Abstract

Background: According to World Health Organization (WHO), vulnerable groups such as persons with disabilities are facing severe impacts of the pandemic. There has always been significant challenges and hurdles in terms of achieving adequate and equitable inclusivity of persons with disabilities in all sections of social life. Education and employment of persons with disabilities were least focused which created more marginalization for the community. The long term impact of these marginalization has also led to the lack of jobs and social security of persons with disabilities, which is very clear now given the crisis in place. In low and middle income countries like Bangladesh the situation is even worse. To better understand the conditions of persons with disabilities in this crisis situation, the present study was initiated to explore the dimensions of livelihood with respect to income and wellbeing of persons with disabilities and to generate evidence for developing policies around these issues.

Methods: A qualitative study was undertaken among 30 persons with disabilities from 8 different geographical divisions of Bangladesh. The interviews were conducted through telephone calls due to the existing COVID-19 crisis and mobility restrictions. The respondents were purposively selected based on gender, type of disability, area of resident (urban, rural) and their ability to communicate, therefore most (25/30) respondents were persons with physical disability. Thematic analysis was conducted to generate the findings of the study.

Findings: Study findings revealed that majority of the respondents were involved in informal jobs. Predominantly males were daily wage-earners and often the sole breadwinner of the families, very few females were involved in economic activities. Since they had no stable income, the economic shock from the COVID-19 pandemic had affected them badly even leading to household level famine. The study identifies low level of education and informal job security as the primary causes of socio-economic insecurity among persons with disabilities, resulting in challenges in ensuring a stable livelihood during crisis situations, such as COVID-19.

Conclusion: Constant alienation of persons of disabilities from the formal sector results in the deterioration of their livelihood standards which even worsen during any emergency crisis such as COVID-19. The study pinpoints that only aided services are not adequate to ensure persons with disabilities' rights rather there is an urgent need of disability inclusion in formal job sector and livelihood training for persons with disabilities. To achieve the Sustainable Development Goals 2030 and to irradiate the inequality towards persons with disabilities in the society it is important for the Government and concern bodies to focus on the inclusiveness with better implementation and monitoring strategies.


Introduction

The COVID 19 pandemic has affected almost 227 countries and regions globally (WHO, COVID19) which has taken a toll on the global population. Different strategies such as lockdown and social distancing have been taken to combat the spread of pandemic. However, these strategies are no less distressing than the pandemic itself and is rather adversely affecting the livelihoods of people and the global economy (WHO, 2020). Some of these strategies are impacting the key aspects of livelihoods, such as employment, education and social security (PPRC & BIGD, 2020). Persons with disabilities, one of the most marginalized groups among the global population are experiencing the worst negative effects of COVID-19 pandemic (WHO, 2017). This stems from their long history of deprivation of persons with disabilities from social inclusion and uneven economic participation due to lack of access in formal education and formal workforce, which results in higher rates of persistent poverty (World Bank, 2020).

Bangladesh, which is a developing country, has a 6.94% prevalence of disability according to the most recent estimates, indicating that there are more than 11 million persons with disabilities in the country. (BBS, 2019). The prevalence of disability is higher in rural areas than in urban areas and most of the households with a disabled person live below the poverty line (BBS/HIES, 2016; Sen & Hoque 2017). More than half (61.5%) of the persons with disabilities do not attend school and about 43% of them are unemployed/do not work at all. Those who are involved with employment are mostly involved with informal jobs (BBS Monograph, 2015). Besides, social stigma associated with disability still exists in Bangladesh as many people tend to believe that disability is a curse or punishment of wrongdoings and discrimination against persons with disabilities is widely spread (World Bank, 2018). Most often they are victims of violence and abuse, and lack adequate knowledge on their rights and access to information as well (NGDW/NCDW/BLAST, 2015). Due to all these reasons, they are the most vulnerable to experience the worse negative impact of any pandemic such as COVID-19.

Despite different strategies including, Rights and Protection of Persons with Disabilities Act 2013, and its subsequent action plan finalized in 2019 in order to meet the needs of persons with disabilities, there seems to be a gap in ensuring the basic needs of education and employment facilities for persons with disabilities in Bangladesh, which have long term impacts as mentioned earlier (BLAST, 2015). According to the data of Bangladesh Bureau of Statistics, children with disability of school going age in Bangladesh were at least twice as likely to not currently be engaged in education compared to their counterparts of the same age group without disabilities (Bangladesh Bureau of Statistics, 2015). Given the lower rates of educational attainment by persons with disabilities in Bangladesh, they mostly engage in the informal job sectors with professions which depend mostly on daily income eg. Day-wage labours, self-employed small business, family labour, or other forms of day-waged work.

