Cleft lip and cleft palate is one the most common congenital anomalies in Pakistan and worldwide. Its incidence in Pakistan is one in 500 live births. Every day in Pakistan 12,000 children are born, this means that every day 24 children are born with cleft lip and cleft palate in Pakistan, 8760 a year. Pakistan has the fourth highest incidence of cleft lip and cleft palate in the world, after China, India and Indonesia. There are some 1.2 million un-operated cleft patients in the world, of which some 200,000-300,000 live in Pakistan. In Sindh, there are around 70-80 thousand.
In Pakistan there are five ethnic groups; Punjabis, Pukthun, Balochi, Sindhi and Mahjirs. So far there is no evidence of a difference in the occurrence of Cleft between the five groups. The common factor is poverty.
The main risk factors for development of Cleft are folic acid deficiency, self medication during the first three months of pregnancy, smoking, alcohol consumption, and elderly father. Most of the poor women of Pakistan are generally undernourished. This worsens when they become pregnant: They already are folic acid deficient and the pregnancy exacerbates the deficiency, putting their child at risk for Cleft. This is very unfortunate, as folic acid is very cheap even in Pakistan.
Another important factor is consanguineous marriage. 60% of parents of a Cleft child are either first degree cousins or second degree cousins.
Simple cleft lip
Cleft palate
Left-hand lip and maxilla cleft
Transverse cranio-facial cleft with partial loss of eye
Full cleft of lip and maxilla
Cleft lips and palates develop from the fourth week of pregnancy, when the parts of the face begin to join together starting from the outside and proceeding inwards. If this process is disturbed and does not complete properly, the various types of clefts are the result.
