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202 FACTORS AFFECTING COMPLIANCE IN THE TREATMENT OF CONGENITAL CLUBFOOT: THE UGANDA CLUBFOOT PROJECT.
  1. S. Pirani,
  2. W. Carlson
  1. University of British Columbia, Vancouver, BC, Canada

Abstract

Clubfoot is a congenital deformity that affects approximately 1 in 1,000 live births per year worldwide. Neglected clubfoot can have a dramatic effect on quality of life, especially in developing countries in which economic survival and commmunity role may be highly dependent on physical ability. In 1999, a national awareness and treatment program for clubfoot was established in Uganda. Over 200 children were initially treated with the Ponseti Method, but despite excellent results, approximately 40% of children failed to complete the Phase 1 treatment. In this study, factors affecting this poor compliance were examined. Using the records at Mulago Hospital and Katalemwa Rehabilitation Home, patients who had previously or were currently being treated for congenital clubfoot were identified. Patients who had been born within the last 3 years with uncomplicated non-syndromic congenital clubfoot were considered for the study. Attempting to classify the patients as compliant or non-compliant was difficult as records in Uganda are extremely scarce and rarely accurate. However, with the aid of Ugandan social workers and orthopedic officers, we were able to identify over 40 patients for the study. A simple survey investigating demographic, socioeconomic, and cultural factors was completed. Patients who were not compliant with treatment were located in their villages around southern Uganda. There were many obstacles in tracing these patients because of poor records, patients relocating to different villages, and lack of roads and addresses. We were able to locate and complete the survey with 10 patients who had not complied with treatment. Preliminary results identified predominant factors such as inabiltiy to pay for transportation to the hospital, women relocating to different villages, and lack of support from the patient's father. These results will help future development projects target specific socioeconomic and cultural issues to improve compliance with the treatment of clubfoot.

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