Retrospective Study to Identify the Clubfoot among the Mothers of Afflicted Children in Kashiben Govardhan Das Patel Children Hospital, Vadodara

 

Mrs. P. Karthika¹, Ms. Afreen², Ms. Asrafa², Ms. Nadira², Ms. Steffy², Ms. Salini²

¹MSc. Nursing, Associate Professor, Welfare College of Nursing and Midwifery,

South Gujarat, Bharuch-392001.

²IV Year Bsc Nursing Students, Welfare College of Nursing and Midwifery, South Gujarat, Bharuch- 392001.

 

ABSTRACT:

Clubfoot is a congenital anomaly most often present at birth. Its is caused by shortened Achilles tendon, which causes the foot to turn in and under. It is more common in male child. Clubfoot can be classified into postural or positional and fixed or rigid. Treatment is necessary to correct clubfoot and usually done in two phases-casting and bracing. Children with clubfoot should be able to take part in regular daily activities once the condition is treated. Objectives: 1. To Identify the causes of clubfoot among the mothers of children. 2. To find out an association between causes of clubfoot with socio-demographic variables. 3. To co-relate the demo graphic variable regarding causes of clubfoot among mothers of afflicted children. Methods: A Retrospective study was conducted from 25^th November 2019 to 5^th December 2019. We have selected the cases by Probability sampling in which Total enumerative sampling technique was used. Total 40 samples were selected from Rehabilitation centre and orthopaedic OPD from Kashiben Govardhandas Patel Children Hospital, Vadodara. It consists of 8 socio demographic variables of mother and 20 dichotomous questionnaire were used to identify the causes of clubfoot among the mothers of afflicted children. Result: Determination of the causes of the afflicted child with clubfoot that, age group of mothers 21-25 is 37.5% and age group of above 31 is 37.5%of mothers had severely afflicted whose score range from 0-6, age group of 26-30 is 17.5 % of mothers had moderately afflicted whose score range from 0-6 and age group of 15-20 is7.5% of mothers had mildly afflicted whose score range from 0-6. There was a significant association between socio-demographic variables and causes of clubfoot that age of the mother, religion, birth order, family income, education, type of marriage, history of clubfoot and complication of the mother Conclusion: As per statistical analysis the researcher conclude that after completion the research there is significant association between socio-demographic variables and causes.

 

 

 

INTRODUCTION:

“Children want the same things we want. To laugh, to be challenged, to be entertained and delighted”

 Dr. Seuss

Clubfoot also known as Congenital Talipes Equinovarus. It is a complex congenital deformity of the foot. The deformity affects structure and position of foot. In clubfoot the baby’s foot is twisted out of shape or position. The foot may be deformed in planter flexion (talipes equinus) or dorsiflexion (talipes calcaneous). The foot maybe abducted and inverted (talipes varus) or abducted everted (talipes valgus) or various combinations of these.

 

“Congenital clubfoot (also termed congenital talipes equinovarus) is a congenital anomaly that occurs in one out of 1000 live birth. [A Padmaja, 2008]

 

“Clubfoot is one of the most common orthopaedic deformities.”

 

“Clubfoot is a complex deformity of foot result of complicated inter relationships between bone, ligament and muscles.” [Manoj Yadav’s, 2015]

 

INCIDENCE AND PREVELANCE OF CLUBFOOT

 

It shows the occurrence of clubfoot.

1 to 3 per 1000 live birth, half of cases are bilateral, boys are two times more affected than girls. 95% cases are talipus equinovarus. associated with spina bifida, meningocele and myelodystrophy. The incidence of clubfoot differ among ethnicities.

 

Factors affecting clubfoot:

·       Malpresentation

·       Cerebral palsy

·       Gender

·       Hip dysplasia

·       Developmental dysplasia of hip

·       Oligohydramnios

·       Family history

·       Smoking

 

TREATMENT:

·      Principles of management: Treatment should be started at birth. Tratment should initially be conservative. Correction must be gradual and gentle avoiding trauma.Early surgery must be only on soft tissues.