In the context of COVID-19 pandemic, a lack of proper income source, uncertainty regarding food security and proper aid and services puts them in a state of social risk (Sen & Hoque, 2017). In addition, there is also a higher health risk involved for persons with disabilities, given the co-morbidities they live with (WHO, 2020). There is clearly a big gap in understanding and meeting the needs of persons with disabilities in Bangladesh, which gets worse in emergency situations such as the COVID-19 pandemic. COVID-19 as it seems, has already increased the pre-existing vulnerabilities of persons with disabilities by shrinking the pool of livelihoods (Relief Web, 2020). However, other than media attention, no strong evidence has been available on this matter in terms of research and/ policy dialogues.

Therefore, to meet this gap, and to better explore the livelihood and social security conditions of persons with disabilities in the context of COVID-19 in Bangladesh, a study has been designed by BRAC James P Grant, School of Public Health, BRAC University. The study, which is Qualitative in its design, aimed to look into the day-to-day experiences of Persons with disabilities, in order to shed light on their vulnerabilities and the causes.

The study explored different dimensions of livelihood, such as income, food security, employment, etc. among persons with disabilities across Bangladesh. This paper highlights some of the major findings of the study, which will be useful for inclusive policy and programme implementations. Findings produced from this study will also help design better strategies to combat the negative effects of COVID-19 pandemic and lay out a base for further research on this topic.

Methodology

To explore the immediate impact of the COVID-19 pandemic on the persons with disabilities in Bangladesh a qualitative study was undertaken. Since the study was conducted during the high time of the COVID-19 pandemic (May to June 2020), we adopted in-depth telephone interview as the data collection method. As a consequence, respondents were purposively selected based on socio-demographic information and their ability to communicate over phone. Total 30 persons with disabilities were interviewed over phone. The study population was enrolled from a nationwide survey of 5,000 persons with disabilities across the 8 the divisions of Bangladesh (Akter et al, 2020).

Both male and female persons with disabilities were selected as study respondents for this study. Persons with different types of disabilities such as physical, visual, and hearing impairments with different socio-economic background were interviewed. Respondents were recruited from both urban and rural areas and different geographical divisions of the country.

Ethical clearance of the study was received from the Institutional Review Board at BRAC James P Grant School of Public Health, BRAC University. Verbal consent was sought before every sitting and recording of the interview. Anonymity and confidentiality were maintained at all times.

A semi structured guideline was utilized to explore their sociodemographic (background) characteristics, household information, employment details, livelihood status, livelihood challenges, coping mechanisms, knowledge regarding social safety net, relief and aid related information, challenges related to obtaining social safety nets and the overall impact of COVID-19 on their daily lives. All the recorded interviews were transcribed and then translated into English. A data matrix was generated to present the findings with respect to each theme. Thematic analysis of the data was conducted using Atlas- Ti Coding software. The researchers tried reaching out to 35 respondents, however 30/35 were successfully interviewed and findings from these 30 respondents were utilized for the analysis.

Findings

1. Background Characteristics

The background characteristics of the respondents are presented in Table 1. Out of the 30 respondents, 18 were male and 12 were female. All respondents were in between the ages of 18-58 years. 10 of the respondents were from urban areas, and 20 were from rural areas. Most of them belong to lower middle socioeconomic to poor socioeconomic levels. More than half of them (17 out of 30) did not participate in any formal education, whereas only 1/30 was involved in any form of formal employment.

Table 1: Background Characteristics of the respondents
Background Characteristics Number of respondents
Age range: 18-58 years
Gender
Male 18
Female 12
Residence
Urban10
Rural20
Employment
Formal Employment1
Informal Employment 22
Unemployed 7
Education
Did not receive any formal education17
Primary and above9
Secondary and above3
Graduate and above 1
Marital Status
Married 17
Unmarried 13
Type of Disability
Physical Disability 25
Hearing Impairment 1
Visual Impairment 4

The findings derived from the thematic analysis on Livelihood challenges and Social Safety Net is presented below with respect to each themes. All the quotations used in this section is cited using pseudonyms to keep the identity of the respondents confidential.

