This brief outlines key findings of a study conducted in late 2016 and early 2017, though a partnership between the Bangladesh Bureau of Statistics (BBS) and Handicap International, with technical oversight from the Nossal Institute for Global Health, University of Melbourne, Australia.

1. HANDICAP INTERNATIONAL BANGLADESH
Towards Global Health: Strengthening the
Rehabilitation Sector through Civil Society
POLICY BRIEF
Rapid Assessment of Disability
in Kurigram and Narsingdi, Bangladesh
BACKGROUND
People with disabilities are often excluded from
development. Disability is central to the 2030 Agenda
for Sustainable Development, which commits to
‘leaving no one behind’ and has targets for disability
inclusion within the Sustainable Development Goals
(SDGs). Understanding and prioritising disability is
therefore essential to deliver on the promise of the new
development agenda. Monitoring progress on disability
inclusive development and the SDGs requires reliable
estimates of disability prevalence, and information
about how disability affects access to and participation
in development programs.
There are several previous estimates of disability
prevalence in Bangladesh. Estimates range from 1.4%
to nearly 32% of the population having a disability.
Differences reflect the range of methods used to
define and measure disability in different surveys and
studies. The Government of Bangladesh is committed
to disability inclusion and has prioritised collection of
accurate and useful disability data to better inform
ongoing national efforts to address the needs and
rights of people with disabilities.
PURPOSE
This brief outlines key findings of a study conducted
in late 2016 and early 2017, though a partnership
between the Bangladesh Bureau of Statistics (BBS)
and Handicap International, with technical oversight
from the Nossal Institute for Global Health, University
of Melbourne, Australia. The study was guided by
the National Consortium on Evidence and Action
on Disability in Health (NCEADH), endorsed by
the BBS, and received ethical approval from the
University of Melbourne. The study was part of the
Handicap International project Towards Global Health:
Strengthening the Rehabilitation Sector through Civil
Society funded by the European Union.
The purpose of the study was to understand the
situation of people with disabilities in two target
areas of Kurigram and Narsingdi. Over 6,500 people,
including adults and children above 2 years old, were
surveyed in the two districts. The survey 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 survey used the Rapid Assessment of
Disability (RAD), developed and tested across Asia and
the Pacific by the Nossal Institute for Global Health.¹
A new Assistive Product Assessment Tool (APAT)
being developed by the World Health Organization
to better understand access to assistive products was
incorporated into the survey. BBS personnel and people
with disabilities and their family members collected the
data using Android based tablets equipped with the
KoBo Toolbox software.
¹ Further information on the RAD is available from:
http://mspgh.unimelb.edu.au/research-groups/nossal-
institute-for-global-health/inclusive-health-and-
development/the-rapid-assessment-of-disability-rad
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2. POLICY BRIEF
Rapid Assessment of Disability in Kurigram and Narsingdi, Bangladesh
OVERALL DISABILITY
FOR ADULTS WAS
5%
OVERALL DISABILITY FOR
CHILDREN WAS BETWEEN
1-2%
© Handicap International Bangladesh
KEY FINDINGS
Disability prevalence among adults
(18 years and above)
• Overall disability prevalence for adults using
the RAD definition was 5.0% (95% CI: 4.1, 6.1) in
Kurigram and 5.0% (95% CI: 4.1, 6.1) in Narsingdi.
• Disability prevalence for adults using only the
Washington Group Short Set of Questions was
4.4% (95% CI: 3.6, 5.4) in Kurigram and 4.0%
(95% CI: 3.2, 4.9) in Narsingdi.
• The most commonly reported difficulties for adults
were psychological distress (3.0% in Kurigram and
2.1% in Narsingdi) and mobility difficulties (2.4% in
Kurigram and 2.2% in Narsingdi).
• Psychological distress was frequently reported
alongside other difficulties. Over 50% of
respondents in Kurigram and over 30% of
respondents in Narsingdi who reported either
sensory, physical, communication or cognitive
difficulties also reported psychological distress.
Disability prevalence among children
• Disability prevalence for children in Kurigram was
1.7% (95% CI: 0.6, 5.2) for children between 2 and 4
years and 1.9% (95% CI: 1.2, 3.1) for children
between 5 and 17 years.
• Disability prevalence for children in Narsingdi was
1.1% (95% CI: 0.3, 4.5) for children between 2 and
4 years and 1.2% (95% CI: 0.7, 2.3) for children
between 5 and 17 years.
• Difficulty with mobility was the most commonly
reported difficulty for children (2-17 years)
in Kurigram.
