Miriam Juma, 33 years old, is one of the victims of clubfoot, a congenital deformity involving one foot or both. Poverty
Juma who lives in Leganga area of Arumeru district in northern Tanzania’s region of Arusha says her parents failed to take her to the medical facilities when she was still young, taking into accounts that the deformity is treatable.
“I’m not blaming my parents on this because they were unaware of the availability of clubfoot treatments,” says Miriam, who was born with bilateral clubfoot.
Scientists do know that clubfoot is not caused by the position of the baby in the womb. In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth, such as spinal bifid, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a fetus doesn’t close properly.
Studies have strongly linked clubfoot to cigarette smoking during pregnancy, especially when there already a family history of clubfoot.
“It was too late when my parents came to realize that clubfoot is treatable as the best period for treating the deformity is between 0 and 5 years of age,” Juma says.
“I felt bad once I came to realize that clubfoot is treatable, but now I have accepted my condition and I remain an ambassador of spreading this gospel that clubfoot deformity has treatment,” says Miriam who is a mother of one.
There are many people in Tanzania who are experiencing Miriam’s situation as a result of failure to get treatment at early stages.
It is estimated that more than 3,000 children born with clubfoot in Tanzania per year, though most of them fail to get treatment at their tender age because of parents’ financial constraints.
It is a relatively common birth defect, occurring in about one in every 1,000 live births. Approximately half of people with clubfoot have it affect both feet, called bilateral clubfoot. In most cases it is an isolated disorder of the limbs. It occurs in males twice as frequently as in females.
“Clubfoot can be treated. What needed is for the parents to know where to take their children with clubfoot complications for treatment,” says Grace Ayoo, one of health workers at the Arusha- based Rehabilitation and Vocational Training Center.
“We have been telling parents to thoroughly check their kids and once a child have been diagnosed with clubfoot, there are many different treatment approaches. Treatment is given immediately after diagnosis to take full advantage of the flexibility in the baby’s bones and joints,” Ayoo says.
“This allows for improved manipulation to try achieving a normal foot,” says the experienced nurse.
The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity, which has been there for the past 75 years and was discovered in North America and has become a primary treatment option in many countries more recently.
The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts. The treatment is based on a sound understanding of the functional anatomy of the foot and of the biological response of muscles, ligaments and bone to corrective position changes gradually obtained by manipulation and casting.
Trine Boe Heim, the person in-charge of the Rehabilitation and Vocational Training Center, describes clubfoot deformity as the biggest challenge developing countries including Tanzania that needs remarkable efforts to combat it.
“Children with clubfoot in this area (Arusha) and Tanzania as a whole are unable to meet medical requirement for treating the physical disorder because medical facilities are very expensive,” she says.
Children with clubfoot need to be taken care by the government, taking into account that treatment of the problem is very expensive, particularly for people in rural communities, who live below one U.S. dollar a day.
“It will take time for every child born with clubfoot to get treatment..in order to reach that stage there is a need for special program to be in place that would compel the government to allocate reasonable amount of money for treatment of children with such physical challenges,” she says.
According to Heim, the challenge affects most the under-five children, who need free medical care.
Currently, parents are forced buy plaster of Paris (POP) on their own in public hospitals, the situation that makes most of them fail to meet such expenses.
“That’s why we’re asking the government to come up with a practical approach to ensure all children of this nature are treated free of child,” she says, adding treatment for a child with clubfoot costs 250 U.S. dollar.
Currently, a total of 350 children with clubfoot are getting treatment at the rehabilitation center.
Arusha Regional Medical Officer Dr. Frida Mokiti admits on the challenge, saying clubfoot deformity needs corrective efforts to scale up its medical treatments.
“We are doing the best to improve health service delivery in the district and country at large, but we need more players to chip in,” she says, calling parents to imbibe a culture of taking their children to medical facilities as earlier as possible.
Countrywide, clubfoot treatments are provided in Bugando Referral Hospital in the Lake zone region of Mwanza, Mbeya Referral Hospital and Iringa Regional Hospital all in southern highlands. Enditem



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