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Perspectives on Neuroscience
Published on: July 31, 2007
Clubfoot treatment in 2015: a global perspective
Rosalind M Owen1, Beth Capper1, Christopher Lavy2
1Global Clubfoot Initative, London, UK.
Insights
Global access to clubfoot treatment remains critically low, with less than 15% of children in low-income countries receiving timely Ponseti treatment. Urgent action is needed to expand national programs and improve treatment access to prevent lifelong disability.
Area of Science:
- Global Health
- Pediatric Orthopedics
- Public Health Policy
Background:
- Clubfoot affects approximately 174,000 newborns annually, with 90% in low- and middle-income countries (LMICs).
- Untreated clubfoot leads to lifelong physical impairment and societal exclusion.
- The Ponseti method offers a highly effective, minimally invasive treatment for clubfoot.
Purpose of the Study:
- To quantify the global number of countries offering clubfoot services.
- To assess the number of children accessing clubfoot treatment, particularly the Ponseti method.
- To identify barriers and facilitators for clubfoot treatment access in LMICs.
Main Methods:
- A cross-sectional study design was employed.
- Data were collected through surveys administered to informants in LMICs regarding clubfoot services in 2015.
- Calculated expected clubfoot cases using a 1.24/1000 births incidence rate; analyzed data using numerical and thematic analysis.
Main Results:
- Responses were received from 55 countries, representing 79% of global clubfoot cases.
- Over 24,000 children received Ponseti treatment in 2015, but coverage was below 25% in most countries.
- National clubfoot programs, often via public-private partnerships, were reported in 31 countries, with higher coverage in the lowest income groups.
Conclusions:
- This study provides the first global overview of clubfoot treatment service provision and access.
- While access to Ponseti treatment in LMICs has increased since 2005, overall coverage remains insufficient.
- Less than 15% of children with clubfoot in LMICs initiate treatment, necessitating urgent expansion of national programs, capacity building, and improved access/adherence to prevent disability.
Introduction:
Clubfoot affects around 174 000 children born annually, with approximately 90% of these in low-income 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. The objective of this cross-sectional study is to quantify the numbers of countries providing services for clubfoot and children accessing these.
Method:
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 were analysed using simple numerical analysis, country coverage levels, trends over time and by income group. Qualitative data were analysed thematically.
Results:
Responses were received from 55 countries, in which 79% of all expected cases of clubfoot were born. More than 24 000 children with clubfoot were enrolled for Ponseti treatment in 2015. Coverage was less than 25% in the majority of countries. 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.
Conclusion:
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 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.
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