Geographic Access to Orofacial Cleft Surgical Care in Ecuador: A Geospatial Analysis

BACKGROUND: Orofacial clefts are the most common craniofacial malformations worldwide, and emerging evidence suggests that their burden in Ecuador may exceed global estimates. Although timely surgical care is essential for functional outcomes, geographic access to cleft surgical services in Ecuador has not been previously evaluated. METHODS: The authors conducted a cross-sectional geospatial analysis of access to public orofacial cleft surgical centers in Ecuador. Geographic access was assessed at the canton level by calculating distance from each canton centroid to the nearest hospital. Road-network driving time from each canton centroid to the nearest hospital was also estimated, and cantons were classified according to 1-hour and 2-hour access. RESULTS: A total of 3 public hospitals providing continuous surgical care for orofacial clefts were identified. Among 218 cantons, the median geodesic distance to the nearest hospital was 106.0 km (IQR, 69.3-140.4), and the median driving time was 157.5 minutes (IQR, 106.2-212.8). Overall, only 13 cantons (6.0%) had 1-hour access, and 46 cantons (21.1%) had 2-hour access to a hospital. The greatest burden was observed in the Amazon region, where the median distance was 138.9 km (IQR, 104.8-184.3), the median travel time was 227.6 minutes (IQR, 191.9-308.3), and no cantons had 1-hour or 2-hour access. CONCLUSION: Geographic access to public orofacial cleft surgical care in Ecuador is limited, particularly in the Amazon region. These findings highlight the need for targeted strategies to improve access to cleft surgical services in underserved areas.