ASSOCIATION BETWEEN POVERTY AND CONGENITAL PHYSICAL DISABILITY A survey study in the northern part of Bangladesh
Amzad Hossain Master’s Thesis Department of Health and Social Management
Masters program of Health and Business Faculty of Social Sciences and Business Studies University of Eastern Finland
December 2018
The UNIVERSITY OF EASTERN FINLAND, Faculty of Social Sciences and Business Studies Department of Health and Social Management
Hossain A.: Association between poverty and congenital physical Disability- A survey study in Bangladesh
Master’s thesis: 50 pages, 2 Appendices (5 pages)
Supervisors: Ulla-Mari Kinnunen, Senior Lecturer, Ph.D., RN.
Virpi Jylhä, Senior Lecturer, Ph.D.
December 2018
Key Words: Poverty, Congenital Physical Disability, Quality of life, Empowerment, Holistic Development.
The aim of this quantitative research was to ascertain the correlation between poverty and congenital disability and what are the recent trends in addressing this issue and future recommendations how different steps and supports to address these two issues in a more productive and holistic way.
A semi-structured questionnaire was developed and pre-tested for attaining relative information about knowledge, understanding and social stigma about poverty and congenital physical disability for this study in Bangladesh. This also gave an insight into what were the specific areas needed to be addressed by the government of Bangladesh, different international and local Non- government organizations working in the field of Disability of Bangladesh.
There were 53 respondents who took part in the study (All from a very low socio-economic background and sufferers of congenital physical disability) and SPSS method of data analysis was used to analyze of the obtained data with different forms of charts (e.g. Bar, Column etc) were used for visual demonstrate the analyzed data. The analysis showed marked drawbacks in the present poverty prone society of Bangladesh which plays as a catalyst in the birth of a physically challenged child. This study also went on to show the prevailing services for reducing the incidents and vast other steps to be taken to make the initiatives more fruitful and holistic as far as causing change on a wider range. How the dimension of poverty (regarding health, education, knowledge, sanitation, and nutrition) impacts on disability (Physical Disability) related to birth – was the principal focus of this research.
1 INTRODUCTION ... 3
2 THEORETICAL BACKGROUND ... 6
2.1 Disability (Physical Disability) ... 6
2.2 Poverty ... 18
2.3 Poverty and Disability ... 21
3 LITERATURE REVIEW ... 23
4 AIMS AND OBJECTIVES OF THE STUDY ... 28
5 METHODOLOGY ... 30
6 RESULTS ... 32
7 DISCUSSION ... 45
7.1 Validity and reliability of the study ... 45
7.2 Discussion of the study findings ... 46
7.3 Strengths and weaknesses of the study ... 48
7.4 The Implication for Future Research, Policy and Practice ... 48
8 CONCLUSION ... 50
9 REFERENCES ... 52
10 APPENDICES ... 57
Appendix A: Questionnaire ... 57
Appendix B: Consent form ... 61
FIGURES
Figure 1: International classification of functioning (WHO 2001) ... 6
Figure 2: Causes for disability/impairment (UNESCO 1995) ... 16
Figure 3: Poverty and Disability cycle (DFID 2000) ... 22
Figure 4: Correlation between Chronic poverty and disability (Chronic Poverty and Disability, Rebecca Yeo, August 2001) ... 27
Figure 5: Correlation between Chronic poverty and disability. (Chronic Poverty and Disability, Rebecca Yeo, August 2001) ... 27
Figure 6: Distribution of the respondents by type of physical disability ... 33
Figure 7: Distribution of the respondents by cause of disability ... 35
Figure 8: Distribution of the respondents by the perception of disability related to complications of pregnancy... 37
Figure 9: Distribution of the respondents by the perception of disability related to lack of awareness ... 38
Figure 10: Distribution of the respondents by the perception of disability related to inadequate nutrition during pregnancy ... 40
Figure 12: Conceptual framework correlating malnutrition and disability (Groce et al, 2014) ... 47
TABLES Table 1: Disability prevalence study in Bangladesh (Marella 2015) ... 17
Table 2: Distribution of the respondents by Age category ... 32
Table 3: Distribution of the respondents by level of education ... 32
Table 4: Distribution of the respondents by type of Employment ... 33
Table 5: Distribution of the respondents by homemade materials ... 34
Table 6: Distribution of the respondents by Monthly family income ... 34
Table 7: Distribution of the respondents by Perception about the cause of disability ... 35
Table 8: Distribution of the respondents by the perception of disability-related with poverty .... 36
Table 9: Distribution of the respondents by the perception of disability related to lack of health services ... 36
Table 10: Distribution of the respondents by the perception of disability related to complication during pregnancy ... 37
Table 11: Distribution of the respondents by the perception of disability related to lack of awareness ... 38
Table 12: Distribution of the respondents by the perception of disability related to inadequate nutrition during pregnancy ... 39
Table 13: Distribution of the respondents by the perception of disability related to suffering from fever during pregnancy ... 40
Table 14: Distribution of the respondents by the most common mode of treatment ... 40
Table 15: Distribution of the respondents by the nearest availability of health services ... 41
Table 16: Distribution of the respondents by available mode of transportation ... 41
Table 17: Distribution of the respondents by the provision of safe drinking water ... 41
Table 18: Distribution of the respondents by the provision of sanitary latrine ... 42
Table 19: Distribution of the respondents by awareness program on disability in the community ... 42
Table 20: Distribution of the respondents by Government and social welfare activity in the community ... 43
Table 21: Distribution of the respondents by disability based NGO activity ... 43
Table 22: Distribution of the respondents by marital status and stigma/taboo/cultural beliefs regarding various health issues present in the society ... 43
Table 23: Distribution of the respondents by the association between adequate nutrition during pregnancy and lack of health services (χ2 test) ... 44
Table 24: Distribution of the respondents by the association between poverty and type of physical disability (χ2 test) ... 44
3 1 INTRODUCTION
The term “Low income” is often used to define poverty by World Health Organization (WHO) veterans. Poverty is manifested as denial in welfare and renders many magnitudes, such as poor income and the incapability to purchase basic belongings and essential services for existence with minimal health and societal dignity. Poverty also consists of physical well-being deprivation, less edification, underprivileged reach to hygienic sanitation and pure drinking water, insufficient physical sanctuary, lack of expression of opinion and inadequate capacity and lack of resources for the betterment of an individual’s life. (World Bank 2004)
"Disability both causes poverty and worsens poverty. People with disabilities often find it difficult to get work and take part in normal activities. In some communities, disability is viewed as the result of evil, witchcraft or divine punishment. Poor communities often cannot afford things like a wheelchair that give people with disabilities some independence." (World Bank 2004)
According to WHO’s international classification of functioning, disability and health (ICF) in 2001, disability undertones that the disability is a negative co-product between a person’s disabling health condition and other contextual features (e.g. environment) (WHO 2001)
