Birth prevalence of congenital talipes equinovarus in low‐ and middle‐income countries: a systematic review and meta‐analysis

Smythe, Tracey; Kuper, Hannah; Macleod, David; Foster, Allen; Lavy, Christopher

doi:10.1111/tmi.12833

Cited by 123 publications

(101 citation statements)

References 45 publications

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“…Although the authors made every attempt to identify and include contacts from every LMIC, it was not possible to do so, and this was also reflected in Shabtai et al ’s 10 study in 2014, which showed no evidence of Ponseti treatment in 80 countries. It is difficult to find accurate estimates of incidence of clubfoot for individual countries; we therefore used an incidence rate of 1.24/1000 births, based on a systematic review by Smythe et al 11 However, without more accurate incidence data, any estimates of expected numbers of cases may be flawed. A confounding factor to the growth in number accessing treatment over time documented in this report is that the number of survey respondents increased over time.…”

Section: Discussionmentioning

confidence: 99%

“…Data returned were collated and analysed using simple descriptive statistics to describe results from 2015 and compare with previous years. ‘Expected cases’ were calculated for every country and were defined as the number of children expected to be born with clubfoot in 2015, using an incidence rate of 1.24/1000 births 11 and the country’s population and birth rate as reported by the World Bank. 12 ‘Coverage’ was defined as the numbers of cases enrolled for treatment under the age of 1 year compared with the expected number of cases born in 2015.…”

Section: Methodsmentioning

confidence: 99%

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Clubfoot treatment in 2015: a global perspective

Owen¹,

Capper²,

Lavy

2018

BMJ Glob Health

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IntroductionClubfoot 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.MethodIn 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.ResultsResponses 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.ConclusionThis 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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clubfoot treatment in 2015: a global perspective

Owen¹,

Capper²,

Lavy

2018

BMJ Glob Health

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“…1 Every year in Bangladesh an estimated 3500 -4000 children are born with a clubfoot deformity, with a global incidence of 1.5 per 1000 live births. 2 Untreated, clubfoot leads to lifelongdeformity causing individual disability and unproductivity. This causes the children to grow up as burdens of the family and ultimately leads to significant poverty.…”

Section: Introductionmentioning

confidence: 99%

“…This causes the children to grow up as burdens of the family and ultimately leads to significant poverty. 1 Armed Forces Medical College, Dhaka Cantonment, Dhaka, Bangladesh; 2 Rajshahi Medical College Hospital, Rajshahi, Bangladesh; 3 Department of Orthopaedic, Abdul Hamid Medical College, Kishorganj, Bangladesh; 4 Shahid Ziaur Rahman Medical College, Bogura, Bangladesh; 5 Chattogram Medical College Hospital, Chattogram, Bangladesh; 6 La Trobe University, Melbourne, Victoria, Australia 19,500 children with clubfoot were enrolled at WFL clinics across Bangladesh. 3 WFL is a charitable project of the Glencoe Foundation, with clinics appended to the Government of Bangladesh initiatives, and acknowledged by the Government as the National Clubfoot Programme in Bangladesh.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Clubfoot Correction at ‘Walk for Life’ Clinic of Mymensingh Medical College Hospital: A Four Year Review

