Perceptions regarding medical management of clubfoot in Kenya

Abstract

Clubfoot is one of the congenital and structural conditions that lead to physical impairment in children globally. Service providers have different perceptions on the various methods of management of clubfoot. This has led to adoption of various approaches of management of clubfoot. Although there is a wide range of experiences of parents/caregivers of children with clubfoot regarding medical management of this condition, there is no documented data on these experiences. The study therefore aimed at exploring the perceptions regarding the medical management of clubfoot in Kenya. The objectives of this study were to explore the service providers and parents/caregivers perceptions on the use of the different methods of medical management of clubfoot; explore the process followed before and after the commencement of management from the service providers and parents/caregivers when using surgical and conservative methods of management as well as exploring the barriers and enabling factors that the service providers experience during the management of clubfoot. Methodology: This study was conducted at talipes clinic of Mbagathi District Hospital, Kenyatta National Hospital and Kijabe Mission Hospital in Kenya. The study utilized a qualitative design and purposive convenient sampling was utilized to recruit participants. Twenty participants were recruited; the sample consisted of ten parents/caregivers of children with clubfoot and ten service providers. Semi-structured interview and probes were used for data collection, interviews were audiotaped and a research assistant took notes, data was collected until saturation. Data was transcribed verbatim and analyzed by thematic-content analysis. The results indicated that most of the service providers perceived Ponseti method as the most effective method of clubfoot management with early intervention. Surgery was found to be the second most utilized method which was indicated for complex and neglected clubfoot. The factors that affected serviceproviders in clubfoot management included: Shortage of trained staff in Ponseti management, missed diagnosis at birth; poor referral system and poor compliance with treatment appointments. The factors that affected parents/caregivers compliance with the treatment regime included: (i) unaffordable transport expenses; (ii) long distance; (iii) little or no social/family support; culture/tradition and stigmatization while compliance was facilitated by (i) good communication between the parents/caregivers and the clinician; (ii) availability of free services (iii) social/ family support. Conclusion: The current study concluded that medical management of clubfoot was a success while majority of parents/caregivers agreed that they were faced with several challenges as fore mentioned which affected the outcome. Recommendation: the study therefore recommends the need to empower the community and service provider with knowledge on clubfoot and its management. There is also need for decentralisation of services and increase the number of health care givers in health facilities who are trained in clubfoot management. Finally physiotherapy academic institutions need to put emphasis on teaching clubfoot management in order to produce effective service providers.