Screening for Developmental Dysplasia of the Hip in Saudi Arabia: Technically Feasible, but Social Barriers Persist

Objectives: Developmental dysplasia of hip (DDH) is a complex spectrum of hip abnormalities, where timely diagnosis and management can improve outcomes.Evaluation soon after birth and during early infancy can help identify at-risk infants.In this study, we present a brief review of our DDH screening program and a retrospective observational study of the barriers to DDH screening/follow-up in a large clinical cohort of infants in the Kingdom of Saudi Arabia (KSA).Methods: This retrospective observational cohort study was conducted in the KSA for an 8-month period between December 2023 and July 2024.We evaluated infants with 2 risk factors for DDH and followed them with at least one in-person visit, followed by direct clinical and/ or telephone contact.A standardized questionnaire was used to understand parental perception and factors affecting compliance with the screening process.Results: We first describe the key components of our DDH screening program, followed by a study of barriers to its success.We followed a cohort of 3,598 infants; 95 were identified as high-risk for DDH.The most frequent prenatal risk factors were breech deliveries, positive family history, preterm birth, and twin gestation.The diagnosis of DDH was confirmed in 48 (50.5%) infants.The major reason for missing the other 47 (49.5%) at-risk patients was ineffective communication.In 36 of 47 cases (76.6%), the contact information had not been recorded correctly.In 11 of 47 (23.4%), parents were not aware of the importance of timely diagnosis and close follow-up.In 13 of 47 (28.6%), difficulties in access to medical support because of long distance/difficult terrain was the primary difficulty.Others either did not believe in the need for screening [2/47 (4.2%)] or missed their appointment [4/47 (8.5%)].In a few families, responsibilities related to other members in the household and cultural beliefs about DDH screening may have contributed to noncompliance.Improvement in parental education regarding DDH raised the compliance rate with follow-up by 20%.Conclusion: Parental noncompliance with DDH follow-up screening programs is influenced by multiple factors.The most frequent reasons were related to difficulties with communication and inaccuracy of parental contact information.Parental education about the importance of timely diagnosis of DDH and the risks of delayed intervention is essential.The geographic location of the families from medical facilities was also important; the access through long distances and/or difficult terrain needs to be improved.