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Banks LM, Das N, Davey C, Adiba A, Ali MM, Shakespeare T, Fleming C, Kuper H. Impact of a disability-targeted livelihoods programme in Bangladesh: study protocol for a cluster randomised controlled trial of STAR. Trials 2022; 23:1022. [PMID: 36527117 PMCID: PMC9758025 DOI: 10.1186/s13063-022-06987-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is little evidence on the impact of livelihood interventions amongst people with disabilities. Effective programmes are critical for reducing the heightened risk of poverty and unemployment facing persons with disabilities. STAR+ is a skills development and job placement programme targeted to out-of-school youth with disabilities (ages 14-35) living in poverty. It is a disability-targeted adaptation to an existing, effective intervention (STAR), which has been designed to address barriers to decent work for people with disabilities. This protocol describes the design of a cluster randomised controlled trial of STAR+ in 39 of the 64 districts of Bangladesh. METHODS BRAC has identified 1500 youth with disabilities eligible for STAR+ across its 91 branch offices (typically a geographical areas covering about 8 km radius from local BRAC office) catchment areas (clusters). BRAC has limited funding to deliver STAR+ and so 45 of the 91 branches have been randomly allocated to implement STAR+ (intervention arm). The remaining 46 branches will not deliver STAR+ at this time (control arm). Participants in the control-arm will receive usual care, meaning they are free to enrol in any other livelihood programmes run by BRAC or other organisations including standard STAR (being run in 15 control branches). The cRCT will assess the impact of STAR+ after 12 months on employment status and earnings (primary outcomes), as well as poverty, participation and quality of life (secondary outcomes). Analysis will be through intention-to-treat, with a random mixed effect at cluster level to account for the clustered design. Complementary qualitative research with participants will be conducted to triangulate findings of the cRCT, and a process evaluation will assess implementation fidelity, mechanisms of impact and the role of contextual factors in shaping variations in outcomes. DISCUSSION This trial will provide evidence on the impact of a large-scale, disability-targeted intervention. Knowledge on the effectiveness of programmes is critical for informing policy and programming to address poverty and marginalisation amongst this group. Currently, there is little robust data on the effectiveness of livelihood programmes amongst people with disabilities, and so this trial will fill an important evidence gap. TRIAL REGISTRATION This study has been registered with the Registry for International Development Impact Evaluations, (RIDIE Study ID: 6238114b481ad ) on February 25, 2022, and the ISRCTN Registry (ID: ISRCTN15742977 ).
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Affiliation(s)
- Lena Morgon Banks
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Narayan Das
- grid.52681.380000 0001 0746 8691BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - Calum Davey
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK ,grid.8991.90000 0004 0425 469XCentre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
| | - Afsana Adiba
- grid.52681.380000 0001 0746 8691BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - M. Mahzuz Ali
- grid.501438.b0000 0001 0745 3561BRAC Bangladesh, Dhaka, Bangladesh
| | - Tom Shakespeare
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Hannah Kuper
- grid.8991.90000 0004 0425 469XInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Al Imam MH, Jahan I, Das MC, Bashar SMK, Khan A, Muhit M, Power R, Akbar D, Badawi N, Khandaker G. SUpporting People in extreme POverty with Rehabilitation and Therapy (SUPPORT CP): a trial among families of children with cerebral palsy in Bangladesh. Dev Med Child Neurol 2022; 65:773-782. [PMID: 36335570 DOI: 10.1111/dmcn.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Abstract
AIM To test the efficacy of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) programme in improving health-related quality of life (HRQoL) and motor function of children with cerebral palsy (CP) and gain in social capital to their ultra-poor families in rural Bangladesh. METHOD This was an open-label cluster randomized control trial. Children with CP aged 5 years or under were randomly allocated to three arms; Arm A: IMCBR; Arm B: community-based rehabilitation (CBR); and Arm C: care-as-usual. The CBR was modified with phone follow-up followed by home-based CBR at 2.5 months post-enrolment because of the COVID-19 pandemic. Intention-to-treat analysis was performed. RESULTS Twenty-four clusters constituting 251 children-primary caregivers' dyads were assigned to three arms (Arm A = 80; Arm B = 82; Arm C = 89). Between baseline and endline, the percentage mean change in the physical functioning domain of HRQoL was highest in Arm A (30.0%) with a significant mean difference between Arm A and Arm B (p = 0.015). Improvement in the mean social capital score was significantly higher in Arm A compared to Arm C (p < 0.001). INTERPRETATION The findings suggest that IMCBR could improve the HRQoL of children with CP and the social capital of their ultra-poor families. Long-term follow-up of the trial participants and future exploration of such interventions are essential. The integrated livelihood and CBR programme holds potential to improve health and well-being of children with CP and their ultra-poor families.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Sk Md Kamrul Bashar
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Arifuzzaman Khan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Rosalie Power
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh.,Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Sydney, Australia
