File
Owen R1,2, Watson D2, Capper B1, Lavy C3
1Global Clubfoot Initiative, London, United Kingdom, 2Chelsea and Westminster Hospital NHS Foundation Trust, Paediatric Physiotherapy, London, United Kingdom, 3Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Orthopaedic and Tropical Surgery, Oxford, United Kingdom
Background: Clubfoot affects around 174,000 children born annually, with approximately 90% of these in low 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. Several studies have shown that physiotherapists are effective in providing Ponseti treatment.
Purpose: The objective of this cross-sectional study is to quantify the numbers of countries providing services for clubfoot and children accessing these. Additional commentary will cover the roles of physiotherapists in providing Ponseti treatment services for children with clubfoot, and how physiotherapists might be involved in scaling up treatment coverage globally.
Methods: In 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 was analysed using simple numerical analysis, country coverage levels, trends over time (using data collected bi-anually since 2007), and by income group. Qualitative data was analysed thematically.
Results: There were 173,996 expected cases of clubfoot worldwide; 157,935 (91%) of these were born in low and middle income countries. Data were included from 650 clinics in 55 countries, in which nearly 80% of all expected cases of clubfoot in LMIC were born. Within these countries 24,436 children were enrolled for Ponseti treatment for clubfoot in 2015. Trends over time showed a steady increase in the numbers of children starting Ponseti treatment in LMIC, with increasing numbers of countries reporting on treatment and offering services. 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. Physiotherapists' roles in managing clubfoot cover a range of activities: national clubfoot programme coordination, management and training, treatment of clubfoot, working with families to increase adherence, monitoring and evaluation and service improvements.
Conclusion(s): This 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, including human resources 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.
Implications: Physiotherapists have a very important role in increasing coverage of treatment for children born with clubfoot. Physiotherapists' manual, critical thinking and reasoning skills, and the time that they are able to spend with patients' families, mean that they are well placed to lead, provide, and improve many aspects of clubfoot treatment.
Keywords: Clubfoot, global health, paediatric orthopaedics
Funding acknowledgements: This research was funded by Global Clubfoot Initiative.
Purpose: The objective of this cross-sectional study is to quantify the numbers of countries providing services for clubfoot and children accessing these. Additional commentary will cover the roles of physiotherapists in providing Ponseti treatment services for children with clubfoot, and how physiotherapists might be involved in scaling up treatment coverage globally.
Methods: In 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 was analysed using simple numerical analysis, country coverage levels, trends over time (using data collected bi-anually since 2007), and by income group. Qualitative data was analysed thematically.
Results: There were 173,996 expected cases of clubfoot worldwide; 157,935 (91%) of these were born in low and middle income countries. Data were included from 650 clinics in 55 countries, in which nearly 80% of all expected cases of clubfoot in LMIC were born. Within these countries 24,436 children were enrolled for Ponseti treatment for clubfoot in 2015. Trends over time showed a steady increase in the numbers of children starting Ponseti treatment in LMIC, with increasing numbers of countries reporting on treatment and offering services. 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. Physiotherapists' roles in managing clubfoot cover a range of activities: national clubfoot programme coordination, management and training, treatment of clubfoot, working with families to increase adherence, monitoring and evaluation and service improvements.
Conclusion(s): This 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, including human resources 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.
Implications: Physiotherapists have a very important role in increasing coverage of treatment for children born with clubfoot. Physiotherapists' manual, critical thinking and reasoning skills, and the time that they are able to spend with patients' families, mean that they are well placed to lead, provide, and improve many aspects of clubfoot treatment.
Keywords: Clubfoot, global health, paediatric orthopaedics
Funding acknowledgements: This research was funded by Global Clubfoot Initiative.
Topic: Paediatrics; Paediatrics; Disability & rehabilitation
Ethics approval required: No
Institution: Global Clubfoot Initiative
Ethics committee: Global data working group
Reason not required: No patient identifiable data was used.
All authors, affiliations and abstracts have been published as submitted.
