Figure 1
Areas of data collection, color-coded by number of subjects.
Table 1
Descriptive Statistics: India CLP Data.
| UNOPERATED CLP ADOLESCENTS | OPERATED CLP ADOLESCENTS | NON-CLP ADOLESCENTS | ||||
|---|---|---|---|---|---|---|
| CLP ADOLESCENT | SIBLING | CLP ADOLESCENT | SIBLING | ALL NON-CLP ADOLESCENTS | NON-CLP HH ADOLESCENTS | |
| Male | 0.579 | 0.579 | 0.492 | 0.555 | 0.522 | 0.504 |
| (0.081) | (0.081) | (0.032) | (0.032) | (0.016) | (0.022) | |
| Age | 14.421 | 13.132 | 14.445 | 14.441 | 14.027 | 13.533 |
| (0.398) | (0.687) | (0.170) | (0.305) | (0.119) | (0.142) | |
| Birth Order | 2.447 | 2.447 | 1.920 | 2.042 | 2.035 | 1.975 |
| (0.225) | (0.232) | (0.071) | (0.061) | (0.033) | (0.042) | |
| Physical Well-being | 0.004 | –0.019 | –0.036 | 0.166 | 0.020 | –0.083 |
| (0.122) | (0.156) | (0.050) | (0.061) | (0.026) | (0.032) | |
| Social Integration | –0.074 | 0.015 | –0.064 | 0.007 | 0.017 | 0.043 |
| (0.083) | (0.069) | (0.029) | (0.029) | (0.014) | (0.018) | |
| Psychological Well-being | –0.219 | –0.002 | –0.089 | 0.000 | 0.012 | 0.068 |
| (0.084) | (0.067) | (0.036) | (0.031) | (0.015) | (0.018) | |
| Academic and Cognitive Abilities | –0.599 | –0.191 | –0.127 | 0.044 | 0.024 | 0.127 |
| (0.126) | (0.139) | (0.055) | (0.054) | (0.024) | (0.029) | |
| Human Flourishing Index | –0.135 | –0.006 | –0.032 | 0.062 | 0.011 | 0.000 |
| (0.050) | (0.056) | (0.023) | (0.023) | (0.010) | (0.013) | |
| N | 38 | 38 | 238 | 238 | 982 | 522 |
Table 2
The Impact of cleft severity and cleft surgeries on speech outcomes.
| PANEL A: | OVERALL SPEECH INDEX1 | OVERALL SPEECH INDEX2 | HYPER-NASALITY | HYPO-NASALITY | AIR EMISSION | UNDER-STANDABILITY | ACCEPTABILITY |
|---|---|---|---|---|---|---|---|
| Cleft Severity | –0.351*** | –0.345*** | –0.280*** | –0.247*** | –0.284*** | –0.305*** | –0.296*** |
| (0.0349) | (0.0353) | (0.0346) | (0.0624) | (0.0452) | (0.0322) | (0.0346) | |
| Cleft Surgeries | –0.0374 | –0.00981 | –0.161** | 0.235** | –0.00767 | –0.0392 | –0.0101 |
| (0.0674) | (0.0715) | (0.0707) | (0.118) | (0.0892) | (0.0596) | (0.0715) | |
| Operation Smile surgeries | –0.137 | ||||||
| (0.112) | |||||||
| N | 954 | 954 | 926 | 925 | 921 | 926 | 925 |
| IMPACT OF EARLY SURGERY MATTER ON SPEECH OUTCOMES: | |||||||
| PANEL B: | OVERALL SPEECH INDEX | OVERALL SPEECH INDEX | HYPER-NASALITY | HYPO-NASALITY | AIR EMISSION | UNDER-STANDABILITY | ACCEPTABILITY |
| Cleft Severity | –0.365*** | –0.359*** | –0.281*** | –0.256*** | –0.313*** | –0.329*** | –0.316*** |
| (0.0361) | (0.0363) | (0.0359) | (0.0676) | (0.0475) | (0.0328) | (0.0364) | |
| Cleft Surgeries | –0.0913 | –0.0629 | –0.165** | 0.206* | –0.0926 | –0.114* | –0.0730 |
| (0.0733) | (0.0757) | (0.0762) | (0.119) | (0.0962) | (0.0678) | (0.0754) | |
| Operation Smile Surgeries | –0.156 | ||||||
| (0.113) | |||||||
| First Surgery ≤ Five Years Old | 0.310* | 0.327* | 0.0238 | 0.173 | 0.525** | 0.460*** | 0.385** |
| (0.166) | (0.168) | (0.176) | (0.295) | (0.218) | (0.168) | (0.171) | |
| N | 954 | 954 | 926 | 925 | 921 | 926 | 925 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01. 1 Test of (full restoration of speech index) rejected (p < 0.01). 2 Test of (full restoration of human flourishing index with Operation Smile surgeries) rejected (p < 0.01).