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Scherer N, Mactaggart I, Huggett C, Pheng P, Rahman MU, Wilbur J. Are the rights of people with disabilities included in international guidance on WASH during the COVID-19 pandemic? Content analysis using EquiFrame. BMJ Open 2021; 11:e046112. [PMID: 34257092 PMCID: PMC8282413 DOI: 10.1136/bmjopen-2020-046112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE People with disabilities are at increased risk from COVID-19. Access to water, sanitation and hygiene (WASH) services and facilities is a fundamental right for all, and is vital in stopping the transmission of COVID-19. However, people with disabilities often face difficulties accessing WASH. Various international organisations have published guidance and recommendations on WASH service provision during the COVID-19 pandemic, and this must include information of relevance to people with disabilities. This study aimed to investigate the inclusion of core concepts of rights for people with disabilities in guidance on WASH during the COVID-19 pandemic. METHOD We used the EquiFrame content analysis tool to analyse the inclusion of 21 core concepts of rights for people with disabilities in international guidance documents on WASH during the pandemic. 29 documents were included from multilateral entities, international consortiums and non-governmental organisations. Key information from the included guidance documents was extracted for each of the 21 core concepts. RESULTS One-third of the WASH guidance did not include any reference to the rights of people with disabilities, and the majority of information was provided by just one guidance document. Most commonly referenced across all was access to WASH, including details on accessible infrastructure (eg, handwashing stations) and communication strategies. Information on many important rights and considerations, such as the affordability of services and caregiver support, was rarely included. CONCLUSION Although some information is provided in international WASH guidance, this often has a narrow focus on access, rather than the full array of rights and considerations that are important for people with disabilities. International guidance should continue to be reviewed and updated to include further information of relevance to people with disabilities, informing a disability-inclusive approach to WASH during the remainder of the COVID-19 pandemic and future crises.
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Affiliation(s)
- Nathaniel Scherer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Islay Mactaggart
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Jane Wilbur
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Bechange S, Jolley E, Gascoyne B, Smith K, Griffiths A, Ngorok J, Schmidt E. Livelihood outcomes in a cohort of youth with disabilities following participation in an economic empowerment programme in rural Uganda. Disabil Health J 2021; 14:101069. [PMID: 33653672 DOI: 10.1016/j.dhjo.2021.101069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little evidence exists on the livelihoods of young people with disabilities in low- and middle-income settings. OBJECTIVE This study examined employability and livelihood outcomes among a cohort of youth with disabilities who participated in an economic empowerment programme in rural Uganda. METHODS Prospective cohort of youth with disabilities participating in an economic empowerment programme in rural Uganda. Livelihood outcomes of participants were assessed through structured interviews at baseline (n = 297) and again at 12 months (n = 252) and analysed using chi-squared tests and generalized estimating equations. RESULTS Of 297 participants at baseline, 144 (48%) were women and the mean age was 21.7 years. At 12 months follow-up, participants were significantly more likely to have a job (OR 3.04, 95% CI 2.10-4.39); to have accessed finance (OR 5.52, 95% CI 3.18-9.56); and experienced community support (OR 2.23, 95% CI 1.51-3.29) compared with baseline. There were no statistically significant changes in having enough money for food or in having experienced community discrimination. CONCLUSIONS The findings suggest that targeted vocational skills training, apprenticeships scheme and a start-up financial package may improve the livelihoods of young people living with disabilities in rural African settings.
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Affiliation(s)
| | - Emma Jolley
- Sightsavers - United Kingdom, Haywards Heath, UK
| | - Ben Gascoyne
- Sightsavers - United Kingdom, Haywards Heath, UK
| | - Karen Smith
- Sightsavers - United Kingdom, Haywards Heath, UK
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Graham L. Differences in employment and income poverty between people with and without disabilities in South Africa. ALTER 2020. [DOI: 10.1016/j.alter.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pinilla-Roncancio M, Mactaggart I, Kuper H, Dionicio C, Naber J, Murthy G, Polack S. Multidimensional poverty and disability: A case control study in India, Cameroon, and Guatemala. SSM Popul Health 2020; 11:100591. [PMID: 32405529 PMCID: PMC7212179 DOI: 10.1016/j.ssmph.2020.100591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Although the association between disability and multidimensional poverty has been consistently found in several studies in Low- and Middle-Income Countries. None of these studies so far has used an extended and internationally comparable questionnaire (extended Washington Group Questionnaire) and a clinical screening of disability. The purpose of this article is to calculate, compare and analyse the levels of multidimensional poverty of people with and without disabilities in Guatemala (national), in one district of Cameroon (Fundong Health District, North West Cameroon) and in one district in India (Mahbubnagar District, Telangana State). We used a case-control study approach; adults with disabilities identified in a population-based disability survey using the Washington Group Extended Questionnaire were matched to age-sex matched controls without disabilities and interviewed about their levels of access and use of different social services. Following the Alkire-Foster method, the levels of multidimensional poverty between cases and control were computed and compared. Additionally, we analysed how disability and other individual characteristics are associated with being poor in each country. The results showed that people with disabilities in all three-study settings face significantly higher levels of poverty and the intensity of their poverty is higher. In the case of Cameroon, differences in the levels of deprivation between people with and without disabilities were smaller than those observed in India and Guatemala. This might suggest that in countries with higher levels of human, economic and social development people with disabilities are being left behind by public policies aiming to reduce poverty and deprivation in basic indicators. In addition, indicators related to health contributed the most to the levels of multidimensional poverty for people with disabilities. These findings provide important evidence about the association of multidimensional poverty and disability and underline the importance of including indicators capturing individual deprivations to analyse poverty for this group. Case control study analysing the levels of multidimensional poverty of people with and without disabilities in one province of India, Cameroon and in Guatemala. People with disabilities in the three countries have higher levels of multidimensional poverty and deprivation.
