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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. 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. 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])). 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.

Suicide is considered as one of the major public health concerns, which can be prevented with cost-effective and timely intervention. In Bangladesh, very few studies assessed the suicidal behavior of rural community people. Thus, this Bangladesh Community Mental Health Study (BD ComMen Study) attempted to understand the current situation of suicidality in Bangladeshi rural community people considering three-time frames: lifetime, past year, and past month. A cross-sectional study was conducted in a rural community in Bangladesh between May 17 and 31, 2022, using a cluster sampling technique. Information on socio-demographics, COVID-19-related factors, depression, anxiety, insomnia, and suicidal behaviors was collected. The Chi-square test or Fisher's exact test and logistic regression were used to analyze the data. During their lifetime, 33.1% of the rural community people had suicidal thoughts, whereas 5.5% made a plan for suicide and 1.8% attempted suicide. The prevalence of past-year suicidal ideation was 3.9%, whereas 1.4% had a suicide plan. In addition, 0.6% had past-month suicidal thoughts, although none of them had planned or attempted suicide. The factors associated with suicidal behaviors included males, lower age, lower educational grade, low-earning jobs, living in a government-provided house, family history of mental health and suicide, and suffering from anxiety and insomnia. Suicidal behaviors among the rural community people are of great concern as most of the rural people in Bangladesh do not have enough mental health literacy for treatment-seeking due to a high level of mental health-related stigma. Thus, this study would likely help to initiate further studies and stimulate suicide prevention programs, because most suicide can be prevented.

To assess the health-related quality of life (HRQoL) and mental health of adolescents with cerebral palsy (CP) in rural Bangladesh. Case-control study of adolescents with CP (10 to ≤18-years) and age and sex matched controls without disability. Primary caregivers were included for proxy report. HRQoL was measured with Bengali versions CP Quality of Life-Teens (CPQoL-Teens) and KIDSCREEN-27. Mental health was measured with Strengths and Difficulties Questionnaire (SDQ). 154 cases and 173 controls matched on age and sex participated (mean age 15.1 (1.6) and 14.9 (1.6) respectively; female n = 48, n = 55 respectively, p>0.05). CPQoL-Teens was administered to adolescents with CP only; mean outcomes ranged from 38.5 (27.4) to 71.5 (16.1) and 'feelings about functioning' was poorest domain for both self- and proxy-report groups. KIDSCREEN-27 was administered to adolescents with CP and controls; adolescents with CP mean outcomes ranged from 25.9 (12.2) to 48.7 (10.56) and were significantly poorer than controls, mean difference 4.3 (95% CI 0.7 to 7.8) to 16.7 (95% CI 14.5 to 18.5), p<0.05. 'Peers and social support' was poorest domain for all groups. In regards to mental health, adolescents with CP reported significantly poorer mean SDQ than peers without disability, mean difference 0.7 (95% CI 0.3 to 1.1) to 7.8 (95% CI 6.7 to 8.9), p<0.05; and were for self-report 7.8 (95% CI 2.6 to 23.0) and proxy-report 12.0 (95% CI 6.9 to 20.9) times more likely to report 'probable' range 'total difficulties' score. Individual item analysis of CPQoL-Teens and KIDSCREEN-27 identified unique areas of concern for adolescents with CP related to pain, friendships, physical activity and energy, what may happen later in life, and feelings about having CP. Financial resources were of concern for both cases and controls. Adolescents with CP in rural Bangladesh are at high risk of poor HRQoL and mental health problems. Effort to reduce the disparity between adolescents with CP and those without disability should consider wellbeing holistically and target dimensions including physical, psychological and social wellbeing. Specific interventions to alleviate modifiable aspects of HRQoL including pain, social isolation, and physical in-activity are recommended.

