Ford-Powell Vikki A, Barker Simon, Khan Md Shariful I, Evans Angela M, Deitz Fredrick R
Walk For Life Ponseti, LAMB Project, Dinajpur, Bangladesh.
J Pediatr Orthop. 2013 Jun;33(4):e40-4. doi: 10.1097/BPO.0b013e318279c61d.
Bangladesh is one of the most populous countries in the world at 160 million with 1/3 existing below the poverty line. With an annual birth rate of approximately 3.2 million, an estimated incidence of 1:900 live births, the country has approximately 5000 new cases of idiopathic congenital talipes equinovarus per annum. The Bangladesh sustainable clubfoot program, Walk for Life (WFL), was conceived to respond to this unmet need.
WFL started in 2009 and has rapidly grown to 35 clinics. Overseas experts initially increased local capacity by training a team of national paramedical staff. Government support enabled integration with the public hospital system and enhanced sustainability. WFL has supplied materials, educational, administrative, and clinical support throughout. All recruited cases underwent Ponseti casting. Demographic, Pirani scores, cast, tenotomy, and bracing data have been prospectively collected from all patients. Detailed review has been undertaken for 1040 patients after 12 months of treatment in 3 divisions of Bangladesh.
Between 2009 and 2011, 6069 feet (3922 patients) were recruited to the project. Of these 1643 feet (1040 patients) have completed a minimum of 1-year follow-up. The male:female ratio was 2.7:1 with a mean age of 22 months at presentation (range, 0 to 36). Typical idiopathic congenital talipes equinovarus responded in a median of 5 casts (range, 1 to 25) with 76% undergoing tenotomy. Thirteen percent were atypical feet requiring a median of 5 casts. The percentage of patients missing at the 12-month point was 12%. Two percent of patients experienced complications.
The Bangladesh clubfoot program demonstrates that rapid case ascertainment is possible in a developing world setting with appropriate logistical support. The use of local physiotherapists and paramedics yielded good clinical outcomes in an environment with full access to clinical review and ongoing training. A higher than expected number of atypical cases have been noted, requiring modified Ponseti treatment. Complications have been few at this early stage.
Level 2-therapeutic study.
孟加拉国是世界上人口最多的国家之一，有1.6亿人口，其中三分之一生活在贫困线以下。该国年出生率约为320万，先天性马蹄内翻足的估计发病率为1:900活产，每年约有5000例特发性先天性马蹄内翻足新病例。孟加拉国可持续马蹄内翻足项目“为生命行走”（WFL）就是为满足这一未得到满足的需求而设立的。
WFL于2009年启动，已迅速发展到35个诊所。海外专家最初通过培训一组国家辅助医疗人员来提高当地能力。政府的支持使该项目能够与公立医院系统整合并增强了可持续性。WFL在整个过程中提供了物资、教育、行政和临床支持。所有招募的病例都接受了庞塞蒂石膏固定法治疗。已前瞻性收集了所有患者的人口统计学数据、皮拉尼评分、石膏固定、跟腱切断术和支具数据。在孟加拉国的3个行政区对1040例患者进行了12个月的治疗后进行了详细复查。
2009年至2011年期间，该项目共招募了6069只脚（3922例患者）。其中1643只脚（1040例患者）完成了至少1年的随访。男女比例为2.7:1，就诊时的平均年龄为22个月（范围为0至36个月）。典型的特发性先天性马蹄内翻足平均需要5次石膏固定（范围为1至25次），76%的患者接受了跟腱切断术。13%为非典型足，平均需要5次石膏固定。在12个月时失访患者的比例为12%。2%的患者出现了并发症。
孟加拉国马蹄内翻足项目表明，在发展中国家的环境中，在适当的后勤支持下，快速确定病例是可行的。在能够充分进行临床复查和持续培训的环境中，使用当地物理治疗师和辅助医疗人员取得了良好的临床效果。已注意到非典型病例的数量高于预期，需要对庞塞蒂治疗方法进行调整。在这个早期阶段，并发症很少。
2级——治疗性研究。
