ECM CLUBFOOT PROJECT

Overall objective: Enhance the capacity of health workers and communities to identity and treat clubfoot at an early stage of infancy.

Specific Objectives:

Improve competencies of frontline health workers (Midwives, Nurses, clinical officers, etc. to identify club foot among neo-natal
Raise awareness within the community among parents, care givers and villager health teams to identity and refer club.
Enhance capacity of health workers to treat and manage club foot using Ponseti’s method.

The Problem-Club Foot.

Clubfoot is a debilitating physical deformity that affects 1.19/1000 newborns in Uganda. The feet of babies born with clubfoot are inverted, which, if left untreated, means the children are forced to walk on the sides or top of their feet. Untreated clubfoot poses significant disability, especially in children, a high morbidity, and serious economic impact to the patient, parents or caretakers, and the community. Untreated children are forced to walk on the dorsum of these stiff deformed feet, which results in chronic pain, ulcerations, and infections. These children are unable to mix freely with their peers because of stigmatization, and as a result, few are able to attend or even complete school. Known traditional surgical treatments are very costly and unattainable for many people, especially in rural areas. However, a simple, cost-effective, non-surgical method (Ponseti’s method) exists to correct clubfoot during early stages of development.

ECM Club foot Intervention:

Every Child Matters (ECM) Uganda with support from D-Prize, is currently supporting health facilities and communities around Kampala and Kayanga Districts in Central Uganda, to increase awareness about clubfoot and enhance the capacity health workers to identity and treat this disability. ECM has devised a three-pronged approach to address these challenges and scale up identification and treatment of clubfoot in Uganda through: a), raising awareness about clubfoot in rural communities, both among the local population, and among the frontline health workers who can refer patients to health facilities.b), training frontline health workers in health facilities to identify clubfoot and make proper referrals for treatment, and finally c), training orthopedic officers in Ponseti’s method for effective treatment of clubfoot.

Expected results

Result 1: Capacity of frontline health workers enhanced to identify clubfoot.

It has been observed that, failure to detect a foot deformity among infants has deprived many children of the opportunity to have it corrected left many children with untreated clubfoot. Through this venture, we conduct trainings including; Training of trainers, continuous medical education (CME) sessions at the health facilities to equip frontline medical personal (mid wives, nurses, clinical officer, medical officers etc.) with skills especially visual foot inspection on young babies such that they can identify and refer positive cases of club foot.

Mentorship and support supervision processes are being implemented to support the ongoing improvement in quality and relevance of practice to encourage all frontline healthcare workers to perform the visual foot inspection whenever newborns or young infants contact the healthcare system, such as at birth, postnatal clinics, and immunization visits. These actions are intended to educate those in birthing and immunization clinics to screen for foot deformities with a visual foot inspection and refer to club foot clinics or orthopedics personel for screening and diagnosis in case of positive cases.

Result 2: Communities, parents, care givers, Traditional Birth attendants (TBA) and villager health teams VHTS, aware and can identity and refer club foot suspected cases to the health facilities

In most communities there are traditional beliefs that clubfoot is caused by evil spirits, witchcraft, a curse, or the mother’s misdeeds, and that treatments are ineffective. This results in a delay in seeking care. Many children are presented late, or not at all, for treatment for many reasons, including lack of awareness of the deformity or concerns about cost of care.

We have rolled out a massive public awareness campaign through radio talk shows, TV, and print media to educate parents and the community by informing about clubfoot, its causes, and that the medical system can manage these problems. This will help unravel the mysteries, misconceptions and beliefs associated with the club make the condition more acceptable. The awareness campaigns will especially also target TBA and VHTs in the community to cater for children born in the community.

Using our in-house orthopedics clinicians, we do conduct mass sensitization and screening sessions at selected hospitals especially on immunization clinic days to identity clubfoot and share knowledge and information with mother and caregivers about club foot. These sessions are integrated with the Maternal and Child health (MCNH) clinic days. Our staff provide mentorship and support supervision on such days to the health workers on duty.

We are aware that about 40% of the deliveries occur at home with support of the TBA and VHTS, these children in most cases are not inspected for foot deformities. In order to strengthen the referral pathways especially for children that are born outside the health system, we provide specific trainings to TBAs and VHTS on how to identity and refer club foot patients or children suspected to have club foot for further diagnosis and management. Simplified IEC materials, especially posters pictorially represented, are provided to these category of people

Result 3: Capacity of health workers enhanced to treat and manage club foot using Ponseti method

Although Orthopedic officers are trained to diagnose, and manage clubfoot while at the health training institutions, challenges within the healthy system, including; inconsistency of supplies at many clinics, limited in-service training to enhance their skills and variable quality of support and supervision of orthopedic officers has over the time reduced the effectiveness of the treatment method.

We collaborate with technical experts to organize refresher trainings for Orthopedic staff including orthopedic officers and orthopedic technologists at selected health facilities on how to manage club foot using Ponseti method and popularize recommended MOH treatment manuals and protocols for club foot management.