Reasons for non-uptake of referral: children with disabilities identified through the Key Informant Method in Bangladesh.

PURPOSE: To identify reasons for the non-uptake of referral for children with disability identified though the Key Informant Method in Bangladesh. METHOD: Core data was collected and analysed using qualitative methodologies. Fifty-one semi-structured interviews were completed with parent(s) of children who had attended a screening camp at the invitation of a Key Informant, but had not taken up their subsequent referral for health or rehabilitative services. Thematic analysis of the interview data resulted in emerging trends that were critically analysed according to the research objective. RESULTS: Seven thematic reasons for non-uptake of referral were identified: severity of the disability; family and community; direct and associated cost; location of referral; negative camp experience; deliberate non-uptake; and procedural problems. Parents often discussed multiple reasons for non-uptake, interrelating socio-cultural, logistical and experiential factors. CONCLUSION: Understanding the reasons for the parents of children with disability not taking up referral is important for the design and implementation of appropriate, relevant and contextual medical and rehabilitative services. The role of Key Informants may be developed from case detection, to include facilitation of effective and efficient uptake of services. IMPLICATIONS FOR REHABILITATION: Programmes to identify children with disability and facilitate subsequent rehabilitation or treatment need to have extensive pre-planned strategies for referral mechanisms and follow up. Although Key Informants were not the focus of investigation, the present study suggests that there is potential for the role of the Key Informants to be extended beyond that of a case detection, to inform and facilitate referral processes and encourage the uptake of services.

Validation of the key informant method to identify children with disabilities: methods and results from a pilot study in Bangladesh.

PURPOSE: To assess whether the key informant method (KIM) is an effective method to identify children with disabling sensory or physical impairments, or epilepsy (tonic-clonic seizures), in a low-income setting. METHODS: In one subdistrict each, the Key Informants (KIs) were trained to recognize children with visual impairment, hearing impairment, physical impairment and epilepsy, respectively. In the fifth subdistrict, the KIs were trained to recognize all four conditions. RESULTS: Of the 2260 children identified by KIs, 1227 attended for examination (54%), of which 911 were diagnosed to have a disabling impairment (74%). KIM had a high sensitivity (average 98%) for case detection in all groups but specificity was lower (average 44%), particularly for hearing impairment. CONCLUSIONS: KIs were able to identify children with epilepsy, sensory and physical impairments. KIM is an effective and low-cost method to identify children with disability in a low-income setting.