ObjectiveTo systematically review, identify and report the screening tools used for early identification of developmental delay in low- and middle-income countries.DesignSystematic review.Data sourcesFour bibliographic databases: Medline (1946 to 13 July 2020), Embase (1974 to 13 July 2020), Scopus (1823 to 11 July 2020) and PsycINFO (1987 to July week 1 2020).Eligibility criteriaPeer-reviewed original articles published in English addressing validated culturally sensitive developmental screening tools among children aged <5 years were included in this review.Data extraction and synthesisOne author (CK, medical librarian) developed the search strategy. Three authors conducted the database search (phase I: CK; phase II: IJ and MKI). Three authors (TF, IJ and MKI) independently screened the title and abstracts. TF, MKI and GK independently performed the full-text review of the screened articles. During each step of the study selection process, disagreements were resolved through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the systematic review. Data extraction and analysis were performed using MS Excel. Meta-analysis was not possible due to heterogeneity of the study findings.ResultsWe identified 3349 articles, of which 18 studies from 10 countries, reporting 16 screening tools, were selected for qualitative synthesis. Six cultural contexts were explored. Twelve general, two motor and two speech-language tools were identified. Seven of them found to be parent-completed ones. Five screening tools (American Speech-Language and Hearing Association, Guide for Monitoring Child Development, Infant Neurological International Battery, New Delhi-Development Screening Questionnaire and Woodside Screening Technique) reported relatively higher sensitivity (82.5%–100%) and specificity (83%–98.93%).ConclusionsLimited number of culturally sensitive developmental screening tools were validated for children aged <5 years in low- and middle-income countries. Revising existing screening tools in different ethnic and cultural settings and subsequent validation with normative value should be a research priority.

Families of children with Cerebral Palsy (CP) often experience extreme poverty, compounded by limited livelihood opportunities and the added demands of caregiving, which further restrict their ability to earn an income. Targeted livelihood interventions may help improve their economic well-being. This study aimed to assess the cost-effectiveness of livelihood interventions to improve household incomes of ultra-poor families of children with CP in rural Bangladesh. This was a mixed-methods study utilising a subgroup of a pragmatic, open-label, cluster randomised controlled trial (RCT). This subgroup was part of the \"Supporting People in Extreme Poverty with Rehabilitation and Therapy (SUPPORT CP)\" trial (ACTRN12619001750178), which was implemented in three rural subdistricts of Sirajganj district, Bangladesh. This RCT involved 251 children across three arms- integrated microfinance-based livelihood and community-based rehabilitation (IMCBR), community-based rehabilitation (CBR), and care-as-usual. We investigated 80 children with CP whose parents received an IMCBR program as part of the SUPPORT CP trial. Additionally, in-depth interviews were conducted with 21 participants from the IMCBR arm. Descriptive statistics to depict respondent characteristics and the average return on investment (ROI) were calculated to evaluate the most cost-effective livelihood support. Furthermore, thematic analysis was performed with the interview data to explore the advantages and disadvantages of different livelihood products. The parents/caregivers of included children with CP were given five forms of livelihood support: Chickens (n = 3, 15 for each), Sewing machine (n = 11, 1 for each), Ghee making utensils (n = 1, 1 for each), Lamb (n = 7, 2 for each), and Goat (n = 59, 2 for each). The average cost of livelihood intervention per family was 65⸱9 USD. The net return on investment after 12 months was 59.0% for lamb, 70.0% for ghee-making tools, 24.0% for goat, 34.0% for sewing machines, and -25.0% for chicken. Lambs proved to be advantageous due to their sustainability, minimal space requirements, and disease resistance. This study suggests that the provision of lambs as livelihood support is the most effective intervention for empowering ultra-poor families with CP in Bangladesh. This experience can potentially enhance the well-being of ultra-poor families in Bangladesh and other low- and middle-income countries.

Background The health-related quality of life (HRQoL) of adolescents with CP in low and middle-income countries is often poor, as is the case in Bangladesh. This exploratory study examined what factors predict the proxy-reported HRQoL of adolescents with CP in rural Bangladesh, a typical low- and middle-income country (LMIC). Methods Adolescents with CP (10 to 18y) were identified using the Bangladesh Cerebral Palsy Register. HRQoL was assessed using the Cerebral Palsy Quality of Life-Teens proxy-report questionnaire (CPQoL-Teens), adolescent mental health using the Strengths and Difficulty Questionnaire (SDQ) and caregiver mental health using the Depression, Anxiety and Stress Scale (DASS-21). Theoretical and statistical interests (i.e. bivariate analysis, p  < 0.05) identified potential predictors which were entered into hierarchical multiple linear regression (HMLR) models in order of clinical significance; HMLR related adolescent clinical characteristics, adolescent and caregiver mental health and proxies of socioeconomic status to CPQoL-Teens dimensions. Results One hundred fifty-four adolescents with CP (mean age 15y 1mo, SD 1y 8mo, female 31.2%) participated in this study. Twenty-four factors were identified to explore for relationship to adolescent proxy-reported HRQoL. Fifteen of the factors correlated to one or more CPQoL-Teens dimension; strongest correlation was between ‘feelings about functioning’ and motor impairment ( r  = 0.545). Nine were predictive of CPQoL-Teens dimensions; adolescent sex, school attendance, severity of motor impairment, hearing and speech impairment, mother’s education, primary caregiver depression and stress, and having a sanitary latrine at home resulting in score changes of between 0.79 (95% CI 0.24 to 1.35) to 35.1 (95% CI 6.03 to 64.22). Conclusions Many of the factors predicting the proxy-reported HRQoL of adolescents with CP are amenable to intervention, and have the potential to improve adolescent wellbeing. Several determinants are priorities of the sustainable development goals (SDGs); these findings should inform resource prioritization to improve the wellbeing of adolescents with CP in Bangladesh and other LMICs.

