Barriers in accessing treatments for cleft lip and cleft palate in Bangladesh
DOI:
https://doi.org/10.3329/bsmmuj.v19i1.86039Keywords:
cleft lip, cleft palate, barrier, access to treatment, stigmaAbstract
Background: Cleft lip and cleft palate are common congenital craniofacial anomalies requiring timely multidisciplinary care, yet access to treatment remains limited in many low- and middle-income settings due to social and structural barriers.
Methods: This study employed a mixed-method services study purposively selected 105 treated and untreated adult patients with a craniofacial anomaly. Data were collected from September 2019 to June 2023. Socio-demographic data were collected utilizing the world health Study on global ageing and adult health (SAGE) survey. A questionnaire was used to assess the socio-cultural, economic, and healthcare barriers including stigmas. The qualitative component included in-depth interviews with 16 patients and 7 key informants involved in cleft services. Samples were obtained from the Department of Orthodontics, Faculty of Dentistry at Bangladesh Medical University, National Institute of Burn and Plastic Surgery, and Bangladesh Specialised Hospital, Dhaka, Bangladesh.
Results: Fear of unnecessary tests (67.6%), inability to visit the doctor regularly (65.7%), long waiting times (62.0%) and fear of not getting treatment from the same physician (61%) were the most commonly reported barriers. Social and familial stigma (70.3%) and financial hardships (50.6%) were the commonly found socio-cultural and socio-economic barriers. The major personal factors for receiving healthcare were work responsibilities and transportation (96.2% each) and fear for personal safety (53.3%). The qualitative findings support the above results.
Conclusion: Perceived fear of caring out undergoing unnecessary investigation by the patients, socio-cultural stigma, economic constraints, and health system limitations continue to hinder access to cleft lip and palate treatment in Bangladesh. Overcoming these barriers is therefore essential to promote equitable access and improve health outcomes for affected individuals.
Downloads
2
0 PDF
2 Review report
2
References
Mohammadi M. Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2022 Apr;123(2):110-120. doi: https://doi.org/10.1016/J.JORMAS.2021.05.008
Cleft Bangladesh. Available at: https://www.cleftbangladesh.org/patient-information/about-cleft/overview.html. [Accessed on 24 Mar 2026]
Chung KY, Sorouri K, Wang L, Suryavanshi T, Fisher D. The Impact of Social Stigma for Children with Cleft Lip and/or Palate in Low-resource Areas: A Systematic Review. Plast Reconstr Surg Glob Open. 2019; 7(10): 2487. doi: 10.1097/GOX.0000000000002487
Al-Namankany A, Alhubaishi A. Effects of cleft lip and palate on children's psychological health: A systematic review. J Taibah Univ Med Sci. 2018; 13(4):311-318. doi: 10.1016/j.jtumed.2018.04.007
Hunt O T, Burden D, Hepper p, Johnston T. The psychosocial effects of cleft lip and palate: A systematic review. The European Journal of Orthodontics. 2005; 27(3):274-285. doi: 10.1093/ejo/cji004
Wilson W L, Chai K C. Cleft craniofacial care in Asia—a narrative review. Frontiers of Oral and Maxillofacial Medicine (FOMM). 2024; 6: 1-9. Available at: https://fomm.amegroups.org/article/view/76133/html. [Accessed on 24 Mar 2026]
Rabah SM, Sabbagh HJ, AlZabin A, Almajed E, Albrahim R, Aldawish R, Alyahiwi L, Alshabnan R, Helal NM, Khan MA, Yousaf MA, Refahee SM, Koraitim MM, Kasem Albadani MS, Khader YS, Al Halasa TK, Al-Batayneh OB, Albatayneh MA. Parental knowledge and barriers to cleft lip and palate care: a cross-cultural study from the Middle East and South Asia. Front Public Health. 2026 Jan 9;13:1691553. doi: 10.3389/fpubh.2025.1691553
Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan W, Lopez Ridaura R, Maximova T, Arokiasamy P, Phaswana-Mafuya N, Williams S, Snodgrass JJ, Minicuci N, D'Este C, Peltzer K, Boerma JT; SAGE Collaborators. Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol. 2012 Dec;41(6):1639-1649. doi: 10.1093/ije/dys210
Khogeer L, Helal N, Basri O, Madani S, Basri A, El-Houseiny AA. Instrument Development and Validation to Assess Care Barriers for Patients in Saudi Arabia with Oral Clefts. Int J Environ Res Public Health. 2021 Mar 25;18(7):3399. doi: 10.3390/ijerph18073399
Adeyemo, Wasiu L; James, Olutayo; Butali, Azeez1. Cleft lip and palate: Parental experiences of stigma, discrimination, and social/structural inequalities. Annals of Maxillofacial Surgery, 2016; 6(2):195-203. doi: 10.4103/2231-0746.200336
Scott C. Litin, M.D. Mayo Clinic Family Health Book, Fifth Edition, [New York] : Time Inc. Home, 2018. Available at: https://www.amazon.com/Mayo-Clinic-Family-Health-Book/dp/1945564024. [Accessed on 24 Mar 2026]
Nachiappan N, Mackinnon S, Ndayizeye JP, Greenfield G, Hargreaves D. Barriers to accessing health care among young people in 30 low-middle income countries. Health Sci Rep. 2022 Jul 20;5(4):e733. doi: 10.1002/hsr2.733
Chopra KK, Arora VK. Covid-19 and social stigma: Role of scientific community. Indian J Tuberc. 2020 Jul;67(3):284-285. doi: 10.1016/j.ijtb.2020.07.012
Bruns DP, Kraguljac NV, Bruns TR. COVID-19: Facts, Cultural Considerations, and Risk of Stigmatization. J Transcult Nurs. 2020 Jul;31(4):326-332. doi: 10.1177/1043659620917724
Almazrou SH, Alfaifi SI, Alfaifi SH, Hakami LE, Al-Aqeel SA. Barriers to and Facilitators of Adherence to Clinical Practice Guidelines in the Middle East and North Africa Region: A Systematic Review. Healthcare (Basel). 2020; 8(4):564. doi: 10.3390/healthcare8040564
Citron I, Neto JB, Costa E, Lima C, Ise A, Menezes C, Roa L, Saluja S, Staffa SJ, da Silva Freitas R, de Andrade Sá ÁJ, Rocha F, Collares MV, Alonso N. Patient-perceived barriers to surgical treatment of cleft lip and palate in Brazil: A multi-region study. J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2375-2386. doi: 10.1016/j.bjps.2022.02.009
Balaji SM. Burden of Orofacial Clefting in India. A Global Burden of Disease Approach. Ann Maxillofac Surg. 2018; 8(1):91-100. doi: 10.4103/ams.ams_196_17
Turlapati S, Krishna S, Deepak KU, Kanagaraja B, Gayathri KA, Jahagirdar D. A Cross-Sectional Study: Are Myths on Cleft Lip and Palate Still Prevalent? Cureus. 2021 Nov 14;13(11):e19579. doi: 10.7759/cureus.19579
Rabah SM, Sabbagh HJ, AlZabin A, Almajed E, Albrahim R, Aldawish R, Alyahiwi L, Alshabnan R, Helal NM, Khan MA, Yousaf MA, Refahee SM, Koraitim MM, Kasem Albadani MS, Khader YS, Al Halasa TK, Al-Batayneh OB, Albatayneh MA. Parental knowledge and barriers to cleft lip and palate care: a cross-cultural study from the Middle East and South Asia. Front Public Health. 2026 Jan 9;13:1691553. doi: 10.3389/fpubh.2025.1691553
Mukanahayo E, Umugwaneza O, Mukundwa PN, Sheferaw ED, Riviello R, Dukundane A, Murithi G, Ntirenganya F, Alayande B. Barriers and delays in access to cleft surgery among children with cleft deformities in Rwanda: a qualitative study. BMJ Open. 2026; 16(1):112929. doi: 10.1136/bmjopen-2025-112929
Nguyen VT, Jagomägi T, Van TN. Maternal Experiences of Having a Child with a Cleft. J Otol Rhinol. 2018; 7(3). doi: 10.4172/2324-8785.1000343
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Tanzila Rafique, Rakia Ishra, Sharlin Akter, Shahriar Mohd Shams, Gazi Shamin Hassan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