2. Livelihood Challenges of persons with disabilities during the COVID-19 crisis

The study findings revealed that most of the respondents were involved in informal jobs, and their occupations ranged from day labourer to beggar, garment worker, tea-stall owner, rickshaw puller, small scale businessman, tutor and tailor. But irrespective of age, gender, region, and educational status, almost all of the respondents reported that they were facing extreme income insecurity during this pandemic. In most of the cases men (10 out of 18) were the ultimate bread winner of their family. Majority of them were found to be involved in informal economy as a consequence most of them either lost jobs, or had reduced income or were working without salary during the pandemic.

Due to the lockdown situation, daily wage earners had suffered the most, as they did not have any savings for coping with this emergency situation. While talking to a 55-year-old, married man with physical disability from a remote area of Cox's bazar, he shared that he had lost his store (tea stall owner) during this pandemic and he started to beg for alms. He mentioned that like previous times people or households do not welcome help seekers because of the coronavirus situation. According to the respondent, the help he used to get from people has declined sharply due to the overall financial constraints. It seems, because of the movement restriction imposed by the authorities and reduced financial capabilities of general people, people like him are facing reduced income and struggling the most during this pandemic. He did not receive any formal education, which prevents him access to many employment opportunities.

At these days, people are not caring towards other at all, because they have their own sufferings. I lost my income and have to beg now. (Rahim, 55 year old men, physical disability, married, poor, rural, IDI)

The lockdown and restrictions due to COVID19 have also added a double burden in the livelihood challenges of persons with disabilities. Saima, a 19 year old woman with physical disability from a rural area shared that she used to run a tea stall for living, but due to the pandemic, she cannot keep her tea stall open as frequent police supervisions and restrictions come in. According to her,

'If such situation continues for 2-3 more days, it will be unimaginable what will happen! I wonder how I will survive; how will I manage my family for the survival!' (Saima, 19 year old women, physical disability, unmarried, tea stall owner, poor, rural, IDI).

Another female respondent Tonny shared a similar experience. She does tailoring work and hardly manages to secure any orders nowadays,

I am not getting enough tailoring orders because of coronavirus. In the last one month I just got two orders, where I used to get 2/3 orders each week. This has a bad impact on my finances, I don't know what else to do. (Tonny, 24 year old female, unmarried, poor, educated, urban, IDI)

Where there are frequent assumptions that persons with disabilities are unable to achieve economic security and independence, or they are unfit to fulfill professional requirements, in reality many of them were the ultimate bread winner of their families as reported in the study. Even though persons with disabilities were actively participating in the country's workforce, job and income related anxiety is still persistent among them.

2.a Livelihood challenges: Food insecurity

Given that the majority of the participants (27/30) belonged from lower middle class to poor class, extreme income uncertainty resulted in consistent food insecurity, leading towards household famine. Moni, a 25 year old married, lower middle-class woman with physical disability, shared that her husband is the only earning member in the family and he lives abroad. Due to the current pandemic situation, the store her husband used to work at has been closed. This caused her and her family a lot of damage financially.

I cannot stock up food due to lack of resources (no fridge or space or extra money). There is not much problem with rice (for now) but other items such as fish, meat, eggs and other vegetables. Since there is not enough finance or storage facility in the house, I have decided to avoid having fish and meat in the house, that way we get to have other groceries in the upcoming days (Moni, 25-year-old women, physical disability, married, housewife, lower middle class, urban, IDI)

Another respondent Beauty shared a similar situation where she and her family are facing extreme food insecurity due to this pandemic.

'Most of the days we are having rice, dal and mashed potato or some other vegetable for meal'. When asked her about protein sources, she said, 'it's hard to find fish now as well as egg and chicken. We are getting to eat vegetables as they grow some near their house.' (Beauty, 24 year old women, physical disability, unmarried, poor, urban, IDI)

While talking to Saima, a 19 year old woman with physical disability from a rural area, she mentioned how the pandemic is adding more factors in the already devastating situation of the household.

Another big trouble of my family is my father's alcohol addiction. If he is given money to buy rice for the family, he does not buy it. He spends it for his addiction instead. This pandemic has made him move towards drug more. (Saima, 19 year old women, physical disability, unmarried, tea stall owner, poor, rural, IDI).