The number of persons with disabilities in Bangladesh is such high in number in context to the prevailing economic vulnerability of the nation, paying specific attention to their special need is understandably a big ask for a poverty prone country like Bangladesh. An overall prevalence of disability in Bangladesh has been estimated about 10% of the total population of Bangladesh (WHO-World Bank 2001). Disability is to some extent treatable (Depending upon the mode and extent of disability) and to an extensive extent, it is preventable, especially those which are directly linked to poverty. An estimated 1.5 million blind children are residing in Africa and Asia. According to WHO estimation 50% of children with hearing impairment is also preventable if taken good care of the mother during pregnancy. (WHO-World Bank 2001)
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Among the most underprivileged and unprivileged group of people in the world, a person with disabilities is highly remarkable and considered as the poorest of the poor considering all spheres of life. According to the estimation of World Bank, a person with disabilities is comprised almost 15% - 20% in the poverty prone countries of the world and in Bangladesh most of the person with disabilities are poor or even under the extreme poverty line. The estimation also shows that 15% of the total population of Bangladesh is suffering from some mode of disability and most of them live in rural areas. The Dhaka city has the maximum pervasiveness of disability of 8.2%, subsequently 4.2% in the division of Chittagong, and then 4.3% each in Khulna and Sylhet division, after that 6.4% Barisal and 6.0% in Rajshahi division. Bangladesh has extensive poverty all over the country and 17.6% of the total inhabitants are suffering from various poverty-related problems such as malnutrition, illiteracy, economic instability, poor health care facility, vulnerable social security, immense lack of empowerment for persons with disabilities, lack/ total absence of disaster preparedness on a whole. There is another possible problem in a country with most of the people suffering to earn their daily minimum wedge for living in poverty and poverty induced disability. The variety of disability and impairments people experiences is tremendous and they affect people's lives and their surroundings in different ways. Some people have single impairment; some have multiple; some got impairment since their birth, whereas some other gets impairment during the phase of their life. It is more likely that poor people have more chance of attaining disability. Poverty is not just lack of money; rather it has many other dimensions, such as- poverty abolishes economic, health-related and social rights (right to health, housing, adequate food, sanitation pure water, and proper education. A research conducted in Dhaka district shows that 4.9% of people in Dhaka are below extreme poverty line among 15.7%, which is the estimation of poverty-prone people in Dhaka city. (WHO-World Bank 2001)
This is a retrospective cohort study of 53 clients who were diagnosed with a congenital physical disability in the northern part of Bangladesh and the reason for conducting the study in that part was the immense attribute of poverty and a greater number of persons with physical disability in that part are comparatively more than any other part of Bangladesh. Many people in Bangladesh think that disability is a curse or result of a bad deed of either of the parents; they view it as a reason for embarrassment and social exclusion for the family.
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Some systemic (Both Government and non-government) interventions have taken place in Bangladesh to raise awareness and ensuring rights for Persons with disabilities in the society but those steps are by no means adequate to resurrect the prevailing widespread exclusion which imposes a heavy effect on the socio-economic deterioration. Disabled Women among Persons with disabilities are even more helpless to social discernment and abandonment. Poor people are more exposed to disability due to lack of education, resource, health service, knowledge, poor maternal health, malnutrition and so on.
Figuring out the relation of poverty with congenital physical disability is the main objective of this research and it follows quantitative approach to ascertain the desired result which is to find survey of target beneficiaries through specific questionnaire, who or a member of whose family has encountered congenital physical disability and his/her/their family is amongst the extreme poverty group in Bangladesh.
6 2 THEORETICAL BACKGROUND
2.1 Disability (Physical Disability)
Throughout the world, disability represents different physical, intellectual, functional and psychosocial limitations. Some of these impairments or disabilities are permanent and some others are temporary. On the other hand, the social model in this regard states that the impairments of the disabled persons are not accommodated and becomes a reason for their social exclusion. This model also deals with omission, domination, marginalization, and discrimination to accuse and remove the obstacles produced by so-called hegemonic social and cultural institution, which forces persons with disabilities towards more vulnerability and exclusion. This social model of disability became distinctive in the year 1980 and was reinforced by different movements and redefined human rights model (Handicap International - CBM 2006).
In order to explain human being’s functioning related limitations (Physical disability), ICF (International Classification of Functioning) also uses the term *Impairment* along with the world *Disability*! ICF was designed to have a scientific basis for understanding and explaining different health and functioning related issues among different health discipline. (WHO 2004)
Figure 1: International classification of functioning (WHO 2001)
In the year 1996, The Ministry of Social Welfare and The National Forum of Organizations Working with the Disabled (NFOWD, Bangladesh) jointly instigated draft paper on different
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factors comprising disability and it became rectified and took shape of The Disability Welfare Act in April 2001.
The paper has defined and classified disabled persons in three different ways are as follows:
1. Persons with congenital physical disability are usually referred to those individuals who got debilitated physically due to any disease/infection while being in their mother’s womb, victim of birth accident, inadequate nutrition of mother or the baby, maltreatment by the uneducated traditional village doctor/religious healers, either from birth or as a result of mother’s sickness.
2. Persons with physical disabilities are also defined as those persons who have an absence of their one or both limbs (Congenitally), partial or full sensation loss of any part of the body, physical deformity (Congenital), lack or loss of physical equilibrium because of neuro-disequilibrium (Developmental or birth accident)
3. Persons with multiple/mixed physical disorder are denoted as People suffering from more than one type of abnormality or in-capacitance from birth. (The Disability Welfare Act 2001)
WHO standard jargon currently used, denotes a precise discrepancy between impairment (psychological), disability (personal) and handicap (social)
1. An impairment refers to the absence or loss or aberration of the psychosomatic, biological or structural entity or function;
2. A disability refers to the restraint or deficiency of capability to do something referred to as normal for a human being.
3. A handicap refers to the shortcoming of a person that hinders him from participating or acting actively as a social being due to his/her disability or impairment.
