The effectiveness of sustainable serial casting for clubfoot deformity in a low resource setting

Aims
Our aim was to assess the effectiveness of the Malawi Clubfoot Programme and comment on such health care strategies in developing countries.
Methods
Medical records of 1069 children attending 29 clinics within Malawi were identified between 2007 and 2013. Due to incomplete recording, only 596 patients had adequate data which could be further analysed.
Results
The mean age of presentation was 103 days (range 0-8 years) with a sex distribution of M1.76:F1. The mean Pirani score at presentation was 4.55 and on completion of casting was 1.39. A correlation was identified between the number of castings and the initial Pirani score (positive coefficient 0.2626 p<0.0001), the final casting score (negative coefficient -0.1441 p<0.0006) and the change in Pirani score (positive coefficient 0.3200 (p<0.0001)). The number of patients attending the clinics increased per year and the average number of castings was reduced from 6 to 5 between 2008 and 2012. There was also moderate correlation between the number of years the programme had been re-instated and the average change in Pirani score between in each casting (R score 0.36)
Conclusion
Serial casting performed by paramedical personnel within an established self- sustained national programme can effectively treat CTEV in low resource countries.