Knowledge And Cultural Beliefs About The Etiology And Management Of Orofacial Clefts In Nigeria's Major Ethnic Groups

ORIGINAL ARTICLES

Knowledge and Cultural Beliefs About the Etiology and Management ofOrofacial Clefts in Nigeria’s Major Ethnic Groups

Fadekemi O. Oginni, B.Ch.D., F.M.C.D.S., Malachy E. Asuku, M.B.B.S., F.W.A.C.S., Ayodeji O. Oladele, M.B.Ch.B.,

F.W.A.C.S., Ozoemene N. Obuekwe, B.Ch.D., F.W.A.C.S., Richard E. Nnabuko, F.W.A.C.S., F.M.C.S.

Objective: To determine the knowledge and cultural beliefs about theetiology and management of orofacial clefts in Nigeria’s major ethnic groups.

Design: Questionnaires designed to elicit respondents’ knowledge andcultural beliefs about the etiology and management of orofacial clefts.

Setting: Northern and southern Nigerian communities where the major ethnicgroups reside.

Participants: Consenting, randomly selected individuals.Results: There were 650 respondents (350 women and 300 men) from 34 of

Nigeria’s 36 states; 65.5% were aged 21 to 40 years and 52.5% were married. Therewere Yoruba (33.7%), Igbo/Bini/Urhobo (40.5%), and Hausa/Fulani (25.8%), withmost having attained primary and secondary education. Of those responding,75% had seen an individual with an orofacial cleft. A significant level of ignoranceabout the cultural beliefs was found. The Hausa/Fulani considered it mostly an actof God; whereas, the Igbo/Bini/Urhobo and Yoruba groups displayed a greatervariety of cultural beliefs. The latter groups implicated witchcraft, evil spirit ordevil, the mother, and occasionally the child. Of respondents, 40% knew thatsurgery was a possible solution, and 22% would recommend a visit to thehospital. Respondents with higher educational attainment produced significantlymore scientifically related etiologic factors and accurate treatment options.

Conclusion: Of respondents, 75% were aware of the existence of orofacialclefts, and a fair knowledge of treatment of orofacial clefts was elicited. Diversecultural beliefs often may present an obstacle to treatment. Improvedawareness about the etiology and management of orofacial clefts is required.

KEY WORDS: culture, etiology, orofacial clefts

Culture, by definition, is the total way of life of

individuals. Immense variations exist in cultural beliefs,

concepts, and practices on particular issues from place to

place. The combination of culture and knowledge, howev-

er, is a powerful tool influencing the behavioral pattern of

any individual and may be a major determinant of health-

seeking behaviors. Poor health-seeking behaviors are

observed in most developing nations (Meremikwo et al.,

2005) for diverse reasons (Obuekwe and Akapata, 2004;

Uzochukwu and Onwujekwe, 2004).

The treatment of birth defects and other disabilities is

influenced particularly by an interplay of cultural beliefs of

the individual, family, and society, as well as folk and

traditional religious beliefs (Cheng, 1990) and available

knowledge. In the past, reports showed that children born

with defects were a bad omen to the family, and they were

concealed or neglected (Gupta, 1969).

The attitudes of patients, patients’ families, and the

community toward the nature, cause, effect, and treatment

of orofacial clefts are important to the therapeutic process

as well as the social and emotional development of patients

(Patel and Ross, 2003). Cultural diversity has a profound

effect on the ways in which families and professionals

interrelate cross-culturally and participate together in

treatment programs (Louw, 2004). Broder (2001) suggested

that interventions need to be culturally sensitive because

Dr. Oginni is Senior Lecturer, Department of Oral and Maxillofacial

Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife,

Nigeria. Dr. Asuku is Consultant Plastic Surgeon, Department of Surgery,

Ahmadu Bello University, Zaria, Kaduna State, Nigeria. Dr. Oladele is

Lecturer, Department of Surgery, Plastic Surgery Unit, Obafemi

Awolowo University, Ile-Ife, Nigeria. Dr. Obuekwe is Associate

Professor, Department of Oral and Maxillofacial Surgery, School of

Dentistry, University of Benin, Benin City, Nigeria. Dr. Nnabuko is

Consultant Plastic Surgeon, Plastic Surgery Department, National

Orthopedic Hospital, Enugu, Nigeria.

