Prevalence of emotional and behavioral problems among adolescents in Bangladesh.

BACKGROUND: Emotional and behavioral problems among adolescents is a global concern. Previous studies conducted in Bangladesh have highlighted the importance to effectively prevent and address emotional and behavioral problems among adolescents to improve their psychological well-being. Despite these efforts, there remains limited research specifically addressing emotional and behavioral problems, conduct disorders, hyperactivity/attention disorders, and peer relationship problems among adolescents in Bangladesh in terms of age, gender, grade, and location. To address this knowledge gap, the present study aimed to comprehensively investigate the prevalence of emotional and behavioral problems among school-going adolescents in Bangladesh. METHODS: The study employed a two-stage stratified cluster sampling technique to recruit a total of 1496 participants. The socio-demographic characteristics of the participants, such as age, gender, grade, location, birth order, family type, monthly family income, and parental education were collected. Emotional and behavioral problems were assessed using the Strength and Difficulties Questionnaire (SDQ), while the chi-square test and logistic regression were used to analyze the data with STATA software. RESULTS: The prevalence of emotional disorder was 9.09% (7.73 - 10.65%). The rate was 21.72% (19.70 - 23.88%) for conduct disorder, 6.21% (5.09 - 7.55%) for hyperactivity, and for peer-relationship problem, the rate was 15.10% (13.37 - 17.01%) among adolescents. Overall, gender, grade, location, monthly family income, and parental education were significantly associated with emotional and behavioral problems. More specifically, adolescent girls (OR = 2.90 for the emotional disorder), grade (8th: OR = 2.07, 9th: OR = 1.95, for the emotional disorder), urban residents (OR = 2.46, for conduct disorder; OR = 2.29, for hyperactivity; OR = 2.03, for peer-relationship problem), poor monthly family income (OR = 2.84, for peer-relationship problem) significantly increased the risk of psychiatric morbidity. CONCLUSION: The study highlights the need for school-based intervention programs to address adolescent emotional and behavioral problems. By targeting vulnerable individuals, these programs can effectively reduce mental health problems among adolescents.

Prevalence and factors associated with digital addiction among students taking university entrance tests: a GIS-based study.

BACKGROUND: The surge in digital media consumption, coupled with the ensuing consequences of digital addiction, has witnessed a rapid increase, particularly after the initiation of the COVID-19 pandemic. Despite some studies exploring specific technological addictions, such as internet or social media addiction, in Bangladesh, there is a noticeable gap in research focusing on digital addiction in a broader context. Thus, this study aims to investigate digital addiction among students taking the university entrance test, examining its prevalence, contributing factors, and geographical distribution using GIS techniques. METHODS: Data from a cross-sectional survey were collected from a total of 2,157 students who were taking the university entrance test at Jahangirnagar University, Bangladesh. A convenience sampling method was applied for data collection using a structured questionnaire. Statistical analyses were performed with SPSS 25 Version and AMOS 23 Version, whereas ArcGIS 10.8 Version was used for the geographical distribution of digital addiction. RESULTS: The prevalence of digital addiction was 33.1% (mean score: 16.05 ± 5.58). Those students who are attempting the test for a second time were more likely to be addicted (42.7% vs. 39.1%), but the difference was not statistically significant. Besides, the potential factors predicted for digital addiction were student status, satisfaction with previous mock tests, average monthly expenditure during the admission test preparation, and depression. No significant difference was found between digital addiction and districts. However, digital addiction was higher in the districts of Manikganj, Rajbari, Shariatpur, and Chittagong Hill Tract areas, including Rangamati, and Bandarban. CONCLUSIONS: The study emphasizes the pressing need for collaborative efforts involving educational policymakers, institutions, and parents to address the growing digital addiction among university-bound students. The recommendations focus on promoting alternative activities, enhancing digital literacy, and imposing restrictions on digital device use, which are crucial steps toward fostering a healthier digital environment and balanced relationship with technology for students.

Latin American Cerebral Palsy Register (LATAM-CPR): study protocol to develop a collaborative register with surveillance of children with cerebral palsy in Latin American countries.

INTRODUCTION: Cerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR). METHODS AND ANALYSIS: The LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared. ETHICS AND DISSEMINATION: Individual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.

Dietary Intake, Feeding Pattern, and Nutritional Status of Children with Cerebral Palsy in Rural Bangladesh.