A closer analysis from the qualitative study suggests that female persons with disabilities who are unemployed and dependent (7 out of 12) on other family members are getting more vulnerable and marginalized in this pandemic period. A 35 year old, poor married woman with physical disability from a rural area shared that she is going through very hard times, as her husband's income got halted.

After this month how I'll manage I don't know as I'm a woman I have nothing to do, my husband has no skills other than driving. He cannot run himself this time. Whatever, he doesn't listen to me, he does what he wants to do. He is not coming home for 2 days, even not contacting me over the phone. I have no education, no employment, nothing. (Dina, 35 year old female, physical disability, married, poor, class 5 passed, rural, IDI)

The findings also reveal that income loss or job insecurity is not only applicable for the poor, rural or the people who have less educational attainment, but also applicable for highly educated or urban people also. One of the respondents, a 30-year-old married middle-class woman with physical disability from an urban area, shared that both she and her husband have master's degrees, and she works as a house tutor, while her husband works in a private company. She lost her tuition due to the closure of educational institutes in the country and her husband is working without full salary during this pandemic.

My husband's office closed down from 24th March, two days before the government announced general holiday. The office authority did not give the salary for March month and said the salary would be given after 4th April when the lockdown will be over. As the lockdown has been increasing they didn't get any salary yet and the office authority said that they will pay after the office reopens….My student's parents called me and asked me to not go there anymore, which means, I am out of any income too. (Amina, 30 year old female, physical disability, married, masters passed, urban, lower middle class, IDI)

As most of the respondents belong to middle class to lower class families, (27/30) they do not have much personal savings to cope with this emergency lockdown situation. Therefore, there is a constant uncertainty about their livelihood. Some of their coping strategies includes: borrowing money or seeking help from relatives or neighbors, skipping meals, depending on home grown vegetable and domestic animals, less protein consumptions, begging etc. Many of the respondents reported about having low blood pressure or weakness due to food shortage or lack of minimum protein consumption due to this.

Most of the respondents reported that, after 5-6 months of this pandemic people seemed to have started to ignore their health risks, as they want to secure their earnings and food. As government's aid or different organizations help failed to cover all the marginalized groups, they had no other choice than to risk their health for livelihoods. One such respondent, Pia, a 19 year old unmarried female with physical disability from a rural area, mentioned that she has a small store as her earning source. Despite maintaining the safety protocols for about a few months, when her family went through an extreme financial crisis, she resumed the activities of the store, compromising the health of herself and her family members. Similar experiences were recorded from other respondents too:

'Though it is recommended not to go outside and avoid crowds or public places, but it's not possible for everyone to stay inside the house. Not everyone is getting the government relief, so they have to go outside for work and that is making crowds again.' (Amina, 30 year old female, physical disability, married, masters passed, urban, lower middle class, IDI)

3. Social safety net for persons with disabilities amid the COVID-19 crisis

3a. Social safety net program: Disability allowance

The Government of Bangladesh has introduced a disability allowance under the social safety net programs, where an amount of 700BDT/month is given to a person with disability, from the disability list prepared by the local social welfare office. This list is prepared based on the needs and requirements of the person with disabilities, as determined by the local leaders and social welfare officers upon submitting relevant documents. Twenty out of 30 respondents of this study, have mentioned that the disability allowance is insufficient to meet their demands, given the hiked prices of daily goods. While talking to Babul, a 22 year old poor, man with visual disability from a rural area, he shared that he did not have any knowledge about any aid or relief program for persons with disabilities, rather, he applied for the disability allowance before March 2020 (Pre-COVID) in the Department of social service office, but did not get any confirmation yet.

I'm not aware about any aid or relief targeted specifically towards persons with disabilities either by government authorities or by non-government organizations. I submitted an application to be enrolled in the disability allowance system under the Ministry of Social Welfare a few months ago, but has not received confirmation on registration yet (Babul, 22 year old man, visual disability, unmarried, gas filling worker, poor, rural, IDI)

Twenty three out of 30 respondents shared that they haven't heard about other special incentives other than the monthly disability allowance, even during this pandemic situation. The respondents mentioned that given the current pandemic and economy situation, they expect monetary help from the government but have received no such facilities.