• Difficulty with self-care was the most commonly
reported difficulty for children 5 to 17 years in
Narsingdi. Difficulty being understood and learning
were the most commonly reported difficulties
among children aged 2 to 4 years in Narsingdi.
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3. Factors associated with disability
• More women than men with disabilities in both districts
reported being separated, divorced or widowed.
• Disability prevalence increased significantly with
increasing age. 16.4% and 13.6% of people aged over
55 years reported having a disability in Kurigram
and Narsingdi respectively.
• People with disabilities in both districts were less
likely to have attended school compared to people
without disabilities.
• People with disability (18-59 years) were more likely
to be unemployed than people without disabilities.
In Kurigram, 29% and 2.1% of people with and
without disability respectively, were unemployed.
In Narsingdi, 28% of people with disability compared to
3.7% of people without disability were unemployed.
• Women with disabilities in both districts were more
likely to undertake unpaid work or be unemployed
compared to men with disabilities.
• Adults who reported poor general health in both
districts were up to two times more likely to report
disability than adults who reported very good or
good health.
• Children with disabilities were less likely to have ever
attended school and more likely to have poor general
health or injuries than children without disabilities in
both districts.
Disability, participation
and access to services
• Adults and children (5-17 years) with disabilities
reported lower well-being compared to people
without disabilities of the same age and gender
in Kurigram.
• Well-being for adults with and without disabilities
was similar in Narsingdi, but children with disabilities
reported lower well-being than children without
disabilities of the same age and gender.
• Adults with disabilities had higher unmet needs for
accessing health, work, community meetings and
social activities than adults without disabilities.
• Adults with disabilities in Kurigram had higher
unmet need for toilet facilities than adults without
disabilities; however, there was no difference in
Narsingdi. Overall, sanitation infrastructure is
poorer in Kurigram.
• A lack of services overall and information about
services were key barriers to accessing services for
both people with and without disabilities.
• Cost was a barrier to accessing health services,
assistive devices and rehabilitation services for both
people with and without disabilities.
• Negative attitudes were a barrier for children with
disabilities to participating in social activities in
Kurigram and in religious activities in Narsingdi.
Access to assistive products
• Nearly 13% of people with disabilities reported using
assistive products (AP).
• People with disability had high self-reported unmet
need for AP. This included people with mild disability
(68% unmet needs), moderate disability (84%) and
severe disability (60%).
• Around half of people who use AP reported spending
less than US$2 on their AP, with almost half of
products being self or home-made.
• Slightly more than half of people with disabilities
reported that they did not use AP because they do
not have information about AP.
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4. IMPLICATIONS
• The findings from this study, along with evidence
from other studies in Bangladesh, highlight the
need for strengthening preventive measures for
disability and the need for promoting disability
inclusive development.
• There is a need to progress strategies for ensuring
equitable access to services and particularly health
and education.
• Primary health and rehabilitation services should be
further strengthened, with emphasis on older people
in rural areas.
• Psychological distress is common in people with
sensory, physical, cognitive or communication
impairments, which suggests a need to address
mental health for people with other impairments.
• Women’s empowerment, and strengthening
policies and programs, may help improve access
to health, education and employment for women
with disabilities. These programs should consider
the intersectionality of gender, disability and other
potential exclusionary factors.
• Increasing community awareness, including
awareness in authorities, community leaders, service
providers and so on, may help address the current
barrier of limited information about services.
• Solutions to further expand access to rehabilitation
and assistive products are needed. Priority areas
include access to assistive products for women and
girls and people with severe disabilities alongside
building community and broader awareness on the
importance of assistive products and how they can
be acquired at low cost.
• Replicating the survey in other districts or nationally
would help better inform and prioritise disability
inclusive development initiatives. Where further
data are required to guide disability specific policy
and programming, larger disability specific surveys
may be needed.
FURTHER INFORMATION
Handicap International
House # SW(F)1/A
Road # 4, Gulshan 1
Dhaka-1212.
Phone: +880 2 9859794
Email: dp@hibd.org
Director, Demography and Health Wing
Bangladesh Bureau of Statistics (BBS)
E-27/A, Agargaon, Dhaka-1207
Phone: -880 2 9101087
Email: mashud2003@yahoo.com
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POLICY BRIEF
Rapid Assessment of Disability in Kurigram and Narsingdi, Bangladesh
Disclaimer: This document has been produced with the assistance of the European Union. The contents are the sole responsibility
of Handicap International and can in no way be taken to reflect the views of the European Union.