Poverty is a key contributor to delayed diagnosis and limited access to early intervention and rehabilitation for children with cerebral palsy (CP) in rural Bangladesh. 97% of families of children with CP live below the poverty line in Bangladesh. Therefore, in low-and middle-income countries (LMICs), efforts to improve outcomes for children with CP (including health-related quality of life, motor function, communication, and nutritional attainments) should also include measures to improve family economic and social capital. We propose a randomised controlled trial (RCT) to evaluate the effectiveness of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) program for ultra-poor families of children with CP in rural Bangladesh. This will be a cluster RCT comparing three arms: (a) integrated microfinance/livelihood and community-based rehabilitation (IMCBR); (b) community-based rehabilitation (CBR) alone; and (c) care-as-usual (i.e. no intervention). Seven clusters will be recruited within each arm. Each cluster will consist of 10 child-caregiver dyads totalling 21 clusters with 210 dyads. Parents recruited in the IMCBR arm will take part in a microfinance/livelihood program and Parent Training Module (PTM), their children with CP will take part in a Goal Directed Training (GDT) program. The programs will be facilitated by specially trained Community Rehabilitation Officers. The CBR arm includes the same PTM and GDT interventions excluding the microfinance/livelihood program. The care-as-usual arm will be provided with information about early intervention and rehabilitation. The assessors will be blinded to group allocation. The duration of the intervention will be 12 months; outcomes will be measured at baseline, 6 months, 12 months, and 18 months. This will be the first RCT of an integrated microfinance/livelihood and CBR program for children with CP in LMIC settings. Evidence from the study could transform approaches to improving wellbeing of children with CP and their ultra-poor families.

Social capital is a multifaceted concept that comprises structural and cognitive portions, and from the perspective of caregivers, it enables access to assistance and participation, improving well-being in resource-constrained settings. In low- and middle-income countries (LMICs) like Bangladesh, mothers are often the sole carers of children with cerebral palsy (CP), which may affect their social capital and livelihood; however, evidence in this regard is limited. This study assessed the effectiveness of integrated microfinance and community-based rehabilitation (IMCBR) on caregivers' social capital in rural Bangladesh. This study was part of a randomized controlled trial (RCT) conducted in Shahjadpur, Sirajganj, with three study arms. Children aged ≤5 years with CP and their primary caregivers were enrolled. Twenty-four clusters (10-14 child-caregiver pairs per cluster) were randomly assigned to Arm-A: IMCBR, Arm-B: community-based rehabilitation (CBR) only, and Arm-C: standard care. Data were collected at the baseline, midline (6 months), and endline (12 months) using a structured questionnaire. Social capital was measured using the Short Adapted Social Capital Assessment Tool (SASCAT), which assesses structural and cognitive dimensions; higher scores indicated greater social capital. The SASCAT was culturally adapted and validated for use in Bangladesh. Descriptive, bivariate, and multivariate analyses were performed. There were 251 dyads enrolled into the trial. At baseline, Arm-A had the lowest social capital scores but showed the greatest improvement by endline (60.0%), followed by Arm-B (54.1%) and Arm-C (6.0%). Structural social capital increased significantly in Arm-A compared with Arm-C (mean difference 2.88; 95% CI: 2.45-3.31; < 0.001) and in Arm-B compared with Arm-C (mean difference 2.46; 95% CI: 2.04-2.87; < 0.001). Cognitive social capital increased the most in Arm-B (10.7%), though group differences were not significant ( > 0.05). In Arm-A, improvements in social capital were inversely associated with the child's Gross Motor Function Classification System (GMFCS) level (β = -0.69; 95% CI: -1.28 to -0.10; < 0.05). IMCBR significantly improved caregivers' social capital, particularly its structural components, in rural Bangladesh.

