Rehabilitation in Bangladesh

Relations between indoor rehabilitation and basic health services in a developing country

Background

and Introduction: Physical rehabilitation is vital for patients to regain maximum function. Approximately 80% of people with a disability live in developing countries, where they face multiple challenges in rehabilitation. The goal of the study was to conduct an analysis of indoor rehabilitation programs based on the demographics and medical conditions of the admitted patients and to relate to the available basic health and rehabilitation facilities.

Methods

This was a mixed method study conducted in an inpatient rehabilitation ward of a tertiary level academic university hospital in a developing country. All admitted patients who stayed for a period of minimum two weeks were included in the study. Demographic and clinical data were obtained by means of a retrospective medical record review utilizing a standardized data extraction form. The study was further strengthened by an online literature search for the available documents for analysis, relation, and discussion.

Results

Among the 1,309 admitted patients was male- female ratio was 10:7, with the majority (31.4%) cases falling between the ages of 46 and 60yrs. Rehabilitation outpatient department was the principal mode of admission (78%), and musculoskeletal and neurological conditions represented the maximum number (79.8%). Majority of patients (60.8%) were discharged home on completion of the rehabilitation program with a large number of patients who were absconded. Poor health budget allocation and lack of prioritization of the rehabilitation sector face multiple challenges, including the rehabilitation team functioning resources, space crisis for expansion which was further impacted by the COVID-19 pandemic.

Conclusions

The country's current health-related rehabilitation process and socio-demographic variables have a negative relationship. There was a large number of missing data in the medical records and many patients were lost prematurely from the indoor rehabilitation program. Musculoskeletal disorders were common, and the majority of patients were discharged home once the program was completed.

Exploration of current challenges in rehabilitation from the perspective of healthcare professionals: Switzerland as a case in point

Rehabilitation is a health strategy with the potential to mitigate the negative health consequences of population ageing and the rise of noncommunicable diseases. Literature indicates that even in high-income countries rehabilitation services can be improved. The purpose of this study is to engage rehabilitation professionals in Switzerland in identifying and prioritizing current challenges in the development and delivery of rehabilitation services. We conducted a qualitative study consisting of interviews with key informants and a stakeholder consultation. Thirteen interviews were conducted and analysed using inductive thematic analysis. Identified challenges were refined, extended, and prioritized through multi-voting in a workshop attended by a wide range of rehabilitation professional organizations. Final results were subject to further analysis and member checking. We identified nineteen challenges, of which eight were viewed as highly important. Results suggest the need to revise the financing system for rehabilitation services, highlighted a poor integration of rehabilitation in primary care, a lack of academic rehabilitation training, and insufficient funding for research. Finally, we identified a perceived lack of awareness for rehabilitation among policy-makers and the public. This study provides a unique perspective on challenges in rehabilitation practice and policy and offers an opportunity for professionals, policy-makers, and other stakeholders, to influence and guide the rehabilitation service agenda both in Switzerland and in terms of mutual learning also in other countries.

Situation analysis of rehabilitation services for persons with disabilities in Bangladesh: identifying service gaps and scopes for improvement

PURPOSE

Rehabilitation needs are rising globally; however, the rate is strikingly higher in low- and middle-income countries (LMICs). Like many LMICs, the situation of rehabilitation services for persons with disabilities (PwDs) in Bangladesh is mostly unknown. We assessed the current situation of rehabilitation services for PwDs in Bangladesh.

MATERIALS AND METHODS

This mixed-method study incorporated an online survey of rehabilitation service providers and a scoping review of documents published on rehabilitation services for PwDs in Bangladesh. Descriptive and thematic analyses were completed.

RESULTS

A total of 1102 rehabilitation service providers were interviewed, and 36 documents were reviewed. Rehabilitation services for PwDs were found not integrated into the mainstream health services, financing mechanisms, information systems, and health policies in Bangladesh. There are 6.8 rehabilitation units for 1 million people, and 6.2% of them are located in rural areas. In terms of the rehabilitation workforce, there are 9.4 physiotherapists, 1.3 occupational therapists, 0.9 speech and language therapists, and 0.2 prosthetist and orthotists for 1 million people in Bangladesh. Majority (66.3%) of rehabilitation services require an out-of-pocket payment.

CONCLUSIONS

A critical shortage and uneven distribution of the rehabilitation workforce are evident, indicating a likelihood of very high unmet rehabilitation needs in Bangladesh. To strengthen the rehabilitation capacity of Bangladesh, rehabilitation services should be integrated into mainstream health policies and programs with a special focus on the rehabilitation workforce training, recruitment and distribution, and allocation of resources.Implications for rehabilitationRehabilitation services in Bangladesh are mostly provided by the private sector, although the government of Bangladesh operates a small number of rehabilitation services outside of the mainstream public health service delivery system.Rehabilitation services are lacking in the primary and secondary health facilities, while services at tertiary level public hospitals are mainly provided by medical technologists in the absence of a qualified rehabilitation workforce.A severe shortage of rehabilitation workforce coupled with an uneven distribution of the existing limited number of rehabilitation services and out-of-pocket expenditures might result in inadequate access and poor rehabilitation service uptake amongst persons with disabilities (PwDs) in Bangladesh.Robust governance and leadership are needed to monitor the implementation of existing legislations and policies and develop strategies to improve the situation of rehabilitation services for PwDs in Bangladesh.

Rehabilitation status of children with cerebral palsy in Bangladesh: Findings from the Bangladesh Cerebral Palsy Register

OBJECTIVE

The objective of this study was to assess the rehabilitation status and factors associated with rehabilitation service utilisation among children with cerebral palsy (CP) in Bangladesh.

MATERIALS AND METHODS

This is a population-based surveillance study conducted among children with CP registered in the Bangladesh CP Register (BCPR), the first population-based register of children with CP aged <18 years (y) in Bangladesh. Children with CP were identified from the community using the key informant method and underwent a detailed neurodevelopmental assessment. Socio-demographic, clinical and rehabilitation status were documented. Unadjusted and adjusted analyses with a 95% confidence interval (CI) were used to identify potential predictors of rehabilitation service uptake.

RESULTS

Between January 2015 and December 2019, 2852 children with CP were registered in the BCPR (mean (standard deviation, SD) age: 7 y 8 months (mo) (4 y 7 mo), 38.5% female). Of these, 50.2% had received rehabilitation services; physiotherapy was the most common type of service (90.0%). The mean (SD) age at commencement of rehabilitation services was 3 y 10 mo (3 y 1 mo). The odds of not receiving rehabilitation was significantly higher among female children (adjusted odds ratio (aOR) 1.3 [95% CI: 1.0-1.7], children whose mothers were illiterate and primary level completed (aOR 2.1 [95% CI: 1.4-3.1] and aOR 1.5 [95% CI: 1.1-2.1], respectively), fathers were illiterate (aOR 1.9 [95% CI: 1.3-2.8]), had a monthly family income ~US$ 59-118 (aOR: 1.8 [95% CI: 1.2-2.6]), had hearing impairment (aOR: 2.3 [95% CI: 1.5-3.5]) and motor severity (i.e. Gross Motor Function Classification System level III (aOR: 0.6 [95% CI: 0.3-0.9]) and level V (aOR: 0.4 [95% CI: 0.2-0.7])).

CONCLUSIONS

Rehabilitation status was poor among the majority of the children with CP in the BCPR cohort, limiting their opportunities for functional improvement. A community-based rehabilitation model focusing on socio-demographic and clinical characteristics should be a public health priority in Bangladesh.