(1) Background: Data on immediate causes of malnutrition among children with Cerebral Palsy (CP) are limited in low- and middle-income countries (LMICs). We aimed to assess the dietary intake pattern, feeding characteristics, and nutritional status of children with CP in Bangladesh; (2) Methods: We conducted a descriptive observational study in Shahjadpur, Bangladesh. Children with CP registered into the Bangladesh CP Register were included. Socio-demographic, clinical, dietary intake, feeding, gastro-intestinal conditions, and anthropometric data were collected. Descriptive and inferential statistics were reported; (3) Results: 75 children (mean (SD) age 3.6 (2.7) years, 42.7% female) and their caregivers participated. Overall, 53.6% and 46.4% of children were underweight and stunted, respectively. Two-thirds children consumed ≤4 out of 8 food groups. Meat, poultry, and fish; dairy products; and sugar consumption was lower among underweight children (43.4%, 48.8%, 25.0%) than others (56.7%, 51.2% 75.0%). Inappropriate feeding position was observed in 39.2% of children. Meal duration was >30 min/meal for 21.7‒28.0% children. Among all, 12.0% had feeding difficulties, 88.0% had ≥1 gastro-intestinal conditions; (4) Conclusions: The study reports preliminary data on the feeding characteristics, dietary intake, and nutritional status of children with CP in rural Bangladesh. The findings are crucial for cost-effective interventions, prevention, and management of malnutrition among children with CP in Bangladesh and other LMICs.

Depression among Bangladeshi diabetic patients: a cross-sectional, systematic review, and meta-analysis study.

AIM: This study aims to assess the prevalence and associated factors of depression among diabetic patients in a cross-sectional sample and perform a systematic review and meta-analysis of the extant studies to date. METHODS: A face-to-face semi-structured interview of established diabetic patients was conducted in four districts of Bangladesh between May 24 to June 24, 2022, and the Patient Health Questionnaire (PHQ-2) was used to detect depression. PRISMA guidelines were followed to conduct a systematic review and meta-analysis, with Bangladeshi articles published until 3rd February 2023. RESULTS: The prevalence of depression among 390 diabetic patients was 25.9%. Having secondary education and using both insulin and medication increased the likelihood of depression, whereas being a business professional and being physically active reduced the likelihood of depression. The systematic review and meta-analysis indicated that the pooled estimated prevalence of depression was 42% (95% CI 32-52%). Females had a 1.12-times higher risk of depression than males (OR = 1.12, 95% CI: 0.99 to 1.25, p < 0.001). CONCLUSIONS: Two-fifths of diabetic patients were depressed, with females at higher risk. Since depression among diabetic patients increases adverse outcomes, improved awareness and screening methods should be implemented to detect and treat depression in diabetic patients.

Nomophobia among university students: Prevalence, correlates, and the mediating role of smartphone use between Facebook addiction and nomophobia.

Nomophobia ('no mobile phone phobia') has been growing issue worldwide in recent years and has been associated with a number of psychological and behavioral health-related problems. However, few studies have examined nomophobia in Bangladesh. Therefore, the severity and correlates of nomophobia, and the mediating role of smartphone use between Facebook addiction and nomophobia was investigated. A cross-sectional study utilizing 585 university students was conducted employing a convenience sampling method. Data were collected using a survey in March 2022. The survey comprised questions related to socio-demographics, behavioral health, academic performance, nomophobia, smartphone addiction, Facebook addiction, insomnia, and depression. The mean score of nomophobia was 88.55 out of 140 (±21.71). The prevalence was 9.4% for mild nomophobia, 56.1% for moderate nomophobia, and 34.5% for severe nomophobia. First-year students had higher levels of nomophobia than other years. Significant predictors for nomophobia included daily duration of smartphone time, psychoactive substance use, and being in a relationship. Nomophobia was significantly associated with smartphone addiction, Facebook addiction, insomnia, and depression. Moreover, smartphone addiction significantly mediated the relationship between Facebook addiction and nomophobia. Strategies that help reduce daily smartphone time, and reduce psychoactive substance use might help reduce nomophobia prevalence among university students.

Sleep duration during the COVID-19 pandemic in Bangladesh: A GIS-based large sample survey study.