All through history, the conception of disability has rested on make-belief ideas and societal stigma and prejudice. The consequence of these stereotyped imaginations and substantial
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accomplishment by the typical social order and organization for the persons with disabilities has been the result of continual negligence and depravity. These negligence blocks are created among persons with disabilities, from normal social, monetary and dogmatic deprivation and segregation in the society, surrounding the community, and educational intuition and last but not the least, even in their own families. Moreover, persons with disabilities face widespread obstacles to accessing services concerning education, employment, health, transportation, and information as well. The outcome of these societal barriers induces worst possible effect upon their health and socioeconomic condition. (WHO 2004)
The term Global Burden of Disease (GBD) denotes the fact that prevalence of disability and accordingly need of rehab services, preventive measures needed in an area specific way and identifying underlying facts causing disability. The disability-adjusted life years (DALY) is another indicator to estimate years lost due to premature death or years lived with disability.
(Murray 1994)
Disability does not necessarily impact the individual alone but on the whole the entire community person with disability surrounded with. The effect of exclusion of persons with disability from participating actively in the betterment of the community is quite high and the after effect has to be carried out by the society in the long run, particularly in terms of the burden of care embraced to it. Vivid effects of exclusion have its effect on the total productivity as well as on the individual's productivity and potential as a whole. From the estimation of UN, 25% of the total population of a country is one way or another adversely affected by some sort of disability. (Leandro & Despouy 1993)
There are three components in terms of direct and indirect cost of disability as described by UN and they are:
1. The direct cost of rehabilitation and other health services, including the cost of traveling to access those services.
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2. Those who are in direct contact with the person with a disability but not affected by it (Caregivers; amount of time they have to spend for the care of the person with a disability)
3. The loss of opportunity cost resulted from the in-capacitance to work like a normal human being to lead an economically viable and productive life. (S. Erb & B. Hariss- White 1999)
According to a research regarding the state of Persons with disabilities in India 'Merely 32million people were reported to be disable in the year 1991 and the collective number of people in the end found to be affected indirectly due to those persons with disabilities were not less than four to five times, a mammoth number of 130 million or more! ' (IBID 1991) An earlier study done in the year 1989 conventionally estimates that the collective cost of blindness to Indian national economy, together with the lowest sustenance allowance for blind people, getting as high as 6 billion every year. (WHO fact sheet 1997)
An analysis of several survey data from Tanzania goes to show that a single household with only one person with disability in the family have a mean consumption lower than 60% of the average (and a headcount of 20% greater than average), guiding the author to end up with the conclusive statement that this might be the hidden cause among all other causes of poverty in Africa.
(Howard White 1999)
Though to be dealt with attention, a gauge that it recently been used widely to enumerate the burden of disease in a country or specific area is DALY (Disability Adjusted Life Year). This quantifies healthy life years lost due to early mortality, with those lost as a result of disability or morbidity. According to estimation by the World Bank, prolong disabilities were a predominant cause for DALY lost worldwide in the year 1990 to an alarming amount of more than a third (34%). (World Development Report 1993)
The effect direct cost of disability is more often than not unequally observed in the economy.
The burden of care is often descended on the family members of the person with a disability, more commonly the mother or other relatives residing in that very family. Caring for a child with
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disability imposes extra workload on the mother of a family living in the extreme poverty as she has to manage extra time from her daily hectic schedule to provide care for the child with disability who is fully dependent on her and thus it takes full tall on her, struggling to ensure living for the entire family, every single day. The burden of are also imposed often on other siblings of the family, especially the girls, which in turn causes her to compromise her education and remain at home to take care of her disabled brother or sister or another relative of the family with some sort of disability. The beneficiary effect of reduction in disability and morbidity to the entire economy is huge and hence ensures increased efficiency, better working opportunity and enabling oneself to a better paying job and longer paying lives. (S. Miles 1999)
The UN, through social policy and development, promotes monitors and evaluates their implemented rules and program (regional, national and international) for persons with disabilities worldwide. They are also responsible to do write-ups and statistical information regarding factors affecting Persons with disabilities life and extend substantial support to government and NGO’s through different projects and defined activities. (UNESCO 1960)
The UN general assembly adopted in the year 1993, on ensuring equal rights for Persons with disabilities has been a milestone for shaping and reforming agendas worldwide, reinforcing the idea and implementing methods for the betterment of Persons with disabilities . In the year 2001, UN general assembly formulated a committee in an ad hoc basis to promote and preserve the rights and dignity of Persons with disabilities, ensuring holistic development and reduce discrimination and promote empowerment. (UN General assembly 2004)
ESCAP provides assistance to the government and self-help groups to generate comprehensive, hinder free and right focused social infrastructure for Persons with disabilities by ensuring their participation in the holistic developmental process, with the help of a full-time Disability advisor (resource person from Asian Development Bank) supporting the role. The support is ensured in the form of operational activities, encouraging networking and collaboration with government bodies, identification and replicating good practice and advisory service holistic betterment of Persons with disabilities . (ESCAP 2015)
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The work of ILO is based on their unique approach (same opportunity, same importance, nondiscrimination, and bringing everyone in the mainstream development), along with encouraging and ensuring proper implication of law and justice on the basis of internationally standardized human and labor rights. ILO program for Persons with disabilities is aimed at ensuring the participation of Persons with disabilities in the present job market by providing them with needed skills, training, knowledge and employability through advocacy, network building with different training centers (Both government and non-government), guidance, policy advisory meetings with government sectors, technical advisory service and cooperating activities. (ILO & Disability 2015)
The WHO, through its integrated work on ICF and implementation of CBR strategy in its disability and Rehabilitation program, works to improve the quality of life and obtain economic solvency by mainstreaming in holistic development activities by ensuring equal opportunities and a hindrance free surroundings for Persons with disabilities . The WHO disability and rehabilitation team provides support to its member states in developing plans and proper implementation strategy for persons with disabilities in collaboration with other UN agencies and international NGO's working in that region, in terms of medical care, rehabilitation, support service, and skill enhancement training. (World report on disability 2011)
UNDP is a worldwide acting development organization with a focus to induce a change in the holistic social structure, improving the knowledge base, an experience-oriented implementation plan for specific regions and plans for proper resource providence and allocation for the betterment of Persons with disabilities and ensure their empowerment and social inclusion.
