What factors impact on the implementation of clubfoot treatment services in low and middle-income countries?: a narrative synthesis of existing qualitative studies

Abstract

BackgroundAround 100,000 children are born annually with clubfoot worldwide and 80% live in low and middle-income counties (LMICs). Clubfoot is a condition in which children are born with one or both feet twisted inwards and if untreated it can limit participation in everyday life. Clubfoot can be corrected through staged manipulation of the limbs using the Ponseti method. Despite its efficacy and apparent availability, previous research has identified a number of challenges to service implementation. The aim of this study was to synthesise these findings to explore factors that impact on the implementation of clubfoot services in LMICs and strategies to address them. Understanding these may help practitioners in other settings develop more effective services.MethodsFive databases were searched and articles screened using six criteria. Articles were appraised using the Critical Appraisal Skills Programme (CASP) checklist. 11 studies were identified for inclusion. A thematic analysis was conducted.ResultsThematic analysis of the included studies showed that a lack of access to resources was a challenge including a lack of casting materials and abduction braces. Difficulties within the working environment included limited space and a need to share treatment space with other clinics. A shortage of healthcare professionals was a concern and participants thought that there was a lack of time to deliver treatment. This was exacerbated by the competing demands on clinicians. Lack of training was seen to impact on standards, including the nurses and midwives attending to the child at birth that were failing to diagnose the condition. Financial constraints were seen to underlie many of these problems. Some participants identified failures in communication and cooperation within the healthcare system such as a lack of awareness of clinics. Strategies to address these issues included means of increasing resource availability and the delivery of targeted training. The use of non-governmental organisations to provide financial support and methods to disseminate best practice were discussed.ConclusionsThis study identified factors that impact on the implementation of clubfoot services in LMIC settings.Findings may be used to improve service delivery.

A Community Audit of 300 “Drop-Out” Instances in Children Undergoing Ponseti Clubfoot Care in Bangladesh—What Do the Parents Say?

“…The emerging role of community facilitators in reducing drop-out once the bracing phase starts, when most adherence falters [38][39][40][41][42], means additional staff and associated costs, but potentially may also in better rates of treatment completion, equating to less resource wastage and better results for more children in correcting clubfoot deformity, allowing them to lead happy and productive lives.…”

Qualidade de vida de crianças com pé torto congênito e a técnica de Ponseti

“…De modo análogo as repercussões sobre a qualidade de vida citadas, essa revisão demonstrou que 86,7% dos artigos que compuseram o corpus documental apontaram para a eficácia elevada no tratamento do PTC de crianças mediante Técnica de Ponseti e a melhora significativa nos níveis de qualidade de vida (BHASKAR;PATNI, 2013;AYANA;KLUNGSØYR, 2014;MAHAPATRA;HAMPANNAVAR, 2014;MINDLER et al, 2014;ELGOHARY;ABULSAAD, 2015;HALLAJ-MOGHADDAM et al, 2015;SUGANDHAVESA et al, 2015;YILDIRIM et al, 2015;AGARWAL et al, 2016;CARPIAUX et al, 2016;EL BATTI et al, 2016;GRIMES et al, 2016;HECK;HECK;PLACZEK, 2016;JAQUETO et al, 2016;KHAN;KHANZADA, 2016;SEEGMILLER et al, 2016;LEBEL et al, 2017;MARQUEZ et al, 2017;MATAR et al, 2017;SHAH et al, 2017;SMYTHE et al, 2017;AGARWAL et al, 2018;DREW;GOOBERMAN-HILL;LAVY, 2018;JOCHYMEK;TUREK, 2018;MEHTANI et al, 2018). É importante destacar que a maior parte dos estudos apresentou nível de evidência I e II, os quais são os melhores e mais confiáveis.…”

Quantitative Analysis of Barriers to Clubfoot Treatment Experienced at a Tertiary Care Institute in India

“…Various studies worldwide have highlighted specific barriers to implementing the Ponseti method for clubfoot treatment. These barriers include poverty, cost of treatment, cost of traveling, caregiver's compliance to the treatment, and the parent responsible for the treatment, to list a few [10,[12][13][14][15][16][17]. The purpose of this study is to analyze the effect of these barriers on the dropout rates observed with the Ponseti method of clubfoot treatment.…”