Abstract
Background:Clubfoot or Congenital Talipes Equinovarus (CTEV) treatment in newborn infants involves simple, non-invasive manipulation and is primarily managed non-surgically if identified early. In low- and middle-income countries (LMICs), less than 15% of patients with CTEV access treatment. This cross-sectional questionnaire study conducted descriptive and regression analysis of institutional reasons for CTEV management in LMICs.Methods:A cross-sectional study was undertaken of 1,489 medical institutions in 62 LMICs. Data were evaluated from the “World Health Organization Situation Analysis tool” database. We analyzed characteristics of institutions that manage and did not manage CTEV. With the use of a multivariate linear regression model, we identified a set of factors linked to referral for non-management of CTEV.Results:A total of 72.7% (1,083/1,395) of institutions surveyed did not manage CTEV. The most common reason cited for not managing CTEV was a lack of sufficient skills, 92.1% (668/725, P<0.001). A total of 39.4% (286/725) of institutions also cited a lack of functioning equipment as a reason. Multivariate linear regression analysis showed lack of training, lack of supplies, and lack of functioning equipment were most closely related to non-management of CTEV.Conclusion and Global Health Implications:We identified that failure to manage CTEV may result from a lack of skills and medical equipment. Increasing the capacity of sustainable training programs may reduce the presently available skill deficit in treating CTEV in LMICs and provide improved health outcomes for those with CTEV. While considerable progress has been made in building capacity for the treatment and management of CTEV in LMICs, structured training programs that support conservative manipulative methods to manage CTEV should be initiated globally.
Highlights
Clubfoot or Congenital Talipes Equinovarus (CTEV) is one of the most common pediatric congenital orthopedic conditions, estimated to occur in 1-2 per 1,000 live births.[1]
While considerable progress has been made in building capacity for the treatment and management of CTEV in low- and middle-income countries (LMICs), more research is required to understand the state of CTEV treatment globally, as well as to understand the characteristics of institutions that are and are not providing CTEV management
Between January 1, 2007 and December 31, 2016, we identified hospitals that responded and did not respond to the portion of theWHO related to CTEV management
Summary
Clubfoot or Congenital Talipes Equinovarus (CTEV) is one of the most common pediatric congenital orthopedic conditions, estimated to occur in 1-2 per 1,000 live births.[1] While the severity may vary from mild to severe deformity of the feet, early detection and treatment within the first few weeks of birth provides the best chance for nonsurgical intervention.The Ponseti method, the most commonly practiced non-surgical approach, involves manipulating the child’s foot into a plantigrade position through the use of casts or braces which align the joint into the correct anatomical position. In low- and middle-income countries (LMICs), less than 15% of patients with CTEV access treatment
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