UNDP's network links and coordinates global and national programs to achieve MDG (Millennium Development Goal) with special emphasis on reduction of poverty, good governance, crisis mitigation, emergency response, energy, and environmental safety, ICT development and safety and HIV/AIDS. Persons with disabilities are treated as the main focus for all these areas of work of UNDP. (UNDP 2015)
UNESCO focuses on promotion and implementation of bringing children with disabilities under the umbrella of inclusive education regardless their physical, mental, emotional, linguistic,
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intellectual shortcomings, as this has been observed as one of the most effective ways to eliminate the discriminatory attitude of the children and society, as well as promoting an inclusive and barrier-free society for all. (UN 2006)
DCG’s are right based and policy rectifying organizations with members from more than 168 countries formally established in Singapore in the year 1982and working closely with UN and its agencies. There are well established national and community-based DPO's (Disabled Peoples Organization) who are actively engaged in policy dialogue with local and national policymakers to ensure rights for persons with disabilities. Bangladesh Protibandhi Kallyan Somity (BPKS) is one of the protagonists in addressing initiatives and movements of Persons with Disabilities in the mainstreaming development approach and policy advocacy. (BPKS 1996)
The World Bank disability and related programs and research wing work to find the core issues affecting the lives of persons with disabilities by formulating cross-sectional working groups in six regions through developing work plans and facilitating coordination between working groups. The expanded strategy of WB Disability and development team concentrates on building a partnership with other development agencies working in the region, as well as multilateral, bilateral and non-government agencies in holistic mainstreaming and avoid duplication of efforts. WB's other relevant country-specific development agenda include PRSPs (Poverty Reduction Strategy Papers). Presently there are 49 interim PRSPs and 40 full PRSPs for countries like Bangladesh, Cambodia, central Asia republics, LAO PDR, Mongolia, Pakistan, Sri Lanka, Vietnam and so on. Donors working in those areas are using these PRSPs as their guiding tool for coordinating and supporting priority development initiatives, monitoring and reduce duplication of poverty analysis. (World Bank 2018)
The integrated correlation between disability, poverty, and health are assumed to be not only having a strong inter-linkage considering the fact that the number of Persons with disabilities has risen up to 1 billion in the past decade or so, comprising 15% of the total population of the entire country (World Bank 2011). Persons with disabilities are amongst underprivileged and marginalized in the societal arena and they are entitled as protagonist among the poorest of the poor. Studies conducted by The Asian Development Bank (ADB) shows about one-fourth of the
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population in the Asia Pacific region is suffering from some variety of disability. (Asian Development Bank 2002)
The pervasiveness of disability is believed to be quite high in Bangladesh predominantly due to over density of population in a small area, prevailing poverty, illiteracy, lack of awareness of causes for congenital disability and means of preventing them and last but not the least, lack of medical and health care services. According to the Bangladesh Population and Housing census 2011, the estimation of persons with disabilities ranges from 1.4 percent to 9 percent amongst the entire population. Organizations like Action aid Bangladesh and SARPV (Social Assistance and Rehabilitation for the Physically Vulnerable) has some sample studies and came up with figures like 8.8% of the total population being affected by some sort of disability.
Bangladesh Protibondhi Kallyan Samity has estimated about 7.8% and Action Aid Bangladesh recorded 14.04% people suffering from some sort of physical or mental impairment in their another study. The main reason for the rural poor people being the ultimate sufferers of disability and its consequences are a lack or total absence of knowledge about the cause and after effects of disability, being superimposed by social taboo and absence of needed pre and postnatal care in or near to their area of residence. An individual bearing disability from his/her childhood faces most amount of marginalization and exclusion from the society and have significantly fewer chances of availing health care, mainstream education and inclusion in the long run, leading to extreme poverty and gradually increasing the burden of care as he/she grows older and disability remains undertreated/untreated (Trani et al. 2010, Groce et al 2011). This extreme condition induced exclusion from the society does not affect only the PWD but also the entire family as a whole.
According to UNCRPD (United Nation Convention on the Rights of Persons with Disabilities), access to appropriate rehabilitation/habilitation service for Persons with disabilities is more a rightful ask, but despite Bangladesh ratifies the convention, very less has been ensured (Despite the extensive plans were been taken) in this regard due to overspread poverty and lack of fund in the country. Rehabilitation services are now provided by 70 rehabilitation centers established nationwide controlled by Ministry of Social Welfare (MOSW), Bangladesh and some non-
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Government organization (With the help of donors like EU, DFID, LCD, LFTW and so on) in the last 5 years. Some other services entitled to persons with disabilities from the Social welfare ministry of Bangladesh are as follows:
1. Training (empowerment) and rehabilitation (Physical and social) of a female with a disability
2. Certificate and Identity Card (personal, VGD, VGF) for persons with disabilities; so that they can avail different support and allotments entitled only to them and some other fake people can't benefit from these supports.
3. Registration of self-help groups of persons with disabilities and thus empowering them to ask for their entitlements and right in a defined group, rather than being alone and
powerless.
4. Financial assistance for students with disabilities
5. Financial assistance for persons with disabilities
6. Small business start-up loans for persons with disabilities (Ministry of Social Welfare of Bangladesh 2018)
The international community is determined to an approved set of development goals, aimed at a gradual reduction in global poverty by speeding up the wheels of economy and empowerment of persons of disabilities by including them in the mainstream development process. This increase in attention towards issues regarding Persons with disabilities is predominantly seen in prescribed guidelines and programs of mutual institutions. (DFID 2000)
New ingenuities within UN to comprise Persons with disabilities in all prevailing and upcoming Millennium Development Goals (MDGs) goes to emphasis on the fact that no nation can prosper or holistic development can never be achieved if there is prevailing poverty and in this connection poverty can't be alleviated keeping a large portion of the population out of the active development process. This inactive portion of the population will mount on the economic burden and hinder/slow down the development process. Thus the importance of community-based rehabilitation emerged as a prime need for sustainable change in the health and holistic wellbeing of persons with disabilities (WHO 2010). This will result in the inactive portion of the population
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converting from a burden to asset and to alleviate poverty and in the process alleviate societal and financial radicalization for Persons with disabilities (WHO - World Bank 2011). Eliminating poverty is by no means achievable without taking the rightful agenda and precise necessity of persons with disability into account. "Poverty prone Persons with disabilities are overwhelmed by a brutal sequence of poverty and disability, each being a consequential reason for each other".
(DFID 2000)
Disability has been continually addressed in the poverty reduction strategy plans (PRSPs) whereas very little could be done to obtain a substantial and sustainable effect in regard to reduce both of it. A recent study review was done by World Bank on 33 PRSPs and 11 PRSP final reports. The obtained outcome was 73% of the PRSPs predicts that Persons with disabilities are amongst the poorest whereas 37% exceptionally said that the intent of strategy regarding the Persons with disabilities are to bring this disadvantaged group in the mainstream development process and 23% revealed the exclusion stigma being the prime most cause for Persons with disabilities to be debarred away from conventional development process. It is important to mention that Bangladesh included persons with disabilities in their PRSP from the year 2011 (Handicap International 2011)
In Bangladesh, Government, international development agencies and international financial institutions have made extensive changes to their rotundity as well as issued specific strategies and plans regarding steps to be undertaken for the betterment of Persons with disabilities.
