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TRANSCRIPT
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