Supporting Ultra-poor Children with Cerebral Palsy and Their Families with Integrated Microfinance/ livelihood and Community-based Rehabilitation Program -A Cluster Randomized Controlled Trial

ABSTRACT

Background and Objective(s) 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. Earlier studies suggested that efforts to improve outcomes for children with disabilities in low-and middle-income countries should include combined measures to improve service provision and family economic/ social capital. This trial aimed to test the efficacy of an integrated microfinance/livelihood and community-based rehabilitation (CBR) (IMCBR) program in improving health-related quality of life (HRQoL) and motor function of children with CP from ultra-poor families and social capital gain to those families from such intervention in rural Bangladesh. Study Design: Cluster randomised controlled trial. Study Participants & Setting: Children with CP aged <=5 years from ultra-poor families in rural Bangladesh. Materials/Methods: Children with CP were randomly allocated in three arms;Arm-A livelihood support and CBR (IMCBR), Arm-B CBR only, and Arm-C care-as- usual. Livestock (e.g. goat, lamb, chicken, etc.) or sewing machines were provided as livelihood support. As part of CBR, group-based goal directed training sessions and parent training sessions were organised weekly and home visits were made fortnightly. The CBR was stopped 2.5 months post-enrollment due to the COVID-19 pandemic and was replaced with phone follow-up. The primary outcome was HRQoL of children while Gross Motor Function Classification System (GMFCS) level of children and social capital of their families were the secondary outcomes. Intention-to- treat analysis was performed. Result(s) Twenty-four clusters including 251 children-primary caregivers' dyads were assigned to three arms;Arm-A= 80, Arm-B= 82, and Arm-C= 89. Between baseline and endline, the percentage change in mean HRQoL was highest in Arm-A (30.0%) with significant mean differences between Arm-A and Arm-B (p=0.015). The GMFCS level significantly changed both in Arm-A (p=0.007) and Arm-C (p=0.011). Also, the improvement in mean total social capital score was significantly higher in Arm-A compared to Arm-B (p<0.001) and Arm-C (p<0.001). Conclusions/Significance: The findings suggest that IMCBR could improve HRQoL and motor functions of children with CP and the social capital of their ultra-poor families. Long-term follow-up of the trial participants and/ or future exploration of such interventions is essential.