Clubfoot treatment in 2015: a global perspective

Abstract

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.

Delivering cost effective healthcare through reverse innovation

“…The Ponseti technique for treating congenital talipes equinovarus, commonly known as clubfoot, was expanded and used at scale in low and middle income countries such as Malawi8 and Uganda,9 which are home to 91% of the 174 000 children born with clubfoot each year,1011 as an alternative to expensive surgical correction. Since then, multiple studies have been published on the efficacy of the treatment,812 and it is now the gold standard treatment for clubfoot in the UK 13…”

Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care

“…[8][9][10] To make matters worse, in some LMICs like The Gambia, estimates predict 85% of children will require surgical care before they are aged 15 years. 11 Children's surgery plays a large role in reducing the morbidity associated with noncommunicable conditions, such as inguinal hernias, 12,13 injuries, and congenital anomalies, 14 as well as various infectious disease complications, such as hydrocephalus and blindness from trachoma. 15 Specific, surgical interventions for children have been found to be even more cost-effective than accepted adult surgeries, even in low-resource settings.…”

Development of a functional prototype of a SMART (Sensor-integrated for Monitoring And Remote Tracking) foot abduction brace for clubfoot treatment: a pre-clinical evaluation

“…Clubfoot is one of the commonest musculoskeletal birth defects, with an incidence of 1.2/1000 live births [ 1 ]. Since over 90% of children born with clubfoot live in low- and middle-income countries (LMICs) where there is limited or no access to treatment, untreated clubfoot is one of the largest causes of physical disability in the world [ 2 ]. The Ponseti method has caused a paradigm shift in the way clubfoot is treated since the past two decades—from extensive surgical procedures to conservative methods of serial manipulation and casting [ 3 ].…”