I did not hear about any sort of social safety net measures like monthly allowance which will be given to us to fight for the upcoming worse situation. A family should be given ten thousand taka, so that a family can have enough food items to survive at least thirty days and the government should provide that. (Harun, 34 year old man, physical disability, educated, married, lower middle class, urban, IDI)

Although most of the respondents reported receiving disability allowance during this pandemic, some (4 out of 30) of them shared that the disability allowance program had been postponed in their area, due to the emergency COVID 19 situation. Saima, a 19 year old unmarried woman with physical disability from a rural area shared that she was informed by one of her neighbours (who is also a person with disability) that the disability allowance program got postponed.

The allowance for disability has been postponed. I have seen on TV that the bank, court and other offices have been closed down. Neither me nor my family members could visit the bank and check for the allowance. But I have come to know from an acquaintance who informed me about the deposit of allowance at the bank, that now the allowance has been postponed. As corona is a contagious disease, it can spread further if anyone goes to the bank to collect the money. (Saima, 19 year old woman, physical disability, unmarried, poor, rural, IDI)

3b. Relief and aid disbursement challenges: Experiences of persons with disabilities

Persons with disabilities recognizes relief and aid disbursement as the most significant social security programmes, especially during emergency situations, such as COVID-19. Most of the respondents shared about their anxiety and interest in this regard. Only 5 out of 30 respondents have shared about receiving food aid from local government representatives. A few of them received personal loans, aids and support from Non-governmental organizations (NGOs)s. Those who have received aids from the government facilities mentioned that the food aid covers: 5 to 10 kg rice, lentil, oil, and potatoes which is sufficient for a family of four for a month.

A 21 years old, unmarried, poor, man with physical disability from an urban area shared, they got government food aid twice in two months, but there is a prevailing uncertainty as to how long this will continue.

I have got the relief from the government. My family has got the government ration, especially the food items. Besides, the responsible persons of the society are providing food items to us. The member and chairman has provided 10 kg rice to our family. I won't get it on a regular basis because there are many families in our locality also. So everyone has to get it (Jamil, 21 old men, physical disability, unmarried, poor, urban, IDI)

Most of the respondents (20 out of 30) complained that they did not get any aid, especially those who were living in rural area. Some of them shared about local government representative's corruption in the aid disbursement process.

A 24 year old unmarried woman with physical disability revealed that she did not receive any aid, as she did not have any political influence.

My family didn't get any relief in this situation. One needs to have a connection with the chairman to get relief. As we don't have any connection, we are not getting any relief. (Koly, 24 year, old women, unmarried, educated, poor, rural, IDI)

The study findings revealed that persons with disabilities sometimes face discrimination while receiving any form of aid, especially women living in rural areas and who have communication disabilities. Bani, a 35 year old poor married woman with physical and communication disability from a rural area shared, she did not receive any aid, though she heard about others receiving aid. According to her, being a women and disabled, made her more vulnerable and discriminated against to get aid, in an emergency situation like this.

In my area, people are getting aid from local chairman-member, like rice, potato, oil etc. But I did not get any because I am disable, women. I did not get that information also. Member-chairmen give aid to people like rice, potato, oil etc. I heard this from an area (neighbor's) people, I do not get this information as I am a woman. I did not get any help till now. (Bani, 35 year, old woman, physical disability, married, poor, rural, IDI)

While discussing the socio-economic status, it was observed that middle class people are suffering more as they are in a dilemma between dignity and need. They cannot earn/help themselves or seek help from others in fear of losing dignity. They cannot stand in the line to receive aid due to their middle class stigma. While talking to the son of a 55 year old man with physical disability from an urban area, he shared, they are going through hurdles as they cannot seek help from others.

Even though we are poor people, we cannot really go there and say we need these things, you know? My father was a government service holder. We are living in hardship, but cannot go for our personal reasons, for fear of our respect and dignity. (Son of Jamil, 55 year, old men, physical disability, lower-middle class, urban, IDI)

Discussion

The impacts of COVID 19 pandemic on the general population in Bangladesh is also quite negative in terms of livelihood challenges, social security and/ food security. In addition to the already existing socioeconomically disadvantaged groups, the emergence of the 'new poor' group which consist of jobless individuals, daily wagers and/ people who have lost their financial solvency during this pandemic, has definitely made it difficult for the social security systems to deal with (PPRC & BIGD, 2020). The main findings of this research brings out the persistent poverty and inability to secure a stable livelihood in this time of crisis for persons with disabilities. This has been connected to the constant alienation of persons with disabilities from formal education, employment and development agenda (United Nations, n.d).