Rahman

Chowdhury

Kabir³

et al. 2019

Bangladesh Med Res Counc Bull

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Background: Every year in Bangladesh an estimated 3500 - 4000 children are born with a clubfoot deformity, which is approximately one of every 1000 children born in Bangladesh. Left untreated, the condition leads to lifelong deformity causing individual disability and potential unproductivity. Affected children grow up as burden to the family and ultimately leads to significant poverty. Methods: This study was conducted at the ‘Walk for Life’ (WFL) clinic Mymensingh Medical College Hospital (MMCH) during February 2011 to December 2014.The non-surgical Ponseti method was applied by the orthopaedic surgeon and physiotherapist. Follow-up for relapsed deformity in children who were treated in 2011 occurred in 2015. Results: A total of 577 children comprised of 175 (30.32%) female and 402 (69.7%) male, a gender rati o F: 2.29 M. Completions of treatment data were available for 471 children, as 106 had dropped out at different stages of the treatment cycle. Sadly, 12 children had died. In 440 (76.4%) children, the parents’ monthly income approximated Tk. 5000, and 364 (82.8%) lived in tin shed houses. The parents with lowest incomes predominated for children with clubfoot. Most parents 383(66.4%) were labourers, small business and service workerswith the lowest income. A family history of clubfoot deformity was found in 8.3%, of which 2.8% were cousins, 1.7% were an uncle.The average number of corrective plaster casts applied before the tenotomy was 3.32% in 477 children. In 73.0% of childrenthree to six casts were used for initial correction. An Achilles tenotomy was performed in 81.0% children, 18% did undergo a tenotomy and one child had multiple tenotomies.Four years following of initial treatment, 99 children were reviewed, and 98 were walking and running. Parents’ satisfaction was 96.0%. Thirteen percent children showed relapse signs. Most of the children treated at the WFL clubfoot clinic were walking normally four years after initial treatment. Conclusion: The Ponseti method is found to be very effective and especially for a developing country like Bangladesh. Poverty and housing condition may play a role in clubfoot disease. The dropout rate across the treatment cycle was 18.4%, warranting closer evaluation. The patronage of the Glencoe Foundation WFL clinics since 2009, played an important role in relieving thousands of Bangladeshi children from disability. Bangladesh Med Res Counc Bull 2018; 44: 132-137

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“…Clubfoot, or congenital talipes equinovarus (CTEV), is one of the most common congenital musculoskeletal deformities. Within the Africa region, clubfoot birth prevalence is estimated as 1.11 (95%CI 0.96–1.26) per 1000 live births [ 1 ]. Untreated clubfoot results in pain, physical impairment and can ultimately cause disability [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of success of the Ponseti method of clubfoot management in sub-Saharan Africa: a systematic review

Smythe

Mudariki

Kuper

et al. 2017

BMC Musculoskelet Disord

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BackgroundClubfoot is one of the most common congenital deformities affecting mobility. It leads to pain and disability if untreated. The Ponseti method is widely used for the correction of clubfoot. There is variation in how the result of clubfoot management is measured and reported. This review aims to determine and evaluate how success with the Ponseti method is reported in sub-Saharan Africa.MethodsFive databases were examined in August 2017 for studies that met the inclusion criteria of: (1) evaluation of the effect of clubfoot management; (2) use of the Ponseti method; (3) original study undertaken in sub-Saharan Africa; (4) published between 2000 and 2017. We used the PRISMA statement to report the scope of studies. The included studies were categorised according to a hierarchy of study methodologies and a 27-item quality measure identified methodological strengths and weaknesses. The definition of success was based on the primary outcome reported.ResultsSeventy-seven articles were identified by the search. Twenty-two articles met the inclusion criteria, of which 14 (64%) reported a primary outcome. Outcomes were predominantly reported though case series and the quality of evidence was low. Clinical assessment was the most commonly reported outcome measure and few studies reported long-term outcome. The literature available to assess success of clubfoot management is characterised by a lack of standardisation of outcomes, with different measures reporting success in 68% to 98% of cases.ConclusionWe found variation in the criteria used to define success resulting in a wide range of results. There is need for an agreed definition of good outcome (successful management) following both the correction and the bracing phases of the Ponseti method to establish standards to monitor and evaluate service delivery.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1814-8) contains supplementary material, which is available to authorized users.

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Birth prevalence of congenital talipes equinovarus in low‐ and middle‐income countries: a systematic review and meta‐analysis

Cited by 123 publications

References 45 publications

Clubfoot treatment in 2015: a global perspective

Clubfoot treatment in 2015: a global perspective

Outcome of Clubfoot Correction at ‘Walk for Life’ Clinic of Mymensingh Medical College Hospital: A Four Year Review

Assessment of success of the Ponseti method of clubfoot management in sub-Saharan Africa: a systematic review

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