Initial program evaluation of the Ponseti method in Nigeria.

The Ponseti method for correcting clubfoot is a safe, effective, and low-cost treatment that has recently been implemented in Nigeria. This study evaluates the initial impact of the Ponseti method and the unique challenges to its diffusion among practitioners and patients. Information was obtained by traveling to Ponseti clinics to interview or give questionnaires to the Ponseti method practitioners and the parents of children with clubfoot. The challenges identified among the practitioners were: 1) an inadequate amount of information; 2) inadequate resources; 3) insufficient training programs; and 4) a lack of funding. The challenges among parents were: 1) a deficit in knowledge about clubfoot and its treatment; 2) financial constraints; 3) culture and religious practices, and 4) difficulties with treatment compliance. Information from this study can be used to implement specific strategies to improve the dissemination and implementation of the Ponseti method for treating clubfoot in Nigeria and throughout West African nations that share cultural and socioeconomic commonalities.

Management of cleft lip and palate in Nigeria: A survey.

Clefts of the lip and/or palate are the most common congenital craniofacial defects and second only to club foot among all congenital anomalies. The management of this condition is resource intensive due to the multidimensional needs. This survey was carried out to ascertain the current state of cleft management in Nigeria with emphasis on training, scope of management, and assessment of treatment outcome.Structured questionnaires were administered to cleft surgeons based on professional and practitioners’ register and the result of literature search for cleft surgeons whose names may not appear in the registers.A total of 69 returned questionnaires were analyzed. The highest number of surgeons was from southwest geopolitical region while the northeast had the least. Fifty-eight (84.1%) were specialists with the fellowships. Forty-seven had been cleft surgeons for <10 years. Majority undertook lip repair between 3 and 4 months while 50% did cleft palate at or more than 9 months. Millard rotation and advancement was used for lip repair by 91.2% and 44 employed the von Langenbeck technique for palatal repair. Forty-six respondents carried out nasal repair at the time of lip surgery with 44 doing this as closed rhinoplasty. Adhesive tapes were usually employed by 44 (63.7%) for managing the protruding premaxilla. Orthodontic evaluation was not usually part of the treatment plan of 34 respondents. Otology assessment and assessment of velopharyngeal competence were rarely done. Revision surgeries, alveolar bone grafting, rhinoplasties, and maxillary osteotomies were uncommon. Interdisciplinary team care approach was practiced by 54 (78.2%) respondents.Findings suggest an increase in the number of surgeons, but the training, scope, and standard of care remain relatively limited. Audit and assessment of the practice should also become points of emphasis.