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

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.

Traditional Marriage in Rural Bangladesh: An Ethical Consideration

One of the common arguments to justify the traditional arrangement to marry off daughters in rural Bangladesh is that through this procedure they get a secured life under their husband’s supervision. It is a well-known proposition that if parents really care about daughters, searching for a bridegroom from a well-off family is the best option. Typically, daughters’ families mainly the father arrange such marriage, and the girl’s consent is hardly taken into account. However, I argue this traditional system values only girls’ caregiving and reproductive roles, ignoring all other life-affirming values. If daughters are not free to decide whether to marry or not to marry, their autonomy as human beings are violated. Moreover, considering marriage as a responsibility shifting process could objectify and commodify women in such a way that would destroy potentials to flourish life and make them a victim of violence. There are strong theoretical and empirical reasons to believe that the entire procedure of marriage is ethically blameworthy and detrimental for women. Sufficient ground can be found to put more priority on developing daughters’ competency to make them economically and socially independent so that they can choose when to marry, whom to marry or not to marry.

Analyzing Infant Mortality in Rural Bangladesh: A Frailty Modeling Approach

In practice, it may happen that data may arise from a hierarchical structure i.e., a cluster is nested within another cluster. In this case, nested frailty model is appropriate to analyze survival data to obtain optimal estimates of the parameters of interest. To identify significant determinants of infant mortality in rural Bangladesh, survival data have been extracted from Bangladesh Demographic and Health Survey (BDHS), 2014. Because of the presence of two-level clustering in data, nested frailty model has been employed for the purpose of analysis. Recommendations have been suggested based on the results obtained from the survival model to reduce the infant mortality in rural Bangladesh to a great extent. Dhaka Univ. J. Sci. 69(2): 63-69, 2021 (July)

Pot Song as a Novel Cancer Communication Intervention: Lessons Learned from Developing, Implementing, and Evaluating a Culturally Grounded Intervention for Breast Cancer Education in Rural Bangladesh

Targeted public education may offer an approach to achieving more effective treatment in countries like Bangladesh, where breast cancer is a leading cause of cancer death in women. Effective cancer education interventions address the target population’s cultural and contextual needs. However, there is little published literature to guide the development of educational cancer interventions in a region where lack of resources combined with cultural stigma about cancer contribute to poor breast health outcomes for women. The goal of the current study was to design, test, and evaluate a culturally grounded intervention to promote breast problem care among women in rural Bangladesh. The current manuscript first describes the process of formative evaluation that led to the development of the intervention, including decisions about the audience, message construction, and mode of intervention delivery. Second, we describe the testing process, including process and outcome evaluation. Finally, we describe the lessons learned from the process. We conclude with recommendations related to cultural grounding for message development, questionnaire design, data collection procedures, and analysis.