Feasibility and barriers of treating clubfeet in four countries.
OBJECTIVE
The purpose of this study was to elucidate why neglected clubfeet still exists despite the availability of a highly (cost)-effective treatment-the Ponseti treatment.


METHODS
A qualitative and partly quantitative study with semi-structured interviews was conducted in four countries: the Netherlands, South Africa, Argentina and Indonesia with both caregivers, mostly parents, of children with clubfoot and practitioners treating clubfoot. The topics discussed with the caregivers (n = 51) were the conceptions of the cause of clubfeet, received information, accessibility, financial aspects, and social stigma. With the practitioners (n = 11) the focus of the interviews was the treatment protocol and finance.


RESULTS
Several barriers towards the start of the treatment were highlighted. At all places treatment was financed by the government, insurance or charity. Nevertheless, the cost of transport and missed working days formed a barrier, although there is a large difference between and within countries. Poverty, long travel duration, and beliefs of supernatural causes for the clubfoot result in delay in the start of treatment.


CONCLUSIONS
These are problems we need to address when making effective treatment available for every child to diminish the burden of neglected clubfoot; especially accessible clinics in rural areas can be a good alternative to highly specialized hospitals in large cities. We as a community should try to find and overcome the barriers to treat these patients, because we have a relatively easy and highly cost-effective treatment option which can be given by trained non-physicians supervised by an interested medical doctor.
Leiden University Medical Centre (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. suzannevanwijck@hotmail.com.
Suzanne F M
SF
van Wijck
Yayasan Stepping Stones Bali, Jalan Pura Wingin, Kalibukbuk, Singaraja, Indonesia. marjanneoomen@icloud.com.
A Marjanne
AM
Oomen
Leiden University Medical Centre (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. H.J.L.van_der_Heide@lumc.nl.
Huub J L
HJ
van der Heide
D001118:Argentina; D001294:Attitude to Health; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000534:rehabilitation*; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D007214:Indonesia; D007223:Infant; D016015:Logistic Models; D008297:Male; D008349:Manipulation, Orthopedic; D009426:Netherlands; D036301:Qualitative Research; D013019:South Africa; D016896:Treatment Outcome
Clubfoot; International; Low-income countries; Ponseti; Qualitative research