Article

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. PATIENTS: 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. CONCLUSION: 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.

Langue : ANGLAIS