Context for Filipino community based orofacial cleft prevention interventions

Among Filipinos of lower SES 1/500 babies are born yearly with an orofacial cleft. This is one of the highest birth prevalence of orofacial clefting in the world. The main purpose of this study was to obtain contextual information prior to planning for community based health interventions in the Philippines regarding orofacial clefting. A descriptive ethnography was used to describe working class Filipinos' (including healthcare workers') current beliefs about the causes, prevention, and treatment of orofacial clefting, and vitamin taking practices during pregnancy. Modifications of Kleinman's explanatory models were made to include questions about people's general and personal beliefs about cause and prevention of cleft. Innovative methods were developed and used in field research and included an oral back translation method and double translation process.

Filipinos reported the following explanations for cause of cleft inheritance, falls, cravings, environmental exposures, and God's will. Beliefs about prevention of cleft included limiting their number of children, being careful not to fall, and avoiding environmental exposures. Filipinos seek surgical repair as treatment for their cleft. Iron was the supplement women reported taking most often during pregnancy. Female participants reported that feeling better, cost of multivitamin, side effects, and bad smell and taste were reasons why they quit taking micronutrients before they had completed the recommended course.

This study is the first to construct a Filipino explanatory model specifically for clefting. In constructing Filipino's explanatory model for clefting we found that people's general causal explanations for cleft were not always congruent with personal causal explanations, and people's causal explanations for cleft were not always congruent with their prevention explanations. Modifying Kleinman's explanatory models to include questions about general and personal explanations for cause of illness and questions about prevention should be used to educe a more complete explanatory model. Results from this research can be used to inform the design of health campaigns and/or possible vitamin trials. These campaigns could include but are not limited to developing information brochures and programs about the cause and prevention of clefting, or developing public health campaigns to promote the use of prenatal vitamins in women of childbearing age.