As I will emphasise, Olivia's reflection that 'things have changed' is as much an expression of ambivalence and anxiety over the possibilities of her (future)
4.5 Bad exemplars
DEMOGRAPHY
A total of one hundred children were studied consisting of fifty subjects (children with cleft deformity) and fifty controls. Three children with cleft lip and palate and associated pansystolic murmur were seen and excluded. No child with cleft deformity and debilitating illnesses was seen during the study period. The control comprises of healthy non-cleft children of the same age group.
There was no case of any parent who did not consent to participate in the study in both groups.
Tables III and IV show the Age-frequency distribution and the Sex-frequency distribution of the children studied respectively.
TABLE III: AGE - FREQUENCY TABLE OF THE CLEFT AND CONTROL POPULATIONS
AGE (MONTHS) FREQUENCY
CLEFT CONTROL
PERCENTAGE(%) CLEFT CONTROL 3-12
13-24
>24
28 25 10 12 12 13
56 50 20 24 24 26 TOTAL 50 50 100 100
TABLE IV: SEX-FREQUENCY TABLE OF THE CLEFT AND CONTROL POPULATIONS
SEX FREQUENCY
CLEFT CONTROL
PERCENTAGE(%) CLEFT CONTROL MALE 20 26 40 52
FEMALE 30 24 60 48 TOTAL 50 50 100 100
TABLE V: COMPARISON OF THE EPIDEMIOLOGICAL FEATURES OF THE STUDY POPULATION
PARAMETERS
AGE –RANGE MEAN (± SD)
CLEFT
3 – 60 (MTHS) 16.84 ±17.01
CONTROL
3 – 54 (MTHS) 18 ±50.13
STATISTICAL SIGNIFICANCE t = -0.531 df = 98
p – value = 0.597 NS ETHNIC GROUPS
YORUBA HAUSA IGBO OTHERS TOTAL
44 (88%) 1 (2%) -
5 (10%) 50 (100%)
45 (90%) -
2 (4%) 3 (6%) 50 (100%)
X2 = 3.511 df = 3
p- value = 0.319 NS
BIRTH ORDER 1
2 3 > 3 TOTAL
19 (38%) 9 (18%) 14 (28%) 8 (16%) 50 (100%)
16 (32%) 18 (36%) 13 (26%) 3 (6%) 50 (100%)
X2 = 1.525 df = 4
p- value = 0.822 NS
df = degree of freedom
(Figures in parentheses are percentages of the total) NS = Not significant {Significant at p < 0.05}
The age distribution of the study population is illustrated in Figure 3.
Test of statistical significance showed that the two groups were similar in demographic and socioeconomic characteristics.
With respect to the feeding practices during infancy between the 2 groups, statistically significant difference was found in the practice of breastfeeding and bottlefeeding with infant formula. (Tables V, VI and VII respectively).
Figure 4: Age distribution of the study population
TABLE VI: SOCIOECONOMIC STATUS OF THE STUDY POPULATION USING OYEDEJI’S CLASSIFICATION OF SOCIAL CLASS AS MODIFIED BY TEMIYE ET AL97, *
SOCIOECONOMIC STATUS
CLEFT (%) CONTROL (%)
I 2 (4) 7 (14)
II 10 (20) 10 (20)
IIIN 21 (42) 19 (38)
IIIM 9 (18) 7 (14)
IV 7 (14) 6 (12)
V 1 (2) 1 (2)
TOTAL 50 (100) 50 (100)
X2 = 4.293, df = 4, p = 0.368 (No significant difference)
* Appendix 4
TABLE VII: FEEDING PRACTICES OF THE STUDY POPULATION DURING INFANCY
FEEDING PRACTICE CLEFT CONTROL STATISTICAL SIGNIFICANCE Breast milk feeding
-direct
yes no
29 (58%) 21 (42%)
46 (92%) 4 (8%)
X2= 15.413 df = 1, p = 0.000, S Breast milk via feeding
bottle
yes no
7 (14%) 43 (86%)
3 (6%) 47 (94%)
X2 = 1.778, df = 1, p = 0.182, NS Breast milk via spoon
yes no
12 (24%) 38 (76%)
9 (18.0%) 41 (82%)
X 2= 0.542, df = 1, P = 0.461 NS Infant formula via
feeding bottle yes no
26 (52%) 24 (48%)
7 (14%) 43 (86%)
X2 = 16.327, df = 1, P = 0.000 S Infant formula via
spoon
yes
no
11 (22%) 39 (78%)
13 (26%) 37 (74%)
X2 = 0.219, df = 1,
P = 0.640 NS NS = Not significant S=significant {significant at p <0.05}
Some mothers adopted more than one feeding practice.
