Undergraduate Honors Thesis Projects

Date of Award

Spring 2020

Document Type

Honors Paper

Degree Name

Biochemistry and Molecular Biology-BS


Biochemistry and Molecular Biology


Lisa Marr

First Committee Member

Lisa Marr

Second Committee Member

Jeffrey Lehman

Third Committee Member

Karen Steigman


Malawi, Late Presentation, Orthopedics, Healthcare Access

Subject Categories

Community Health and Preventive Medicine | Health Services Research | Higher Education | International Public Health | Public Health


Staff at CURE International, a non-profit organization that provides orthopedic care in Malawi, noticed a high prevalence of patients with congenital orthopedic conditions who are presenting late for treatment. Late presentation results in prolonged pain or discomfort for the patient and has the potential for increased cost to the institution, longer duration of treatment, and decreased quality of outcomes. To identify the factors that influenced presentation delays, we surveyed the caregivers of patients with congenital conditions that were seen in out-patient clinics, in-patient wards, and mobile clinics across the country. Sixty-two caregivers were surveyed; forty-two patients had a diagnosis of clubfoot and twenty patients had other diagnoses. This study found that caregivers were statistically more likely to bring their child in late for treatment if they possessed any one of the following characteristics: they were residents of the Northern or Central regions of Malawi, were illiterate, were not notified at birth of their child’s condition, had a child with a congenital orthopedic condition other than clubfoot, gave birth at home rather than at a hospital, or did not live close to a main road. Other correlations were made between survey answers and late presentation, but they were either not statistically analyzed or not considered to be statistically significant. Caregivers that were older, reported unaffordable transportation, had a monthly income on the lower spectrum, or had more than three children/dependents were more likely to bring their child in late for care. The small sample size limits the statistical power of the results. Further analysis of the existing data or a larger clubfoot study across all CURE locations with a revised questionnaire would be valuable for determining these critical deterrents to timely access.