A portion of this work was presented orally at the International Cleft

Lip and Palate Foundation Conference, Eastbourne, United Kingdom, in

June 2006 and at the Third International Conference on Birth Defects and

Disabilities in the Developing World, Rio de Janeiro, Brazil, in June 2007.

Submitted May 2007; Accepted September 2008.

Address correspondence to: Dr F. O. Oginni, Department of Oral and

Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo Univer-

sity, Ile-Ife Nigeria. E-mail [email protected] or foginni@oauife.

edu.ng.

DOI: 10.1597/07-085.1

327

parental and extrafamilial contexts may differ acrossvarying cultures and ethnicities. Total care delivery,

therefore, calls for a proper understanding and identifica-

tion of culturally based stigmas and beliefs associated with

such conditions. A rural Mexican belief, for example,

suggests that a pregnant woman is in danger of having a

‘‘harelipped baby during a solar eclipse’’ (Castro, 1995,

pp. 229–238). In China, some people believe that a pregnant

woman should not eat rabbit meat for fear of giving birth to ababy with a ‘‘harelip’’ (Cheng, 1990). However, cultural

beliefs about birth defects in Nigeria are unknown.

Nigeria, Africa’s most populous country, has anestimated population of about 140 million people. Addi-

tionally, the country is blessed with a diverse cultural

heritage, as revealed by Nigeria’s approximately 250 ethnic

groups. Although the country is a multicultural society, the

Hausa/Fulani, Igbo/Bini/Urhobo, and Yoruba are consid-

ered its three major ethnic groups.

As in other African countries, orofacial clefts constitute a

substantial proportion of birth defects in the Nigerian

population (Strauss, 1985; Obuekwe and Akapata, 2004).

Iregbulem (1982) reported that the prevalence of cleft lip

and palate in a Nigerian population was 0.4 per 1000births. It was reported and widely believed that orofacial

birth defects were stigmatized in Nigeria. Furthermore,

infanticide was practiced, and attitudinal barriers to the

development of rehabilitation resources existed there

(Strauss, 1985). The presence of adults and school-aged

children with untreated orofacial clefts in Nigerian

communities suggest enhanced survival of children born

with the defect. Moreover, it is a reflection of poor health-seeking behaviors and financial constraints, among other

probable factors, and some level of adjustment to

stigmatization in affected individuals.

Accordingly, we sought to determine the knowledge,attitudes, and cultural beliefs in Nigeria’s major ethnic

groups regarding the etiology and management of orofacial

clefts. The findings of this research will form a basis for

formulating an effective awareness campaign tool relevant

to educating the public on the etiology, predisposing

factors, and management of orofacial clefts.

MATERIALS AND METHODS

The authors administered a structured questionnaire

(Appendix A) by interview to consenting, randomly

selected individuals in communities of northern and

southern Nigeria. We used the cluster sampling technique

in selecting communities and simple randomization inselecting respondents among passersby and dwellers within

selected clusters. The study was conducted between

October 1, 2006, and December 31, 2006. Principles

outlined in the Declaration of Helsinki were followed.

The questionnaire was designed to elicit respondents’

knowledge of and cultural beliefs about the etiology and

management of orofacial clefts. Questions inquiring about

respondents’ beliefs and knowledge regarding the etiology

of orofacial clefts were open ended. Section A of the

questionnaire inquired about standard socio-demographic

features of respondents, and section B was designed to

assess their knowledge and cultural beliefs about the

etiology of orofacial clefts as well as possible treatment

modalities. The respondents were grouped into three

categories based on ethnicity: Hausa/Fulani, Igbo/Bini/

Urhobo, and Yoruba. The responses given were scored for

correctness.

Data were entered into a computer and analyzed using

Statistical Package for the Social Sciences (SPSS) statistical

software (SPSS, Inc., Chicago, IL). Simple descriptive

statistics, chi-square tests, and Pearson correlations were

used. A p level of # .05 was considered statistically significant.