Although several studies have been conducted in Bangladesh regarding sleep problems during the COVID-19 pandemic, none have utilized a large nationwide sample or presented their findings based on nationwide geographical distribution. Therefore, the aim of the present study was to explore the total sleep duration, night-time sleep, and daily naptime and their associated factors as well as geographic information system (GIS) distribution. A cross-sectional survey was carried out among 9730 people in April 2020, including questions relating to socio-demographic variables, behavioral and health factors, lockdown, depression, suicidal ideation, night sleep duration, and naptime duration. Descriptive and inferential statistics, both linear and multivariate regression, and spatial distribution were performed using Microsoft Excel, SPSS, Stata, and ArcGIS software. The results indicated that 64.7% reported sleeping 7-9 h a night, while 29.6% slept less than 7 h nightly, and 5.7% slept more than 9 h nightly. 43.7% reported 30-60 min of daily nap duration, whereas 20.9% napped for more than 1 h daily. Significant predictors of total daily sleep duration were being aged 18-25 years, being unemployed, being married, self-isolating 4 days or more, economic hardship, and depression. For nap duration, being aged 18-25 years, retired, a smoker, and a social media user were at relatively higher risk. The GIS distribution showed that regional division areas with high COVID-19 exposure had higher rates of non-normal sleep duration. Sleep duration showed a regional heterogeneity across the regional divisions of the country that exhibited significant associations with a multitude of socioeconomic and health factors.

Associated Impairments among Children with Cerebral Palsy in Rural Bangladesh-Findings from the Bangladesh Cerebral Palsy Register.

BACKGROUND: We aimed to describe the burden, severity, and underlying factors of associated impairments among children with cerebral palsy (CP) in rural Bangladesh. METHODS: This study reports findings from the Bangladesh Cerebral Palsy Register-the first population-based surveillance of children with CP in any LMIC, where children with confirmed CP aged < 18 years are registered by a multidisciplinary team following a standard protocol. Associated impairments were documented based on clinical assessment, available medical records, and a detailed clinical history provided by the primary caregivers. Descriptive analysis, as well as unadjusted and adjusted logistic regression, were completed using R. RESULTS: Between January 2015 and February 2022, 3820 children with CP were registered (mean (SD) age at assessment: 7.6 (5.0) y; 39% female). Overall, 81% of children had ≥1 associated impairment; hearing: 18%, speech: 74%, intellectual: 40%, visual: 14%, epilepsy: 33%. The presence of a history of CP acquired post-neonatally and having a gross motor function classification system levels III-V significantly increased the odds of different types of associated impairments in these children. Most of the children had never received any rehabilitation services and were not enrolled in any mainstream or special education system. CONCLUSIONS: The burden of associated impairments was high among children with CP, with comparatively low receipt of rehabilitation and educational services in rural Bangladesh. Comprehensive intervention could improve their functional outcome, participation, and quality of life.

The Sexual and Reproductive Health of Adolescents with Cerebral Palsy in Rural Bangladesh: A Qualitative Analysis.

Adolescents with disability in the Global South have unique sexual and reproductive health (SHR) experiences and needs; however, they are rarely included in SRH discourse. This qualitative study, conducted in rural Bangladesh, used semi-structured interviews to understand how adolescents with cerebral palsy (CP) experience their SRH. Participants were recruited from the Bangladesh Cerebral Palsy Register and included 24 adolescents with CP (n = 12 female; n = 12 male) and 76 parents (n = 56 mothers, n = 17 fathers, n = 3 other relatives). Data were analyzed using reflexive thematic analysis. Findings highlighted heterogeneity among adolescents with CP including differences for adolescent men versus women. For some adolescent men with CP, sexual maturity was viewed as bringing new opportunities, whereas for other men, adolescence affirmed exclusions and some transgressed sociocultural norms as they struggled to navigate their pubescent body alongside new privacy requirements. For adolescent women with CP, sexual maturity was associated with new domestic responsibilities, silence and secrecy regarding menstruation, and increased vulnerability to sexual violence and abuse. Adolescent men and women with CP spoke about marriage as something "everybody wants," however, was deemed "impossible" for those with more impairment-related support needs. Both adolescent men and women with CP lacked access to SRH information and support. Mothers positioned providing care to their adolescent child with CP after puberty as "shameful." Our findings suggest that disability, health, and education services in rural Bangladesh need to adopt a life-course approach that incorporates the SRH of adolescents with CP. We recommend the provision of SRH education that addresses the physical, cognitive, and social needs of adolescents with CP.

