By Mathew Shayo MPhil.CL.PT (Orthopedics and Rheumatology) KCMC CLUBFOOT CLINIC By Mathew Shayo MPhil.CL.PT (Orthopedics and Rheumatology)

Background Use of Ponseti Method started back in 2008 Few staff were trained on the method Less interdisciplinary approach Students were receiving Ponseti training during their clinical rotations

Studies Ponseti knowledge gap was established among Physiotherapists in 8 regions of Tanzania (Shayo & Van dn Bergh, 2013) In 2014 more Ponseti knowledge gap and lack of interdiscplinarity was observed among health workers working with clubfoot children in Kilimanjaro region Need of immediate collaboration and training

Steps Collaboration with Usa River Rehabilitation Centre Agreed to provide training to participants from six district hospitals in Kilimanjaro Hospital Agreed to provide training to physiotherapist finalist students twice a year Fellowship training to health workers Connected our clinic to Miracle feet

Training at school of Phys

Fellowship attachment

Staff are empowered to treat neglected cases

Joining Miracle feet Since July 2015 Supply of material Continuous education Fellowship attachment Equipment supply Improved data collection

Statistics 1st July - 31st Dec 2015 Category Number of cases # of patient enrolled 25 # of patients served males females 34 9 Laterality: Bilateral Left Right 22 8 4 Affected relative: affected Not affected 5

Statistic ct. Treatment stage: Casting Tenotomy Bracing 28 1 5 Dropouts: Casting 7 Bracing: Good Fair Poor 3 # of patients with 8+ casts # of visits 165 # of casting 110

Impression Communication need to be improved Follow-up in a near by clinics may be necessary Parent support and education is necessary

Age of First Visit

Age of First Visit Majority visits at the first three months; there are still some cases captured at the late stage. Community awareness may reduce/alleviate the problem in future.

Age of First Cast

Age of First Visit There are still some neglected cases in the society, although few. Further studies may be necessary. Midwife education on early detection is necessary.

Future plans More training to service providers in the periphery i.e. district hospitals Regular training on advanced Ponseti Outreach to provide early detection and referral education to midwives and traditional birth attendants. Network with NGOs, DPOs, FBOs

Thanks Tanzania without adult disability due to clubfoot is possible