Children with cerebral palsy in bangladesh:Their contribution to the development of a rehabilitation training programme

Purpose: Although cerebral palsy is the most prevalent health condition linked to childhood disability in Bangladesh, support and rehabilitation for this group is limited and intervention development is slow. An initiative to address these unmet needs was the development of a parent/caregiver training programme for the rehabilitation of children with cerebral palsy. The aim of this study was to explore what was important in the everyday lives of children with cerebral palsy in rural Bangladesh and take their views into account to inform the training programme. Methods: Qualitative data was collected from 12 children with cerebral palsy, between 5 - 14 years of age. The children were purposively selected from among those who attended the training programme. A participatory method called the ‘Feeling Dice’ was used to elicit children’s feelings about their everyday lives. The approach was easy to use, acceptable in the local context, the children enjoyed the activity, and it generated rich information. Results: ‘Inclusion in play’ and ‘being able to attend school’ made the children happy and were their two main priorities, yet were not key issues for parents. The children were frustrated by their dependence on others for day-to-day activities such as feeding, bathing, and transport to school. Children also played an important part in encouraging their parents to attend the training course. Conclusion: This study showed that valuable information can be gathered from children with cerebral palsy by using a simple and adaptable participatory research tool. Children’s views and priorities sometimes differed from those of their parents and carers, and is useful for developing more relevant and valid interventions. Children need to be recognised as important ‘agents of change’ within their own rehabilitation. This methodology is in harmony with the UNCRPD recommendations, and supports inclusive and rights-based intervention development

Socio-demographic determinants of the severity of locomotor disability among adults in Bangladesh: a cross-sectional study, December 2010-February 2011.

BACKGROUND: Socio-demographic variables are widely known to have an association with the presence of any disability. However, the association between the severity of locomotor disability and socio-demographic variables has never been investigated in Bangladesh. METHODS: A cross sectional survey of adults with locomotor disabilities was conducted between December 2010 and February 2011 at the Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh. During the study period 328 adults with locomotor disabilities met our selection criteria, but 316 consented and participated in the study. The 55-item Locomotor Disability Scale was used to measure disability. This study investigated the socio-demographic determinants of the severity of locomotor disability: age, gender, marital status, educational attainment, occupation, income status, type of house, living in own/rented house, household monthly income, household population and area of residence. RESULTS: Participants' age was positively associated with the severity of their locomotor disability (β = 0.01; 95% CI: 0.004 to 0.02), adjusting for diagnosis and other socio-demographic variables studied. Individuals who had an income experienced 0.35 (95% CI: -0.63 to -0.07) points decrease in the severity of disability than those did not have an income, adjusting for diagnosis and rest of the socio-demographic variables studied. In comparison to the unemployed individuals, students, homemakers, and individuals in elementary occupation respectively experienced 0.75 (95% CI: -1.08 to -0.43), 0.51 (95% CI: -0.82 to -0.19) and 0.37 (95% CI: -0.66 to -0.08) points decrease in the severity of locomotor disability, adjusting for diagnosis and rest of the socio-demographic variables studied. CONCLUSIONS: The severity of locomotor disability has an association with individuals' age, income status and occupation of the adults with such disability in Bangladesh. No such association was evident with other socioeconomic position and demographic variables. This finding suggests that people with locomotor disabilities in Bangladesh experience similar disabling built and attitudinal environments irrespective of their socioeconomic positions and demographic characteristics. Further community-based studies are needed to confirm such conclusions

Factorial structure of the locomotor disability scale in a sample of adults with mobility impairments in Bangladesh.

BACKGROUND: Disability does not only depend on individuals' health conditions but also the contextual factors in which individuals live. Therefore, disability measurement scales need to be developed or adapted to the context. Bangladesh lacks any locally developed or validated scales to measure disabilities in adults with mobility impairment. We developed a new Locomotor Disability Scale (LDS) in a previous qualitative study. The present study developed a shorter version of the scale and explored its factorial structure. METHODS: We administered the LDS to 316 adults with mobility impairments, selected from outpatient and community-based settings of a rehabilitation centre in Bangladesh. We did exploratory factor analysis (EFA) to determine a shorter version of the LDS and explore its factorial structure. RESULTS: We retained 19 items from the original LDS following evaluation of response rate, floor/ceiling effects, inter-item correlations, and factor loadings in EFA. The Eigenvalues greater than one rule and the Scree test suggested a two-factor model of measuring locomotor disability (LD) in adults with mobility impairment. These two factors are 'mobility activity limitations' and 'functional activity limitations'. We named the higher order factor as 'locomotor disability'. This two-factor model explained over 68% of the total variance among the LD indicators. The reproduced correlation matrix indicated a good model fit with 14% non-redundant residuals with absolute values > 0.05. However, the Chi-square test indicated poor model fit (p  .91. Among the retained 19 items, there was no correlation coefficient > .9 or a large number of correlation coefficients .3) cross loadings and the correlation between the two factors was .657. The 'mobility activity limitations' and 'functional activity limitations' sub-scales demonstrated excellent internal consistency (Cronbach's alpha were .954 and .937, respectively). CONCLUSIONS: The 19-item LDS was found to be a reliable and valid scale to measure the latent constructs mobility activity limitations and functional activity limitations among adults with mobility impairments in outpatient and community-based settings in Bangladesh