Almost all institution both inside the country and working worldwide are having their contribution in the disability sector of Bangladesh, posing more importance on the social model of disability (As a mode of preventive measures of disability) alongside the physical model (For curative initiative regarding the prevailing disability situation in Bangladesh). In a study propagated by UNESCO in the year 1995 on the overall situation of disability in the world, shows that disability or impairment is caused due to congenital disease 20%, malnutrition of the pregnant mother 20%, infectious disease 11% which are more closely related with poverty and poverty induced congenital disability. (UNESCO 1995)
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Figure 2: Causes for disability/impairment (UNESCO 1995)
According to an estimation of WHO, about 10 million people in Bangladesh are suffering from some form of disability but there are very inadequate data to validate this hugely important economically and socially overwhelming assumption. Here are some of the very few study findings in a tabulated form:
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Table 1: Disability prevalence study in Bangladesh (Marella 2015)
Authors Study Sample Ages Disability measures Prevalence Bangladesh
Bureau of Statistics
Census 2010 National census
All ages Questionnaire on different modes of disabilities.
1.4 %
Titumur and Hossain
Disability in Bangladesh:
Prevalence, Knowledge, attitude and Practices, 2004.
13,025 individuals.
All ages Questionnaire on different modes of disabilities
5.6 %
Mitra and Sambamoorti
World Health Survey 2002–
2004
5,931 households and 5,549 individuals
18 year s and above
Questions on the basis of Vision, Mobility, concentration or remembrance, and self-hygiene.
22.0 %
World report on Disability
World Health Survey 2002–
2004
5,931 households and 5,549 individuals
18 year s and above
16 questions on pain, sleep, self-hygiene, vision, cognition, affect, interpersonal relationships,
mobility, and energy
31.9 %
Bangladesh Bureau of Statistics
Household Income and Expenditure Survey 2010
12,240 households
All ages Questionnaire on the basis of Vision, hearing, Mobility and climbing, cognition or concentration, self- hygiene, and Inter- personal
9.1 %
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communication) Cherry et al. Gonoshasthay
a Kendra survey 2010
43417 individuals from 600 villages.
60 year s and above
12 questions based on Vision, hearing, mobility, cognition, self-hygiene, and communication.
26.0 %
Marella et al.
(current study)
Rapid
Assessment of Disability Survey 2010
2315
individuals in Bogra, Bangladesh.
18 year s and above
15 questions based on WG questions: vision, hearing, mobility, communication, gross and fine motor,
cognition, appearance, and psychological distress.
8.9 %
2.2 Poverty
Economist around the world has always seen or measured poverty on the basis of the low level of income compared with the lowest wedge of per capita income for the country as well as low level of consumption of wealth available for them in the given society. Social policy architects and welfare economists contemplate poverty as those entities whose daily wedge is below an identified survival level widely referred to as poverty margin. Nevertheless, steps like those are often unsuccessful to draw a distinct difference between revenue and living in a poverty prone society. Two of the most outdated measures for poverty (ratio of the headcount and the income discrepancy ratio) have been criticized by Amartya Sen as according to his research these two steps are unable to ascertain the income distribution among poor into consideration. Moreover, they tend to cause further degradation of the situation of people who are already poor. Other authors came up with the study output that poverty can never be seen from one single point of measure, whereas it has multidimensional factors to comprise it as a whole like a resource
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availability and consumption, housing, average living cycle, edification, attainment of public goods must be taken into contemplation. On the whole, people who find it extremely difficult to meet their basic survival needs in their day to day life are known or referred to as extremely poor. The World Bank measurement for extreme poverty indicator denotes when the income per day for an individual is equal or less than 1$(USD). (Sen 1983)
According to DESA (United Nations Department of Economic and Social Affairs), poverty is more than lack of earnings and resourceful possessions to guarantee a continual source of livelihood. Its indicators include hunger and malnutrition, restricted or no admittance to basic education and other basic amenities needed to live a minimal healthy life, social discrimination, and exclusion, as well as the lack of social participation for an individual in the decision making phase. Poverty is not merely a matter of in-capacitance of meeting basic survival needs. It is on the whole a syndromic compilation of structural imbalance, manifested in all spheres of human existence. So on collective note poverty denotes radicalization, isolation and other monetary, dogmatic, communal and ethnic dimensions of withdrawal, marginalization, vulnerable situation and at the very end resulting exclusion from the societal system.
According to Dube and Charowa (2005), poverty origins from no or lack of access to basic set- up or amenities and it is reinforced by peoples lack of admittance to cultivable land, money for business startups, expertise to enhance their prevailing capacity, institutions to upgrade their knowledge, productive assets and minimal resource needed to ensure sustainable growth and livelihood.
Nobel prize winner Amartya Sen stated very significantly that poverty is a standard at which one is incapable of "attaining satisfactory contribution in shared actions and be free from civic disgrace induced by disappointment in satisfying conventions". (Sen A 1983)
The concept of poverty according to the Human Rights Commissions report can be described in three distinctive ways (CHRI Millennium Report). The first and the most expressive definition drawn from the rest as poverty is an undesired situation in which there is absence or lack of essential facilities resulting from inadequate or absence of income. There is an invisible
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or expressed benchmark for an individual's minimum level of income and standard of living in every societal accepted system. Those unmet individuals who are below that benchmark level are recommended as poor or marginalized in the society. The second definition of poverty is grounded with regard to basic or fundamental needs. Incapability to access or meet basic human needs (Food, clothing, dwelling, education, and health) for existence is poverty or to remain deprived or excluded such need for a short or long term is poverty. The third way of expressing poverty is in regard to the lack or absence of opportunities, which is a paradigm shift from the traditional basis of defining poverty only on the regard to fundamental need and income. It denotes the fact that individuals, despite having good health and capacity to overcome the poverty barrier, are somewhat deprived due to lack of sustainable opportunity in the society they belong. This implicit absence of opportunity pushes them in the regime of unemployment further resulting in inadequate income hence obtaining the in-capacitance to meet basic human needs.
