The Uganda Sustainable Clubfoot Project (USCCP)
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1/18/12 1 The Uganda Sustainable Clubfoot Project (USCCP) Shafique Pirani MD Richard Mathias MD Jackson Amone MPH Jacinto Amandua MPH Joseph Konde Lule PhD Edward Naddumba MMed Ben Mbonye FRCS Norgrove Penny MD Fulvio Franceschi MD Background Need for sustainable clubfoot Rx in developing countries • Economically/Socially suitable for nation’s societies Ponseti Clubfoot treatment • Iowa - 78% good outcomes at 40 years Uganda Clubfoot Project (1999-2003) • Task shifting • Care by paramedicals specially trained in Ponseti method • Locally made foot abduction brace (Steenbeek) • Pilot - 78% corrected (Macharia 2003) Methods USCCP (2004-11) • Public health approach • Goal = Sustainable, universal, effective, efficient, and safe Ponseti clubfoot treatment Build capacity • For Ponseti treatment in Ugandan healthcare system • For Ponseti training in Ugandan healthcare schools Evaluations • Incidence survey to establish burden • Rapid ethnographic survey to understand what Ugandans know, feel and believe about clubfoot • Outcomes surveys
Transcript of The Uganda Sustainable Clubfoot Project (USCCP)
1/18/12
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The Uganda Sustainable Clubfoot Project (USCCP)
Shafique Pirani MD Richard Mathias MD
Jackson Amone MPH Jacinto Amandua MPH
Joseph Konde Lule PhD Edward Naddumba MMed Ben Mbonye FRCS
Norgrove Penny MD Fulvio Franceschi MD
Background
Need for sustainable clubfoot Rx in developing countries • Economically/Socially suitable for nation’s
societies Ponseti Clubfoot treatment
• Iowa - 78% good outcomes at 40 years Uganda Clubfoot Project (1999-2003)
• Task shifting • Care by paramedicals specially trained
in Ponseti method • Locally made foot abduction brace
(Steenbeek) • Pilot - 78% corrected (Macharia 2003)
Methods
USCCP (2004-11) • Public health approach • Goal = Sustainable, universal, effective,
efficient, and safe Ponseti clubfoot treatment Build capacity
• For Ponseti treatment in Ugandan healthcare system • For Ponseti training in Ugandan healthcare schools
Evaluations • Incidence survey to establish burden • Rapid ethnographic survey to understand what Ugandans know,
feel and believe about clubfoot • Outcomes surveys
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Task Cadre Screening Nurse/midwife Dx/Ponseti care Ortho Officer Tenotomy Med Officer Brace making Ortho Tech Surgery Ortho Surgeon
Build capacity for Ponseti treatment
MoH approved Clubfoot care pathway - Task shifting to paramedicals
Screening for foot deformities at birth
Build capacity for Ponseti treatment
Awareness campaign: • Clubfoot can be treated • Treatment is free
Children treated per year by region
Network of 40 clubfoot clinics
0 200 400 600 800 1000 1200
west east north central total
2006
2007
2008
2009
2010
155
48
851
23 21 0
100 200 300 400 500 600 700 800 900
ortho officers
ortho techs
nurses
surgeons
physios
Healthcare Workers trained
Build capacity for Ponseti treatment
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1003
213
995
70
1215
3496
0
500
1000
1500
2000
2500
3000
3500
4000
ortho officers
ortho techs
medical residents nurses total
Students trained
Build capacity for Ponseti treatment
Comprehensive Ponseti training module accepted into curricula: • 4 Medical Schools • 2 paramedical Schools • 32 Nursing/Midwifery
Schools
Evaluations
Incidence survey
Graph1: Number of babies born with Club foot in each month.
0
2
4
6
8
10
12
Mar.2006AprilMayJune Ju
lyAugSept Oc
tNovDec
Jan.2007FebMarAprilMayJune Ju
lyAugSept Oc
tNov
# O
f b
ab
ies
wit
h c
lub
fee
t
Total
Births 110,336
Births with clubfeet
1.2 per 1000
M:F 2.4:1
Ethnocultural survey
Ethnocultural survey of clubfoot
“I absconded from treatment because the
kids father provided no support”
Mother
“Traditionally, people think that there are unappeased spirits causing the problem. Therefore, caretakers usually take their children to traditional healers for correction before they come to hospitals.”
Practitioner treating clubfoot, Mbarara.
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Outcome Survey of Ponseti Clubfoot Treatment
• Prospective 7 center cohort study (1/07 – 10/08) • 370 children (259 m /111 f ) • 512 clubfeet • 85% < 13/52 at start of Rx • Assessments:
1. Deformity correction by Pirani Score 2. Parental satisfaction of foot appearance/function by Roye DSI
1 2
Parental satisfaction of foot appearance/function
• 223/370 traced (60%) • 20 deaths • 82% 3-5yrs • 155M:68F
USCCP Summary
• National Plan for Ponseti clubfoot management based on public health principles
• Meeting Intended Outcomes o Integration of Ponseti treatment within Ugandan
healthcare system o Integration of teaching Ponseti treatment within
Ugandan higher education system • Outcomes satisfactory to early/mid childhood • Further studies needed
o Factors associated with obstacles to care o Economic analysis
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WHO press release surrounding publication of the Report, June 2011
Incidence of Clubfoot in Uganda. R. Mathias, J. Konde Lule, G. Waiswa, E. Naddumba, S. Pirani, Can J Public Health 2010;101:341-44.
Understanding Clubfoot in Uganda: A rapid ethnographic study J. Konde-Lule, S. Neema, S. Gitta, T. McElroy. Makerere University Institute of Public Health, 2005.
Understanding the barriers to clubfoot treatment adherence in Uganda: A rapid ethnographic study, T. Mcelroy, J. Konde-lule, S. Neema, S. Gitta, Disability and Rehabilitation, 2007; 29: 845 – 855
Ponseti Clubfoot Management, Teaching Manual for Healthcare Providers in Uganda, Editor: Lynn Staheli, Global Help, 2008
Towards Effective Ponseti Clubfoot Care - The Uganda Sustainable Clubfoot Care Project, S. Pirani, E. Naddumba, R. Mathias, J. Konde-Lule, N. Penny, T. Beyeza, B. Mbonye, J. Amone, F. Franceschi, Clin Orthop Relat Res 2009, 467:1154–1163
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