Cost-effectiveness of livelihood interventions for families of children with cerebral palsy in rural Bangladesh

Background: Families of children with Cerebral Palsy (CP) often experience extreme poverty, compounded by limited livelihood opportunities and the added demands of caregiving, which further restrict their ability to earn an income. Targeted livelihood interventions may help improve their economic well-being. This study aimed to assess the cost-effectiveness of livelihood interventions to improve household incomes of ultra-poor families of children with CP in rural Bangladesh. Method: This was a mixed-methods study utilising a subgroup of a pragmatic, open-label, cluster randomised controlled trial (RCT). This subgroup was part of the “Supporting People in Extreme Poverty with Rehabilitation and Therapy (SUPPORT CP)” trial (ACTRN12619001750178), which was implemented in three rural subdistricts of Sirajganj district, Bangladesh. This RCT involved 251 children across three arms— integrated microfinance-based livelihood and community-based rehabilitation (IMCBR), community-based rehabilitation (CBR), and care-as-usual. We investigated 80 children with CP whose parents received an IMCBR program as part of the SUPPORT CP trial. Additionally, in-depth interviews were conducted with 21 participants from the IMCBR arm. Descriptive statistics to depict respondent characteristics and the average return on investment (ROI) were calculated to evaluate the most cost-effective livelihood support. Furthermore, thematic analysis was performed with the interview data to explore the advantages and disadvantages of different livelihood products. Results: The parents/caregivers of included children with CP were given five forms of livelihood support: Chickens (n = 3, 15 for each), Sewing machine (n = 11, 1 for each), Ghee making utensils (n = 1, 1 for each), Lamb (n = 7, 2 for each), and Goat (n = 59, 2 for each). The average cost of livelihood intervention per family was 65⸱9 USD. The net return on investment after 12 months was 59.0% for lamb, 70.0% for ghee-making tools, 24.0% for goat, 34.0% for sewing machines, and −25.0% for chicken. Lambs proved to be advantageous due to their sustainability, minimal space requirements, and disease resistance. Conclusions: This study suggests that the provision of lambs as livelihood support is the most effective intervention for empowering ultra-poor families with CP in Bangladesh. This experience can potentially enhance the well-being of ultra-poor families in Bangladesh and other low- and middle-income countries.