87. The Impact of Maternal Healthcare Factors on Access to Primary Cleft Surgery in Resource-limited Settings

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PURPOSE: Timely surgical intervention is essential to optimizing outcomes in patients with cleft lip and palate (CLP). Antenatal care empowers expectant mothers to improve their maternal health literacy, strengthen engagement with their local health system, and gain access to early cleft diagnosis and counseling. In these ways, access to antenatal care might increase the likelihood of timely postnatal cleft care. In this study, we evaluate the impact of antenatal healthcare factors on access to primary CLP repair in LMICs. METHODS: We conducted a retrospective chart review of patients with CLP who presented to a charitable cleft care organization between 2021 and 2024 across Bolivia, Panama, Ghana, Colombia, Dominican Republic, Ecuador, Guatemala, Honduras, Jordan, Morocco, Paraguay, Peru, South Africa and Venezuela. Patients were included if they underwent primary CLP repair during the study period and had complete health record information on variables of interest. Health records were reviewed for antenatal care visits, maternal age, maternal smoking, and travel distance and time to program. Delayed cleft care was defined as primary lip repair beyond 9 months and primary palate repair beyond 18 months. Our primary outcome of interest was age at primary lip or palate repair. Data were analyzed using chi-square and t-tests, followed by simple and multivariate logistic regression as appropriate. RESULTS: A total of 400 CLP patients met inclusion criteria, of which 344 underwent primary lip repair and 204 primary palate repair. Delayed repair occurred in 36.9% of lip patients and 46.1% of palate patients. Delayed primary lip repair occurred at a mean age of 20.2 ± 16.9 months, while delayed primary palate repair occurred at a mean age of 41.2 ± 28.2 months. Fewer antenatal care (ANC) visits were associated with delayed lip repair (p = 0.006). Longer travel times to surgical programs were also associated with delayed lip repair (p = 0.03). Maternal employment as a homemaker was associated with delayed palate repair (p < 0.05). Simple logistic regression showed greater number of ANC visits (p = 0.006) and less travel time (p = 0.03) were associated with decreased odds of delayed lip repair. Multivariate logistic regression found that more ANC visits (OR = 1.15 (1.06 - 1.26), p < 0.001), living within a 2-hour radius (OR = 1.81 (1.04 - 3.16), p = 0.03), and lesser travel times to surgical program (OR = 0.98 (0.96 - 0.99), p = 0.05) were all associated with decreased odds of delayed lip repair. CONCLUSION: A greater number of antenatal care visits and lesser travel times are associated with decreased odds of delay in cleft lip repair, highlighting the role maternal healthcare plays in accessing surgical care for CLP children. Improving access to maternal healthcare may represent an important element in reducing delays in cleft surgery across LMICs.

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