Clubfoot in Malawi: treatment-seeking behaviour

Bedford, Karen; Chidothi, Paul; Sakala, Harris; Cashman, J. N.; Lavy, Chris

doi:10.1258/td.2011.110121

Cited by 11 publications

(14 citation statements)

References 4 publications

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“…Other studies have also shown that transport expenses are a major barrier to follow-up in Malawi (Yu et al 2007, Bedford et al 2011). The present study lends some support to the assumption that patients who do not have problems do not return for review, at least in Malawi, as no infections were found in the 29 patients who did not return for follow-up of their own accord.…”

Section: Discussionmentioning

confidence: 98%

“…Surgeons working in low-income countries (LICs) often have the impression that patients do not return for follow-up if they have no complaints, but that they do return if they have a serious problem. A frequent reason given by patients for not returning for review in Malawi is the cost of transport (Yu et al 2007, Bedford et al 2011). In an earlier study of the SIGN Online Surgical Database (SOSD), we found that a statistical model supported the notion that patients who do not return for follow-up after trauma surgery in LMICs have few infections (Young et al 2011), but prospective studies with better follow-up rates are needed to shed more light on this.…”

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Complications after intramedullary nailing of femoral fractures in a low-income country

et al. 2013

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BackgroundSome surgeons believe that internal fixation of fractures carries too high a risk of infection in low-income countries (LICs) to merit its use there. However, there have been too few studies from LICs with sufficient follow-up to support this belief. We first wanted to determine whether complete follow-up could be achieved in an LIC, and secondly, we wanted to find the true microbial infection rate at our hospital and to examine the influence of HIV infection and lack of follow-up on outcomes.Patients and methods137 patients with 141 femoral fractures that were treated with intramedullary (IM) nailing were included. We compared outcomes in patients who returned for scheduled follow-up and patients who did not return but who could be contacted by phone or visited in their home village.Results79 patients returned for follow-up as scheduled; 29 of the remaining patients were reached by phone or outreach visits, giving a total follow-up rate of 79%. 7 patients (5%) had a deep postoperative infection. All of them returned for scheduled follow-up. There were no infections in patients who did not return for follow-up, as compared to 8 of 83 nails in the group that did return as scheduled (p = 0.1). 2 deaths occurred in HIV-positive patients (2/23), while no HIV-negative patients (0/105) died less than 30 days after surgery (p = 0.03).InterpretationWe found an acceptable infection rate. The risk of infection should not be used as an argument against IM nailing of femoral fractures in LICs. Many patients in Malawi did not return for follow-up because they had no complaints concerning the fracture. There was an increased postoperative mortality rate in HIV-positive patients.

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Section: Discussionmentioning

confidence: 98%

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Complications after intramedullary nailing of femoral fractures in a low-income country

et al. 2013

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“…A priority in planning for and providing appropriate and accessible services is the identification of barriers to care and strategies to overcome them [4]. There now exists a wealth of literature focusing on care-seeking behaviour and associated barriers concerning different disabilities in a range of settings [see for example [5][6][7][8][9]. Although local context shapes the presentation of barriers faced by people with disabilities (as it shapes perceptions of disability itself [10]), common themes are evident.…”

Section: Introductionmentioning

confidence: 99%

Reasons for non-uptake of referral: children with disabilities identified through the Key Informant Method in Bangladesh

Bedford

Mackey

Parvin

et al. 2013

Disability and Rehabilitation

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Programmes to identify children with disability and facilitate subsequent rehabilitation or treatment need to have extensive pre-planned strategies for referral mechanisms and follow up. Although Key Informants were not the focus of investigation, the present study suggests that there is potential for the role of the Key Informants to be extended beyond that of a case detection, to inform and facilitate referral processes and encourage the uptake of services.

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“…Em um estudo realizado em Malawi e Uganda, houve uma série de considerações errôneas sobre as causas do pé torto e muitas vezes as pessoas não procuravam tratamento porque não tinham conhecimento sobre a sua disponibilidade e não consideravam o pé torto como uma condição corrigível (16,17) . Em estudo realizado no Paquistão, foi encontrado que muitas vezes a culpa da doença era atribuida às mães, o que pode levar à estigmatização das famí-lias de crianças com pé torto e gerar um impacto negativo sobre as mães dessas crianças (18) .…”

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Congenital clubfoot: parents’ considerations about the disease and its treatment

et al. 2018

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RESUMOObjetivos: Conhecer quais as impressões dos pais em relação ao diagnóstico do pé torto congênito e seu tratamento. Essas informações podem favorecer a persistência ao tratamento, quebra de tabus e sucesso terapêutico. Métodos: Estudo qualitativo e descritivo com 10 pais cujos filhos são portadores de pé torto congênito. A tabulação dos dados ocorreu por meio da utilização de três figuras metodológicas: ideia central, expressões-chaves e o discurso sujeito coletivo. Resultados: Quando indagados sobre a impressão gerada quando o filho foi diagnosticado com pé torto congênito, 70% referiram sentimento de tristeza, susto e preocupação, sendo que apenas 30% demonstraram uma aceitação tranquila do diagnóstico, desprovida de medo e preocupação. Quando indagados em relação ao tratamento que estava sendo feito, 100% dos pais demonstraram otimismo e satisfação com os resultados apresentados; ainda, 40% opinaram em relação ao nível de conforto trazido pelos métodos terapêuticos, e 20% citaram a importância do envolvimento de toda a equipe da saúde na abordagem terapêutica. Conclusão: Medo e preocupação foram sentimentos frequentemente apresentados, que melhoravam com a melhor elucidação por parte da equipe de saúde em relação a doença. Em relação à terapêutica, a grande satisfação por parte dos pais foi unânime. Nível de Evidência V; Opinião de Especialista.Descritores: Pé torto; Bioética; Doenças do pé; Saúde da criança; Saúde materna. ABSTRACTObjectives: To learn parents' impressions regarding the diagnosis of congenital clubfoot and its treatment. This information may favor persistence with treatment, breakdown of taboos and therapeutic success. Methods: A qualitative and descriptive study with 10 parents whose children have congenital clubfoot. The tabulation of the data occurred through the use of three methodological figures: central idea, key expressions and collective subject discourse. Results: When asked about impressions generated when their child was diagnosed with congenital clubfoot, 70% reported feelings of sadness, fright and worry, and only 30% showed a calm acceptance of the diagnosis, devoid of fear and worry. When asked about the treatment that was being done, 100% of the parents showed optimism and satisfaction with the results presented, 40% mentioned the comfort level brought by the therapeutic methods and 20% mentioned the importance of the involvement of the entire health team in the therapeutic approach. Conclusion: Fear and concern were common feelings, which improved with the best elucidation by the health team regarding the disease. Regarding therapy, the parents' satisfaction was unanimous. Level of Evidence V; Expert Opinion.

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Clubfoot in Malawi: treatment-seeking behaviour

Cited by 11 publications

References 4 publications

Complications after intramedullary nailing of femoral fractures in a low-income country

Complications after intramedullary nailing of femoral fractures in a low-income country

Reasons for non-uptake of referral: children with disabilities identified through the Key Informant Method in Bangladesh

Congenital clubfoot: parents’ considerations about the disease and its treatment

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