Factors Associated with Clubfoot Bracing among Mothers of Children Under Five Years Attending AIC Cure International Hospital in Kijabe, Kenya

Abstract

Disability has emerged as a major public health problem worldwide. Physical disabilities are common in nations with disparate levels of socioeconomic development, among them clubfoot. Clubfoot presents early in neonatal life and if not treated becomes more disabling with age. Prevalence of clubfoot has been established to be 1.1 per 1000 births in the United States. In Africa, the prevalence has been established to be 1.2 per 1000 births in Uganda and 3.4 in 1000 births in Nigeria. The study sought to determine factors associated with non-compliance to bracing in clubfoot management among children under five years in AIC Cure International Children’s Hospital, Kijabe, Kenya. The study adopted a cross-sectional descriptive design. It was carried out at AIC Cure International Children’s Hospital, Kijabe, Kenya between April and August 2018. The study used a sample size of 174 participants. Ethical approval was sought from KNH/UON Ethical Review Committee before data collection. A semi-structured pre tested questionnaire was used to collect data. Four focused group discussions were conducted among mothers of children with different characteristics. Quantitative data was entered for analysis using SPSS version 23.0. Chi square and Fisher’s exact tests were performed to determine association between dependent and independent variables. Presentation was done through frequencies, percentages, tables and charts. Data from FGDs was analyzed using a three-stage thematic approach. Verbatim and textual summaries was used to present qualitative data where applicable. The proportion of non compliance to bracing was 16.8%, and the cases of non-compliance to bracing were mostly reported in mothers of male children (23.1%), and mostly among mothers of children aged between 7-9 months of age (25.0%). Majority of those who did not comply to bracing (36.8%) had secondary education and below. Inability to meet transport costs, gender of the child and level of knowledge had significant association with bracing with a p-value of 0.006, 0.001 and 0.026 respectively. The study concluded that 83.2% of mothers complied to bracing which is a very positive finding. However, 16.8% of children with club foot are at a risk of getting a permanent disability because their mothers did not comply to bracing, which calls for an intervention since this is a public health risk. Also, 37.2% of the mothers did not exhibit knowledge on bracing which poses a disability risk to their children. The study recommends sensitization of communities/households through community heath volunteers and empowerment of local facilities to be able to manage conditions like clubfoot in order to avoid relapse or even permanent disability due to non-compliance. There is also need for health education and promotion on clubfoot bracing and compliance.