World Journal of Surgery

, Volume 37, Issue 7, pp 1562–1570 | Cite as

Getting the Job Done: Analysis of the Impact and Effectiveness of the SmileTrain Program in Alleviating the Global Burden of Cleft Disease

  • D. PoenaruEmail author



The study measured the success of SmileTrain, the largest cleft charity globally, in alleviating the global burden of disease (GBD). It was done by estimating averted disability-adjusted life years (DALYs) and delayed averted DALYs because of the global backlog in cleft procedures.


Anonymized data for all procedures in the SmileTrain global database were analyzed by age, sex, country, region, and surgery type. DALYs averted were calculated using life expectancy tables and established and estimated disability weights. The cost-effectiveness analysis used mean SmileTrain procedural disbursement figures. Sensitivity analysis was performed using various cleft incidence rates, life expectancy tables, and disability weights.


During 2003–2010 a total of 536,846 operations were performed on 364,467 patients—86 % in Southeast Asia and the western Pacific region. Procedure numbers increased yearly. Mean age at primary surgery—6.2 years (9.8 years in Africa)—remained fairly constant over time in each region. Globally, 2.1–4.7 million DALYs were averted through the operations at a total estimated cost of US$196 M. Mean DALYs per patient were 3.8–9.0, and mean cost per DALY was $72–$134. Total delayed GBD due to advanced age at surgery was 191,000–457,000 DALYs.


Despite an unparalleled number of surgeries performed and yearly increase by one charity, the unmet and delayed averted cleft GBD remains significant in all regions. Large geographic disparities reflect varied challenges regarding access to surgery. Cleft surgeries are cost-effective interventions to reduce the global burden of disease (GBD). Future challenges include increased collaboration among cleft care providers and a focus on remote global areas by building infrastructure and local training.


Cleft Palate Disability Weight Western Pacific Region Year Live With Disability Cleft Palate Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the SmileTrain NYC head office staff for providing the database and for their expert advice and enthusiastic support. We also acknowledge the expert advice of Drs. Andrew Hodges (CoRSU, Kampala, Uganda), Richard Gosselin (School of Public Health, Berkeley University, El Granada, CA), Scott Corlew (ReSurg International), and Doruk Ozgediz (Global Partners in Anesthesia and Surgery).

Conflict of interest

The author declares no conflicts of interest in this work.


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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  1. 1.BethanyKids at Kijabe HospitalKijabeKenya
  2. 2.Stoney CreekCanada

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