Al Imam Mahmudul Hassan, Jahan Israt, Das Manik Chandra, Bashar Sk Md Kamrul, Khan Arifuzzaman, Muhit Mohammad, Power Rosalie, Akbar Delwar, Badawi Nadia, Khandaker Gulam
CSF Global, Dhaka, Bangladesh.
Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.
Dev Med Child Neurol. 2023 Jun;65(6):773-782. doi: 10.1111/dmcn.15445. Epub 2022 Nov 6.
To test the efficacy of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) programme in improving health-related quality of life (HRQoL) and motor function of children with cerebral palsy (CP) and gain in social capital to their ultra-poor families in rural Bangladesh.
This was an open-label cluster randomized control trial. Children with CP aged 5 years or under were randomly allocated to three arms; Arm A: IMCBR; Arm B: community-based rehabilitation (CBR); and Arm C: care-as-usual. The CBR was modified with phone follow-up followed by home-based CBR at 2.5 months post-enrolment because of the COVID-19 pandemic. Intention-to-treat analysis was performed.
Twenty-four clusters constituting 251 children-primary caregivers' dyads were assigned to three arms (Arm A = 80; Arm B = 82; Arm C = 89). Between baseline and endline, the percentage mean change in the physical functioning domain of HRQoL was highest in Arm A (30.0%) with a significant mean difference between Arm A and Arm B (p = 0.015). Improvement in the mean social capital score was significantly higher in Arm A compared to Arm C (p < 0.001).
The findings suggest that IMCBR could improve the HRQoL of children with CP and the social capital of their ultra-poor families. Long-term follow-up of the trial participants and future exploration of such interventions are essential. The integrated livelihood and CBR programme holds potential to improve health and well-being of children with CP and their ultra-poor families.
Half of the families who received livelihoods were impacted by a cold-wave, suggesting the need for a more disaster-resilient livelihood asset. The integration of livelihood with community-based rehabilitation programme helps to improve health-related quality of life of children with cerebral palsy and the social capital of their ultra-poor families.
测试一项综合小额信贷/生计与社区康复（IMCBR）计划在改善孟加拉国农村极端贫困家庭中脑瘫（CP）儿童的健康相关生活质量（HRQoL）和运动功能以及增加其社会资本方面的效果。
这是一项开放标签的整群随机对照试验。5岁及以下的CP儿童被随机分配到三个组；A组：IMCBR；B组：社区康复（CBR）；C组：常规护理。由于新冠疫情，CBR在入组2.5个月后改为电话随访，随后进行居家CBR。进行意向性分析。
24个整群共251对儿童-主要照料者被分配到三个组（A组 = 80；B组 = 82；C组 = 89）。在基线和终点之间，HRQoL身体功能领域的平均变化百分比在A组最高（30.0%），A组和B组之间存在显著的平均差异（p = 0.015）。A组的平均社会资本得分改善显著高于C组（p < 0.001）。
研究结果表明，IMCBR可以改善CP儿童的HRQoL及其极端贫困家庭的社会资本。对试验参与者进行长期随访以及对此类干预措施进行未来探索至关重要。综合生计与CBR计划有潜力改善CP儿童及其极端贫困家庭的健康和福祉。
接受生计援助的家庭中有一半受到寒潮影响，这表明需要更具抗灾能力的生计资产。将生计与社区康复计划相结合有助于改善脑瘫儿童的健康相关生活质量及其极端贫困家庭的社会资本。
