Prevalence and Factors Associated With Preoperative Malnutrition Among Nonsyndromic Cleft Lip and Palate in Rwanda

Background: Cleft lip and/or palate (CL±P) is among the most common congenital craniofacial anomalies, with affected children at high risk of malnutrition due to feeding difficulties. This study aimed to determine the prevalence and factors associated with preoperative malnutrition among patients with nonsyndromic CL±P in Rwanda. Methods: A multicenter cross-sectional study was conducted over a 1 year period among children younger than 5 years undergoing primary cleft repair. Nutritional status was assessed using the World Health Organization growth standards. Malnutrition was defined as stunting (height-for-age z score ≤ −2) or wasting (weight-for-length z score ≤ −2). The data were analyzed using descriptive statistics, bivariate analysis, and logistic regression. Results: Of 116 infants, the median age was 6.5 months (interquartile range: 3–10 mo), and 64% were male. The overall prevalence of malnutrition was 47% (95% confidence interval: 38–56). Stunting was observed in 41% (19% moderate, 22% severe) and wasting in 9% of the patients. Malnutrition was significantly associated with older infant age ( P = 0.0099), lack of postnatal nutrition education ( P = 0.0232), nonbreastfeeding at the time of surgery ( P = 0.0088), early introduction of complementary feeding ( P = 0.0034), cow’s milk consumption ( P < 0.001), and having both cleft lip and palate ( P = 0.0101). On multivariate analysis, the consumption of cow’s milk ( P = 0.001) and cleft type (palate or lip and palate) ( P = 0.028) remained significant factors. Conclusions: Nearly half of the cleft patients operated on were malnourished preoperatively. Strengthening preoperative nutritional support is essential to reduce this burden.