Supporting Ultra Poor People with Rehabilitation and Therapy among families of children with Cerebral Palsy in rural Bangladesh (SUPPORT CP): Protocol of a randomised controlled trial

Mahmudul Hassan Al Imam; Israt Jahan; Mohammad Muhit; Manik Chandra Das; Rosalie Power; Arifuzzaman Khan; Delwar Akbar; Nadia Badawi; Gulam Khandaker

doi:10.1371/journal.pone.0261148

Supporting Ultra Poor People with Rehabilitation and Therapy among families of children with Cerebral Palsy in rural Bangladesh (SUPPORT CP): Protocol of a randomised controlled trial

PLoS One. 2021 Dec 31;16(12):e0261148. doi: 10.1371/journal.pone.0261148. eCollection 2021.

Authors

Mahmudul Hassan Al Imam^{1

2

3

4}, Israt Jahan^{1

2

3}, Mohammad Muhit^{1

2}, Manik Chandra Das^{1

2}, Rosalie Power^{2

5}, Arifuzzaman Khan^{1

2

4

6}, Delwar Akbar⁷, Nadia Badawi^{8

9}, Gulam Khandaker^{3

4

10}

Affiliations

¹ CSF Global, Dhaka, Bangladesh.
² Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.
³ School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.
⁴ Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.
⁵ Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, New South Wales, Australia.
⁶ School of Public Health, The University of Queensland, Brisbane, Australia.
⁷ School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia.
⁸ Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.
⁹ Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Westmead, New South Wales, Australia.
¹⁰ Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.

Abstract

Introduction: Poverty is a key contributor to delayed diagnosis and limited access to early intervention and rehabilitation for children with cerebral palsy (CP) in rural Bangladesh. 97% of families of children with CP live below the poverty line in Bangladesh. Therefore, in low-and middle-income countries (LMICs), efforts to improve outcomes for children with CP (including health-related quality of life, motor function, communication, and nutritional attainments) should also include measures to improve family economic and social capital. We propose a randomised controlled trial (RCT) to evaluate the effectiveness of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) program for ultra-poor families of children with CP in rural Bangladesh.

Material and methods: This will be a cluster RCT comparing three arms: (a) integrated microfinance/livelihood and community-based rehabilitation (IMCBR); (b) community-based rehabilitation (CBR) alone; and (c) care-as-usual (i.e. no intervention). Seven clusters will be recruited within each arm. Each cluster will consist of 10 child-caregiver dyads totalling 21 clusters with 210 dyads. Parents recruited in the IMCBR arm will take part in a microfinance/livelihood program and Parent Training Module (PTM), their children with CP will take part in a Goal Directed Training (GDT) program. The programs will be facilitated by specially trained Community Rehabilitation Officers. The CBR arm includes the same PTM and GDT interventions excluding the microfinance/livelihood program. The care-as-usual arm will be provided with information about early intervention and rehabilitation. The assessors will be blinded to group allocation. The duration of the intervention will be 12 months; outcomes will be measured at baseline, 6 months, 12 months, and 18 months.

Conclusion: This will be the first RCT of an integrated microfinance/livelihood and CBR program for children with CP in LMIC settings. Evidence from the study could transform approaches to improving wellbeing of children with CP and their ultra-poor families.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Bangladesh / epidemiology
Cerebral Palsy / economics*
Cerebral Palsy / epidemiology
Cerebral Palsy / rehabilitation*
Child
Child, Preschool
Family
Geography
Humans
Pilot Projects
Poverty / economics*
Residence Characteristics
Rural Population*

Grants and funding

This project is funded by the Research Foundation of Cerebral Palsy Alliance (https://cerebralpalsy.org.au/our-research/research-foundation-and-institute/)(Steptember Project Grant PG02218) and internal funding from CSF Global (http://csf-global.org/). The funders did not and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.