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

• Published in: PloS one 2021-12, Vol.16 (12), p.e0261148-e0261148
• Main Authors: Al Imam, Mahmudul Hassan, Jahan, Israt, Muhit, Mohammad, Das, Manik Chandra, Power, Rosalie, Khan, Arifuzzaman, Akbar, Delwar, Badawi, Nadia, Khandaker, Gulam
• Format: Article
• Language: English
• Subjects: Bangladesh - epidemiology; Biology and Life Sciences; Care and treatment; Caregivers; Cerebral palsy; Cerebral Palsy - economics; Cerebral Palsy - epidemiology; Cerebral Palsy - rehabilitation; Child; Child, Preschool; Children; Children & youth; Clusters; Cognition & reasoning; Cognitive ability; Communication; Earth Sciences; Families & family life; Family; Geography; Health aspects; Health services; Humans; Integrated approach; Intervention; Livelihood; Medicine and Health Sciences; Mental health; Microfinance; Nutritional status; Paralysis; Parents; People and Places; Pilot Projects; Poverty; Poverty - economics; Public health; Quality of life; Registered Report Protocol; Rehabilitation; Research and Analysis Methods; Residence Characteristics; Rural Population; Social capital; Social Sciences; Socioeconomic factors; Soft skills; Training; Urban poor
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261148

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. 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. 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.