The distribution of the cleft population is presented in Table VIII. Figure V shows that 82% had cleft of primary palate or cleft of primary and secondary palate (i.e. cleft lip ± palate) while 18% had cleft of secondary palate (cleft palate only). Among those who had cleft of primary palate, 47.8% each of cases of cleft of primary palate were located on either right or left while 4.4% was bilateral.
In patients with cleft of primary and secondary palate, 33.3% was located on the right while 38.9% was located on the left. The cleft was bilateral in 27.8% of cases in this group. Among those with cleft of secondary palate, the soft palate was involved in 55.6% of cases while hard and soft palate were involved in 44.4% of cases.
TABLE VIII: DISTRIBUTION OF THE CLEFT DEFORMITIES STUDIED
TYPES OF CLEFT FREQUENCY PERCENTAGE(%)
10 palate only
Right 11 22
Left 11 22
Bilateral 1 2
Total 23 46
10 and 20 palate
Right 6 12
Left 7 14
Bilateral 5 10
Total 18 36
20 palate only
Hard and soft 4 8
Hard palate only - -
Soft palate only 5 10
Total 9 18
Grand total 50 100
Figure 5: Distribution of the children based on the major types of cleft deformities present
The distribution of the nutritional status of the study population based on weight for age, height for age and weight for height is presented in Table IX.
The prevalence of malnutrition by the indices of nutritional status using nutritional indicators of underweight, stunting and wasting respectively is shown in figure 6. There was no statistically significant difference observed in the prevalence of acute malnutrition manifested as underweight in the cleft and the control group (cleft =26%, control = 18%, P = 0.334). The prevalence of stunting, an indicator of chronic malnutrition was 14% in the cleft group and 10% in the control group. This was not statistically significant as P value = 0.538. The prevalence of wasting was 18%
for the cleft group while for the control group it was 14%. P value of 0.585 also shows that this does not attain statistical significance.
TABLE IX: NUTRITIONAL STATUS OF THE STUDY POPULATION
USING WAZ, HAZ, WHZ.
NUTRITIONAL STATUS
WAZ (UNDERWEIGHT) CONTROL CLEFT
HAZ (STUNTING) CONTROL CLEFT
WHZ WASTING) CONTROL CLEFT Normal 41 (82%) 37 (74%) 45 (90%) 43 (86%) 43 (86%) 41 (82%) Malnourished 9 (18%) 13 (26%) 5 (10%) 7 (14%) 7 ( 14%) 9 (18%) Total 50 (100%) 50 (100%) 50 (100%) 50 (100%) 50 (100%) 50 (100%) Statistical
Significance
X2 = 0.932, df = 1, p=0.334 X2 =0.379, df = 1, p= 0.538 X2 = 0.298, df=1, p= 0.585
WAZ – Weight for Age Z score HAZ – Height for Age Z score WHZ – Weight for Height Z score
Figure 6: Prevalence of malnutrition in the cleft and Control
Using the MUAC (Table X), the results showed that 16% and 4% of the children with cleft and control respectively were below the -2 standard deviation as per the reference values by age specific cut-off points (MUAC for age ). The difference between the 2 groups using the MUAC for age was however not statistically significant ( P
= 0.122).
Table X also shows the result of nutritional status for the study population using triceps skinfold thickness for age. The nutritional status of the cleft population using triceps skinfold thickness for age showed a prevalence of malnutrition of 32% while for the control group the prevalence was 16% (Figure VII). This observed reduction in nutritional status with triceps skinfold thickness with a p value of 0.061 also failed to reach statistical significance.
TABLE X: NUTRITIONAL STATUS OF THE STUDY POPULATION USING MUAC FOR AGE AND TSFT FOR AGE
Mid Upper Arm Circumference for Age z score (12 – 60mths)
-normal (> -2.00 SD) -malnourished
( -2.00 and below)
A
CLEFT
(TOTAL = 25) 21 ( 84%) 4 (16%)
CONTROL (TOTAL =28) 27 (96%) 1 ( 4%)
Statistical significance X2 = 2.388, df = 1, P = 0.122
Triceps Skinfold Thickness for Age z score
-normal(>-2.00SD) -malnourished
( - 2.00 and below)
CLEFT
34 (68%) 16 (32%)
CONTROL
42 (84%) 8 (16%)
Statistical significance X2 = 3.509, df = 1, P = 0.061
Figure 7: Prevalence of malnutrition in the cleft and control groups using muac for age and tsft for age