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Improving care for children born with clubfoot.

helping children to walk

ACT - mother and child

...bringing us closer to a day when children born with clubfoot no longer face a life of disability.
- Scott Reichenbach, CURE Clubfoot

Around 200,000 children born each year are affected by clubfoot, with 80% of these in low and middle income countries. Without treatment, the condition becomes ‘neglected clubfoot’, a painful and severely disabling deformity. However, in up to 95% of cases, clubfoot can be treated successfully using the Ponseti method of treatment, especially if this is initiated early.

The Africa Clubfoot Training (ACT) Project was a two-year project (2015-7) funded by the UK Department for International Development (DFID) that has strengthened training and delivery capacity for clubfoot treatment in sub-Saharan Africa.  It has supported existing clubfoot treatment programmes through training a new cadre of national clubfoot trainers in 18 countries.

The ACT Project has helped to strengthen partnerships between clubfoot service delivery partners within Ethiopia and across the region. A team of UK NHS, Ethiopian and regional African trainers designed and developed training materials for a standardized clubfoot provider and instructor course. The courses were piloted in Ethiopia (September 2015, January 2016 and July 2016) and in Rwanda (October 2016), bringing together senior clubfoot practitioners from across the region, including orthopaedic surgeons, physiotherapists and clinical officers, to review the new instructor course materials and to enhance their training.  This collaboration resulted in new Basic and Advanced Clubfoot Treatment Provider Courses, and a Clubfoot Train The Trainer Course.

In addition, the project has helped to improve treatment for children with neglected clubfoot, and is reviewing the outcomes of non-surgical treatment of this condition at CURE Ethiopia Children’s Hospital over two years. (Read our publication: 'Development and validation of a delayed presenting clubfoot score to predict the response to Ponseti casting for children aged 2-10'.)

Scott Reichenbach, Operations Director for CURE Clubfoot, said of the project, “We are excited and grateful for the unique opportunity to bring together clubfoot leaders from across the region with a team from Oxford, GCI and CURE to design and develop a training tool that can be replicated across sub-Saharan Africa. This grant provides an avenue to teach the Ponseti method throughout a region, bringing us closer to a day when children born with clubfoot no longer face a life of disability.”

 

Clubfoot — Before and After

Clubfoot — Before and After

 

The  project was funded by the UK Department for International Development (DFID) through a Health Partnership Scheme grant awarded by Tropical Health Education Trust, for the benefit of UK and partner country health sectors.

To find out more, including how to access the new training materials, please contact actproject@ndorms.ox.ac.uk

Our aim is to continue supporting our partners in Africa in rolling out training for health workers in treatment of clubfoot, and to continue to develop and improve training resources and mentoring support for these health workers. 

University of oxford crowdfunding campaign for clubfoot training:

In November 2016 we successfully ran a University of Oxford crowdfunding campaign with OxReach which raised over £80,000 from over 300 donors to help more children born with clubfoot to walk and live normal lives.You can find out more about the campaign here and about ways to give to support our work at https://www.campaign.ox.ac.uk/africa-clubfoot . Our updates on how we have used these funds to support clubfoot training in Africa are here.

Since 2017:

  • We have worked with our partners Global Clubfoot Initiatve to disseminate the ACT training materials to other organisations and partners providing clubfoot training.
  • We have advised on and supported GCI members with rolling out the ACT Basic, Advanced and Train The Trainer courses in Africa in English and French, and a new working group at GCI focuses on supporting the implementation of ACT training in Africa, and reviewing use of the materials.
  • We have received support from MiracleFeet to translate the materials to Spanish, which have now been piloted and are in use in Latin America.
  • As requested by our partners, we have translated the materials to Portuguese to widen access to training in Africa.
  • We have worked with the UK Clubfoot Consensus Group (UKCCG) to adapt the scope and format of the training materials for the UK and other high-income country training environments, which are known now as Global Clubfoot Training Level 1 and Level 2, and accredited by the Royal College of Surgeons of England
  • NDORMS celebrates World Clubfoot Day on 3 June annually together with other clubfoot organisations worldwide, to increase awareness of clubfoot and its treatment.
  • See here for more news about the ACT project

Publications

We have published academic papers on the development and outcomes of the training materials:

See here for more research on clubfoot undertaken by NDORMS members.

Partners

The ACT Project is a partnership between the NDORMS at the University of Oxford, CURE Ethiopia Children’s HospitalCURE ClubfootGlobal Clubfoot Initiative (GCI), CURE International UK and local ministries of health.

Photos on this page © courtesy of CURE Clubfoot

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