Early detection and treatment of clubfoot in a rural setting in South Africa

Abstract

Clubfoot is one of the most common musculoskeletal congenital disorders and annually affects around 174 000 babies worldwide. Untreated clubfoot leads to significant permanent impairment and problems with ambulation, thus presenting a potential public health dilemma. Clubfoot can however be corrected with a non-surgical method referred to as the Ponseti method. This gives a child normal, pain free mobility and the potential to grow up as a productive member of society. Treatment for clubfoot needs to be implemented as soon as possible after birth of the child to produce the best results and avoid possible relapse of the clubfoot. Diagnosis and treatment of clubfoot starting at, or later than three months of age, is regarded as late detection and treatment. The purpose of this study was to determine the healthcare-seeking behaviour of guardians of children with clubfoot at or after the age of three months to promote early detection and treatment. A qualitative study was conducted to explore the reasons for seeking healthcare at Ponseti clinics for children that were three months or older; and to describe the challenges that the guardians experienced in seeking healthcare for their children. Data collection was done through semi-structured interviews at two public sector hospitals in KwaZulu Natal Province. Two major themes emerged from the study, namely discovering the clubfoot deformity, and the challenges guardians experienced in seeking healthcare for their children with clubfoot. There is a lack of knowledge about clubfoot resulting in late detection and initiation of treatment; and that clubfoot is a treatable condition which can result in the child leading a normal life if treated with the Ponseti method. Participants attending antenatal care were not informed by health practitioners of clubfoot being a potential birth defect. In some cases, guardians approached health practitioners early, but were referred late to a Ponseti clinic. Guardians in the study experienced several challenges when seeking healthcare for their children, including financial, transport and family responsibility challenges. They described having a child with clubfoot as an emotionally taxing journey. Recommendations are made for education, practice, policy, and research. An information brochure was designed to promote early detection and treatment of clubfoot.