There are multiple activities and policies taken by the Government of Bangladesh, under its social safety net program, by the Ministry of Social Welfare. Some of these are cash transfers, social protection and social empowerment. Different monetary and in kind support (disability allowance, aids) and vocational trainings are provided under these three broad headings. BDT 743.67 billion has been allocated for the social safety net programme of the Government of Bangladesh for the fiscal year of 2019-2020. BDT 26.52 billion is allocated for programmes that are expected to directly benefit persons with disabilities specifically. However, there is a distinct gap in the demands and supply given to the persons with disabilities as recorded in the study. In the context of COVID-19, Bangladesh government proposed an allocation of 9 55.74 billion BDT budget for the social security sector, which covers the 16. 83 percent of the total proposed budget for the next fiscal year 2021-2022. (The Financial Express, 2021). However, our study findings indicate that, different implementation challenges such as lack of information, monitoring, and inability to pinpoint proper source are acting as barriers in availing proper social safety interventions. In addition to that, the lack of any special services/ interventions targeting the needs of persons with disabilities makes them more vulnerable and aggregates to their sufferings. This is probably because most government plans & programs are drafted with mostly keeping the able-bodied people in mind, alienating the demands for as mentioned earlier. (Devandas, 2020).

Data from the Bangladesh Bureau of statistics indicate that Bangladesh has more than 50 million workers in the informal sector, a sector which neither guarantees a proper income and nor any form of job security. Though the pandemic has affected the groups working in the formal sector too, there is no doubt that the informal sector has been hit harder, especially adding to the fact that most formal jobs (e.g., teaching, banking and sales) can be maintained online, which is not the case when it comes to informal jobs (e.g., daily labour work and running shops). (Divadkar & Sheikh Tanjeb Islam, 2020; Banks, et al. 2020).

In line with this study, other researchers have also shown how the stigmatization and stereotyping of persons with disabilities have led them to fall out of the social systems, social interactions, formal economy, hindering the livelihood progresses, community engagement and making them vulnerable in crisis situations eg. COVID-19 pandemic. (United Nations, 2018; Banks et al, 2020).

Several cases of this study demonstrated that lack of disability inclusion in the formal education, training and employment system have left no choice for persons with disabilities than being involved in informal work where there is no job security, which is the most required thing in such emergency situations. As a consequence, the economic impact of this pandemic has been devastating on their livelihood (Relief web, 17 Sep, 2020). This discrimination in the education and employment sector is an outcome of the persistent negative social attitude towards persons with disabilities. This negative attitude stems from the idea that a person with disability is not competent, requires special attention to accommodate and is not a going to add any potential in the workforce. (Banks et al, 2020) (United Nations, n.d).

More focus is required for persons with disabilities and the social safety programs need to be designed in a disability friendly manner, focusing on the special needs of persons with disabilities (e.g., separate line/queue waivers, door-door facilities) in order to ensure that they can at least access the services (Divadkar & Sheikh Tanjeb Islam, 2020). Since the disability allowance is also an important part of the social safety program, in order to strengthen the overall social safety the disability allowance program also needs to be reformed.

Two major strengths of the study were: inclusion of study respondents from different parts of Bangladesh and use of a semi structured guideline to collect data from the respondents.

One of the limitations of this study was that it mostly included perspectives and experiences of persons with disabilities with physical impairments since communication over phone was the only available option during the imposed lockdown due to COVID19 in the country. Since this was a qualitative study, representation of all persons with disabilities could not be ensured, the results of this study is not generalizable and is specific to the context of this study.

Conclusion

In line with the claims by different national and international agencies, the study also reflects that persons with disabilities are vulnerable during pandemics and crisis situations. More funding and better monitoring strategies are required to combat the livelihood challenges of persons with disabilities in such pandemic situation. The services and interventions need to be designed by keeping the priorities and challenges of persons with disabilities in mind. In addition, there is no alternative to ensuring proper education and employment opportunities for persons with disabilities in producing better livelihood outcomes for this vulnerable population in future.

Acknowledgement:

This study was supported by the Royal Embassy of the Kingdom of Netherlands. The Authors would like to thank the support from the Royal Embassy of the Kingdom of Netherlands, Ministry of Social Welfare, Government of Bangladesh.

Conflict of Interest & Disclosure Statement:

The authors declare that they have no conflict of interest from the direct applications of this research.

References

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