Figure 2
Kernel Density of Speech Quality by Cleft and Surgery Status.
Table 3
The Impact of cleft severity and cleft surgeries on physical and health outcomes (Household Fixed Effects).
| OVERALL PHYSICAL WELLBEING1 | OVERALL PHYSICAL WELLBEING2 | OVERALL PERCEIVED PHYSICAL WELLBEING | WEIGHT FOR HEIGHT | GRIP STRENGTH | |
|---|---|---|---|---|---|
| Cleft Severity | –0.0722*** | –0.0742*** | –0.135*** | –0.0820*** | –0.0167 |
| (0.0213) | (0.0212) | (0.0345) | (0.0316) | (0.0203) | |
| Cleft Surgeries | 0.0369 | 0.0215 | 0.0968 | 0.0449 | –0.0218 |
| (0.0442) | (0.0502) | (0.0674) | (0.0465) | (0.0371) | |
| Operation Smile Surgeries | 0.0707 | ||||
| (0.0794) | |||||
| N | 1118 | 1118 | 1118 | 1118 | 1118 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01. 1 Test of (full restoration of physical outcomes index at early surgery) not rejected (p = 0.21). 2 Test of (full restoration of physical outcomes index) not rejected (p = 0.78).
Table 4
The Impact of cleft severity and cleft surgeries on social integration (Household Fixed Effects).
| SOCIAL INTEGRATION1 | SOCIAL INTEGRATION2 | SOCIAL INCLUSION | PROSOCIAL BEHAVIOR | FREEDOM FROM BULLYING | PARENTAL SUPPORT | |
|---|---|---|---|---|---|---|
| Cleft Severity | –0.0716** | –0.0648* | –0.0887*** | –0.0202 | –0.0891*** | –0.0184 |
| (0.0347) | (0.0345) | (0.0340) | (0.0368) | (0.0309) | (0.0327) | |
| Cleft Surgeries | 0.0691 | 0.120* | 0.0932 | 0.0102 | 0.0605 | –0.0227 |
| (0.0667) | (0.0687) | (0.0666) | (0.0730) | (0.0608) | (0.0620) | |
| Operation Smile Surgeries | –0.233** | |||||
| (0.119) | ||||||
| N | 1118 | 1118 | 1118 | 1118 | 1118 | 1118 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01. 1 Test of (full restoration of social integration) not rejected (p = 0.95). 2 Test of (full restoration of social integration index) not rejected (p = 0.07).
Figure 3
Kernel Density of Social Inclusion by Cleft Status.
Table 5
The Impact of cleft severity and cleft surgeries on psychological well-being (Household Fixed Effects)
| OVERALL PSYCHOLOGICAL WELL-BEING1 | OVERALL PSYCHOLOGICAL WELL-BEING2 | DEPRESSION | ANXIETY | HOPE | SELF-ESTEEM | |
|---|---|---|---|---|---|---|
| Cleft Severity | –0.0373 | –0.0468* | –0.0339 | –0.0259 | –0.00445 | –0.0346 |
| (0.0280) | (0.0284) | (0.0328) | (0.0327) | (0.0301) | (0.0257) | |
| Cleft Surgery | –0.0285 | –0.0129 | –0.00126 | –0.00112 | –0.0942 | 0.0407 |
| (0.0537) | (0.0688) | (0.0719) | (0.0683) | (0.0627) | (0.0491) | |
| Operation Smile Surgeries | 0.137 | |||||
| (0.123) | ||||||
| N | 1118 | 1118 | 1118 | 1118 | 1118 | 1118 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01. 1 Test of (full restoration of psychological well-being) rejected (p = 0.04). 2 Test of (full restoration of psychological well-being) not rejected (p = 0.42).