·      Manipulation of the foot: Teach parents for manipulation. Supervise the parents for perfection. Implement the manipulation procedure to gain confidence of parents and their cooperation.

·      The Pirani scoring system: The Pirani scoring system, devised by Shafiq Pirani, MD, of Vancouver, BC, consists of six categories, three in the hindfoot and three in the midfoot; the Pirani scoring system can be used to identify the severity of the clubfoot and to monitor the correction.

·      Traditional nonoperative treatment: With traditional nonoperative treatment, splintage begins at 2-3 days after birth; merely bring the foot to the best position obtainable, and maintain this position either by strapping every few days or by changing casting weekly until either full correction is obtained or correction is halted by some irresistible force

·      Plaster of Paris casts

·      Denis-Browne splint

·      Bracing for clubfoot

 

NEED FOR STUDY:

Michelle C. et all 2013 Vietnam conducted study on “Descriptive epidemiology of clubfoot in vietam : a clinic based study”. The aim of this study was to evaluate specific environmental and socioeconomic factors that may increase the risk of an infant being born with clubfoot. The result of our study confirm male sex as a strong risk factor for clubfoot (63% of males compared to 33% of females, n=96). The proportion of cases with bilateral clubfoot was similar to those previously reported. Prior studies have demonstrated a higher prevalence of right sided clubfoot. This study shows young maternal age to be significantly associated with increased risk of clubfoot (35% of case mothers younger than 25 yrs old compared to 18% of control mothers (P=0.033). Mainly males are more commonly affected by clubfoot by 2:1 ratio and 50% cases affected with bilaterally.

 

REVIEW OF LITERATURE:

Adnan Ansar, Ahmed Ehsanur Rahmar et all (2018), conducted study on “systematic review and meta analysis of global birth prevalence of clubfoot.”- A study protocol. The aim of this systematic review and metaanalysis is to estimate the global birth prevalence of congenital clubfoot. A standard data extraction form used to extract relevant information from included studies the Joanna Briggs Institute appraised checklist used to access over all quality of studies reporting prevalence. The result of the studies are over all random effects of pulled estimate with 95% CIS [P>0.05].

 

Rosalind M Owen et all (2015) conducted study on “Clubfoot treatment in 2015: a global perspective”. The aim of the study is clubfoot affects approximately 90% of these in low income and middle income countries (LMIC). therefore the minimally invasive ponseti treatment is highly effective. The objective of this cross-sectional study is to quantify the numbers of countries providing services for clubfoot children. The result may responses were received from 55 countries, in which 79% of all expected cases of clubfoot were born. More than 24,000 children with clubfoot were enrolled for ponseti treatment in 2015.Coverage was less than 25% in the majority of countries. There were higher level of response and coverage within the lowest income country group.31 countries reported a national programme for clubfoot, with the public private partnership.

 

METHODOLOGY:

RESEARCH APPROACH:

A quantitative research approach was adopted in present study as the researcher wants to know the causes of clubfoot among the afflicted mothers of children in kashiben Govardhandas Patel Children Hospital, Vadodara.

 

RESEARCH DESIGN:

The research design selected in this study is retrospective research design to identify the causes of clubfoot.

 

VARIABLES OF THE STUDY:

Dependent variable:

mothers of afflicted children with clubfoot.

 

Independent variable:

identify the causes of clubfoot.

 

Setting of study:

The present study will be conducted in Kashiben Govardhandas Patel Children Hospital of Vadodara city which will be selected according to the convenience of the researcher and easy geographical accessibility.

 

Population of study:

0-15 years of children with clubfoot.

 

Sample:

The samples of present study include, 0-15 years of children with clubfoot in Kashiben Govardhandas Patel Children Hospital, Vadodara.

