Scotland Malawi Partnership 2009

The Malawi National Clubfoot Program

The Malawi National Clubfoot ProgramINTRODUCTION

What is Clubfoot?Why is it a problem?What is the Ponseti Method?What is the MNCP?What has it achieved?How can we help/ purpose of SMP?

What is Clubfoot?• Commonest significant congenital

lower limb deformity• Incidence Of Clubfoot twice that in

US / Europe (2 / 1,000 live births)

• 200,000 children / year worldwide– less than 3% treated– In Malawi – approx 1200 new cases

per year• Do badly if left untreated

Why is clubfoot importantCommon & Completely treatable with simple

cost effective non-operative techniqueWhen badly or un-treated

• Painful walking• Obvious stigma• Can’t wear shoes• Considered “useless” or cursed”• Do not gain education• Poor employment / marriage

prospects

Untreated Clubfoot

Clubfoot treatment in MalawiPrior to 2000: Manipulation & casting

Haphazard Poor technique High Failure rate

Surgery Not universally available Expensive Left foot stiff Poor long-term results

• Specific method of manipulation

• Specific method of serial casting

• Local Anaesthetic Tenotomy of the Achilles Tendon

• A specific method of bracing

• Long term follow up for recurrence

Current Treatment in Malawi:

The Ponseti Method

Dr Ignacio Ponseti

Clubfoot – The Ponseti method

• Must start as early as possible

Clubfoot – The Ponseti method

• Must start as early as possible

1.Weekly manipulations and casting for ~5w

2.Tenotomy and final cast for 3w

3.Braces full time for 3m and night time until 4y

Ponseti Casting

Tenotomy

Bracing

The Ponseti Treatment Summary

Malawi National Clubfoot Program1. Aims to eradicate poorly treated and

untreated clubfoot in Malawi2. Program of educating all clinical staff

treating clubfoot in country in PONSETI TECHNIQUE

3. Set up treatment centres in all DGHs4. Ensure supply of treatment

materials5. Provide support and Counselling6. Educate communities 7. Become self-sustaining in 5 y

Malawi National Clubfoot Program

Set up in November 2002

– Has trained over 100 Clinical Officers, Rehabilitation Assistants and Technicians

– Has 28 treatment centres each with at least 2 councillors

Malawi National Clubfoot Program

– Treated over 1000 patients

– Full time coordinator– Distributes free braces

and emergency casting material

– Started training community midwives

Malawi National Clubfoot Program

• Costs 70,000 USD / yr – forecast to increase to over 100,000 USD / y to treat up to 1000 patients / y

• Huge saving to economy - 10 times cheaper and better than surgery– CURE operates on 100-200 “missed”

children / y– Cost off $1200 / patient – Surgery = almost 1/4million USD/y for

200 children

Malawi GovernmentMalawi Government Cure Clubfoot WorldwideCure Clubfoot Worldwide Malawi Against Physical Malawi Against Physical

Disabilities (MAP)Disabilities (MAP) Malawi Council for the Malawi Council for the

Handicapped (MACOHA) / Handicapped (MACOHA) / CBMCBM

MALAWI NATIONAL CLUBFOOTMALAWI NATIONAL CLUBFOOT PROJECT STAKEHOLDERSPROJECT STAKEHOLDERS

Ministry of HealthMinistry of Health

MNCP and Scotland-Malawi PartnershipNeeds Partnership in Support

– Assistance with Training • Professional Expertise (Scottish Accredited

Trainers)• Financial Assistance

– Assistance with Fundraising• Expert advice• Scottish Parliament Funding Application

MNCP and Scotland-Malawi PartnershipConclusions• Clubfoot is common in Malawi and treatable• Untreated gives terrible unnecessary

suffering, deprivation, stigmatisation and expensive surgery

• SMP in position to assist with training and sourcing funding and possibly more?

Thank You