, Volume 467, Issue 5, pp 1154-1163
Date: 24 Mar 2009

Towards Effective Ponseti Clubfoot Care: The Uganda Sustainable Clubfoot Care Project

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Abstract

Neglected clubfoot is common, disabling, and contributes to poverty in developing nations. The Ponseti clubfoot treatment has high efficacy in correcting the clubfoot deformity in ideal conditions but is demanding on parents and on developing nations’ healthcare systems. Its effectiveness and the best method of care delivery remain unknown in this context. The 6-year Uganda Sustainable Clubfoot Care Project (USCCP) aims to build the Ugandan healthcare system’s capacity to treat children with the Ponseti method and assess its effectiveness. We describe the Project and its achievements to date (March 2008). The Ugandan Ministry of Health has approved the Ponseti method as the preferred treatment for congenital clubfoot in all its hospitals. USCCP has trained 798 healthcare professionals to identify and treat foot deformities at birth. Ponseti clubfoot care is now available in 21 hospitals; in 2006–2007, 872 children with clubfeet were seen. USCCP-designed teaching modules on clubfoot and the Ponseti method are in use at two medical and three paramedical schools. 1152 students in various health disciplines have benefited. USCCP surveys have (1) determined the incidence of clubfoot in Uganda as 1.2 per 1000 live births, (2) gained knowledge surrounding attitudes, beliefs, and practices about clubfoot across different regions, and (3) identified barriers to adherence to Ponseti treatment protocols. USCCP is now following a cohort of treated children to evaluate its effectiveness in the Ugandan context.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This study was funded by support from the Canadian International Development Agency and the CBM International.
Each author certifies that where appropriate his or her institution has approved the human protocol for investigations and that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained.
All of the electronic supplementary materials have been reprinted with permission of their respective sources (Dr. George William Lutwama, “Prevalence of Physical Movement Disabilities Among Children in Rukungiri District, Uganda”; Dr. Joseph Theuri Macharia “The Idiopathic Clubfoot: Short-term Results of Treatment with the Ponseti Method at Mulago Hospital”; and Dr. Sam Zaramba, Director General of Health Services of the Uganda Ministry of Health, educational materials).