 

Sample size:

Totally 40 samples who met the inclusion criteria were will select for the present study.

 

Sampling Technique:

Total enumerative sampling technique was used for the present study.

 

Criteria for Selection of Sample:

1.     Inclusion criteria

2.     Exclusion criteria

 

1.     Inclusion criteria:

·       Children with age 0-15 years.

·       Children with clubfoot.

·       Mothers who are willing to participate.

·       Mothers who are interested to be part of the study.

·       Mothers who are present.

·       Mothers who can understand and communicate in Gujarati.

 

2.     Exclusion criteria:

·       Mothers who are not willing to participate.

·       Mothers who are not intersted to be part of the study.

·       Mothers who are not having children with clubfoot.

·       Mothers who are absent on the of study.

 

 

DESCRIPTION OF THE TOOL:

SECTION I: Discription Of Demographic Variables of Afflicted Children Mothers with Clubfoot.

 

TABLE 1: Frequency and Percentage distribution of afflicted children mother with clubfoot according their Age, Religion, Birth order of child, Family income, Education, Type of marriage, History of clubfoot, Complications during pregnancy.

S.No		Variables	Frequency	Percentage
1.	Age	15 – 20	3	7.5%
		21 - 25	15	37.5%
		26 - 30	7	17.5%
		31 above	15	37.5%
2.	Religion	Hindu	20	50%
		Muslim	17	42.5%
		Christian	15	7.5%
3.	Birth order of child	1	22	55%
		2	13	32.5%
		3	5	12.5%
		4	0	0%
4.	Family income	Less than 5000	13	5%
		5001 -10,000	21	52.5%
		10,001 -15,000	13	32.5%
		15,001 -20,000	2	5%
		Above 20,000	2	5%
5.	Education	Primary	13	32.5%
		Secondary	20	50%
		Graduation	5	12.5%
		Post graduation	1	2.5%
		Uneducated	1	2.5%
6.	Types of marriage	Consanginous	16	16%
		Non-consaginous	24	60%
7.	History of clubfoot	Mothers relation	5	12.5%
		Fathers relation	5	12.5%
		Nil	30	75%
8.	Complication during pregnancy	Oligohyramnious	13	37.5
		PID	5	12.5%
		GDM	0	0%
		Malpresentation	10	25%
		nil	18	45%

 

SECTION II: To identify the causes of afflicted children mother with clubfoot

 

TABLE 2: MEAN, MEDIAN, MODE & SD OF SELECTED CASES OF AFFLICTED CHILD MOTHERS

AFFLICTED CHILD MOTHERS	Mean [X]	Median [M]	Mode [Z]	Standard deviation [SD]
Yes	16.97	17	18	5.9717
No	3.025	3	2	6.1238

 

 

TABLE 3: ASSOCIATION OF THE CAUSES OF AFFLICTED CHILDREN WITH CLUBFOOT WITH SELECTED DEMOGRAPHIC VARIABLES.

S. No	Demographic variable	Degree of freedom	Calculated value	Table value	Result
1	Age of mother	6	22.071	12.59	significant
2	religion	4	20	9.49	significant
3	Birth order	6	18	12.59	Significant
4	Family income	8	216.5	12.51	Significant
5	Education	388	15.51	8	Significant
6	Type of marriage	24	3.84	1	Significant
7	History of clubfoot	4	35	9.49	Significant
8	Complication during pregnancy	8	27.9	12.51	Significant

 

 

The data presented in the table 3 represent that there is significant relationship between the causes of clubfoot with social demographical variables like age of mother, religion, birth order, family income, education, type of marriage, history of clubfoot, complication during pregnancy.

 

Research hypothesis-

There will be an significant association between with selected demographical variables, Hypothesis is accepted.

 

IMPLICATION FOR NURSING EDUCATION:

The Child Health Nursing curriculum needs to be recognized to enable nursing personnel to identify causes of clubfoot regarding children so as to provide supportive education to cope up with proper management of clubfoot condition.

