BMJ paediatrics open · 2026
Understanding barriers to rehabilitation: child and family determinants of service utilisation in the Enabling Inclusion programme in rural South India.
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Coutinho Franzina, Saxena Gauri, Brien Marie, Poojari Deepalaxmi, Ramachandran Selvam, Bhrasadiya Nisha, Srinivasan Sankara Raman, Venkatachalapathy Navamani, Dahan-Oliel Noemi, Krishna Dinesh
Аннотация
BACKGROUND: Early identification and consistent intervention are essential to optimising developmental outcomes in children with neurodevelopmental disabilities. However, evidence on service utilisation patterns in low-resource contexts remains limited. This study examined the demographic characteristics and rehabilitation service utilisation of children enrolled in an early intervention programme, called the Enabling Inclusion (EI) programme in rural South India.
METHODS: A retrospective analysis of 6069 children receiving EI services between 2015 and 2024 was conducted. The investigators set a threshold for adequate therapy utilisation as children having received at least 42 therapy sessions over a 6-month period. Descriptive statistics and inferential analyses (including analysis of variance and Kruskal-Wallis tests) were used to explore the relationships between demographic factors (age, sex and diagnosis) and service utilisation outcomes, including number of therapy visits and duration of programme participation.
RESULTS: The average age at enrolment was 8 years and 7 months, with a male predominance (58%). Cerebral palsy (25%) and speech and language disorders (16%) were the most common diagnoses. Children under 6 received significantly more specialist visits (age: β=-5.19, p<0.001; age²: β=0.38, p<0.001), while older children relied more heavily on community rehabilitation workers (age: β=-11.30, p<0.001; age²: β=0.725, p<0.001). Children with intellectual disability, autism and cerebral palsy were significantly more likely to meet the threshold for adequate therapy utilisation, while those with hearing impairments and specific learning disabilities showed lower service uptake (p=0.034).
CONCLUSION: The findings highlight age-specific and diagnosis-specific patterns in rehabilitation use, underscoring the need for adaptable, community-based strategies that ensure equitable access to early intervention in rural, resource-limited settings.
METHODS: A retrospective analysis of 6069 children receiving EI services between 2015 and 2024 was conducted. The investigators set a threshold for adequate therapy utilisation as children having received at least 42 therapy sessions over a 6-month period. Descriptive statistics and inferential analyses (including analysis of variance and Kruskal-Wallis tests) were used to explore the relationships between demographic factors (age, sex and diagnosis) and service utilisation outcomes, including number of therapy visits and duration of programme participation.
RESULTS: The average age at enrolment was 8 years and 7 months, with a male predominance (58%). Cerebral palsy (25%) and speech and language disorders (16%) were the most common diagnoses. Children under 6 received significantly more specialist visits (age: β=-5.19, p<0.001; age²: β=0.38, p<0.001), while older children relied more heavily on community rehabilitation workers (age: β=-11.30, p<0.001; age²: β=0.725, p<0.001). Children with intellectual disability, autism and cerebral palsy were significantly more likely to meet the threshold for adequate therapy utilisation, while those with hearing impairments and specific learning disabilities showed lower service uptake (p=0.034).
CONCLUSION: The findings highlight age-specific and diagnosis-specific patterns in rehabilitation use, underscoring the need for adaptable, community-based strategies that ensure equitable access to early intervention in rural, resource-limited settings.