title: Problems encountered by parents of infants with clubfoot treated by the Ponseti method in Madagascar: A study to inform better practice.
abstract: OBJECTIVE
  Ponseti treatment for clubfoot is effective and inexpensive, improving children's social participation. Two rehabilitation centres in Madagascar piloted Ponseti treatment; however, at one centre 46% of infants failed to complete treatment. The aim of this study was to determine the causes of defaulting in order to facilitate subsequent improvements nationwide when treatment is rolled out to all centres.
  
  
  METHODS
  Questionnaire-based interviews.
  
  
  METHODS
  Twenty mothers of infants younger than 1 year were interviewed after 3 months of treatment in relation to difficulties they experienced with continuing treatment.
  
  
  RESULTS
  Fifteen families of these had financial problems: 7 incurred debt, 2 sold possessions, 4 parents stopped work an 2 did not give any further details. All mothers experienced distress; 9 hid their child's foot, and 8 were accused of wrong-doing during pregnancy. Three families travelled more than 500 km to the treatment centre and journeys were costly and difficult. Ponseti splints were acceptable, but aftercare of the splints proved problematic.
  
  
  CONCLUSIONS
  Repeated travel to the clinic resulted in financial and social burden on the families, which reduced their ability to engage in treatment. The findings of this study are similar to work from other countries, but publications on rehabilitation from Madagascar are few. Improved support for parents, information, splinting with better materials and provision of treatment more locally are needed. Financial support for parents is key to enhancing children's life chances.
authors.affiliation: Le Centre d'Appareillage de Madagascar, Antananarivo, Madagascar.
authors.forename: Harisoanirina
authors.initials: H
authors.lastname: Ramahenina
authors.forename: Rory J
authors.initials: RJ
authors.lastname: O'Connor
authors.forename: M Anne
authors.initials: MA
authors.lastname: Chamberlain
mesh_terms: D003025:Clubfoot / Q000191:economics / Q000534:rehabilitation*; D017281:Cost of Illness; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008270:Madagascar; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods* / Q000592:standards; D019637:Orthopedic Procedures / Q000379:methods; D010290:Parents / Q000523:psychology*; D010865:Pilot Projects; D011364:Professional Practice / Q000592:standards*; D012047:Rehabilitation Centers / Q000592:standards; D012934:Social Isolation; D013165:Splints