Rehabilitation status of children with cerebral palsy in Bangladesh: Findings from the Bangladesh Cerebral Palsy Register.

Mahmudul Hassan Al Imam,Hayley Smithers-Sheedy,Mohammad Muhit,Nadia Badawi,Gulam Khandaker,Sarah Mcintyre,Israt Jahan,Manik Chandra Das,Enamul Kabir

doi:10.1371/journal.pone.0250640

Abstract

The objective of this study was to assess the rehabilitation status and factors associated with rehabilitation service utilisation among children with cerebral palsy (CP) in Bangladesh. This is a population-based surveillance study conducted among children with CP registered in the Bangladesh CP Register (BCPR), the first population-based register of children with CP aged <18 years (y) in Bangladesh. Children with CP were identified from the community using the key informant method and underwent a detailed neurodevelopmental assessment. Socio-demographic, clinical and rehabilitation status were documented. Unadjusted and adjusted analyses with a 95% confidence interval (CI) were used to identify potential predictors of rehabilitation service uptake. Between January 2015 and December 2019, 2852 children with CP were registered in the BCPR (mean (standard deviation, SD) age: 7 y 8 months (mo) (4 y 7 mo), 38.5% female). Of these, 50.2% had received rehabilitation services; physiotherapy was the most common type of service (90.0%). The mean (SD) age at commencement of rehabilitation services was 3 y 10 mo (3 y 1 mo). The odds of not receiving rehabilitation was significantly higher among female children (adjusted odds ratio (aOR) 1.3 [95% CI: 1.0-1.7], children whose mothers were illiterate and primary level completed (aOR 2.1 [95% CI: 1.4-3.1] and aOR 1.5 [95% CI: 1.1-2.1], respectively), fathers were illiterate (aOR 1.9 [95% CI: 1.3-2.8]), had a monthly family income ~US$ 59-118 (aOR: 1.8 [95% CI: 1.2-2.6]), had hearing impairment (aOR: 2.3 [95% CI: 1.5-3.5]) and motor severity (i.e. Gross Motor Function Classification System level III (aOR: 0.6 [95% CI: 0.3-0.9]) and level V (aOR: 0.4 [95% CI: 0.2-0.7])). Rehabilitation status was poor among the majority of the children with CP in the BCPR cohort, limiting their opportunities for functional improvement. A community-based rehabilitation model focusing on socio-demographic and clinical characteristics should be a public health priority in Bangladesh.

Highlights

Childhood disability is a global public health concern due to its lifelong impact on physical and psychological wellbeing
Between January 2015 and December 2019, 2852 children with Cerebral palsy (CP) were registered in the Bangladesh CP Register (BCPR) (mean age: 7 y 8 months (4 y 7 mo), 38.5% female)
Rehabilitation status was poor among the majority of the children with CP in the BCPR cohort, limiting their opportunities for functional improvement

Summary

Introduction

Childhood disability is a global public health concern due to its lifelong impact on physical and psychological wellbeing. An estimated 80% of childhood disability occurs in low- and middle-income countries (LMICs) [1]. Despite this high burden, there is limited information on access to rehabilitation services in LMICs [2]. The 2030 Agenda for Sustainable Development Goals warrants that children with disabilities should enjoy equal access to health care and rehabilitation (Goal #3 Good health and wellbeing) regardless of their abilities and socioeconomic status (Goal #10 Reduce inequality). Cerebral palsy (CP) is one of the leading causes of childhood disability, with an estimated 50 million people living with CP worldwide [3,4]. The burden of CP is estimated to be substantially higher in LMICs compared to high-income countries (HICs) [6,7]

Methods

Results

Conclusion