Table 6
The Impact of cleft severity and cleft surgeries on Academic and Cognitive Ability (Household Fixed Effects).
| ACADEMIC AND COGNITIVE ABILITIES1 | ACADEMIC AND COGNITIVE ABILITIES2 | ACADEMIC ABILITIES | DIGIT SPAN MEMORY TEST | MATH ABILITIES | READING ABILITIES | |
|---|---|---|---|---|---|---|
| Cleft Severity | –0.0820*** | –0.0888*** | –0.0821*** | –0.0630*** | –0.0749*** | –0.0661** |
| (0.0273) | (0.0279) | (0.0290) | (0.0238) | (0.0286) | (0.0284) | |
| Cleft Surgeries | 0.0500 | –0.000992 | 0.0648 | 0.0245 | 0.0579 | 0.0533 |
| (0.0545) | (0.0533) | (0.0614) | (0.0445) | (0.0580) | (0.0626) | |
| Operation Smile Surgeries | 0.235** | |||||
| (0.109) | ||||||
| N | 1118 | 1118 | 1118 | 1118 | 1118 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01. 1 Test of (full restoration of academic and cognitive abilities) not rejected (p = 0.33). 2 Test of (full restoration of academic and cognitive ability) not rejected (p = 0.42).
Figure 4
Kernel Density of Academic and Cognitive Ability.
Table 7
The Impact of cleft severity and cleft surgeries on Human Flourishing Index (Equality Weighted index of Outcome Summaries, Household Fixed Effects).
| HUMAN FLOURISHING INDEX1 | HUMAN FLOURISHING INDEX2 | HUMAN FLOURISHING INDEX | HUMAN FLOURISHING INDEX | |
|---|---|---|---|---|
| Cleft Severity | –0.0834*** | –0.0861*** | –0.0629*** | –0.0650*** |
| (0.0253) | (0.0258) | (0.0175) | (0.0176) | |
| Cleft Surgeries | 0.0109 | –0.00919 | –0.0223 | –0.0400 |
| (0.0449) | (0.0473) | (0.0317) | (0.0371) | |
| Operation Smile Surgeries | 0.0924 | 0.0850 | ||
| (0.103) | (0.0943) | |||
| Household FE | X | X | ||
| Regional FE | X | X | ||
| N | 1118 | 1118 | 1118 | 1118 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01. 1 Test of (full restoration of human flourishing index) rejected (p = 0.01). 2 Test of (full restoration of human flourishing index) not rejected (p = 0.97).
Table 8
Effects of Additional Surgeries: Required and Performed.
| SPEECH INDEX | PHYSICAL WELLBEING | SOCIAL INTEGRATION | PSYCHOLOGICAL WELLBEING | ACADEMIC/COGNITIVE | HUMAN FLOURISHING | |
|---|---|---|---|---|---|---|
| Required 2–3 Surgeries | –1.373*** | –0.231* | –0.244 | –0.382** | –0.392** | –0.465*** |
| (0.259) | (0.119) | (0.226) | (0.192) | (0.183) | (0.161) | |
| Required 4–5 Surgeries | –1.579*** | –0.177 | –0.462 | –0.241 | –0.543** | –0.481** |
| (0.307) | (0.157) | (0.322) | (0.233) | (0.227) | (0.227) | |
| Required 6–7 Surgeries | –2.156*** | –0.403** | –0.439 | –0.394* | –0.796*** | –0.701*** |
| (0.314) | (0.168) | (0.284) | (0.214) | (0.244) | (0.204) | |
| Received 1 Surgery | 0.213 | 0.105 | 0.236 | 0.281 | 0.296 | 0.431** |
| (0.280) | (0.143) | (0.258) | (0.219) | (0.200) | (0.187) | |
| Received 2 Surgeries | 0.0283 | –0.0997 | 0.194 | 0.113 | 0.418* | 0.136 |
| (0.332) | (0.177) | (0.299) | (0.241) | (0.248) | (0.222) | |
| Received 3+ Surgeries | –0.268 | 0.0717 | 0.176 | 0.00750 | 0.412 | 0.125 |
| (0.329) | (0.192) | (0.285) | (0.221) | (0.251) | (0.214) | |
| N | 954 | 1118 | 1118 | 1118 | 1118 | 1118 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01.
