IRAQ'S EXPERIENCE WITH CLUB FOOT MANAGED BY PONSETI METHOD

¹ICRC, Physical Rehabilitation Program /PRP, Najaf, Iraq

Background: MOH in Iraq didn’t conduct Ponseti method in their projects. Estimated children with CF were1600 annually, Crude Birthrate is 32.7/1000,Prevalence of CF is1.19/1000 babies population of 40 million, Orthopedic surgeons were using surgery as a main treatment for many years, also the children are the most affected segment in the absence of public health during conflicts and the disruption of basic health programs and the failure to accompany them to health clinics by parents when the conflict intensifies, ICRC decided to take a position to provide support to Iraqi specialists willing to use the Ponseti method as a part of physical rehabilitation program.

Purpose: Decreasing Overuse or unwanted surgical intervention of CF treatment

Methods: ICRC in collaboration with MoH, launched 3 clinics, Using ACT basic and advance training, after that we conducted this prospective study for 40 cases of congenital idiopathic CF who underwent primary treatment by either Ponseti or surgery intervention in 2016 and 2017 until they reached treatment plan, that happened in 2021 and 2022, the study conducts for 1 CF clinic out of 3. The results comparison between these treatments by data collection analyzing methods including four elements which are observation, assessment, function and cost.

Results: Established 3 clinics using Ponseti method by ICRC in 2016,2018 and 2020, during Ponseti and surgery elements analyzing: the observations were 93.25% Ponseti cases ,66.4% surgery cases. the assessments were 91.6%Ponseti,56.3% surgery. Ponseti Functionality was 93.25% while Surgery functionality was 66.2%. Ponseti treatment cost was 400$ compared with 1000-3000$ surgery cost.CF cases treated with Ponseti were increasing of following annually according to awareness sessions about EDCF.in-addition to the success results were 92.66% during recording and monitoring. surgical intervention with gradually decreasing of following,during monitoring and recording till 2022 ,was 62.9% less than Ponseti Results in the same year after 5 years due to the complication surgery intervention like tight muscles, foot movement limitation, foot appearance ,infection ,high cost and recurrence.

Conclusions: Ponseti treatment was managed with significantly without or no surgical intervention. its Successful and clear results with using Ponseti method especially its less cost than surgical intervention and increasing of following this procedure according to Provide awareness sessions about EDCF for doctors and parents.
As a result ,second clinic has been opened to provide Ponseti method. the project will handover to MoH in 2025, Ponseti method has been adopted as the primary treatment for clubfoot in Iraq.

Implications: Discussion the possibilities with key stakeholders and decision makers to adapt services and education strategy is planning to better align programs and include it in education curriculum and make awareness via Media and TV, ensuring effectiveness of physiotherapist in this field and include them to learn these procedures.

Funding acknowledgements: ICRC/Personal funding

Keywords:
Club foot (CF)
Africa Club Foot Training (ACT)
EDCF (early detection of Clubfoot)

Topics:
Paediatrics
Paediatrics

Did this work require ethics approval? Yes

Institution: ICRC and Clubfoot clinic

Committee: ICRC/PRP manager and responsible of Clubfoot clinic

Ethics number: 9647835417814