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. 2020 Dec;10(2):020410.
doi: 10.7189/jogh.10.020410.

The role of smoke from cooking indoors over an open flame and parental smoking on the risk of cleft lip and palate: A case- control study in 7 low-resource countries

Allyn Auslander  1   2 , Roberta McKean-Cowdin  1   3 , Frederick Brindopke  2   4 , Beau Sylvester  2 , Melissa DiBona  4 , Kathy Magee  4 , Rijuta Kapoor  1 , David V Conti  1 , Sylvia Rakotoarison  5 , William Magee 3rd  1   2 ; Operation Smile International Family Study Group*
Affiliations

The role of smoke from cooking indoors over an open flame and parental smoking on the risk of cleft lip and palate: A case- control study in 7 low-resource countries

Allyn Auslander et al. J Glob Health. 2020 Dec.

Abstract

Background: Cleft is one of the most common birth defects globally and the lack of access to surgery means millions are living untreated. Smoke exposure from cooking occurs infrequently in developed countries but represents a high-proportion of smoke exposure in less-developed regions. We aimed to study if smoke exposure from cooking is associated with an increased risk in cleft, while accounting for other smoke sources.

Methods: We conducted a population-sampled case-control study of children with cleft lip and/or palate and healthy newborns from Vietnam, Philippines, Honduras, Nicaragua, Morocco, Congo, and Madagascar. Multivariable regression models were used to assess associations between maternal cooking during pregnancy, parental smoking, and household tobacco smoke with cleft.

Results: 2137 cases and 2014 controls recruited between 2012-2017 were included. While maternal smoking was uncommon (<1%), 58.3% case and 36.1% control mothers cooked over an open fire inside. Children whose mothers reported cook smoke exposure were 49% (95% confidence interval (CI) = 1.2-1.8) more likely to have a child with a cleft. This was consistent in five of seven countries. No significant associations were found for any other smoke exposure.

Conclusions: Our finding of maternal cook smoke and cleft in low-resource countries, similar to maternal tobacco smoke in high-resource countries, may reflect a common etiology. This relationship was present across geographically diverse countries with variable socioeconomic statuses and access to care. Exposures specific to low-resource settings must be considered to develop public health strategies that address the populations at increased risk of living with cleft and inform the mechanisms leading to cleft development.

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Conflict of interest statement

Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cooking indoors over an open flame – odds ratio and 95% confidence interval excluding each country (all cleft types combined).
Figure 2
Figure 2
Cooking indoors over an open flame – odds ratio and 95% confidence interval by country (all cleft types combined).
See this image and copyright information in PMC

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References

    1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569-624. 10.1016/S0140-6736(15)60160-X - DOI - PubMed
    1. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC.Cleft lip and palate. Lancet. 2009;374:1773-85. 10.1016/S0140-6736(09)60695-4 - DOI - PubMed
    1. Gundlach KK, Maus C.Epidemiological studies on the frequency of clefts in Europe and world-wide. J Craniomaxillofac Surg. 2006;34 Suppl 2:1-2. 10.1016/S1010-5182(06)60001-2 - DOI - PubMed
    1. Cooper ME, Ratay JS, Marazita ML.Asian oral-facial cleft birth prevalence. Cleft Palate Craniofac J. 2006;43:580-9. 10.1597/05-167 - DOI - PubMed
    1. Kadir A, Mossey PA, Blencowe H, Moorthie S, Lawn JE, Mastroiacovo P, et al. Systematic review and meta-analysis of the birth prevalence of orofacial clefts in low- and middle-income countries. Cleft Palate Craniofac J. 2017;54:571-81. 10.1597/15-221 - DOI - PubMed