SUpporting People in extreme POverty with Rehabilitation and Therapy (SUPPORT CP): A trial among families of children with cerebral palsy in Bangladesh.

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. WHAT THIS PAPER ADDS: Half of the families who received livelihoods were impacted by a cold-wave, suggesting the need for a more disaster-resilient livelihood asset. The integration of livelihood with community-based rehabilitation programme helps to improve health-related quality of life of children with cerebral palsy and the social capital of their ultra-poor families.

Novel weight estimation equation for children with cerebral palsy in low-resource settings: Validation in a population-based cohort.

AIM: To validate a novel equation to estimate weight from mid-upper arm circumference (MUAC) among children with cerebral palsy (CP) in rural Bangladesh. METHOD: Children with CP aged 2 to 18 years registered in the Bangladesh CP Register were randomly selected. Data on sociodemographics, Gross Motor Function Classification System level, and anthropometric measurements were extracted. Bland-Altman plots with a 95% agreement limit and Lin's concordance correlation coefficient with 95% confidence intervals (CI) were reported to measure agreement between observed and estimated weight. Percentage error was used to determinate the method's accuracy. RESULTS: There were 497 participants with a mean age at assessment of 9 years (SD 4 years 11 months) (47.7% female). Lin's concordance correlation coefficient between the observed and estimated weights was 0.90 (95% CI 0.89-0.92). Bland-Altman plots showed a reasonable accuracy of the equation in the study cohort. The mean percentage error of the equation was 5.04%. The average difference between observed and estimated weights was -1.02 kg (SD 5.1). The differences between observed and estimated weights were significantly greater among children with weight-for-age, height-for-age, or BMI-for-age z-scores less than or equal to -4. INTERPRETATION: It is possible to predict the weight of children with CP from MUAC with sufficient accuracy. The equation can be used for populations in low-resources and low- and middle-income countries. WHAT THIS PAPER ADDS: The equations predict the weight of children with cerebral palsy from their mid-upper arm circumference reasonably accurately. The difference between observed and estimated weights ranged between 0 kg and ± 5 kg in 81.5% of children. Sex and Gross Motor Function Classification System level did not affect the accuracy of the equations. The equations were less accurate for estimating the weight of severely undernourished children.

Epidemiology of cerebral palsy among children in the remote Gorkha district of Nepal: findings from the Nepal cerebral palsy register.

PURPOSE: To describe the epidemiology of cerebral palsy (CP) among children in Gorkha, Nepal. METHODS: We established the first population-based register of children with CP aged <18 y in Gorkha, Nepal (i.e., Nepal CP Register). Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary assessment team. Socio-demographic, etiology, motor severity, rehabilitation, and educational status were documented. RESULTS: Between January and October 2018, 182 children with confirmed CP were registered (mean (standard deviation (SD)) age: 10 years 1 months (4 years 10 months), 37.4% females). The majority (88.3%) had CP acquired pre- or perinatally. Mean (SD) age of CP diagnosis was four years five months. Mothers who did not receive any formal schooling had 4.5, 3.1, and 6.3 times higher odds of having inadequate antenatal care, homebirth, and unskilled birth attendants, respectively, when adjusted for other factors. Most children had spastic CP (77.5%) and Gross Motor Function Classification System level III-V (54.9%). Overall, 45.8% had never received rehabilitation services, 58.0% of school-aged children were not attending schools. The median age of receiving rehabilitation services was three years zero months. CONCLUSIONS: The delayed diagnosis and clinical severity indicate the overall poor health status of children with CP in Nepal which could be improved by ensuring early diagnosis and intervention. Implications for rehabilitationThe first population-based cerebral palsy register in Nepal suggests diagnosis of CP is considerably delayed among children.The high burden of severe motor impairment and poor communication skill with limited access to timely rehabilitation among children with CP in Nepal is concerning.Capacity development of community-based health workers and mothers of children with CP could help implementing community-based programs for prevention and early diagnosis of CP, and to promote early intervention for children with CP in remote Gorkha, Nepal.

Prevalence and associated factors of suicidal behaviors among Bangladeshi rural community people: Findings from the 'BD ComMen Study'.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Prevalence and risk factors of sleep problems in Bangladesh during the COVID-19 pandemic: a systematic review and meta-analysis.