Here the urge has been shifted from the individual to the prevailing societal situation which compels or decides the fate of people lacking opportunity that fails to insulate him from the insecurity and further pushing him in the poverty black hole. (CHRI Millennium Report 2001)
A part of the entire population whether it is individual, families or a group of people are referred as poor when they lack the resource to afford the diet needed to live a minimal healthy life, participation his hampered in the societal activities for being marginalized, having the dwelling condition and facilities that are habitual, or at least extensively reinvigorated, or permitted, in the social order of their belongingness. (Townsend 1979)
The empirical observation of this research is to find a correlation between poverty and congenital disability and several factors that have been discussed till now are predominantly responsible to cause it. Economically vulnerable people in society are known to be struggling to meet basic health care needs, hygiene, proper food, and sanitation causing a vulnerable environment for the newborn to be born. Moreover, they do not have the money to reach for proper health care facilities during pregnancy and eventually compelled to deliver the child through illiterate village doctors/ nurses/ religious healers, leading to congenital disability in most of the cases found for children born with a disability. (DFID 2000)
21 2.3 Poverty and Disability
WHO has brought a totally new and realistic concept for ICFD (International Classification of Functioning and Disability, the Beta-2 version of ICIDH-2) to address disability from a refined point of view. The utmost purpose of International Classification of Impairments, Disabilities, and Handicaps-2 (ICIDH-2) classification is to provide a customary definition and framework for analyzing human functioning as an integral component of health (WHO 2011). The categorization bears information regarding three main modes of the human body which is:
Physical, Individual and societal; and corresponds a number of combines a list of biological factors, as they have superimposed effect on all the factors mentioned earlier. (WHO 1980)
This mentioned paper is only predominantly discussing chronic and long-term functional limitations. So, for the people suffering from chronic impairments which may or may not affect his/her natural way of living and some of which if corrected may not necessarily hinder his/her Activities of Daily Living (The Economist 1999). Disability is a relevant term, which is normally interpreted as a barrier or hindrance in doing/performing anyone to his/her part as a social being. But at the same time what is disabling for someone and posing a hindrance for him/her in performing as an active social being, for others it might not be the case and he/she can be an active part of the society with the same amount of disability. For example, various modes of psychosocial and psychological conditions may hinder an individual to act as an active social being whereas it can be unrecognized/ not that effective to exclude someone from acting as a social being. In some countries, infertility has been seen as physical shortcomings for a female and society/surrounding poses psychological stress on females whereas it's not the case in western culture. A physical condition as COPD or allergic rhinitis can be a disabling condition for farmers in a village but not that disabling for someone working in the office-based city condition etc. (Howard White 1999)
In order to observe disability to the core, an in-depth measure of both the affected individual and estimation of the surrounding determining factors has to be done along with the prevailing social background. A study on disability insurance by National Institute on Disability and Rehabilitation Research (Washington D.C 1996) denotes the fact that, disability insurance
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variation is linked with the various incentives embedded in the disability insurance programs.
The study shows that a higher proportion of disabling households in rural India was found to be below the poverty line that had very minimal aggregate of assets, small or no land in their name and greater debt in comparison to households which has no disabled member residing there. A study in Sierra Leon went on to show that disable people were not considered as poor as they were provided with adequate support networks and proper labor contracts. (Elwan Ann 1999)
Figure 3: Poverty and Disability cycle (DFID 2000)
The integral reason to understand the correlation between poverty and disability is to have a deep understanding of the economic implication of inclusion and exclusion on the societal, country- based and on the whole global. Poverty and disability are predominantly related to a cyclic order, each having a huge impact on the other outcome. This cyclic correlation has a strong theoretical basis to support its formation as the conditions associated with lack of access to health care, pure drinking water, hygiene and sanitation, poor nutrition, below par living condition, lack of basic education superimposes the causes for neonate disability. These obstacles and difficulties faced by persons with disabilities are preventable and to some extent lowered by proper planning which will bring them from exclusion to inclusion otherwise the disadvantages associated with disabilities can prevail in the long run affecting all spheres of society alongside the individual him/herself. (DFID 2000)
23 3 LITERATURE REVIEW
The main origin and effect of disability is poverty. The association between poverty and disability can be easily diagnosed and distinguished. This link between poverty and disability is manually resistant and Persons with disabilities and their families represent a significant number of the poverty prone part of the society in Bangladesh. Poor people in the whole world are more likely to have the disability in their whole lifetime than those who are financially solvent. The portion of persons with disabilities within underdeveloped and poverty prone nations is considerably higher than that found in the richer or developed countries. (DFID 2000)
As it has been observed that disability might be caused due to interlinked reasons, in a country where there is a widespread disability, poverty can also be a by-product of that higher percentage of disability in the society (Rao 1990). The causes are inadequate nutrition/undernourishment, less access to preventive medical care, persons with disabilities giving birth to newborn, exposure to high-risk environments responsible for congenital disability for the child, poor sanitation facilities, illiteracy, lack of health awareness programs for pregnant women in the poverty prone areas etc. A synchronized deprivation is the effect of the coherent relationship between poverty (related to economic solvency), weakness (social disability) and physical disability (Described by the medical model of disability). This syndrome is made of Philosophical fortification, penalizing experience and psychological extermination (the severe lack of consequential correspondence in behavioral development); a cognitive and vocal improvement and stimulus deprivation which collectively affect the involvement of lower income groups in the societal and economic scenario on the whole. Poverty and disability are interconnected. The new UNCRPD (UN Convention on the Rights of persons with disabilities) has shown a distinctive association between poverty and disability. (UNCRPD 2006).
Many authors like Elwan (1999), Zimmer (2008), Parnes (2009) argued that the source and effect of disability is poverty. The mechanisms of these relations are now more or less known to all.
Anam and Bari conducted a study in 1999 among street children with disability in Dhaka city and found that- 63.33% of the street children with disabilities have no education, 38% of those street children have disabilities or impairments caused by congenital and birth-related problems,
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57.5% and 32.5% of their mother had received treatment from traditional and religious healers respectively during their sickness in pregnancy. Titumir and Hossain (2005) conducted a study on the Cause of Disability, found that the majority of the people blamed the lack of birth-related pre and postnatal health care as the predominant reason for disability. As most of the people under poverty line can't afford a healthy and hygienic atmosphere for their delivery (In case of the post-delivery situation) and more often than not the secondary complications arising post- delivery situation are a cause for congenital disability. Some also convict a congenitally defected child as a result of his/her parents' sins.