·       The Students can utilize the self structured knowledge questionnaire to identify the causes of clubfoot.

·       The result can use as an example by teacher in the class room for giving important health education.

·       Guidance and counselling with parents before conceiving pregnancy regarding risk associate with pregnancy and prevention of complication.

 

Implication for nursing research:

One of the aims of nursing research is to contribute the knowledge to the body of nursing, to expand and broaden the scope of nursing.

·       The study helps nurse researcher to develop insight into the development of teaching module and material for clubfoot condition towards promotion of quality of life and selected aspect of clubfoot children.

·       This study can effectively utilize by emerging research for their reference purposes.

 

Implication for nursing administration:

Nurse administrator should take part in making of healthy policy, development of protocol and sending order with respect to clubfoot children.

·       Seek a detail history of clubfoot or neuromuscular disorder and perform general examination to identify any other abnormalities.

·       Examine the feet with child prone with planter aspect of feet visualized and supine to evaluate internal rotation and varus. If child can stand determine whether the foot is plantigrade, whether the heel is bearing weight and whether it is in varus, valgus or neutral.

 

RECOMMENDATIONS:

·       The study can be conducted with larger sample in another setting.

·       A comparative study may be conducted on which groups are more vulnerable to affect with clubfoot.

·       A similar study can conducted in physiotherapy or rehabilitation.

 

REFERENCES:

1.     A. Mustafa, Textbook of Nursing Research and Statistics, Published by Aitbs Publishers India, page no – 570.

2.     Parul Datta’s “Textbook of Child Health Nursing” second edition, published by Jaypee Brothers, page no – 456.

3.     Manoj Yadav’s “Child Health Nursing”, Published by Pee Vee (Regd), Page no- 636.

4.     B. T. Basavanthappa, “Text Book of Nursing Research” 1 st edition, Published by Jaypee Brothers, Page no – 712 to 713.

5.     Jacob Annamma, “A comprehensive Textbook of Midwifery, “1 St Edition, Published by Jaypee Brothers, Page no -72.

6.     Suresh K Sharma, “Nursing Research and Statistics”, 2nd edition, Published by Elsevier, page no – 246 to 293.

7.     B.T. Basavanthappa, “Textbook of Community Health Nursing”, 1 St edition, Published by Jaypee Brothers (P) New Delhi; page no – 205 ,206.

8.     Sunanda. S. Roy, “A Textbook of ' Nursing Research and Statistics', 2 nd Edition, Published by Kumar Publishing House, Page no – 57 to 60.

9.     Dorothy R. Marlow, Barbara A. Redding, “Textbook of Pediatric Nursing”, Published by Jaypee Brothers, Page no.-529.

10.  A Pajmaja,” Textbook of Child Health Nursing”, Published by Jaypee Brothers, page no.-636.

11.  Dobbs MB, Gurnett CA.Update on clubfoot: etiology and teatment. Clin Orthop Relat Res 2009.

12.  Smythe T, Kuper H, Macleod D, et al. Birth prevalence of congenital talipes equinovarus in low-and middle-income countries:a systematic review and meta-analysis.Trop Medline Health 2017.

13.  Irani RN, Sherman MS. The pathological Anatomy of Idiopathic clubfoot.clin.Orthop. Gurnett CA,Boeham S, Connolly A, Reimschisel T, Dobbs MB. Impact of congenital talipes equinovarus etiology on treatment outcomes. Dev Medline 2008;50(7): page no:498-502

14.  Zhao D, Li H, Result of clubfoot management using the ponseti method: A Systematic Review. 2014 page no:1329;1336. (Retrieved from http://www .ncbi.nlm.nih.gov/pubmed/18604059)

 

 

Received on 07.01.2020          Modified on 26.02.2020

Accepted on 18.04.2020     © AandV Publications all right reserved