Towards Effective Ponseti Clubfoot Care: The Uganda Sustainable Clubfoot Care Project
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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.
KeywordsClubfoot Ponseti Method Idiopathic Clubfoot Congenital Clubfoot Canadian International Development Agency
We thank the Canadian International Development Association, the Association of Universities and Colleges of Canada, Global HELP Organization, and the CBM International for their encouragement and support for the Uganda Sustainable Clubfoot Care Project. We also thank Dr Jacinto Amandua, Dr Deo Bitariho, Sue Cutts, Marieke Dreise, Veronica Dumba, Dr John Ekure, Dr Lawrence Ekware, Sam Jjumba, Sam Kayondo, Benon Kaziba, Dirissa Kitemagwa, Brad Locke, Theresa McElroy, Dr Geoffrey Madewo, Dr Didus Mugisa, Henry Musoke, Dr David Muzira, Stella Nema, Dr Isidor Ngayomela, Stella Nyange, Alfred Otim, Professor Nelson Sewankambo, Dr Stephen Ssebaggala, Dr Lynn Staheli, Michiel Steenbeek, Dr Gonzaga Waiswa, Dr Nathan Wanawa, and Dr Sam Zaramba for their valuable contributions to the Project. We thank the Rotary clubs of Burnaby and New Westminster Royal City, Rotary International and the Rotary Committee for International Development for their support for the introduction of Ponseti clubfoot treatment to Uganda.
- 1.Atria J. Accessibility and relevance of education for children with disabilities in Uganda. Uganda Society for Disabled Children, 2003. Available at: http://www.usdc.or.ug/USDC/publications.aspx. Accessed December 1, 2008.
- 2.Atria J. The situation of children with disabilities in Uganda. In: Barton T, Wamai G. Equity and Vulnerability: A Situation Analysis of Women, Adolescents and Children in Uganda. Uganda National Council for Children; 1994.Google Scholar
- 4.Canadian International Development Agency. Available at: http://www.acdi-cida.gc.ca. Accessed December 1, 2008.
- 6.CBM International. Available at: http://www.cbm.org. Accessed December 1, 2008.
- 8.Cochrane AL. Effectiveness and Efficiency: Random Reflections on Health Services. London, UK: Royal Society of Medicine Press (Nuffield Provincial Hospitals Trust); 1972.Google Scholar
- 9.Global HELP Organization. Available at: http://www.global-help.org. Accessed December 1, 2008.
- 10.Haynes B. Can it work? Does it work? Is it worth it? Br Med J. 1999;319:652–653.Google Scholar
- 13.Ministry of Finance, Planning and Economic Development, Uganda. Poverty Eradication Action Plan 2004-8. Available at: http://www.finance.go.ug. Accessed December 1, 2008.
- 14.Ministry of Health, Uganda. Essential services for rehabilitative health care for persons with disabilities in the district, 1999. Available at: http://www.health.go.ug. Accessed July 1, 2008.
- 15.Ministry of Health, Uganda. Making a difference for persons with disabilities: learn more about disability and rehabilitation (1997). Available at: http://www.health.go.ug. Accessed July 1, 2008.
- 16.Ministry of Health, Uganda. National Health Policy. Available at: http://www.health.go.ug. Accessed July 1, 2008.
- 17.Ponseti IV. Congenital Clubfoot: Fundamentals of Treatment. New York, NY: Oxford University Press; 1996.Google Scholar
- 20.Uganda Population and Housing Census 2002. Available at: http://www.ubos.org. Accessed July 1, 2008.
- 21.United Nations Development Programme: Uganda. Available at: http://www.undp.or.ug/index.php. Accessed July 1, 2008.
- 22.University Partnerships in Cooperation and Development. Available at: http://www.aucc.ca/upcd-pucd/index_e.html. Accessed July 1, 2008.