Rehabilitation of Persons with Spinal Cord Injury in Bangladesh.

There is a knowledge gap about the rehabilitation system for the persons with spinal cord injury (SCI). A rehabilitation scenario is necessary to conduct a national community survey in conjunction with the International Spinal Cord Injury Community Survey (InSCI) in order to gather data on the lived experiences of people with SCI, to map out the health and rehabilitation system of Bangladesh, it's demographic characteristics, accessible resources and rehabilitation challenges. Information for this narrative report was acquired through a structured questionnaire, which was supplemented by an online search of agencies, government websites, rehabilitation-related organizations and published papers during the period of March 2020 to April 2021. Bangladesh is a developing country with a vast population and a developing health care system. Representative government and non-government rehabilitative care settings a total of sixteen survey replies (n=16) were obtained. During the year 2019, a total of 1035 people with SCI were seen. The majority of patients with SCI were hospitalized by a non-government facility (38.65%), whereas the two main public general hospitals consulted roughly 30.0% of people with SCI. The rehabilitation team leader in the majority of the facilities (93.75%) was a physiatrist, but just a few had a full complement of rehabilitation professionals and only 12.5% of settings provide community care. Indoor rehabilitation facilities, equipment and a competent rehabilitation staff are not available at many of the tertiary care facilities including National Trauma Institute (NITOR), where most of the SCI report first after the trauma. A consistent and nationwide data source is unavailable and the majority of the available SCI research publications are hospital-based demographic studies in Bangladesh. SCI was commonly due to work-related trauma in young male manual laborers due to fall from height or road traffic accidents. The country faces multiple challenges in rehabilitation of people with SCI regarding triage, a referral system development, infrastructure and shortage of expert human resources in addition, currently there is no three-tier rehabilitation care continuum available. Keeping pace with the transition to a developed country by 2041, the Bangladesh health sector also has to be oriented to face the focused challenge of caring for people with SCI. As recommended by WHO Rehabilitation 2030 initiatives, establishment of an SCI dedicated national institute and escalation of number of related specialists such as trauma and orthopedic surgery, spinal neurosurgery and physical rehabilitation medicine, skilled professionals such as rehabilitation nurses, therapists, case managers and social workers to work in a team required for specialized care of SCI.

International Spinal Cord Society (ISCoS) database: Asian Spinal Cord Network (ASCoN) Pilot Project [IDAPP].

STUDY DESIGN: Global mapping project of ISCoS for traumatic spinal cord injury (T-SCI) highlighted paucity of data from low and middle income countries (LMICs). Recognizing this gap, IDAPP study of one year duration was proposed as the first step to develop an International SCI database. OBJECTIVES: Primary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies. SETTING: Nine centers from Asia. METHODS: All patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers. RESULTS: Results showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%). CONCLUSIONS: The study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.

Cervical spinal cord injury due to fall while carrying heavy load on head: a problem in Bangladesh.

STUDY DESIGN: Observational study. SETTING: Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh. METHODS: This observational study was conducted on 84 patients of Cervical spinal cord injury (CSCI) due to fall while carrying heavy load on head. They were admitted at the CRP, Dhaka, Bangladesh between January 1999 and December 2001. Relevant personal information, neurological status, types of bony injuries and x-ray findings were noted down in pre-structured questionnaire. In addition, each subject was interviewed to find out the cause of accidental fall while carrying heavy load on head. RESULTS: Age of the studied subjects ranged between 10 to 50 years. All were male of whom 79 (94%) subjects were farmers and/or low cost daily laborers. In all, 72% percent of the subjects were carrying 60-80 kg weight on their head when fall occurred. A total of 48 (57%) subjects had complete neurological lesion. The most common vertebral levels were C5 and C6. So far the mechanism of injury is concerned hyper flexion of the cervical spine predominated (61%) over hyperextension (36%). CONCLUSION: Fall while carrying heavy load on head is a common cause of CSCI in Bangladesh. The victims are mostly young farmers or unskilled day laborers who were not habituated to carry heavy load on head.