Skip to main content
SpringerLink
Log in

Incidence of Clubfoot in Uganda

  • Quantitative Research
  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Background

While the congenital clubfoot deformity is a common deformity recorded in Uganda, the incidence of the condition had never been accurately determined. The objective of this study was to measure the overall incidence of congenital clubfoot deformity in a representative sample of births.

Methods

A study of all babies born with foot anomalies took place from March 2006 to October 2007. The study was based at 8 Regional Hospitals with active maternity units and a functioning clubfoot clinic. All babies with foot deformities at birth at any of eight centres as detected by the delivery room staff were referred to the respective centre’s clubfoot clinic. The children were examined by clubfoot clinic orthopedic officers who diagnosed the specific deformity. Children referred to the clinic from any source and born at the maternity unit were included in the study. The denominator was all live births at the centre during the study period.

Results

The total number of live births during the study period was 110,336. The maternity units of the centres identified 290 infants with a foot deformity. One hundred and thirty infants born during the study period were diagnosed in the clubfoot clinic as having a congenital clubfoot deformity. The proportion of infants with a clubfoot deformity was 1.2 per 1000 births over the 20-month period. The male to female ratio was 2.4:1.

Recommendation

The rate of clubfoot deformities in the newborn can be used to estimate the numbers of children who should be treated and to estimate resource needs for the identification and management of this treatable congenital malformation. By comparing the number of those treated with the expected number of cases, the numbers of children with neglected clubfoot can be calculated.

Résumé

Contexte

Quoique le pied bot soit une déformation congénitale fréquente en Ouganda, cette déformation n’a jamais été observée en détail. L’objectif de cette étude est de mesurer la fréquence du pied bot parmi un échantillon représentatif de naissances.

Méthode

En mars 2006, les données ont été recueillies dans huit hôpitaux généraux ayant une pouponnière et une clinique pour le pied bot. Parmi l’ensemble des nouveaux nés, ceux ayant une déformation ont été dirigés vers une clinique se spécialisant dans le traitement du pied bot. Les orthopédistes de cette clinique ont posé leur diagnostique pour chacune des déformations. Ce sont uniquement les bébés référés à la clinique par les huit hôpitaux qui font l’objet de cette étude.

Résultats

Pendant la durée de l’étude (mars 2006 à octobre 2007), un total de 110 336 naissances vivantes a été enregistré. Les pouponnières ont identifié 290 bébés ayant une déformation. Puis, les orthopédistes de la clinique spécialisée ont diagnostiqué 130 bébés avec une déformation congénitale du pied bot. Proportionnellement, les enfants avec une déformation du pied bot se chiffre à 1,2 par 1000 naissances, pour cette période de 20 mois. Le ratio garçon/fille est de 2,4:1.

Recommandations

Le taux de déformation congénitale du pied bot chez les nouveaux nés peut être utilisé pour déterminer le nombre d’enfants devant être traités, ainsi que pour évaluer les montants nécessaires pour l’identification et l’administration de cette déformation inhérente soignable. En comparant la quantité d’enfants traités avec le nombre prévu de cas, il est possible de calculer le nombre d’enfants ayant un pied bot négligé.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genetics 1998;79:90–96.

    Article  CAS  Google Scholar 

  2. Cartlidge I. Observations on the epidemiology of club foot in Polynesian and Caucasian populations. J Med Genetics 1984;21:290–92.

    Article  CAS  Google Scholar 

  3. Boo NY, Ong LC. Congenital talipes in Malaysian neonates: Incidence, pattern and associated factors. Singapore Med Journal 1990;31:539–42.

    CAS  Google Scholar 

  4. Wynne-Davies R. Genetic and environmental factors in the etiology of talipes equinovarus. Clin Orthopaed Related Res 1972;84:9–13.

    Article  CAS  Google Scholar 

  5. De Andrade M, Barnholtz JS, Amos CI, Lochmiller C, Scott A, Risman M, Hecht JT. Segregation analysis of idiopathic talipes equinovarus in a Texan population. Am J Med Genet 1998;79:97–102.

    Article  Google Scholar 

  6. Wynne-Davies R. Family studies and etiology of club foot. J Med Genetics 1965;2:227–32.

    Article  CAS  Google Scholar 

  7. DePuy J, Drennan JC. Correction of idiopathic clubfoot: A comparison of results of early versus delayed posteromedial release. J Pediatr Orthopaed 1989;9:44–48.

    Article  CAS  Google Scholar 

  8. Wynne-Davies R. Family studies and the cause of congenital club foot. J Bone Joint Surgery Br 1964;46:445–63.

    Article  CAS  Google Scholar 

  9. McElroy T, Konde-Lule J, Neema S, Gitta S. The Uganda Sustainable Clubfoot Care Project. ‘Understanding the barriers to clubfoot treatment adherence in Uganda: A rapid ethnographic study’. Disability & Rehabilitation 2007;29:845–55.

    Article  CAS  Google Scholar 

  10. Pirani S. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot. Presented at the Pediatric Orthopaedic Society of North America, St. Louis, Missouri, May 2004.

    Google Scholar 

  11. Pirani S. The Ponseti method and results in developing nations. Presented at the Symposium on Conservative Methods on the Treatment of Clubfeet. SICOT. San Diego, CA, August 30, 2002.

    Google Scholar 

  12. Ponseti IV. Congenital Clubfoot. Fundamentals of Treatment. Oxford, NY: Oxford University Press, 1996.

    Google Scholar 

  13. Cardy AH, Barker S, Chesney D, Sharp L, Maffulli N, Miedzybrodzka Z. Pedigree analysis and epidemiological features of idiopathic congenital talipes equinovarus in the United Kingdom: A case control study. BMC Musculoskelet Disord 2007;8:62.

