title: Predictors of referral uptake in children with disabilities in Bangladesh--exploring barriers as a first step to improving referral provision.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, Camden, London, United Kingdom. r.nesbitt@uni-heidelberg.de
authors.forename: R C
authors.initials: RC
authors.lastname: Nesbitt
authors.forename: S
authors.initials: S
authors.lastname: Mackey
authors.forename: H
authors.initials: H
authors.lastname: Kuper
authors.forename: M
authors.initials: M
authors.lastname: Muhit
authors.forename: G V S
authors.initials: GV
authors.lastname: Murthy
mesh_terms: D000293:Adolescent; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000534:rehabilitation / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires