Cleft Lip and Palate in Zanzibar, Tanzania: Establishing Baseline Epidemiological Profiles and Surgical Timing at a Tertiary Hospital

Abstract

Background Cleft lip and/or palate (CL/P) is a common congenital craniofacial malformation with marked geographic variation. No epidemiological data were available for Zanzibar. Objectives To estimate the hospital-based presentation rate of CL/P, describe its pattern by type and laterality, assess sex distribution, and determine age at presentation among patients treated at Mnazi Mmoja Hospital (MMH) from 2020 to 2024. Methods A retrospective cross-sectional study was conducted on the medical records of patients diagnosed with CL/P at MMH over a 5-year period. Data on age at diagnosis, sex, cleft type, laterality, and age at time of intervention were collected and analyzed. Results A total of 200 cases were included, yielding a hospital-based presentation rate of 0.66 per 1,000 live births. Females accounted for 52% of cases and males 48%. Unilateral cleft palate (CP) was the most common type (53.5%), followed by unilateral cleft lip (CL) (25.5%). Most cases were unilateral (98.5%). The association between males and isolated CL showed a trend but did not reach statistical significance (OR = 1.45, 95% CI: 0.77-2.75). The most common age of presentation was 1 month to 1 year (45.5%). Most procedures were performed at ages 1.5 to 3 years (32.5%). Conclusions CL/P in Zanzibar is characterized by a predominance of isolated CP and a slight female majority. The observed hospital-based presentation rate likely underestimates the true prevalence, highlighting gaps in early detection and access to care. Strengthening early diagnosis, establishing a cleft registry, improving multidisciplinary management, and ensuring timely surgical intervention are essential to enhance outcomes.