Prevalence and Risk Factors of Perioperative Malnutrition Among Non-Syndromic Cleft Lip and/or Palate Patients in Rwanda

BACKGROUND: Cleft lip and/or palate (CLP), a common congenital anomaly, predisposes children to malnutrition, adversely affecting surgical outcomes. This study evaluated the prevalence and risk factors of perioperative malnutrition in children with CLP in Rwanda. METHODS: A multicenter, cross-sectional study was conducted among children ≤60 months undergoing primary cleft surgery in Rwandan hospitals. Data on demographics, anthropometry, clinical characteristics, caregiver knowledge, and feeding practices were collected. Risk factors for malnutrition were assessed using univariate and multivariate logistic regression. RESULTS: Among 116 children, 47% were malnourished. Stunting was observed in 35% (including 19% with severe stunting) and wasting in 9% (3% severely). Malnutrition prevalence was higher in children aged ≥4 months (53% vs. 27%), males (50% vs. 40%), and those with bilateral clefts (56% vs. 44%). Most patients had unilateral clefts (78%): isolated cleft lip (33%), cleft lip and palate (39%), and isolated cleft palate (7%). Bilateral clefts (22%) included isolated cleft lip (7%), isolated cleft palate (3%), and combined cleft lip and palate (11%). At surgery, 50% of children were breastfeeding, with barriers including inability to suck, regurgitation, fatigue (41%), milk scarcity (30%), and early weaning (29%). Risk factors for malnutrition included age ≥4 months (85%, p = 0.010), lack of nutritional education (37%, p = 0.023), cow’s milk consumption (78%, p < 0.001), and cleft type involving both lip and palate (63%, p < 0.001). Multivariate analysis confirmed cow’s milk consumption (p = 0.002) and cleft type (p = 0.005) as significant predictors. CONCLUSION: Nearly half of CLP patients were malnourished preoperatively, underscoring the need for early nutritional interventions.