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Predictors of referral uptake in children with disabilities in Bangladesh – Exploring barriers as a first step to improving referral provision

Purpose: Making services available to children with disabilities in low- and middle-income countries does not guarantee their use. This study aims to identify factors associated with the uptake of referrals in order to investigate barriers to service use. Methods: Children with impairments identified in two districts of Bangladesh were invited to attend screening camps where their condition was confirmed; they were provided with referrals for rehabilitation and treatment services. Predictors of referral uptake were identified using logistic regression. Results: Overall referral uptake was 47%, 32% in Sirajganj and 61% in Natore. There was no association between age or gender and referral uptake. Factors predictive of referral uptake were higher income in Sirajganj (OR = 2.6 95%CI 1.4–5.0), and the districts combined (OR = 1.6 95%CI 1.1–2.1); maternal literacy in Natore (OR = 1.6 95%CI 1.0–2.5); and epilepsy in all three models (Sirajganj: OR = 2.6 95%CI 1.7–4.0; Natore: OR = 13.5 95%CI 6.5–28.3; Combined: OR = 4.6 95%CI 3.3–6.5). Physical impairment was associated with increased odds of uptake in Sirajganj and in the combined model (OR = 2.7 95%CI 1.8–4.1; OR = 3.34 95%CI 2.2–5.2). Conclusions: Even when some logistical and financial assistance is available, children with impairment from low-income families may require additional support to take up referrals. There may be greater willingness to accept treatment that is locally provided, such as medication for epilepsy or therapy at village level. Implications for Rehabilitation Providing a referral for treatment or rehabilitation is often not enough to ensure access to service for children with disabilities in low and middle income countries. Uptake of referral can be influenced by many factors, and individuals face different types of barriers. Financial and logistical support can help increase referral uptake. Low monthly income and maternal illiteracy is associated with lower uptake even when assistance is provided.