Every Thursday, a group of mothers travel to Mulago National Referral Hospital. These are mothers of children born with clubfoot hoping to meet experts who will save their children’s feet from deformation. 

It is the same thing the scientists do to accident victims who end up losing the limbs and legs though on daily basis.

This is big concern arising from motor Vehicle and Boda boda riders failing to observe road safety guidelines in Uganda.

Background

Dr Mallon Nyati, a consultant in orthopaedics surgery at Mulago National Referral Hospital, says there are various department that handle various born relates health challenge including club foot and born fractures caused by road accidents

In the case of fractures caused to humans in the country, he says it is on the increase especially when the country introduced motor cycle riding commonly known as Boda bodas as a business for individuals.

Citing the Annual Crime and Traffic Road Safety report 2021, Dr Nyati noted that of the 4,159 road accident fatalities countrywide, 1,390 were motorcyclists while 528 were passengers on motorcycles

Motorcyclists killed in road accidents have topped annual fatalities statistics for the first time in the history of traffic in Uganda. 

He says Police attribute the high cases of fatalities and injuries among motorcyclists to indiscipline.

The injuries related to boda bodas equally contribute significantly to the number of road traffic injuries seen at Mulago hospitals, taking out significant resources including consumables and the health worker time.

Dr Nyati explains that his team handles these challenges hand in hand with other born related diseases club foot being one of them.

According to Dr Nyati, in 2008, the ministry of health started Uganda’s sustainable clubfoot project with partners to adopt the Ponseti method.

This was in partnership with the Association of surgeons of Uganda, the Uganda nurses and midwives council, the Medical School at Makerere University and Mbarara University, among others. 

Medical students and nurses were taught how to administer treatment in children born with clubfoot and awareness created in communities across the country. This has helped in managing clubfoot. 

Currently, ministry of health statistics reveal that of every 1,000 children born, one will be born with club foot. Most affected are boys and the ratio is two girls to three boys. 

Managing born fractures arising from road accidents

Dr Nyati citing a 2021 study about characteistics and injury partners on road traffic injuries in urban and rural areas noted in 2010, the United Nations (UN) announced a Decade of Action for Road Safety to emphasize the burden of road traffic associated injuries and fatalities globally

The importance of this was further affirmed by their inclusion into the health targets of the Sustainable Development Goals launched in 2015: Until 20201, a 50% reduction in road traffic deaths and injuries is to be achieved.

In August 2020, the United Nations Assembly rung in the second Decade of Action from 2021 to 2030 by reinstituting the goal to reduce injuries associated with accidents by 50% in the next 10 years

He explained that Uganda shows a vast burden of non-fatal injuries and resides at the top range of countries with the highest death rates due to unsafe roads.

However, little is known about the differences in road traffic associated injuries between urban and rural areas and potential influence factors.

In sectional study conducted by a retrospective medical record review from trauma cases admitted in 2016 to hospitals in rural and urban areas in Uganda injury severity scores were calculated and analysed

According to the 1683 medical records reviewed, the mean age of trauma patients in the dataset under investigation was 30.8 years with 74% male.

The trauma in-hospital mortality was 4% while prevalence of traumatic injuries is 56.4%.

Motorcycle users representing 49.6% and pedestrians 33.7% were identified as the most vulnerable groups in both urban and rural setting while mild injuries of extremities 61.6% and the head/neck-region 42.0% were registered most.

The frequency of road traffic injuries is homogenous in the urban and rural hospitals and the interventions should therefore be intensified ubiquitously.

He notes that at Mulago refereal hospital there is 24 desk of health workers to receive patients involved in accidents with the acute unit and a section dealing with discharged patients who come for review

However the team is overwhelmed because of limited staff and under funding to acquire enough drugs as well as fracture related equipment to help all patients

The estimated cost of care per injured patient is about USD 300 therefore Dr Nyati and team recommend that Boda Bodas continue to be a major cause of road traffic injuries and a significant economic burden.

The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws.

How to correct club foot 

In as far as club foot is concerned Dr Nyatis explained that types of clubfoot with congenital being the most common serious birth defect. 

He notes that in 2008, it was discovered that more than 1,500 children are born with clubfoot in Uganda each year. The number may have dropped given the current awareness about it.

Diriisa Kitemagwa, the principal orthopaedics clinical officer at the hospital, says clubfoot is a range of foot abnormalities usually present at birth (congenital) in which a baby’s foot is twisted out of shape or position. 

Kitemagwa stresses that these congenital abnormalities can be corrected if the operation is carried out shortly after the baby is born.

Successful operations

Anita Namutebi, a resident of Salama Road Village in Munyonyo, is one of the mothers whose baby was born with the defect but it has since been corrected.

The 29-year-old mother of three says her other children were born without any defects and she was traumatised by her youngest child’s condition. 

“However, I am grateful that my husband Dan Kasaga gave me emotional support. I also received advice from my brother that the defect could be easily corrected,” says Namutebi. 

The baby underwent corrective surgery when she was two months old. “After the operation, she was given special shoes to help straighten her legs,” she recounts. The baby girl’s limbs are now free from any deformity.

She urges mothers of children born with such conditions to act urgently and seek medical attention at Mulago National Referral Hospital where services are free of charge. 
Types

He notes that Clubfoot can occur either in one or both feet and can range from mild to severe. 

Kitemagwa explains that clubfoot happens because the tendons  which are bands of tissue that connect muscles to bones and muscles in and around the foot are shorter than they should be.

The widely accepted method is the Ponsetic treatment method which involves manipulation of the tissue of the baby and casting.

The Ponseti method

The Ponseti method was developed by Dr Ponseti, an orthopaedic surgeon based at the University of Iowa in 1963 following extensive anatomical study of the foot.

It has been shown to be safer and more efficient than surgery for the treatment of clubfoot.

This technique, according to Kitemagwa, uses a very specific series of manipulations and castings to correct the foot deformity and complete tenotomy (a surgical act which involves the division of a tendon) of the Achilles’ tendon in most cases to eliminate deformity followed by a further three weeks in a cast. 

The patient must then wear a foot abduction orthosis, a set of boots attached on an immovable bar fulltime for three months.

Thereafter, at night at least until the age of four.

About 200 children born with clubfoot are registered at Mulago National Referral Hospital every year but overall, in all government hospitals, about 2,067 are registered per year.

He advises mothers to consume foods that contain amino acids, calcium and take tablets which contain iron, folic acid and zinc, which are good for bone formation.

Challenge
Kitemagwa notes that usually, mothers who come to the clinic come back for consequent visits with a few cases dropping out along the way due to transport challenges especially those who come from far.

For parents who delay to take their babies, correction may be a challenge because of the expenses. It is important for mothers to start treatment at birth.