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Chakraborty R1, Islam Q2, Jalal F3, Marella M4, Nguyen L4, Pryor W4
1Handicap International - Humanity & Inclusion, Technical Unit, Dhaka, Bangladesh, 2Bangladesh Bureau of Statistics, Demography and Health Wing, Dhaka, Bangladesh, 3Handicap International - Humanity & Inclusion, Programme, Dhaka, Bangladesh, 4University of Melbourne, Nossal Institute for Global Health, Melbourne, Australia
Background: In concert with rehabilitation services including physiotherapy, Assistive Products (AP) can transform lives by facilitating independence and community participation and preventing further disability. The World Health Organization estimates that worldwide, 1 billion people require AP and that the need could double by 2050. Availability and affordability of AP is particularly challenging in low-resourced countries like Bangladesh where, despite growing commitment to AP in health, disability and social sectors, little is known about unmet needs and access patterns.
Purpose: A survey was conducted in two areas of Kurigram and Narsingdi districts to determine unmet and met needs for AP, characteristics of AP users, barriers to use of AP, and characteristics of current supply methods.
Methods: A modified version of the WHO's draft Assistive Technology Assessment Tool - Needs Module (ATA-Needs) was utilized to survey a sample of 4254 adults, as part of a cross sectional study that estimated disability prevalence for the two districts and compared levels of well-being, access to services and participation in community life between people with and without disabilities. The ATA-Needs tool was administered to all adult participants (18 years and older) who identified any functional difficulties using the Washington Group Short-Set (WG) of six disability questions, and their matched controls.
Results: Around 7% of adults in the study districts used at least one AP. AP use increases with more severe difficulties- 10%, 29%, and 40% of people who reported 'some difficulties', 'a lot of difficulties', or 'cannot do at all', respectively. APs are more commonly used to address self-care (9%), mobility (7%), and vision (5.4%) difficulties. 72% of people with any difficulty reported a need for AP that they do not already have. Unmet need for AP varies with severity of functional difficulty, 68% of people reporting some difficulties, 84% with moderate difficulties and 60% with severe difficulties. 80% of people who use AP reported that their APs mostly or completely met their needs. 46% of all AP were home or self-made. Half of study AP users spent less than USD$1.80 on their AP. The average cost of AP increased with disability severity, but people with greater functional difficulties were less likely to report that AP addressed their needs.
Conclusion(s): There is a profound unmet need for AP in Bangladesh. The use of AP varies between different functional domains, with less emphasis on AP for communication and learning difficulties than on mobility and self-care. Costs and poor knowledge about their availability and use were major barriers. Scale up efforts and strategies to build knowledge of local sources, and to expand the range of products available and used are urgently needed in Bangladesh.
Implications: New emphasis on AP in rehabilitation services, NGOs, and the private sectors, along with decentralisation strategies, may be needed. Options for AP provision should include both simple, low-cost devices using local materials and technology, and appropriate devices to meet more complex needs. The survey method used in this study could be modified and replicated in other districts to inform local practice, combined with building local awareness on AP.
Keywords: Assistive products, Bangladesh, Rehabilitation services
Funding acknowledgements: The European Union, through “Towards Global Health”, implemented by Handicap International-Humanity & Inclusion Bangladesh, with Nossal Institute for Global Health.
Purpose: A survey was conducted in two areas of Kurigram and Narsingdi districts to determine unmet and met needs for AP, characteristics of AP users, barriers to use of AP, and characteristics of current supply methods.
Methods: A modified version of the WHO's draft Assistive Technology Assessment Tool - Needs Module (ATA-Needs) was utilized to survey a sample of 4254 adults, as part of a cross sectional study that estimated disability prevalence for the two districts and compared levels of well-being, access to services and participation in community life between people with and without disabilities. The ATA-Needs tool was administered to all adult participants (18 years and older) who identified any functional difficulties using the Washington Group Short-Set (WG) of six disability questions, and their matched controls.
Results: Around 7% of adults in the study districts used at least one AP. AP use increases with more severe difficulties- 10%, 29%, and 40% of people who reported 'some difficulties', 'a lot of difficulties', or 'cannot do at all', respectively. APs are more commonly used to address self-care (9%), mobility (7%), and vision (5.4%) difficulties. 72% of people with any difficulty reported a need for AP that they do not already have. Unmet need for AP varies with severity of functional difficulty, 68% of people reporting some difficulties, 84% with moderate difficulties and 60% with severe difficulties. 80% of people who use AP reported that their APs mostly or completely met their needs. 46% of all AP were home or self-made. Half of study AP users spent less than USD$1.80 on their AP. The average cost of AP increased with disability severity, but people with greater functional difficulties were less likely to report that AP addressed their needs.
Conclusion(s): There is a profound unmet need for AP in Bangladesh. The use of AP varies between different functional domains, with less emphasis on AP for communication and learning difficulties than on mobility and self-care. Costs and poor knowledge about their availability and use were major barriers. Scale up efforts and strategies to build knowledge of local sources, and to expand the range of products available and used are urgently needed in Bangladesh.
Implications: New emphasis on AP in rehabilitation services, NGOs, and the private sectors, along with decentralisation strategies, may be needed. Options for AP provision should include both simple, low-cost devices using local materials and technology, and appropriate devices to meet more complex needs. The survey method used in this study could be modified and replicated in other districts to inform local practice, combined with building local awareness on AP.
Keywords: Assistive products, Bangladesh, Rehabilitation services
Funding acknowledgements: The European Union, through “Towards Global Health”, implemented by Handicap International-Humanity & Inclusion Bangladesh, with Nossal Institute for Global Health.
Topic: Service delivery/emerging roles
Ethics approval required: Yes
Institution: Nossal Institute for Global Health, University of Melbourne, Australia.
Ethics committee: Dentistry & Health Sciences Human Ethics Standing Committee
Ethics number: 1647660.1
All authors, affiliations and abstracts have been published as submitted.