Figure 5
Impacts of Severity and Restoration. (Numbers of Surgeries Needed and Performed).
Table 9
Conditional Impacts by Varying Levels of Cleft Severity.
| SPEECH INDEX | PHYSICAL WELLBEING | SOCIAL INTEGRATION | PSYCHOLOGICAL WELLBEING | ACADEMIC/COGNITIVE | HUMAN FLOURISHING | |
|---|---|---|---|---|---|---|
| Required 2–3 Surgeries | –1.648*** | –0.196 | –0.472* | –0.555** | –0.686*** | –0.631*** |
| (0.306) | (0.129) | (0.261) | (0.241) | (0.209) | (0.184) | |
| Required 4–7 Surgeries | –1.745*** | –0.148 | 0.338 | –0.0643 | –0.270 | –0.146 |
| (0.457) | (0.175) | (0.561) | (0.249) | (0.389) | (0.369) | |
| Received 1–3 Surgeries | –0.950* | –0.00612 | 0.364** | 0.0476 | –0.535* | 0.0936 |
| (0.511) | (0.315) | (0.158) | (0.317) | (0.318) | (0.294) | |
| Received 4+ Surgeries | –2.772*** | 2.792*** | 0.618*** | –1.553*** | 0.546*** | 0.982*** |
| (0.0827) | (0.0593) | (0.0933) | (0.0794) | (0.0712) | (0.0723) | |
| Required 2–3 Surgeries × Received 1–3 Surgeries | 1.508** | 0.0308 | 0.187 | 0.439 | 1.264*** | 0.512 |
| (0.615) | (0.355) | (0.342) | (0.435) | (0.399) | (0.372) | |
| Required 4+ Surgeries × Received 1–3 Surgeries | 0.777 | –0.174 | –1.058* | –0.187 | 0.494 | –0.385 |
| (0.697) | (0.371) | (0.598) | (0.421) | (0.512) | (0.485) | |
| Required 4+ Surgeries × Received 4+ Surgeries | 2.064*** | –2.917*** | –1.027* | 1.208*** | –0.755* | –1.340*** |
| (0.500) | (0.221) | (0.621) | (0.310) | (0.422) | (0.397) | |
| Conditional Impacts of Surgeries on Varying Levels of Cleft Severity: | ||||||
| Received 1–3 Surgeries + (Required 2–3 Surgeries × Received 1–3 Surgeries) | 0.558* | 0.024 | 0.551* | 0.486* | 0.729*** | 0.605*** |
| (0.343) | (0.163) | (0.303) | (0.297) | (0.242) | (0.226) | |
| Received 1–3 Surgeries + (Required 4+ Surgeries × Received 1–3 Surgeries) | –0.172 | –0.180 | –0.694 | –0.139 | –0.041 | –0.291 |
| (0.473) | (0.196) | (0.557) | (0.274) | (0.402) | (0.387) | |
| Received 4+ Surgeries + (Required 4+ Surgeries × Received 4+ Surgeries) | –0.707 | –0.125 | –0.409 | –0.345 | –0.209 | –0.358 |
| (0.048) | (0.210) | (0.603) | (0.290) | (0.415) | (0.387) | |
| N | 954 | 1118 | 1118 | 1118 | 1118 | 1118 |
[i] OLS with fixed effects at the household level. Standard errors clustered at the household level and are in parentheses. Regressions control for individual variables including gender, birth order, and age. Dependent variables are all standardized Kling et al. [13] indices. * p < 0.10, ** p < 0.05, *** p < 0.01.
Figure 6
Measured Impacts of Surgeries Conditional Upon Number of Surgeries Required.