Childhood disabilities, household poverty, and inequality: A population-based case-control study in rural Bangladesh.

Aim: To explore the relationship between household poverty, inequality, and disability among children in rural Bangladesh.

Method: This was a matched case-control study in Shahjadpur, northern Sirajganj, Bangladesh. Children aged younger than 18 years with disabilities (i.e.

Cases: those with cerebral palsy, spina bifida, hydrocephalus, muscular dystrophy, spinal cord injury, amputation, club foot, cleft lip or palate, trauma or burn-related injury or impairment, congenital deformity, genetic condition, and visual, hearing, and speech impairments) and age-, sex-, and location-matched children without disabilities (i.e. controls) were recruited. Cases were identified using the key informant method. Household poverty likelihood and socioeconomic status (SES) were assessed using a validated poverty scorecard. Descriptive and inferential analyses were completed.

Results: Between October 2017 and February 2018, 1274 cases and 1303 controls were recruited (median age at assessment 9 years 10 months [interquartile range 6 years 0 months-13 years 7 months] and 9 years 10 months [5 years 8 months-12 years 0 months] respectively). The household poverty likelihood was 7% higher among cases than controls (p < 0.001). Parental employment, family income, and school enrolment rate were significantly lower among cases than controls especially in the families with low SES. Both underweight and stunting were significantly higher among cases than controls (p < 0.001 for both). Receipt of rehabilitation services and health-care seeking from formal sectors were significantly lower among cases from families with low SES than high SES (60% vs. 71%, p = 0.03; 10% vs. 33%, p < 0.001 respectively).

Interpretation: Our findings are crucial to develop interventions and reduce the inequalities between children with and without disabilities in low-resource settings such as Bangladesh as highlighted in the global agenda of the Sustainable Development Goals.