Epidemiology of Cleft Lip and Palate in Bhutan, 2015–2022

This study presents the first comprehensive epidemiological assessment of cleft lip (CL) and cleft palate (CP) in Bhutan, based on the National Birth Defects Surveillance Data Registry (2015–2022).

Background

• CLP is the most common congenital craniofacial anomaly worldwide, with an estimated prevalence of 1 in 700 live births.
• Prior to this study, no systematic analysis of CLP prevalence and incidence in Bhutan had been reported.

Methods

• Retrospective review of 89,078 live births between 2015 and 2022.
• Data derived from three national referral hospitals, classified using ICD-11 codes (Q35–Q37).
• Poisson regression was used to compute incidence trends, and chi-square tests examined associations with maternal and child characteristics.

Results

• 122 newborns with cleft conditions were identified, representing 8.7% of all birth defects and a period prevalence of 1.37 per 1,000 live births.
• Incidence peaked in 2019 at 1.96 per 1,000 live births, before declining slightly in 2022 (1.50 per 1,000).
• Male newborns were more commonly affected (59%) than females (41%).
• The majority of cases were unilateral clefts, with unilateral cleft lip (Q36.90) being the most frequent subtype.
• Maternal age distribution varied, with the highest proportion among mothers aged 25–29 years (29.5%), followed by 20–24 years (24.6%).
• An increasing proportion of preterm births (40% in 2022) was observed among cleft cases.

Discussion & Implications

• Bhutan’s CLP prevalence (1.37/1,000) is comparable to Asian populations such as Japan and China, but lower than Nepal and India.
• The rising trend reflects improved surveillance systems, including the Bhutan Every Newborn Action Plan (2016) and WHO-supported birth defect monitoring.
• Male predominance aligns with international findings of sex-related susceptibility to congenital anomalies.
• The study emphasizes the need to:
  • Strengthen national birth defect registries (e.g., SEARO-Newborn and Birth Defects Database).
  • Enhance antenatal and neonatal care programs.
  • Address data gaps for determinants of CLP.

Conclusion

The study establishes baseline epidemiological data for cleft lip and palate in Bhutan, showing increasing prevalence trends and identifying key demographic correlates. Findings call for sustained surveillance and programmatic action to reduce the burden of orofacial clefts.

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Recommended citation: Tobgyel K, Rai P, Choden K, Gyeltshen T (2024) Epidemiology of cleft lip and palate in Bhutan, 2015–2022. BMC Oral Health 24, 1385. https://doi.org/10.1186/s12903-024-05177-7
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