A Case Study Based Slope Stability Analysis at Chittagong City, Bangladesh

Heavy rainfall occurs almost every year in Bangladesh and induces landslides in the hilly regions of this country. Among them the Chittagong City has the worst scenario―as there lives a dense population, extending from the plain lands to the hilly area. So, for risk mitigation and management in this landslide prone city, slope safety margin should be determined. From this context, this article presents factor of safety (FS) values in terms of landslide hazard at Chittagong city, based on geotechnical parameters and slope geometry. Thus a preliminary idea on the allowable stress for slope design could be made from this study. In total, 16 hazard sites of the 2007 and 2008, rainfall induced, landslides were examined as a case study along with subsequent collection of in situ soil samples of the failed slopes for geotechnical laboratory analysis. For FS calculation, the limit equilibrium method for infinite slopes was deployed along with the Cousins’ stability chart. FS values from 0.94 to 1.57 were found at the hazard sites. The results imply that FS value more than 1.57 should be used for slope safety margin. Moreover, from a probabilistic approach, the authors recommend FS > 1.80 as optimum value for the region. Furthermore, a relationship between slope height to slope length ratio, or slope angle and FS was established for this region for a quick calibration of FS value by simple on-field measurement of slope parameters. It is expected that this scenario based finding would contribute in mitigation of landslide hazard risk at the study area. Additionally, site specific FS values were presented in a map by color indexing. This research could ascertain the location wise slope strength requirement and be considered as a guideline for future calculation for slope safety design against rainfall triggered landslides in this city

Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study

Abstract Background Malaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas. Methods A randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages. Results The knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2 = 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72–5.72)], (η2 = 0.64). The average of mothers’ knowledge about malaria was increased by 64 % (η2 = 0.64), the use of LLINs was increased by 79 % (η2 = 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages. Conclusions These results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs

The Development Of Expert Learners In The Classroom

The term &lsquo;expert learner&rsquo; refers to students who are actively engaged with the materials learned and take responsibility for their own learning. Literature reviews suggested the use of metacognitive approach to help develop students to become expert learners. Research on development of expert learners can be traced from movements that focused on the importance of learning strategies and &ldquo;learning how to learn&rdquo; approach. Some researchers combined the role of teachers and students in formulating a framework on how to develop expert learners. This study aimed to identify issues related to the development of expert learners in the classroom. Data were collected from focus group with students and teachers in Malaysia.&nbsp; Findings were reduced into thematic categories representing students&rsquo; and teachers&rsquo; perceptions on the issues. Results of the study showed that the use of metacognitive strategies among students is very minimal and many teachers did not aware the benefit of making the learning process visible to students. The implementation of &ldquo;learning to learn&rdquo; approach in the teaching and learning process remain one of the key problem need to be address in order to help students learn effectively in the classroom

Developing the content of a locomotor disability scale for adults in Bangladesh: a qualitative study.

BACKGROUND: Bangladesh has an estimated 17 million adults with disabilities. A significant proportion of them are believed to have locomotor disabilities. There are over 300 non-governmental organizations providing different types of rehabilitation services to them. However, there is no locally developed and validated locomotor disability measurement scale in Bangladesh. The purpose of this study was to develop a locomotor disability scale with disability indicators suitable for adults in Bangladesh. METHODS: Semi-structured interviews were conducted with 25 purposively selected adults with locomotor disabilities to generate scale items. At the second stage, cognitive interviews were conducted with 12 purposively selected adults with locomotor disabilities in order to refine the measurement questions and response categories. Data were analysed using the framework technique- identifying, abstracting, charting and matching themes across the interviews. RESULTS: For a locomotor disability scale, 70 activities (disability indicators) were identified: 37 mobility activities, 9 activities of daily living, 17 work/productivity activities and 7 leisure activities. Cognitive interviews revealed that when asking the respondents to rate their difficulty in performing the activities, instead of just mentioning the activity name, such as taking a bath or shower, a detailed description of the activity and response options were necessary to ensure consistent interpretation of the disability indicators and response options across all respondents. CONCLUSIONS: Identifying suitable disability indicators was the first step in developing a locomotor disability scale for adults in Bangladesh. Interviewing adults with locomotor disabilities in Bangladesh ensured that the locomotor disability scale is of relevance to them and consequently it has excellent content validity. Further research is needed to evaluate the psychometric properties of this scale