RESULTS

There were 650 respondents (350 women and 300 men)

from 34 of Nigeria’s 36 states. The ethnic groups

represented were Yoruba (33.7%), Igbo/Bini/Urhobo

(40.5%), and Hausa/Fulani (25.8%). No significant gender

differences by age group were observed (Table 1). Howev-

er, a significant (p , .05) male predilection was observed in

the Hausa ethnic group (Table 1). Of the respondents,

65.5% were aged 21 to 40 years (Table 1) and 52.5% were

married. About 8% (n 5 54) of respondents had no formal

education, 37.2% (n 5 242) had primary education, and

54.5% (n 5 354) had postsecondary education (Fig. 1).

Three quarters of respondents had seen at least one

individual with an orofacial cleft, and these respondents

were mostly from the Igbo/Bini/Urhobo (85%) and Yoruba

(77%) ethnic groups (Table 2). The individuals seen with

TABLE 1 Respondents’ Ethnic Group, Age, and Marital Status by

Gender (n = 650)

Variables Men, n (%) Women, n (%) Total, n (%)

Ethnic groups

Hausa/Fulani 103 (15.8) 65 (10.0) 168 (25.8)

Igbo/Bini/Urhobo 102 (15.7) 161 (24.8) 263 (40.5)

Yoruba 95 (14.6) 124 (19.1) 219 (33.7)

Total 300 (46.2) 350 (53.8) 650 (100.0)

x2 5 21.95, df 5 2, p # .05

Age group (y)

0–20 22 (3.4) 26 (4.0) 48 (7.4)

21–40 199 (30.6) 227 (34.9) 426 (65.5)

41–60 64 (9.8) 85 (13.1) 149 (22.9)

.60 15 (2.3) 12 (1.8) 27 (4.2)

Total 300 (46.2) 350 (53.8) 650 (100.0)

x2 5 1.63, df 5 3, p . .05

Marital status

Single 144 (22.2) 148 (22.8) 292 (45.0)

Married 155 (23.8) 186 (28.6) 341 (52.4)

Divorced* 0 (0.0) 5 (0.8) 5 (0.8)

Widowed* 1 (0.2) 11 (1.7) 12 (1.9)

Total 300 (46.2) 350 (53.9) 650 (100.1)

x2 5 1.63, df 5 2, p , .05

* Merged for analysis.

328 Cleft Palate–Craniofacial Journal, July 2010, Vol. 47 No. 4

orofacial clefts were identified rarely as their close relations

(4.1%) and usually as an unknown person just passing by

(Fig. 2). Of the orofacial clefts seen by respondents, 45%

had been repaired surgically. Nothing had been done for

21% of the individuals, and the respondents could not tell

what had happened in 25% of cases (Fig. 3).

A significant majority of respondents provided one or

more perceived reasons for the defects (p , .05). Among

FIGURE 1 Respondents’ educational attainment (n = 650).

TABLE 2 Perceptions of the Etiology of Orofacial Clefts by Ethnic Groups in North and South Nigeria

Ethnic Groups

Total, n (%)Hausa/Fulani, n (%) Igbo/Bini/Urhobo, n (%) Yoruba, n (%)

Have you ever seen an individual with facial cleft?

Yes 97 (58.0) 223 (85.0) 169 (77.0) 489 (75.0)

No 71 (42.0) 40 (15.0) 50 (23.0) 161 (25.0)

x2 5 40.93, df 5 2, p , .05

Respondents’ perceptions of cause*

Don’t know 72 (36.5) 48 (20.4) 48 (21.1) 168 (25.5)

God 53 (26.9) 0 (0.0) 4 (1.8) 57 (8.6)

Evil spirit/witchcraft/enemy 10 (5.1) 5 (2.1) 18 (7.9) 33 (5.0)

Sickness/infection 9 (4.6) 11 (4.7) 14 (6.1) 34 (5.1)

Drugs/chemical concoction 21 (10.7) 36 (15.3) 33 (14.5) 90 (13.6)

