Around 200,000 children born each year are affected by clubfoot, which left untreated becomes a painful and severely disabling deformity. However, in up to 95% of cases, clubfoot can be treated successfully using the Ponseti method of treatment. Oxford has been leading the Africa Clubfoot Training (ACT), a two-year project that boosts delivery capacity for clubfoot treatment in sub-Saharan Africa, by training more healthcare workers to provide life-changing treatment for children.
What we did:
We worked with other partners to develop the Africa Clubfoot Training (ACT) materials to meet the need for more healthcare workers in Africa trained to provide Ponseti treatment for children born with clubfoot. We developed three inter-linked interactive courses. First, we developed a 2-day Train The Trainer course to train more local trainers who can roll out clubfoot training and can mentor clubfoot treatment providers. Second, we developed a 2-day Basic Clubfoot Treatment Provider course to train in how to treat children under two years with clubfoot. Finally, we developed a 2-day Advanced Non-surgical Clubfoot Treatment Provider Course to train in how to treat walking age children with clubfoot, and advanced management of more complicated clubfoot cases.
How we did it:
We worked with over 50 clubfoot trainers from across Africa to write, review, pilot and edit the materials, and created teaching presentations, manuals, videos, and interactive workshop materials. International and UK clubfoot experts, including the UK Clubfoot Consensus Group advised on the training materials. We tested the materials in English (Ethiopia and Kenya) and French (Rwanda) with healthcare workers from across Africa. We responded to feedback from the trainers, and also the experiences of the families who brought their children to take part in the training courses.
What the trainees say:
“The training had a great impact in my management of clubfoot as well as making me a resource person to other medical professionals.
With the high incidence affecting Kenya and Africa as a whole, more training needs to be conducted so as to reach out to as many of these children as possible.
Left untreated, clubfoot leads to a lifetime disability, with the affected people experiencing pain and difficulty in walking. These people also find it difficult to access education, employment and experience exclusion from society.”
Dr. Paul Mang’oli is an orthopaedic surgeon at the AIC-CURE Children's Hospital in Kijabe, Kenya.
The results:
Since the materials were published in 2017, they have been used in over 60 courses in over 28 countries, mainly in Africa, but also beyond. These include Guinea Bissau, Senegal, Cameroon, Iraq, Myanmar and Tanzania. They have also been translated into Spanish (thanks to funding from MiracleFeet NGO) and Portuguese (thanks to fundraising through the University of Oxford’s crowdfunding OxReach campaign). Working with UKCCG, we have adapted the materials to tailor them for the UK training setting, and this version of the materials, known as Global Clubfoot Training Level 1 & 2, is now accredited by the Royal College of Surgeons and regularly used across the UK to train physiotherapists, surgeons, and other healthcare providers who treat clubfoot.
Publications
We have published 3 papers relating to the ACT project:
The feasibility of a training course for clubfoot treatment in Africa: A mixed methods study. Tracey Smythe, Rosalind Owen, Grace Le, Esperance Uwizeye, Linda Hansen, Christopher Lavy. Published: September 13, 2018https://doi.org/10.1371/journal.pone.0203564.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203564
The development of a training course for clubfoot treatment in Africa: learning points for course development. Tracey Smythe, Grace Le, Rosalind Owen, Birhanu Ayana, Linda Hansen and Christopher Lavy. BMC Medical Education201818:163 https://doi.org/10.1186/s12909-018-1269-0 Published: 13 July 2018
https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-018-1269-0
Development and validation of a delayed presenting clubfoot score to predict the response to Ponseti casting for children aged 2–10. Nunn, T.R., Etsub, M., Tilahun, T. et al. Strat Traum Limb Recon (2018). https://doi.org/10.1007/s11751-018-0324-z Published 15 November 2018
https://link.springer.com/article/10.1007%2Fs11751-018-0324-z
Acknowledgments:
ACT Project Director: Professor Chris Lavy OBE MD MCh FRCS
ACT Programme Manager: Grace Drury
The ACT project was led by the University of Oxford's Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, CURE Clubfoot and Global Clubfoot Initiative (GCI), and funded by the UK Department for International Development through the Health Partnerships Scheme.