The outbreak of the novel coronavirus disease 2019 (COVID-19) has altered people's lives worldwide and fostered the emergence of sleep problems. However, no systematic review and meta-analysis has yet been conducted to rigorously evaluate the impact of COVID-19 on sleep problems from a Bangladeshi perspective. As a result, the current systematic review and meta-analysis aims to fill this knowledge gap, which may lead to a better understanding of the prevalence and risk factors associated with sleep problems. To conduct this systematic review, PRISMA guidelines were followed; a literature search was conducted to include studies published till 5th March 2022 from the inception of COVID-19 pandemic in Bangladesh searching databases such as PubMed, Scopus. A total of eleven studies were included. The JBI checklist was used to assess the methodological quality of included studies. The overall estimated prevalence of sleep problems was 45% (95% CI: 32% to 58%, I2 =99.31%). General populations were more affected by sleep problems [52% (95% CI: 36% to 68%, I2 =98.92%)] than the healthcare professionals [51% (95% CI: 23% to 79%, I2 =97.99%)] (χ2 = 137.05, p <0.001). Additionally, results suggested that suffering from sleep problems were higher among female (OR: 1.15; 95% CI: 1.03 to 1.29 compared to men); urban residents (OR: 1.77; 95% CI: 1.55 to 2.02 compared to rural); and anxious person (OR: 5.15; 95% CI: 4.32 to 6.14 compared to non-anxious), whereas single participants less likely to suffer from sleep related problems (OR: 0.81; 95% CI: 0.71 to 0.94). The prevalence rate of sleep problems was high and the general populations was at particularly high risk. Further longitudinal studies are warranted to investigate the trajectories of such sleep problems as a function of pandemic changes.

Improving epilepsy control among children with cerebral palsy in rural Bangladesh: a prospective cohort-based study.

OBJECTIVE: To define the prevalence and seizure subtypes among children with cerebral palsy (CP) in rural Bangladesh and explore barriers to optimum epilepsy control. DESIGN: Prospective cohort study. SETTING: The study was conducted in Shahjadpur, a rural subdistrict of Bangladesh. PARTICIPANTS: Children (<18 years) with CP and epilepsy identified using the Bangladesh CP Register (BCPR) in the study site. METHODS: Assessments were conducted in three focused epilepsy clinics overseen by a paediatric neurologist between December 2016 and January 2018, with intervening phone and video-conference follow-ups. Details of event type, frequency and medication compliance were collected. Antiepileptic drugs (AEDs) were prescribed based on seizure type, family income, comorbidity and medication availability. RESULTS: 23.4% (170/726) of the BCPR cohort had a clinical diagnosis of epilepsy of whom 166 were assessed. Following the focused epilepsy clinics, 62.0% (103/166) children were clinically determined to have ongoing epileptic seizures. 62.1% (64/103) had generalised onset tonic clonic seizures, 27.2% (28/103) had focal onset seizures with impaired awareness and 10.7% (11/103) had other seizure types. None of the children with prolonged seizures (31/103) had an emergency seizure management plan. Non-epileptic events were being pharmacologically treated as seizures in 18.1% (30/166) children. Financial constraints were the main reason for non-compliance on follow-up. CONCLUSIONS: Gaps in optimum epilepsy management in rural Bangladesh are amenable to improvement anchored with local healthcare workers. Training and clinical care focused on recognition of common seizure types, seizure mimics and rationalising use of available AEDs can be facilitated by better referral pathways and telehealth support.

Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review.

BACKGROUND: Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs. METHODS: Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported. RESULTS: Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m-18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions. CONCLUSION: There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs.

A Social Business Model of Early Intervention and Rehabilitation for People with Disability in Rural Bangladesh.