Accident 3 (1.5) 5 (2.1) 16 (7.0) 24 (3.6)

Attempted abortion 0 (0.0) 18 (7.7) 3 (1.3) 21 (3.2)

Abnormal gene 3 (1.5) 26 (11.1) 6 (2.6) 35 (5.3)

Congenital/hereditary 19 (9.7) 66 (28.1) 63 (27.6) 148 (22.4)

Smoke 0 (0.0) 2 (0.9) 2 (0.9) 4 (0.6)

Radiation 1 (0.5) 4 (1.7) 1 (0.4) 6 (0.9)

Malnutrition 3 (1.5) 6 (2.6) 7 (3.1) 16 (2.4)

Environment 2 (1.0) 3 (1.3) 2 (0.9) 7 (1.1)

Parents’ offense 1 (0.5) 1 (0.4) 6 (2.6) 8 (1.2)

Other 0 (0.0) 4 (1.7) 5 (2.2) 9 (1.4)

Total 197 (100.0) 235 (100.0) 228 (100.0) 660 (100.0)

x2 518.24, df 52, p , .05 (some respondents supplied multiple reasons)

Cultures’ perceptions of cause*

Don’t know 91 (54.2) 148 (56.4) 62 (28.1) 301 (46.3)

God 69 (41.1) 7 (2.5) 9 (3.9) 85 (13.1)

Devil/evil spirit/witchcraft 7 (4.2) 42 (16) 77 (35.4) 126 (19.4)

Retribution/mother sinned 1 (0.6) 16 (6.1) 27 (12.4) 44 (6.8)

Reincarnation 0 (0.0) 21 (8.0) 18 (8.4) 39 (6.0)

Curse 0 (0.0) 19 (7.4) 0 (0.0) 19 (2.9)

Ancestral origin 0 (0.0) 10 (3.6) 0 (0.0) 10 (1.5)

Evil child 0 (0.0) 0 (0.0) 26 (11.8) 26 (4.0)

Total 168 (100.0) 263 (100.0) 219 (100.0) 650 (100.0)

x2 5 43.2, df 5 2, p , .05

* All except ‘‘Don’t know’’ merged for analysis.

Oginni et al., KNOWLEDGE AND CULTURAL BELIEFS ABOUT OROFACIAL CLEFTS 329

the variety of reasons offered, 22% (148/660) referred to it

as a congenital defect (Table 2). A majority of respondents

in the Hausa group (42.4%) attributed it to God but rarely

to witchcraft, evil spirit, or devil (8%), which was the most

common belief in the Igbo/Bini/Urhobo and Yoruba ethnic

groups (Table 2). The mother and occasionally the child

were implicated by the latter tribes. Overall, the Yoruba

and Igbo/Bini/Urhobo groups displayed a greater variety of

cultural beliefs, as shown in Table 2.

As presented in Figure 4, treatment options supplied by

the respondents included surgery (40%), visit to the hospital

(22%), nothing (5%), don’t know (9%), and others (24%).

The options classified as ‘‘others’’ included taking the child

to a native doctor, prayer houses, and spiritualists.

Using the respondents’ educational attainment and the

correctness of their responses, a positive correlation was

found between the correctness of responses given and the

respondents’ educational attainment (p , .05). Respon-

dents with higher educational attainment were able to list

most etiologic factors with scientific connotations as well as

correct definitive treatment options.

DISCUSSION

Nigeria is a multiethnic country with three major ethnic

groups having distinct languages/dialects and styles of

dress. To a lesser extent, however, these groups may be

classified based on their religious inclinations. The northern

groups, for instance, are predominantly Muslims; whereas,

the southern groups are mainly Christians. Traditional

African religion is not practiced as widely as the

aforementioned; however, it seems to thrive more in the

South than in the North.

The demographic pattern of respondents in this study

substantiates diversity in the various ethnic groups studied.

We attribute the statistically significant paucity of female

respondents in the Hausa/Fulani group largely to the

prevalent Islamic lifestyle, which renders most women in

purdah, a religious practice that prevents women from

being seen by men, inaccessible to a survey like this.