    Article  CAS  Google Scholar 

  14. Moorth RN, Hashmi SS, Langois P, Canfield M, Waller DK, Hecht JT. Idiopathic talipes equinovarus (ITEV) (clubfoot) Texas. Am J Med Genetics 2005;132:376–80.

    Article  Google Scholar 

  15. Morcuende J, Doran LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using Ponseti method. J Pediatrics 2004;113:376–81.

    Article  Google Scholar 

  16. Shimizu N, Hamada S, Mitta M, Hiroshima K, Ono K. Etiological considerations of congenital clubfoot deformity. In: Tachdjian MO, Simons G (Eds.), The Clubfoot: The Present and a View of the Future. New York, NY: Springer, 1993.

    Google Scholar 

  17. Ballantyne JA, Macnicol MF. Congenital talipes equinovarus (clubfoot): An overview of the aetiology and treatment. Mini-symposium: The paediatric foot. Current Orthopaedics 2002;16:85–95.

    Article  Google Scholar 

  18. Danielsson LG. Incidence of congenital clubfoot in Sweden. Acta Orthopia Scandinavia 1992;63:424–26.

    Article  CAS  Google Scholar 

  19. Valdivieso García JL, Escassi Gil A, Zapatero Martínez M, Ayala Montoro J, Blanco López F, Gutiérrez Canto M, et al. Prospective study of equinovarus foot in 20,000 live newborn infants. [article in Spanish] An Esp Pediatr 1988;28:325–26.

    PubMed  Google Scholar 

  20. Carey M, Bower C, Mylvaganam A, Rouse I. Talipes equinovarus in Western Australia. Paediatr Perinatal Epidemiol 2003;17:187–94.

    Article  Google Scholar 

  21. Baker S, Chesney D, Miedzybrodzka Z, Maffuli N. Genetics and epidemiology of idiopathic congenital talipes equinovarus. J Pediatr Orthopaedics 2003;23:265–72.

    Google Scholar 

  22. Chapman C, Stott NS, Port RM, Nicol RO. Genetics of club foot in Maori and Pacific people. J Med Genetics 2000;37:680–83.

    Article  CAS  Google Scholar 

  23. Madzivire D, Useli D, Mashegede PT, Siziya S. Minimum incidence of congenital talipes equinovarus (CTEV) and past treatment evaluation of residual deformities in a population in Zimbabwe. Central African J Med 2002;48:33–38.

    CAS  Google Scholar 

  24. Mkandawire NC, Kaunda E. Incidence and Patterns of Congenital Talipes Equinovarus (Clubfoot) Deformity at Queen Elizabeth Central Hospital, Banter, Malawi. East and Central African J Surg 2004;9:28–31.

    Google Scholar 

  25. Tindall AJ, Steinlechner CW, Lavy CB, Mannion S, Mkandawire N. Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: A realistic alternative for developing world? J Paediatric Orthopaedics 2005;25:627–29.

    Article  Google Scholar 

  26. Robertson W. Jr, Corbett D. Congenital clubfoot. Month of conception. Clin Orthoped Relat Res 1997;338:14–18.

    Article  Google Scholar 

  27. Krogsgaard MR, Jensen PK, Kjaer I, Husted H, Lorentzen J, Hvass-Christensen B, et al. Increasing incidence of club foot with higher population density: Incidence and geographical variation in Denmark over a 16-year period—an epidemiological study of 936,525 births. Acta Orthopaedica 2006;77:839–46.

    Article  Google Scholar 

  28. Sackett DL. Bias in analytic research. J Chron Dis 1979;32:51–63.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Population and Public Health, University of British Columbia, Vancouver, BC, 5804 Fairview Ave, V6T 1Z3, Canada

    Richard G. Mathias MD

  2. School of Public Health, Makerere University, Kampala, Uganda

    Joseph Konde Lule PhD

  3. Department of Orthopedics, Mulago Hospital, Kampala, Uganda

    Gonzaga Waiswa MD & Edward K. Naddumba MMed

  4. Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada

    Shafique Pirani MBBS

Authors
  1. Richard G. Mathias MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph Konde Lule PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gonzaga Waiswa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward K. Naddumba MMed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shafique Pirani MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Uganda Sustainable Clubfoot Care Project

Corresponding author

Correspondence to Richard G. Mathias MD.

Additional information

Acknowledgements: This study was carried out as part of the Uganda Sustainable Clubfoot Care Project (USCCP), a six-year project funded by the Canadian International Development Agency. USCCP partners include: The University of British Columbia; Makerere University; the Ugandan Ministry of Health; the Children’s Orthopaedic Rehabilitation Unit (CORU), Uganda; and Christian Blind Mission (CBM).

We thank the maternity units, the clubfoot clinic staff and the medical directors at each of the centres who were partners in the completion of this study. Members of the Uganda Sustainable Clubfoot Care Project include S. Pirani, E.K. Naddumba, J. Konde-Lule, R. Mathias, B. Mbonye, F. Franceschi, J. Amoni.

We acknowledge the help of our research assistants: Ms. Marieke Dreise, Mr. Dirisa Kitemagwa, Mr. Henry Musoke.

The Uganda Sustainable Clubfoot Care Project is supported by the Canadian International Development Agency and the Association of Universities and Colleges of Canada.

Conflict of Interest: None to declare.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mathias, R.G., Lule, J.K., Waiswa, G. et al. Incidence of Clubfoot in Uganda. Can J Public Health 101, 341–344 (2010). https://doi.org/10.1007/BF03405299

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03405299

Key words

Mots clés

Search

Navigation