Burden and Trend of Craniofacial Cleft in 54 Countries of Africa, 1990-2023 and Forecast to 2030: An Analysis of the Global Burden of Disease 2023 Study.

INTRODUCTION

Craniofacial clefts are among the most prevalent congenital anomalies worldwide and represent a substantial public health burden. Their impact is disproportionately high in Africa, where limited access to timely surgical care and comprehensive health services-including feeding support, speech therapy, and psychosocial care-exacerbates outcomes and contributes to long-term disability and reduced quality of life. This study provides a novel contribution by systematically contextualizing both the fatal and nonfatal burden of craniofacial clefts across 54 African nations, thereby generating evidence to inform health policy and guide resource allocation.

METHODS

We used the Global Burden of Disease (GBD) 2023 framework to estimate the prevalence, incidence, disability-adjusted life-years (DALYs), and mortality associated with craniofacial clefts. Data sources included vital registration systems, household surveys, disease registries, and published scientific literature. Estimates were generated using the disease modeling meta-regression tool DisMod-MR 2.1, and the Cause of Death Ensemble model (CODEm) to derive cause-specific mortality rates. Results were stratified by age, sex, location, and year for the period 1990-2023 in Africa, and are presented as counts and age-standardized rates per 100,000 person-years. For each measure, 95% uncertainty intervals (UIs) were calculated based on the 2.5th and 97.5th percentiles of the posterior distribution. Forecasts of future trends were produced using an autoregressive integrated moving average (ARIMA) model.

RESULTS

In 2023, Africa recorded an estimated 839,000 cases of craniofacial cleft (95% uncertainty interval [UI] 677,000-1,030,000), 223,000 DALYs (67,400-682,000), and 1900 deaths (300-7100), accounting for 19.7% of global prevalence, 40.2% of global DALYs, and 57.6% of global craniofacial cleft-related mortality. Between 1990 and 2023, the absolute number of cases doubled, although the age-standardized prevalence rate remained relatively stable. In 2023, age-standardized DALY rates ranged from 9.0 per 100,000 (5.6-13.6) in north Africa to 12.6 per 100,000 (3.4-41.8) in eastern sub-Saharan Africa. Over the same period, total DALY counts declined by 36.1% (-72.1 to 144.6), and the age-standardized DALY rate decreased by 61.4% (-82.8 to 32.5). By 2030, DALYs attributable to craniofacial clefts in Africa are projected to reach 200,000 (146,000-255,000), with an age-standardized rate of 8.1 per 100,000 (5.1-11.1). The quality of care index (QCI) showed modest improvement, rising from 72.5% in 1990 to 78.9% in 2023 across both sexes. In 2023, Tunisia (99.5%) and Libya (99.1%) reported the highest QCI scores, while Somalia (26.3%) and the Central African Republic (14.1%) recorded the lowest. Notable gains were observed in Ethiopia (from 30.9% to 71.2%) and Mozambique (from 30.5% to 63.1%) over the past 3 decades. Quality of care was strongly correlated with the Sociodemographic Index (SDI; r=0.87, P<0.001).

CONCLUSION

Craniofacial clefts in Africa contribute disproportionately to DALYs and mortality, with slower declines in premature deaths compared with high SDI regions. Quality of care was strongly correlated with SDI, reflecting persistent inequities. Although age-standardized prevalence, incidence, mortality, and DALY rates have declined-suggesting progress from preventive strategies and expanded surgical access-the overall burden remains high and heterogeneous across countries. Sustained investment in prevention, timely surgery, and rehabilitation, alongside stronger health systems, is essential to reduce disability and improve outcomes.