That most respondents were 21 to 40 years old is also a

reflection of the most active socioeconomic age group in

the society. Our respondents were a relatively mature

sample in terms of age and marital status.

In addition, the observation that 75% of respondents had

seen individuals with orofacial clefts substantiates the

significant prevalence of orofacial clefts in Nigeria and

suggests that affected individuals are surviving infancy. An

ample level of awareness about the existence of orofacial

clefts, especially in the Yoruba and Igbo/Bini/Urhobo

groups, also can be inferred. This does not necessarily

suggest higher prevalence of orofacial clefts in the

aforementioned regions but rather, better awareness.

Respondents identified most individuals they had seen

with an orofacial cleft as unknown persons (65%) or an

acquaintance (31%) and very rarely as a close family

relation (4.1%). We presume that this pattern is a reflection

of rejection and typical willingness to dissociate from what

is considered a misfortune.

A substantial level of ignorance about cultural beliefs of

the etiology of orofacial clefts is apparent in our study

FIGURE 2 Relationship of respondents to individuals seen with orofacial

clefts (n = 489).

FIGURE 3 Respondents’ reply to the question, ‘‘What was done for the

individual?’’ (n = 489).

330 Cleft Palate–Craniofacial Journal, July 2010, Vol. 47 No. 4

population. We attribute this to a combination of

modernization and a semirural study population. Perhaps

respondents drawn from a purely rural population would

generate better awareness of the cultural beliefs; nonethe-

less, a significant range of cultural beliefs was volunteered

by the studied groups.

Only a minority of respondents had no opinion about the

etiology of orofacial cleft. Others supplied a range of

reasons that varied by ethnic group. God’s will was the

major reason supplied by Hausa/Fulani respondents. This

is in agreement with previous findings of the same ethnic

group in Nigeria (Olasoji et al., 2007) and also concurs with

the cultural beliefs supplied by a majority in the Hausa/

Fulani ethnic group, thus suggesting a high level of culture

agreement. This is also in agreement with the belief of the

Chamorros, an Asian American group that views a cleft as

FIGURE 4 Percentages of respondents’ answers to the question, ‘‘What can be done to help individuals with these defects?’’.

Oginni et al., KNOWLEDGE AND CULTURAL BELIEFS ABOUT OROFACIAL CLEFTS 331

a gift from God (Cheng, 1990), as well as a rural Indian

population (Weatherley-White et al., 2005).

Unlike the Hausa/Fulani group, the Yoruba and Igbo/

Bini/Urhobo respondents’ personal opinions appeared to

differ considerably from the prevailing cultural beliefs.

Although evil spirit, witchcraft, and devil were prominent

cultural beliefs reported, a majority of the respondents

did not agree with these as reasons for the defect. Rather,

a combination of drugs, chemicals, and concoctions were

implicated by a majority. Furthermore, and closely

related to this, they suggested attempted criminal

abortion through the use of drugs. It is interesting that

sickness, infection, abnormal gene, radiation, malnutri-

tion, and the environment also were offered as reasons

for the defect in these groups. Again, this lends credence

to a shift from the cultural beliefs, which we attribute to

an increase in critical observation and influence of formal

education. A number of the respondents’ opinions of the

etiology of orofacial clefts were classified as ‘‘other’’ in

the results. These included opinions such as ‘‘parents

violated cultural laws,’’ ‘‘parent(s) bore false witness,’’ ‘‘it

is the child’s destiny,’’ and ‘‘mother killed and mutilated

a goat,’’ among others.

The belief of Buddhists (Cheng, 1990), who consider

birth defect a fate for which nothing can be done, can be

likened to seeing orofacial clefts as a gift from God or the

will of God. This belief may be a deterrent for seeking

treatment because the thinking may be ‘‘after all, man

cannot be wiser than God.’’

