A collaborative public health approach to clubfoot intervention in 10 low-income and middle-income countries

Owen, Rosalind; Penny, J. Norgrove; Mayo, Andrew; Morcuende, José A.; Lavy, Christopher

doi:10.1097/bpb.0b013e3283504006

Cited by 30 publications

(28 citation statements)

References 8 publications

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“…There are several examples of successful and sustainable implementations of clubfoot programs in low-and middle income programs [5,8,22]. This could be a great solution in Indonesia, because at present there is no national program giving access to clubfoot care for the whole population in need.…”

Section: Discussionmentioning

confidence: 99%

“…With an estimated incidence of 1:1000 newborns, every year about 100,000-200,000 children are born with a clubfoot worldwide, from which about 80 % are in low-or middle-income countries [5,6]. The majority of these feet are not treated, leaving the child disabled for the rest of their life.…”

Section: Discussionmentioning

confidence: 99%

“…The Ponseti treatment provides, in over 95 % of the cases, a foot which is completely functional and pain free when started before the walking age; however, most of the studies with this high amount of successful treatment are from industrialized countries [1,2]. In the English literature there are numerous examples present of successful introduction of the Ponseti method in the low-and middle-income setting [3][4][5][6]. Given the relatively simple and highly cost-effective treatment, the question arises as to why neglected clubfoot still exists.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and barriers of treating clubfeet in four countries

Wijck

Oomen²,

Heide

2015

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to elucidate why neglected clubfeet still exists despite the availability of a highly (cost)-effective treatment-the Ponseti treatment. Methods A qualitative and partly quantitative study with semi-structured interviews was conducted in four countries: the Netherlands, South Africa, Argentina and Indonesia with both caregivers, mostly parents, of children with clubfoot and practitioners treating clubfoot. The topics discussed with the caregivers (n=51) were the conceptions of the cause of clubfeet, received information, accessibility, financial aspects, and social stigma. With the practitioners (n=11) the focus of the interviews was the treatment protocol and finance. Results Several barriers towards the start of the treatment were highlighted. At all places treatment was financed by the government, insurance or charity. Nevertheless, the cost of transport and missed working days formed a barrier, although there is a large difference between and within countries. Poverty, long travel duration, and beliefs of supernatural causes for the clubfoot result in delay in the start of treatment. Conclusion These are problems we need to address when making effective treatment available for every child to diminish the burden of neglected clubfoot; especially accessible clinics in rural areas can be a good alternative to highly specialized hospitals in large cities. We as a community should try to find and overcome the barriers to treat these patients, because we have a relatively easy and highly costeffective treatment option which can be given by trained nonphysicians supervised by an interested medical doctor.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility and barriers of treating clubfeet in four countries

Wijck

Oomen²,

Heide

2015

International Orthopaedics (SICOT)

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“…Although Owen et al 5 have reported a larger series of 7705 cases, these were drawn from 10 different nations, with no single nation contributing >651 patients. The Bangladeshi clubfoot project has therefore secured an unprecedented rate of case ascertainment in its first 2 years.…”

Section: Project Organizationmentioning

confidence: 99%

The Bangladesh Clubfoot Project

Ford-Powell¹,

Barker

Khan³

et al. 2013

Journal of Pediatric Orthopaedics

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“…The authors have completed surveys every 2 years since 2007, including as many treatment providers in LMIC as possible in order to monitor progress in ending disability caused by clubfoot. 9 …”

Section: Introductionmentioning

confidence: 99%

Clubfoot treatment in 2015: a global perspective

Owen¹,

Capper²,

Lavy

2018

BMJ Glob Health

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IntroductionClubfoot affects around 174 000 children born annually, with approximately 90% of these in low-income and middle-income countries (LMIC). Untreated clubfoot causes life-long impairment, affecting individuals’ ability to walk and participate in society. The minimally invasive Ponseti treatment is highly effective and has grown in acceptance globally. The objective of this cross-sectional study is to quantify the numbers of countries providing services for clubfoot and children accessing these.MethodIn 2015–2016, expected cases of clubfoot were calculated for all countries, using an incidence rate of 1.24/1000 births. Informants were sought from all LMIC, and participants completed a standardised survey about services for clubfoot in their countries in 2015. Data collected were analysed using simple numerical analysis, country coverage levels, trends over time and by income group. Qualitative data were analysed thematically.ResultsResponses were received from 55 countries, in which 79% of all expected cases of clubfoot were born. More than 24 000 children with clubfoot were enrolled for Ponseti treatment in 2015. Coverage was less than 25% in the majority of countries. There were higher levels of response and coverage within the lowest income country group. 31 countries reported a national programme for clubfoot, with the majority provided through public–private partnerships.ConclusionThis is the first study to describe global provision of, and access to, treatment services for children with clubfoot. The numbers of children accessing Ponseti treatment for clubfoot in LMIC has risen steadily since 2005. However, coverage remains low, and we estimate that less than 15% of children born with clubfoot in LMIC start treatment. More action to promote the rollout of national clubfoot programmes, build capacity for treatment and enable access and adherence to treatment in order to radically increase coverage and effectiveness is essential and urgent in order to prevent permanent disability caused by clubfoot.

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A collaborative public health approach to clubfoot intervention in 10 low-income and middle-income countries

Cited by 30 publications

References 8 publications

Feasibility and barriers of treating clubfeet in four countries

Feasibility and barriers of treating clubfeet in four countries

The Bangladesh Clubfoot Project

Clubfoot treatment in 2015: a global perspective

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