The global birth prevalence of clubfoot: a systematic review and meta-analysis

BACKGROUND: Estimates of the birth prevalence of clubfoot in low and middle income settings range from 0.5 to 2 per 1000 births. However, there is currently no estimate of global birth prevalence of clubfoot. METHODS: We conducted a systematic review of studies reporting the birth prevalence of clubfoot across all countries and regions worldwide in the last 10 years. Africa Wide Information, EMBASE, CINAHL, Global Health, LILACS and Medline databases were searched for relevant studies from January 1st 2012 to February 9th 2023. Pooled prevalence estimates were calculated using the inverse variance method, and a random effects model was applied to account for heterogeneity between studies. Quality appraisal was performed using a modified Newcastle–Ottawa Quality Assessment Scale for Cohort studies. This review was registered with PROSPERO, CRD42023398410. FINDINGS: The search generated 757 studies. Thirty-five studies from 36 countries and five WHO regions were included. The pooled prevalence of clubfoot was 1.18 per 1000 births (95% CI: 1.00–1.36) based on data from 44,818,965 births. The highest prevalence rates were observed in low- and middle-income countries, particularly in the South-East Asia Region (1.80, 95% CI: 1.32–2.28) and the Africa Region (1.31, 95% CI: 0.86–1.77). We estimate that 176,476 (95% CI: 126,126–227,010) children will be born with clubfoot globally each year. INTERPRETATION: This study provides a comprehensive estimate of the global prevalence of clubfoot and highlights the significant burden of this condition, particularly in low- and middle-income countries. The findings underscore the need for improving access to effective treatment and prevention strategies in resource-limited settings. FUNDING: SR received funds from the 10.13039/100020000Global Clubfoot Initiative and the Rhodes Trust.