Unlike the Hausa/Fulani (predominantly Islamic)

group, the cultural beliefs supplied by the other (southern)

ethnic groups indicate the prominence of traditional

African religion in these locations. It is surprising that

none of the cultural beliefs given is comparable with

scientifically supported predisposing factors. Such cultural

beliefs (particularly among the Yorubas) include insinuat-

ing that the child is an evil spirit that gained access to the

mother’s womb because she walked in the hot sun (at

about 1:00 PM) or late at night in the dark (after 7:00 PM)

when it is believed that evil spirits walk around and seek a

place to stay. The belief is that such spirits displace a

healthy child and take his or her place. Also, the spirits of

individuals who died suddenly in vehicle crashes are

believed to replace healthy children in a mother’s womb

with their maimed bodies. Similar to Dagher and Ross’

(2004) findings, others believe that witchcraft or an enemy

could have done it to afflict the parents of the child with

sorrow. Some viewed it as a consequence of hunting

activities by the child’s father, who must have killed a

strange animal. The deformity, according to them, is a

result of the harm done to the strange animal. Similarly,

some believe ardently that the pregnant mother must have

walked amid warriors and in the process, the child

sustained gunshot injuries or machete cuts. Such injuries,

according to them, only become apparent at birth and

take the form of an orofacial cleft.

Traditional African religion is associated with a number

of laws that, according to some of respondents, must have

been violated for a defect like a cleft to have occurred. For

example, some see orofacial clefts as an aftermath of eating

certain food items that are forbidden, failure to fulfill some

obligations like eating and drinking relevant concoctions

during pregnancy, or stealing by either the father or

mother. Oftentimes, wrongdoings were traced to the

mother who, according to the respondents, would be

confronted with implicating and derogatory expressions

like ‘‘You are the only one that can explain where you got a

child like this from’’; ‘‘Your sin has found you out’’; ‘‘We

have never seen this in this family’’; and ‘‘You must have

bad eggs in your body,’’ among others.

Furthermore, some Nigerians believe that there must be

a curse at work and that the problem could have ancestral

origin. This belief was elicited only in the Yoruba and Igbo/

Bini/Urhobo groups. Here, the problem is traced back to

parents, grandparents, or even great-grandparents doing

something evil. This idea is in agreement with the

documented opinion of Filipinos and Chinese (Cheng,

1990). On some occasions, the Yoruba and Igbo/Bini/

Urhobo would also implicate the child directly and call

him/her evil. This may have been a reason for infanticide.

Closely related to infanticide and exclusively common to

the southern ethnic groups is the belief that individuals with

orofacial clefts are reincarnated children (Clarke, 1976).

The infant mortality rate in Nigeria was very high several

decades ago. Most cultures attributed this to activities of

evil spirits. However, with modernization it became

apparent that these were the results of poor infection

control, malnutrition, and inadequate care of the newborn

including lack of immunization against major childhood

killer diseases, among other reasons. The belief was that the

dead child had gone to the spirit world and had been

reincarnated into the same home by his/her choice to afflict

the parents with sorrow. This belief fits perfectly into a

situation where an underlying genetic problem predisposes

to repeated infant mortality, stillbirth, and congenital

deformities in the same couple. They affirm their belief

that the same child is reincarnating on the strength of very

close resemblance between the departed and the newborn,

forgetting that it is still virtually the same gene at work in

the couple. Grandparents, parents, family herbalists, or a

combination of these agree to and do maim the corpses of

such children to make them unacceptable to the spirit

world, hoping that the child would reincarnate with a

maimed body that is cleft lip, palate, or any physical

congenital defect and therefore stay alive. In their thinking,

the deformity guarantees staying alive, and an ardent

believer in this may resist a repair for fear of the child dying

again.

It is quite impressive to note that a majority of our

respondents would suggest surgery and/or a visit to the

hospital as a remedy. Nevertheless, a substantial 38% did

not have any idea of the correct approach to the situation.

332 Cleft Palate–Craniofacial Journal, July 2010, Vol. 47 No. 4

Measures like taking the child to a spiritual home, prayer

house, or doing nothing were offered also.

