MSU partnering with hospital in Ethiopia on clubfoot, hip dysplasia education

Videos instruct parents on early detection, symptoms and corrective procedures.

Dr. Richard Gardner explains to MSU faculty member Dr. Julia Bello-Bravo treatment procedures of a patient in the CURE Children's Hospital In Ethiopia.
Dr. Richard Gardner explains to MSU faculty member Dr. Julia Bello-Bravo, left, treatment procedures of a patient in the CURE Children's Hospital In Ethiopia.

Through animated video, two Michigan State University (MSU) professors in the College of Agriculture and Natural Resources are helping parents, healthcare professionals and midwives in Ethiopia detect the early signs of clubfoot and dislocated hips in infants.

Some 4,000 children in Ethiopia are born with clubfoot each year. Many are also born with a dislocated hip (also known as Developmental Dysplasia of the Hip, or DDH). Early detection is vital to correcting these developmental conditions without surgery.

Michigan State University assistant professor in the Department of Food Science and Human Nutrition Julia Bello-Bravo and MSU Foundation Professor in the Department of Entomology Barry Pittendrigh have been working with CURE Ethiopia Children’s Hospital on recognizing these conditions and seeking early treatment.

“The videos have been a hugely valuable way of communicating about each health condition and the management of those in a way that is hard to portray in pictures and text alone,” said Rick Gardner, orthopedic surgeon and medical director at CURE Ethiopia.

“The videos have been shown to parents and healthcare professionals alike and are integral to developing the (treatment) programs. They have been integral to our DDH midwife education program. They are easy to understand and are a wonderful way of portraying the main issues in a highly accessible format,” Gardner said.

Scientific Animations Without Borders (SAWBO) was founded by Bello-Bravo and Pittendrigh about a decade ago to provide agricultural information to diverse audiences in more than 140 different languages. The success of those early videos fostered more animations on topics related to health and equality.

In 2014, SAWBO partnered with CURE Ethiopia on the clubfoot video. In 2016, Gardner inquired about creating a video on hip dysplasia. Bello-Bravo and Pittendrigh traveled to Ethiopia and met with Gardner to learn more about the challenges and the children affected by the condition.

Drs. Richard Gardner (left) and Julia Bello-Bravo (right) discuss collaborative efforts in a waiting room in the CURE Children's Hospital In Ethiopia.

“We were immediately convinced by Dr. Gardner of the need for a hip dysplasia video, because of the need to alert mothers to the symptoms and treatment available for their infants,” Bello-Bravo said. “If treated early, it's a simple cloth harness (that effectively puts the hip back into joint). Later in life, substantial surgery is needed, followed by months in a body cast.”

Gardner said clubfoot is easily diagnosed early in a child’s life.

“We have approximately 1,500 children per year receiving treatment for clubfoot and this number is expanding each year with the aim of providing nationwide coverage in the years to come,” he said.

“Currently, the majority of children with hip dysplasia are diagnosed when they start to walk with a limp. We are working to develop a similar screening program as those in high-income countries where DDH is routinely diagnosed in infancy and managed without the need for surgery. The huge challenge is raising awareness in Ethiopia, not just among the public, but in the healthcare sector. The SAWBO animation has been an essential part of the program.”

Gardner said the videos are effective due to their wide distribution and accessibility across a diverse range of parents, medical professionals and midwives.

“There aren’t many hospitals (in Ethiopia) that will treat these kinds of problems, so families may have to travel long distances to reach the hospital and they need to know that these treatment options are available for their children,” Bello-Bravo said. “Thus, our goal was to develop a tool that could be used for awareness across a great diversity of groups and areas, both in urban and rural areas.”

Bello-Bravo and Pittendrigh collaborate with teams of researchers and other experts in putting together the information for each animation, while volunteers translate the language and partner with SAWBO animators to create the videos. The animations can take months or upwards of a year to produce. The process also requires a large number of experts to ensure the content is factual and current.

“I think one of the things that's quite exciting about this is the collaboration of global professionals and the technology that allows us all to work together from all corners of the world. Experts are giving their time to create something that is used around the world and often we never even have to leave our desks,” Pittendrigh said. 

In the case of the clubfoot animation, the group worked with five orthopedic surgeons from around the world, all of whom volunteered their time.  

“One of the most powerful things about SAWBO is our ability to tap into a global network of talented people as volunteers, such as orthopedic surgeons for the clubfoot animation, towards outcomes of common good. In this case, helping children to walk,” Bello-Bravo said.

In addition, Bello-Bravo’s research program is focused on how such content can be made impactful and scalable.  She recently published an article showing the effectiveness of SAWBO’s videos on educating farmers in Mozambique on post-harvest bean storage methods. The report showed that distributing the videos in the local language results in high knowledge retention and adoption rates.

“People are willing to learn from these videos,” Bello-Bravo said. “You can take these across cultures and see a very broad use.” 

This effect has been seen in Ethiopia through clubfoot and hip dysplasia education and has also recently been integrated into training programs for medical professionals.

“The (hip dysplasia) video has been shown to over 180 midwives and has been an integral part of their training in infant hip examination,” Gardner said. 

According to Bello-Bravo, “Our goal has been focused on making the materials accessible for the general population, and it is exciting to see such content is also being used in medical training efforts.”

CURE Ethiopia is a pediatric orthopedic teaching hospital located in Ethiopia’s capital city, Addis Ababa. The hospital saw nearly 10,000 patients in Fiscal Year 2019 and performed nearly 3,000 procedures.

SAWBO animations can be viewed at the organization’s website. The animations are free and available for educational use.

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