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Affiliation(s)
- Mónica Pinilla-Roncancio
- School of Medicine, Department of Public Health, Universidad de los Andes, Carrera 7 # 116 -05, Bogotá, Colombia
- Corresponding author
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Jonathan Naber
- National Council on Disability, Guatemala City, Guatemala
| | - G.V.S. Murthy
- Indian Institute of Public Health, Hyderabad, India
- Department is Clinical Research, Infectious Tropical Diseases Faculty, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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No One Left Behind? Comparing Poverty and Deprivation between People with and without Disabilities in the Maldives. SUSTAINABILITY 2020. [DOI: 10.3390/su12052066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 2030 Sustainable Development Goals call for the disaggregation of all indicators by disability and other characteristics so as to “leave no one behind” from development progress. Data on disability, however, is acknowledged to be lacking, which is essential for informing policy and planning. Consequently, this study estimates the prevalence of disability in the Maldives and compares indicators of poverty and living conditions between people with and without disabilities, using nationally-representative, population-based data (n = 5363). The prevalence of disability was estimated at 6.8%. Overall, this research finds that people with disabilities are at risk of being left behind from progress across multiple Sustainable Development Goal domains, including in combatting income poverty, food insecurity and exclusion from health, education, work and social participation, and vulnerability to violence. Further, amongst people with disabilities, people with cognitive and mental health impairments, people living outside the capital, Male’, and children and working-age adults tend to face the highest levels of deprivation.
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Mactaggart I, Maung NS, Khaing CT, Kuper H, Blanchet K. A case-control study of musculoskeletal impairment: association with socio-economic status, time use and quality of life in post-conflict Myanmar. BMC Public Health 2019; 19:1502. [PMID: 31711455 PMCID: PMC6849317 DOI: 10.1186/s12889-019-7851-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background Musculoskeletal impairments (MSI) are a major global contributor to disability. Evidence suggests entrenched cyclical links between disability and poverty, although few data are available on the link of poverty with MSI specifically. More data are needed on the association of MSI with functioning, socio-economic status and quality of life, particularly in resource-poor settings where MSI is common. Methods We undertook a case-control study of the association between MSI and poverty, time use and quality of life in post-conflict Myanmar. Cases were recruited from two physical rehabilitation service-centres, prior to the receipt of any services. One age- (+/− 5 years of case’s age) and sex- matched control was recruited per case, from their home community. 108 cases and 104 controls were recruited between July – December 2015. Cases and controls underwent in-depth structured interviews and functional performance tests at multiple time points over a twelve-month period. The baseline characteristics of cases and controls are reported in this manuscript, using multivariate logistic regression analysis and various tests of association. Results 89% of cases were male, 93% were lower limb amputees, and the vast majority had acquired MSI in adulthood. 69% were not working compared with 6% of controls (Odds Ratio 27.4, 95% Confidence Interval 10.6–70.7). Overall income, expenditure and assets were similar between cases and controls, with three-quarters of both living below the international LMIC poverty line. However, cases’ health expenditure was significantly higher than controls’ and associated with catastrophic health expenditure and an income gap for one fifth and two thirds of cases respectively. Quality of life scores were lower for cases than controls overall and in each sub-category of quality of life, and cases were far less likely to have participated in productive work the previous day than controls. Conclusion Adults with MSI in Myanmar who are not in receipt of rehabilitative services may be at increased risk of poverty and lower quality of life in relation to increased health needs and limited opportunities to participate in productive work. This study highlights the need for more comprehensive and appropriate support to persons with physical impairments in Myanmar.
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Affiliation(s)
- Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Nay Soe Maung
- University of Public Health (UPH), Myorma Kyaung Street, Yangon, Myanmar
| | - Cho Thet Khaing
- University of Public Health (UPH), Myorma Kyaung Street, Yangon, Myanmar
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Sadiki MC, Radzilani-Makatu M, Zikhali MP. Acquired physical disability: Personal meanings in a rural South African setting. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2018.1547865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Walsham M, Kuper H, Banks LM, Blanchet K. Social protection for people with disabilities in Africa and Asia: a review of programmes for low- and middle-income countries. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/13600818.2018.1515903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Matthew Walsham
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Global Development Institute, University of Manchester, Manchester, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Karl Blanchet
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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