We can minimise the risk that our children will be born with clubfoot

12Jun 2019
The Guardian
We can minimise the risk that our children will be born with clubfoot

Clubfoot is a birth defect where one or both feet are rotated inward and downward. The affected foot and leg may be smaller than the other. In about half of those affected, both feet are involved.

Most cases are not associated with other problems.  Without treatment, people walk on the sides of their feet, which causes problems with walking.  

 Because the cause of clubfoot is unknown, there are no definite ways to prevent it from occurring. However, we can minimize the risk that our children will be born with a clubfoot by not smoking or drinking during mothers’ pregnancy.

The exact cause is usually unclear.  Initial treatment is most often with the Ponseti method.  This involves moving the foot into an improved position followed by casting, which is repeated at weekly intervals.  Once the inward bending is improved, the Achilles tendon is often cut, and braces are worn until the age of four.  Clubfoot occurs in about 1 in 1,000 newborns.

There are many hypotheses about how clubfoot develops. Some hypothesis include: environmental factors, genetics, or a combination of both. Research has not yet pinpointed the root cause, but many findings agree that  it is likely there is more than one different cause and at least in some cases the phenotype may occur as a result of a threshold effect of different factors acting together. 

The Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) has encouraged parents to seek treatment as soon as possible for children with clubfoot.

CCBRT’s Chief Executive Officer, Brenda Msangi made the call in Dar es Salaam recently when speaking to journalists as part of commemorating the World Clubfoot Day—an initiative of the Ponseti International Association to commemorate the birthday of Ignacio Ponseti, the pioneer of the Ponseti technique for clubfoot treatment.

The day is commemorated on June 3rd each year and it is used to create awareness and fundraise for free and low-cost clubfoot treatment at CCBRT,

Parents and guardians are encouraged to seek treatment as soon as possible for children with clubfoot, which we provide free of charge at CCBRT for children below the age of five.  With the support of partners like Miraclefeet and CBM, the lives of hundreds of children with clubfoot improve dramatically following treatment at CCBRT. We thank our partners not only for supporting clubfoot treatments, but also helping to prevent disability in Tanzania.

Clubfoot can cause pain when walking or the inability to walk, leading to social stigma and preventing children from going to school. Clubfoot has an estimated prevalence of 1 out of 750 live births annually.

Of the approximately1, 813,000 children who are born with clubfoot annually worldwide, 80 per cent of these are in low and middle income countries. 400,000 of those cases found in sub-Saharan Africa (22 pc), and in Tanzania, 2,500 to 2,800 children every year are born with the condition.

The earlier the initiation of treatment, the better the outcome of the treatment.  Children who end their series of treatment too early can require painful and expensive surgery later, with limited success rates. In 2013, CCBRT partnered with TIGO to reduce the amount of children that drop out of clubfoot treatment. Clubfoot is mainly treated with a technique called the Ponseti Method.This approach is the gold standard of treatment for clubfoot, correcting alignment through a process of manipulation, casting and bracing over a period of time to manipulate the affected foot. Here at CCBRT, we are proud to treat about 400 children with clubfoot annually, enabling Tanzanian children to reach their full potential.


Sub-Saharan Africa correlated with  changes in the demand for ivory from China


Poaching has been defined as the illegal hunting or capturing of wild animals, usually associated with land use rights. According to Encyclopædia Britannica, poaching was performed by impoverished peasants for subsistence purposes and a supplement for meager diets. Poaching was as well set against the hunting privileges of nobility and territorial rulers. By contrast, stealing domestic animals  as in cattle raiding, for example  classifies as theft, not as poaching.

Since the 1980s, the term  poaching has also referred to the illegal harvesting of wild plant species. In agricultural terms, the term  poaching is also applied to the loss of soils or grass by the damaging action of feet of livestock which can affect availability of productive land, water pollution through increased runoff and welfare issues for cattle.

Austria and Germany refer to poaching not as theft, but as intrusion in third party hunting rights. While Germanic law allowed any free man including peasants to hunt, especially on the commons, Roman law restricted hunting to the rulers. In Medieval Europe feudal territory rulers from the king downward tried to enforce exclusive rights of the nobility to hunt and fish on the lands they ruled. Poaching was deemed a serious crime punishable by imprisonment, but the enforcement was comparably weak until the 16th century. Peasants were still able to continue small game hunting, but the right of the nobility to hunt was restricted in the 16th century and transferred to land ownership.

Elephant poaching in Africa has dropped significantly from a peak in 2011, according to a new analysis of annual surveillance data. The progress seems to have resulted in large part from declining demand for ivory in China, which has banned the trade, and government action in some African countries.

  According to a study published in the journal Nature Communications. The annual poaching mortality rate fell from a high of more than 10 per cent in 2011 to less than 4 per cent in 2017, but the researchers warned that current levels were still unsustainable and could spell trouble for the future of the animals on the continent.

An estimated 350,000 elephants remain in Africa, but 10,000 to 15,000 are killed by poachers every year.The team, from the University of York, University of Freiburg and the Convention on International Trade in Endangered Species, analysed data from 53 protected sites across 29 countries between 2002 and 2017.

They observed a decline in the annual poaching mortality rate – the percentage of elephants killed through poaching each year – and found it was linked with reduced demand for ivory across China that may be linked to a drop in the Chinese economy. The number began to fall before the introduction of a ban on ivory trade in the country in 2017, they said. Differences in poaching between sites was found to be linked with levels of corruption and poverty.

“We are seeing a downturn in poaching, which is obviously positive news, but it is still above what we think is sustainable so the elephant populations are declining,” said Dr Colin Beale, co-author of the study from the University of York.“The poaching rates seem to respond primarily to ivory prices in south-east Asia and we can’t hope to succeed without tackling demand in that region.”The researchers called for continued investment in law enforcement to reduce poaching, alongside action to cut ivory demand and tackle corruption and poverty. Severin Hauenstein, from the University of Freiburg, said: “This is a positive trend, but we should not see this as an end to the poaching crisis. After some changes in the political environment, the total number of illegally killed elephants in Africa seems to be falling but, to assess possible protection measures, we need to understand the local and global processes driving illegal elephant hunting.”