A survey conducted on "Disability and Poverty in Developing Countries" in the year 2011 by Mitra, Posarac and Vick using data from respondents of 15 developing countries found that disability was vividly related to higher poverty prone areas, as well as regions with a high percentage of illiteracy rates, lower wages, and a higher percentage of social taboo and disbelief . A study conducted by Tareque Begum and Saito (2014) on “Inequality and Disability in Bangladesh” went on to show that an incline in disability was observed across affluence groups;
entities from middle or rich families are been observed to have fewer persons with disabilities than those living in poor families. A study conducted on 267 children in Turkana and Kenya on
"Childhood Disability and Malnutrition". The study shows 67% of the cause of disability is congenital, 13% is for illness, 6% is for birth-related problems and 5% in for birth trauma. Only 15% of the children with disabilities received treatment (Though it varies from place to place inside a specific region or country). Obstacles of receiving treatments were 34% for lack of awareness, 33% for lack of money, 18% for lack of perceived need and 4% for lack of proper transportation (CBM - Kenya Red cross 2013). A research conducted in the year 2000 by Durkin M.S, Khan N.Z on “Prenatal and Postnatal Risk Factors for Mental Retardation among Children in Bangladesh” and found that cognitive disability related to social, economic factors and malnutrition especially the maternal iodine deficiency (Durkin M. S; Khan N. Z, 2000).
ICDDRB and UNICEF conducted a study in the year 2011-2012, which showed that the brain development of a baby is severely affected by the spectacular act. During pregnancy, deficiency in folic acid may cause spinal defects and cleft palate. In Bangladesh, iodine deficiency is found among 40% of school-aged children, which causes curable intellectual disability and impaired psychomotor development in those children. (ICDDRB - UNICEF 2011-2012)
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Disabled children are discriminated in their own families, society and workplace, which is the foundation of the highest desecration of rights of Persons with disabilities in Bangladesh. Many people in Bangladesh believe that being disabled is a curse and a penalty for evil deeds, which also effects right to get proper care, medical services, education etc. In Bangladesh, malnutrition of mothers and children, various diseases, accidents and unprofessional (untrained village midwives) delivery and inborn condition are some of the crucial reasons for disabilities. There are some good health services for disabled children, but most of those are less generalized and often available only in urban areas. So they are more likely to serve a few numbers of children, especially more affluent groups. There is some accessible Community-based rehabilitation (CBR) programs, support by non-governmental agencies (mostly funded by developed countries), but they have limited geographic coverage and insufficient resource to provide immediate treatment to the disabled children (UNICEF 2014). According to Situation Assessment and Analysis of Children and Women in Bangladesh, stated in the year 2009 that
"The principal cause for disability among newborn are primarily maternal complications, complications during delivery, lack of hygiene, accidents and malnutrition while the baby in their mother's womb" (UNICEF 2009). Another study was conducted by Priya K. Malone, Elisabeth R Despres and others in 2010 on "Perception of Disability among mothers of children with disability in Bangladesh: Implications for rehabilitation service delivery". This study states that- the seniors of a family strongly believe in the traditional explanation that restricts the disabled person of that family to get appropriate treatment. (Maloni K & Despres R 2010)
In developing countries, estimation states that only 2% of Persons with disabilities are having the right to use to rehabilitative service and other health-related basic services (Despouy 1993).
Malnourishment and micronutrient deficits continue to hinder the full mental and physical growth of millions of children in Bangladesh. Children with restricted congenital growth among children aging fewer than 5 are reported to be 54 % among the poorest groups (UNICEF 2009).
The full mental and physical development of millions of children in Bangladesh is greatly hampered due to malnutrition and micronutrient deficiencies which are predominantly caused by poverty. Growth anomalies or stunting among children less than 5 years of age has been reported to be 54% in the poorest group in Bangladesh. Other reasons for disability among newborn in Bangladesh has been reported as being associated to absent/ inadequate and/or inaccessibility to
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basic health care facilities, inadequate/mal-nutrition, insufficient supply of safe drinking water and hygienic sanitation and birth accidents. Poverty, discriminatory beliefs/behaviors are the core reasons for these limitations (UNICEF 2009). A study named "Poverty and Blindness: A survey of the literature" performed by Sight savers international (SSI) has shown a precise correlation between poverty and visual impairment. The review inflects a strong picture how multiple dimensions of poverty influences the pre and post congenital life of an inborn and how this, in turn, influences an impact on visual capacity and eventually causing partial or complete loss of vision (SSI 2006). An estimation performed by The International Disability and Development Consortium reveals that 98% of children with disabilities are deprived of any formal education (IDDC 1999). At least 40 million children with disabilities according to the World Bank are devoid of receiving any formal education and thus their exclusion from obtaining necessary knowledge that is mandatory for employment, compels them to be economically and psychosocially dependent on others. A contemporary study on the education of children with disabilities by UNESCO goes to show that only 1-2% of children with disabilities are able to obtain some form of education despite their limitations caused by their congenital disability induced by poverty and its way to alarming in present situation and forcing them to be dependent on others all the time.
A research titled "Educating Children in Difficult Circumstances: Children with Disabilities"
performed by CSID (Centre for Services and Information on Disability, Bangladesh) in the year 2002 goes to show that only a mere 11% of children with disabilities from their birth, are capable of receiving some sort of formal education and the prime most reason being their congenital disability and poverty. Reports go to show that those families having children with disability are amongst the most disadvantaged, neglected and marginalized when it comes to education and receiving basic services related to health and well-being. Out of 1.4 million children with disabilities who belong to the age group of primary school, only 4% had access to basic education where there is no disability service in those areas and the majority of the children were suffering from mild to moderate physical impairments. (CSID 2002). Rebecca in her study regarding "Chronic poverty and Disability" has brought about the compelling relationship between poverty and disability which reveals that being poor vividly increases the chances for giving birth of disabled children, as the overwhelming effect of immense inadequacy of
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nutritional food, sanitation, basic and specialized (Maternal) health service, hygienic shelter, basic education and economic solvency. Furthermore, due to immense poverty, her pregnant mother is often compelled to work in the most hazardous atmosphere, increasing the risk for her own self as well as the baby in her womb. All these factors collectively contribute to illness, injury and congenitally deformed child. (Yeo R 2001)
Figure 4: Correlation between Chronic poverty and disability (Chronic Poverty and Disability, Rebecca Yeo, August 2001)
Figure 5: Correlation between Chronic poverty and disability. (Chronic Poverty and Disability, Rebecca Yeo, August 2001)
28 4 AIMS AND OBJECTIVES OF THE STUDY
The principal focus of the research is to figure out the relation of poverty with the congenital physical disability is the main objective of this research. How different dimension of poverty (regarding income status, health, education, nutrition, hygiene, and sanitation etc) impacts on physical disability related to birth is the principal focus of this research.