A new tool to measure approaches to supervision from the perspective of community health workers: a prospective, longitudinal, validation study in seven countries

Background: The global scale-up of community health workers (CHWs) depends on supportive management and supervision of this expanding cadre. Existing tools fail to incorporate the perspective of the CHW (i.e. perceived supervision) in terms of supportive experiences with their supervisor. Aligned to the WHO’s strategy on human resources for health, we developed and validated a simple tool to measure perceived supervision across seven low and middle-income countries. Methods: Phase 1 was carried out with 327 CHWs in Sierra Leone. Twelve questions, informed by the extant literature on health worker supervision, were reduced to six questions using confirmatory factor analysis. Phase 2 employed structural equation modelling with 741 CHWs in six countries (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique), to assess the factorial validity, predictive validity, and internal reliability of the questions at three time-points, over 8-months. Results: We developed a robust, 6-item measure of perceived supervision (PSS), capturing regular contact, two-way communication, and joint problem-solving elements as being critical from the perspective of CHWs. When assessed across the six countries, over time, the PSS was also found to have good validity and internal reliability. PSS scores at baseline positively and significantly predicted a range of performance-related outcomes at follow-up. Conclusion: The PSS is the first validated tool that measures supervisory experience from the perspective of CHWs and is applicable across multiple, culturally-distinct global health contexts with a wide range of CHW typologies. Simple, quick to administer, and freely available in 11 languages, the PSS could assist practitioners in the management of community health programmes

Exploring the context in which different close-to-community sexual and reproductive health service providers operate in Bangladesh: a qualitative study

Background A range of formal and informal close-to-community (CTC) health service providers operate in an increasingly urbanized Bangladesh. Informal CTC health service providers play a key role in Bangladesh’s pluralistic health system, yet the reasons for their popularity and their interactions with formal providers and the community are poorly understood. This paper aims to understand the factors shaping poor urban and rural women’s choice of service provider for their sexual and reproductive health (SRH)-related problems and the interrelationships between these providers and communities. Building this evidence base is important, as the number and range of CTC providers continue to expand in both urban slums and rural communities in Bangladesh. This has implications for policy and future programme interventions addressing the poor women’s SRH needs. Methods Data was generated through 24 in-depth interviews with menstrual regulation clients, 12 focus group discussions with married men and women in communities and 24 semi-structured interviews with formal and informal CTC SRH service providers. Data was collected between July and September 2013 from three urban slums and one rural site in Dhaka and Sylhet, Bangladesh. Atlas.ti software was used to manage data analysis and coding, and a thematic analysis was undertaken. Results Poor women living in urban slums and rural areas visit a diverse range of CTC providers for SRH-related problems. Key factors influencing their choice of provider include the following: availability, accessibility, expenses and perceived quality of care, the latter being shaped by notions of trust, respect and familiarity. Informal providers are usually the first point of contact even for those clients who subsequently access SRH services from formal providers. Despite existing informal interactions between both types of providers and a shared understanding that this can be beneficial for clients, there is no effective link or partnership between these providers for referral, coordination and communication regarding SRH services. Conclusion Training informal CTC providers and developing strategies to enable better links and coordination between this community-embedded cadre and the formal health sector has the potential to reduce service cost and improve availability of quality SRH (and other) care at the community level

Intimate Partner Violence and Pregnancy Termination among Tajikistan Women: Evidence from Nationally Representative Data

Intimate partner violence is the most common kind of violence and a significant public health issue. The relationship between intimate partner violence and pregnancy termination among Tajikistan women was investigated in this study. The data for this research was collected from the Tajikistan Demographic and Health Survey 2017. This research has used the data of married women aged between 15 to 49 years. The findings from the study indicate that around 23.2% of married women in Tajikistan have experienced physical violence. The respondent’s age, region, and employment status was significantly associated with pregnancy termination (p < 0.05). Similarly, women who can refuse sex with their partner and ask their partner to use a condom are more likely to terminate pregnancy (p < 0.05). The characteristics of the husband or partner that had a significant positive association with pregnancy termination of married women in Tajikistan are age, educational level, and alcohol drinking status of their husbands (p < 0.05). This study also establishes the significant relationship between pregnancy termination and physical or emotional violence experienced by women (p < 0.05). The dynamics of domestic abuse need to be understood by healthcare providers to aid women in making decisions on whether or not to terminate their pregnancy