In view of the fact that successful and complete cleft carerequires recognition and consideration of cultural diversity

and differing ethnic and cultural interactional styles, we

opine that it is probably insufficient to provide surgical

remedies alone for orofacial clefts. The knowledge and

beliefs of potential care recipients may hinder them from

obtaining the maximum benefit from such methods. Based

on the findings of this study, an effective, culturally

sensitive public health and awareness package should beput in place for the population described. A similar

program would work for populations that share similar

cultural beliefs about orofacial clefts and other birth

defects. Such programs must be directed at eliminating

the identified unfounded cultural beliefs as well as other

related issues peculiar to each ethnic group.

We acknowledge that a bigger sample size may have been

desirable. However, financial limitations precluded a largerstudy. To a large extent, the study design has reduced bias

and misrepresentation of respondents’ opinions by the

sampling techniques used. Also, making the aspects on

belief open ended gave the respondents the opportunity to

fully express their opinions. Language barriers were

eliminated by using the authors, who are indigenes of the

various ethnic groups, to administer the questionnaires.

Furthermore, the use of open-ended questions, which gaverespondents the opportunity to fully express their opinions,

represents a strength of this study. In our opinion, these

findings may not differ grossly from those of other

Nigerian ethnic groups.

CONCLUSION

An understanding of the cultural beliefs about theetiology of orofacial clefts in the regions was gained. We

also were able to elicit a fair knowledge of the actual

etiology and treatment of orofacial clefts, particularly in

the southern ethnic groups. Orofacial clefts are seen often

as an act of God by northern ethnic groups. Southern

groups, however, are likely to attribute it to diverse cultural

beliefs, some of which implicate the mother and/or the

child. The need for more enlightenment about etiology and

treatment of orofacial clefts is apparent. The detrimental

beliefs must be debunked through an effective health

education and awareness campaign specially designed and

incorporated into the specified ethnic groups in Nigeria.

This could be applicable to non-Nigerian ethnic groups

that share the same beliefs.

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Oginni et al., KNOWLEDGE AND CULTURAL BELIEFS ABOUT OROFACIAL CLEFTS 333

APPENDIX A

(QUESTIONNAIRE)

SECTION A

1. TRIBE:

2. STATE OF ORIGIN:

3. AGE: [,15yrs] [16–20] [21–30] [31–40] [41–50] [51–60]

[.61]

4. GENDER: [MALE] [FEMALE]

5. EDUC. ATTAINMENT: [Nil] [Pry] [Sec.] [Ordinary Na-

tional Diploma] [Higher National Diploma] [BSc/BA]

[MSc] [PhD] [Others] (Please indicate ……………

……………………………………………….)

6. MARITAL STATUS: [Married] [Single] [Divorced] [Widow]

7. OCCUPATION:

SECTION B

1a. Have you ever seen a child or an individual

like this? [Yes] [No]

B. If Yes to 1a above, whose child or children?

C. What was done for the child / children?

………………

…………………………………………..

2. In your opinion what is responsible for this?

3. What are the beliefs about this condition in

your culture or how does your culture explain

this occurrence?

4. What can be done to help someone in this

condition?

5. Other Remarks

APPENDIX A

(QUESTIONNAIRE)

SECTION A

1. TRIBE:

2. STATE OF ORIGIN:

3. AGE: [,15yrs] [16–20] [21–30] [31–40] [41–50] [51–60] [.61]

4. GENDER: [MALE] [FEMALE]

5. EDUC. ATTAINMENT: [Nil] [Pry] [Sec.] [Ordinary National Diploma] [Higher National Diploma] [BSc/BA] [MSc] [PhD]

[Others] (Please indicate …………………………………………………………….)

6. MARITAL STATUS: [Married] [Single] [Divorced] [Widow]

7. OCCUPATION:

SECTION B

1A. Have you ever seen a child or an individual like this? [Yes] [No]

B. If Yes to 1a above, whose child or children?

C. What was done for the child / children? …………………………………………………………..

2. In your opinion what is responsible for this?3. What are the beliefs about this condition in your culture or how does your culture explain this occurrence?

4. What can be done to help someone in this condition?

5. Other Remarks

334 Cleft Palate–Craniofacial Journal, July 2010, Vol. 47 No. 4