Research question
- How the different dimension of poverty impacts on physical disability related to birth (Congenital physical Disability)?
- How can be the amount of congenital physical disability reduced?
Bangladesh being a poor third-world country where even a healthy individual finds it hard to afford basic needs for living (Food, clothing, shelter, education and health) for himself/ herself, the situation of persons with disabilities is beggars’ description. Different government, non- government and international organization have worked over a long period of time to improve the situation and most of the initiatives have been according to the therapeutic model of rehabilitation (Providing therapeutic and assistive device support for the persons with disabilities). But different studies and researches have shown the need for the Social model of rehabilitation being far more effective (As it addresses most of the social problems which are responsible for the birth of disable child and hence reducing those problems will in turn reduces the amount of disable child births and induces more effective way to encounter disability related problems in the society) in the present scenario.
Working for five long years very closely with different Government, Non-government organizations (NGOs) and international donors like European Union (EU, Light for the world (Netherlands), DFID-LCD (UK), AusAID (Australia) and so on, who are providing and donating a healthy amount of support to improve the overall situation of persons with disabilities in Bangladesh. So far the rehabilitation support of these organizations have been more concentrated into the therapeutic and assistive device support, whereas in my view there should be more
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concentration in the economic empowerment of persons with disabilities and their families, better nutritional support during pregnancy (Both through increasing awareness about proper nutrition during pregnancy and providing basic nutritional support), improving sanitation and more social awareness to eradicate the social stigma and taboo hovering around disability. The reason why the social model of rehabilitation will be more effective in the present scenario is, the social model more or less intervenes before the disability actually takes place and interventions (Awareness) in the stage of pregnancy or future mothers will actually reduce the amount of birth of disable (Physical disability) children on a whole. The overall aim of the research is to ascertain the impact of lack of different dimensions of basic life needs in the most poverty prone region of Bangladesh (Northern Region) and how these results is causing poverty and in turn how this poverty can induce the birth of the physically disabled child in Bangladesh.
30 5 METHODOLOGY
This is a questionnaire (Semi-structured and close-ended) survey-based quantitative research conducted from May 2018 to October 2018. The study was carried out within the northern part of Bangladesh where the prevalence of poverty and congenital physical disability is greater than others parts of Bangladesh among poor families, having a disabled family member (congenital physical disability). Only the persons who have members in their family with the congenital physical disability were included in the study. Any other persons with disabilities, who were not suffering from disability from their birth, were excluded from the study. For data collection, simple random sampling was used. The study sample has been taken 53.
An interview schedule was developed to collect data from the respondent. Interview schedule had Semi-structured closed-ended questions. The developed interview schedule was tested prior to implementation, to assess sensitiveness and appropriateness in ascertaining the relevant information and to facilitate the desired outcome of the study. Pre-testing of the questionnaire took place in Centre for Disability in Development, Savar campus where they provide service to people with disability coming from different parts of Bangladesh and only persons with congenital disability (In case if the persons with congenital physical disability is unable to communicate, I interviewed her/his attendant) was chosen for the pre-testing. The respondents were contacted personally and the desired information according to the questionnaire has been collected with due accuracy and confidentiality after explaining the objective to the respondents and getting their approval to participate in the study.
The questionnaire was first prepared in English and then translated to Bengali for the convenience of the respondents. After data collection was over, the questionnaires were re- checked for any incompleteness, any need for correction and internal consistency to exclude any irrelevant data/information. Data management included computerization of data through data coding and editing in SPSS. The editing portion involved verification of information for consistency, relevance and any disproportion in data input. Ethical clearance has been obtained from all the respondents on an individual basis. A written consent form stating the objective of the study as well as the confidentiality issues was read and signed by the respondents before them taking part in the study. The study was designed and carried out keeping the cultural and
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religious sensitivity of the respondents in mind and they were dealt with utter respect and empathy. As the study population, belong to only the northern part of Bangladesh, the end result have the limitation of generalization on the whole and hence might not be depicting the situation on the whole for overall physically disabled population of Bangladesh.
32 6 RESULTS
This was a retrospective cohort study of 53 clients who were diagnosed with the congenital physical disability in the northern part of Bangladesh to find out the association between poverty and congenital physical Disability. A semi-structured, pre-tested, modified, interviewer administrated questionnaires were used to collect the information. All the data were entered and analyzed by using Statistical Packages for Social Science (SPSS) software version 16.0 (Chicago).
Table 2: Distribution of the respondents by Age category
Age category (in Years) Frequency Percentage
1-5 12 22.6
6-10 25 47.2
11-15 16 30.2
Mean ± SD 8.57±3.920
Table 2 reveals that majority of the respondents (47.2%) were in the age group 6-10 years followed by 30.2% and 22.6% were 11-15 years and 1-5 years respectively.
Table 3: Distribution of the respondents by level of education
Level of education Frequency Percentage
None 38 71.7
Primary 1 1.9
Junior school 8 15.1
Matriculation 6 11.3
Total 53 100.0
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Table 3 explores that 71.7% of the respondents did not have any institutional education among them only 15.1% had junior level education, 11.3% had matriculation and only 1.9% had primary level education.
Table 4: Distribution of the respondents by type of Employment
It is shown by Table 4 that only 9.4% of the respondents were employed.
Figure 6: Distribution of the respondents by type of physical disability
Figure no 6 shows that majority of the respondents (60.4%) had mixed type of physical disability followed by 32.1%, 5.7%, and 1.9% had athletic, diplegic and hemiplegic respectively.
0 5 10 15 20 25 30 35
Diplegic Hemiplegic Athetoid Mixed
Employment status Frequency Percentage
Non-employed 48 90.6
Employed 5 9.4
Total 53 100.0
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Table 5: Distribution of the respondents by homemade materials
Table 5 explores that half of the respondents homemade by mud and rest of the 24.5% made by tin, 13.2% by bamboo and 11.35 by brick.
Table 6: Distribution of the respondents by Monthly family income
Table 6 shows that 66.0 % of the respondents monthly family income was between 5000-10000 BDT followed by 22.6% and 11.3% was between 2000-4000 and 10000 & above respectively.
Homemade materials Frequency Percentage
Bamboo 7 13.2
Mud 27 50.9
Tin 13 24.5
Brick 6 11.3
Total 53 100.0
Monthly family income Frequency Percent Between 2000-4000 BDT 12 22.6 Between 5000-10000 BDT 35 66.0
10000 and above 6 11.3
Total 53 100.0
