Cambodia has the highest rate of untreated cleft lip and palate in infants, out of more than 100 low- and middle-income countries, a new global study has found.

The Kingdom’s rate of unrepaired cleft lip and palate stood at 28.5 per 100,000 people, compared to just 2.5 in Romania. The report, published in World Journal of Surgery on July 14, used data from Operation Smile surgical programs in 12 countries, together with information from the World Health Organization (WHO) and World Bank.

From there, it developed a model to estimate the numbers of cleft lip and palate cases that went untreated before the ideal ages of 1 and 2, respectively, in 113 nations. “Our model provides marked insight into the global surgical backlog due to cleft lip and palate,” the report states.

While the most populated countries had the largest number of untreated cases – such as India, with more than 200,000 – Cambodia’s 4,312 cases had the highest prevalence relative to its smaller population.

“[Cleft lip and palate] disproportionately affects those in low-resource settings secondary to poor nutrition and a lack of prenatal care,” the report continues. “A number of significant barriers to surgical care exist in low- and middle-income countries . . . including prohibitive costs, lack of availability, and social stigma.”

The study comes a year after Operation Smile – an organisation specialising in the surgery – wrapped up its operations in Cambodia.

But a spokesperson at Phnom Penh’s Children’s Surgical Centre, which performs the surgery free of charge, said the backlog and demand had fallen, due to an “influx of medical mission teams and more local surgeons being competent with cleft surgery [which] has made access to these surgeries more available”.

The centre conducted 140 of the life-changing surgeries for children last year, compared to a peak of 348 in 2011.

Dr Chou Vivath, WHO’s national professional officer on disability and rehabilitation, said his organisation was working with the government to include “rehabilitation intervention” on health-centre guidelines.

The aim, he said in an email, was “to improve the early identification and proper referral of people with some health conditions, including cleft palate, to proper support services”.

No one from the Ministry of Health could be reached for comment yesterday.