 

Sci. 2010; 10(1):31-9.  

6.Rakotoarison RA. Cleft lip and palate in Madagascar 1998-2007. British Journal of oral of 

oral and Maxillo-facial Surgery.2012; 50(5):430-4. 

7.Coleman JR, Sykes JM. The embryology, classification, epidemiology and genetics of facial 

clefting. Fac Plast Surg Clin.  2001;9:1–13.  

8. Fogh- Anderson P. Cleft lip and palate : Inheritance of Harelip and cleft palate.

Munksgaard, Copenhagen, Calnan JS. Oparaexdomebiologiaehareditariae universities.  1942.  

9. Al- Johar A, Ravichandran K, Subhani S. Pattern of cleft lip and palate in hospitalbased 

population in Saudi Arabia: retrospective study. CleftPalateCraniofac J. 2008; 45 : 592–6.  

10. Honein MA, Rasmussen SA, Reefhuis J, Romitti PA, Lammer EJ, Sun L, et al. Maternal 

smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. 

Epidemiology. 2007; 18 : 226–33.  

11. Hagberg C, Larson O, Milerad J. Incidence of cleft lip and palate and risks ofadditional 

malformations. Cleft Palate Craniofac J. 1997; 35 : 40–5.  

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