Peer-reviewed article

Prevalence of Malnutrition in Children with Cleft Conditions in Madagascar: A Cross-Sectional Study.

Daniel D Otobo, Charlotte Steppling, Ashley Myles, Natalie Torres, Emily M Jones et al. · 5 Mar 2026

Abstract

ObjectiveThis study aims to assess the prevalence, patterns, and distribution of malnutrition among pediatric patients evaluated for cleft surgery in Madagascar.MethodologyDesign/Setting: This Retrospective cross-sectional study assessed 658 patients who presented for cleft care between 2020 and 2023 during surgical programs of an International Cleft Surgical Non-Profit Organization in Madagascar.Intervention/Outcome MeasuredPatient demographics and anthropometry of all patients were measured. The weight-for-length Z score/weight-for-height Z score World Health Organization Growth Chart Z scores, as well as mid-upper arm circumference for patients aged > 6 months to 59 months, were measured and recorded. Patients were grouped based on gender and age.ResultsOf the 658 patients screened for surgery, 96% were malnourished (mild to severe malnutrition), and 83% of the screened patients had to be enrolled in the nutrition program (Z scores ≤ -2standard deviation) for nutritional optimization before surgery could be considered. At the time of this study, 239 patients had received surgery, while 309 were awaiting surgery. The majority had combined cleft lip and palate (59%), and over half of the mothers were unable to breastfeed their children at all due to the cleft condition(s) (53%). The highest prevalence (52.4%) and severity (68.1%) of malnutrition was observed among infants under 6 months old.ConclusionThe malnutrition status among patients with a cleft lip and/or palate in Madagascar is high (96%, p < .001). When children with cleft conditions who were malnourished (96%) were compared with the under-5 malnutrition status among non-cleft patients (47%) in Madagascar, it was a ratio of 2:1.