We explore the treatment-seeking behaviour of guardians of patients undergoing treatment for clubfoot at clinics run by the Malawi National Clubfoot Programme (MNCP). Core data was collected and analysed using qualitative methodologies of critical medical anthropology. Sixty detailed case studies were completed, each based on an extended open-ended interview with patient guardians. Two positive drivers in seeking treatment for clubfoot were identified: a desire to correct the impairment; and a direct instruction to do so, usually from a health-care professional. Four main barriers prevented treatment seeking: lack of knowledge about the condition and its treatment; familial resistance; logistical obstacles; and socio-economic pressures. In delivering effective health care, organizations should seek to minimize barriers and their impact, whilst maximizing drivers that lead to positive action.

This paper examines local theories of the causation of clubfoot expressed by the guardians of children undergoing treatment at clinics run by the Malawi National Clubfoot Programme (MNCP). Core data was collected and analysed using qualitative methodologies of critical medical anthropology. Sixty detailed case studies were completed, each based on an extended open-ended interview with patient guardians. Five main theories of causation were put forward: God; the devil; witchcraft or curses; biological reasons; and inherited condition. Each was elaborated in a variety of ways. There is growing international recognition of the importance of examining the relationship between culture and disability. This study is the first attempt to do so for clubfoot in Malawi. It provides a platform on which to build future qualitative research that can be harnessed by the MNCP and similar initiatives to develop their knowledge base and service provision, both in Malawi and the wider African context.