BACKGROUND: Despite the high burden of childhood disability in low-and middle-income countries (LMICs), the opportunity for early intervention and rehabilitation is very limited. Studies have found that community-based rehabilitation service is effective for children with cerebral palsy (CP); however, such services are not readily available in LMICs, and services run by non-profit organisations on external funding are often not sustainable. In this study, we report the lesson learnt in establishing a social business model of early intervention and rehabilitation services for children with CP and adults with disabilities in a rural subdistrict of Bangladesh. METHODS: Case study of a rural early intervention and rehabilitation centre (i.e., the model centre) implemented between May 2018 and September 2019. An economic evaluation incorporating gross margin analysis along with descriptive statistics was performed to assess the social business potentials of the model centre. RESULTS: The establishment of this model centre cost ~5955 USD with an average monthly running cost of ~994 USD. During the 17 months study period, 7038 therapy sessions (average eight sessions per patient) were offered to 862 patients with musculoskeletal and neurological disorders. The most common clinical presentations were low back pain (35.6%; n = 307). Six percent (n = 52) of the attendees were children with CP (mean (SD) age 6.3 (4.0) years; 35.7% (n = 19) were female), who received 1392 sessions, on average 27 sessions per child. The centre reached the break-even point at the 13th month and remained profitable for the next 4 months of the study period. An average session fee of 2.2 USD resulted in a gross margin of -1458 USD and 1940 USD in 2018 and 2019, respectively. Revenue to cost ratios for the 2 years were 0.27:1 and 0.51:1 while average rates of return were -41.4% and 10.1%, respectively. Sensitivity analysis revealed that session numbers including 5000, 6000, 7000, 8000, 9000, and 10,000 were required to break even at the session fees of 3.0, 2.50, 2.0, 2.0, 1.5, and 1.5 USD, respectively. CONCLUSION: Our social business model of an early intervention and rehabilitation service provides evidence of enhancing access to services for children with CP as well as adults with disabilities while ensuring the sustainability of the services in rural Bangladesh.

Psychometric Validation of the Bangla Fear of COVID-19 Scale: Confirmatory Factor Analysis and Rasch Analysis.

The recently developed Fear of COVID-19 Scale (FCV-19S) is a seven-item uni-dimensional scale that assesses the severity of fears of COVID-19. Given the rapid increase of COVID-19 cases in Bangladesh, we aimed to translate and validate the FCV-19S in Bangla. The forward-backward translation method was used to translate the English version of the questionnaire into Bangla. The reliability and validity properties of the Bangla FCV-19S were rigorously psychometrically evaluated (utilizing both confirmatory factor analysis and Rasch analysis) in relation to socio-demographic variables, national lockdown variables, and response to the Bangla Health Patient Questionnaire. The sample comprised 8550 Bangladeshi participants. The Cronbach α value for the Bangla FCV-19S was 0.871 indicating very good internal reliability. The results of the confirmatory factor analysis showed that the uni-dimensional factor structure of the FCV-19S fitted well with the data. The FCV-19S was significantly correlated with the nine-item Bangla Patient Health Questionnaire (PHQ-90) (r = 0.406, p < 0.001). FCV-19S scores were significantly associated with higher worries concerning lockdown. Measurement invariance of the FCV-19S showed no differences with respect to age or gender. The Bangla version of FCV-19S is a valid and reliable tool with robust psychometric properties which will be useful for researchers carrying out studies among the Bangla speaking population in assessing the psychological impact of fear from COVID-19 infection during this pandemic.

Epidemiology of eye diseases among children with disability in rural Bangladesh: a population-based cohort study.

AIM: To describe the epidemiology of eye diseases among children with disability in rural Bangladesh. METHOD: We established a population-based cohort of children with disability using the key informant method. Children younger than 18 years with disability (i.e. physical, visual, hearing, speech, epilepsy) were included. We used detailed ophthalmological assessments following World Health Organization (WHO) protocols by a multidisciplinary team including an ophthalmologist, optometrist, physician, and physiotherapist. Visual impairment, blindness, and severe visual impairment (SVI) were defined by following WHO categories. RESULTS: Between October 2017 and February 2018, 1274 children were assessed (43.6% female; median [interquartile range] age 9y 10mo [6y -13y 7mo]). Overall, 6.5% (n=83) had blindness/SVI, and 5.6% (n=71) had visual impairment. In the group with blindness/SVI, 47% (n=39) had cortical blindness; of those, 79.5% (n=31) had cerebral palsy (CP). The other main anatomical sites of abnormalities in this group included lens (13.3%, n=11), cornea (10.8%, n=9), and optic nerve (9.6%, n=8). In the group with visual impairment, 90.1% (n=64) had refractive error. Overall, 83.1% (n=69) and 78.8% (n=56) of those with blindness/SVI and visual impairment had avoidable causes. Most children with blindness/SVI and visual impairment lacked access to education. INTERPRETATION: The burden of blindness/SVI/visual impairment is high among children with disability in rural Bangladesh, mostly due to avoidable causes. Overrepresentation of CP and cortical blindness in the group with blindness/SVI and refractive error in the group with visual impairment highlights the need for integration of ophthalmology assessment, eye care, and refraction services in comprehensive health care for children with disability including CP in rural Bangladesh.