Smythe Tracey, Owen Rosalind M, Aspden Adam, Everhart Jennifer, Abera Endashawu, Amaraegbulam Peace, Flores Rosalyn, Valdez Liza, Lavy Chris
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, South Africa.
BMJ Glob Health. 2025 Mar 28;10(3):e017861. doi: 10.1136/bmjgh-2024-017861.
Approximately 200 000 children are born each year with clubfoot, the majority of whom live in low-income and middle-income countries (LMICs). If untreated, clubfoot causes pain and reduced mobility, leading to activity limitations and disability. The Ponseti method is a highly effective and minimally invasive treatment. This observational study aims to quantify the countries providing clubfoot services and the children receiving treatment in 2023 and compares progress since data were first collected in 2005.
In January and February 2024, data on clubfoot treatment in 2023 were collected from 70 countries. Informants completed a survey about new cases enrolled, treatment outcomes and health system integration. Data were analysed using descriptive statistics, with adjustments made for duplicates, and included clinic locations, the number and ages of children starting treatment, types of support available and Ministry of Health involvement. We compared coverage trends over time and used a cartogram to visualise the extent of clubfoot programme coverage across countries.
Responding countries accounted for 83% of all expected cases in LMICs. There was an increase in enrolment numbers, to 40 382, in 2023. Despite this progress, treatment coverage remained low at approximately 22% across respondent countries. While integration of clubfoot services into national healthcare systems varied widely, strong public-private partnerships in many countries suggest a foundation for sustainable, long-term treatment programmes. However, quality care remained a challenge, with only 67% of children receiving their first foot abduction brace, indicating gaps in ensuring comprehensive treatment necessary for successful clubfoot management. Lingering effects of COVID-19 restrictions include a higher percentage of cases enrolled after 1 year of age.
A larger proportion of children in LMICs received Ponseti treatment in 2023 compared with 2005. However, more work is needed to expand national programmes, build sustainable, high-quality treatment capacity and ensure all children get the care they need to avoid lifelong disability.
每年约有20万名儿童出生时患有马蹄内翻足，其中大多数生活在低收入和中等收入国家（LMICs）。如果不进行治疗，马蹄内翻足会导致疼痛和行动能力下降，进而导致活动受限和残疾。庞塞蒂方法是一种高效且微创的治疗方法。这项观察性研究旨在量化2023年提供马蹄内翻足治疗服务的国家以及接受治疗的儿童数量，并比较自2005年首次收集数据以来的进展情况。
2024年1月和2月，从70个国家收集了2023年马蹄内翻足治疗的数据。受访者完成了一项关于新登记病例、治疗结果和卫生系统整合情况的调查。使用描述性统计方法对数据进行分析，并对重复数据进行了调整，数据包括诊所位置、开始治疗的儿童数量和年龄、可用的支持类型以及卫生部的参与情况。我们比较了不同时期的覆盖趋势，并使用了专题地图来直观展示各国马蹄内翻足项目的覆盖范围。
做出回应的国家占LMICs所有预期病例的83%。2023年登记人数有所增加，达到40382人。尽管取得了这一进展，但在做出回应的国家中，治疗覆盖率仍较低，约为22%。虽然马蹄内翻足服务纳入国家医疗系统的情况差异很大，但许多国家强大的公私伙伴关系为可持续的长期治疗项目奠定了基础。然而，优质护理仍然是一项挑战，只有67%的儿童获得了第一个足部外展支具，这表明在确保成功治疗马蹄内翻足所需的全面治疗方面存在差距。新冠疫情限制措施的持续影响包括1岁后登记病例的比例更高。
与2005年相比，2023年LMICs中有更大比例的儿童接受了庞塞蒂治疗。然而，需要开展更多工作来扩大国家项目、建立可持续的高质量治疗能力，并确保所有儿童都能获得所需的护理，以避免终身残疾。