ObjectiveTo evaluate the predictive validity of best practice early detection tools for cerebral palsy (CP) in a high-risk cohort.Study designProspective longitudinal cohort study.SettingNeonatal intensive care unit of a regional tertiary hospital in Bangladesh.ParticipantsNeonates with risk factors for CP admitted to Mymensingh Medical College Hospital Neonatal Intensive Care Unit between November 2019 and March 2020.Outcome measuresGeneral Movements Assessment (GMA) at writhing and fidgety periods; Hammersmith Infant Neurological Examination (HINE) and Peabody Developmental Motor Scales Second Edition (PDMS-2) conducted in person at 3, 12 and 24 months. The Developmental Assessment of Young Children (DAYC-2), Ages and Stages Questionnaire (ASQ-3) and Developmental Milestones Chart (DMC) were administered remotely at 6, 9, 12, 18 and 24 months. Due to the impact of COVID-19, a proportion of the cohort was not able to have GMA fidgety videos completed and the first HINE assessment was delayed.ResultsA total of 227 infants were enrolled. Of the surviving infants assessed at 24 months, 36 (29%) had a confirmed diagnosis of CP. The most accurate combination of tools for early detection was GMA and HINE at 3 months (sensitivity 0.91; specificity 1.00). The PDMS-2 Total Motor Quotient, with an optimised cut-off of 59, showed high accuracy at 24 months (sensitivity 0.94; specificity 0.99). Among the tools administered remotely, the DAYC-2 PD, DMC (Gross and Fine Motor domains) and ASQ-3 (Gross and Fine Motor domains) demonstrated strong predictive validity—both individually and in combination—at 9, 12, 18 and 24 months, supporting their use as practical alternatives when in-person assessments are not feasible.ConclusionsDespite pandemic-related disruptions, an accurate diagnosis was possible as early as 3 months of age using the best practice tools. Our findings support the practicability of scalable early detection models integrating in-person and remote assessments to improve access to timely diagnosis.

Background Mental health challenges are a growing global public health concern, with university students at elevated risk due to academic and social pressures. Although several studies have exmanined mental health among Bangladeshi students, few have integrated conventional statistical analyses with advanced machine learning (ML) approaches. This study aimed to assess the prevalence and factors associated with depression, anxiety, and stress among Bangladeshi university students, and to evaluate the predictive performance of multiple ML models for those outcomes. Methods A cross-sectional survey was conducted in February 2024 among 1697 students residing in halls at two public universities in Bangladesh: Jahangirnagar University and Patuakhali Science and Technology University. Data on sociodemographic, health, and behavioral factors were collected via structured questionnaires. Mental health outcomes were measured using the validated Bangla version of the Depression, Anxiety, and Stress Scale-21 (DASS-21). Statistical analyses included chi-square tests and binary logistic regression, while seven ML models including, K-Nearest Neighbors (KNN), Random Forest (RF), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Categorical Boosting (CatBoost), Logistic Regression (LR), and Support Vector Machine (SVM) were employed to predict mental health outcomes. Results The prevalence of depression, anxiety, and stress was 56.9%, 69.5%, and 32.2%, respectively. Significant associated factors for depression included unfriendly family relationships, enrollment in commerce, and cigarette smoking. Female gender, unfriendly family relationships, academic year, and cigarette smoking were significant factors for stress. No significant factors were identified for anxiety. Among ML models, SVM achieved the highest accuracy for depression prediction (accuracy = 0.5693; precision = 0.7560; log loss = 0.6847), LR for anxiety (accuracy = 0.6948; precision = 0.7881), and CatBoost for stress (accuracy = 0.6706; precision = 0.6454; F1-score = 0.5777; log loss = 0.6284). Feature importance analyses highlighted faculty of study and relation with family as the top predictors. ROC-AUC values indicated moderate discriminatory performance (all ≥ 0.5). Conclusions Integrating machine learning with conventional analyses enhances the identification and prediction of factors associated with depression, anxiety, and stress among university students. These findings support the implementation of campus-based mental health screening, accessible counseling, and peer support programs, and highlight the value of data-driven approaches for developing targeted university mental health policies.