ArticlesChild disability screening, nutrition, and early learning in 18 countries with low and middle incomes: data from the third round of UNICEF's Multiple Indicator Cluster Survey (2005–06)
Introduction
Improvements in child survival in many low-income and middle-income countries in recent decades have coincided with a growing global awareness of children's functional status and the effects of childhood disabilities on individuals, families, and populations.1, 2, 3, 4 Despite rising interest in child disability, little is known about the frequency and situation of children with disabilities in countries with low and middle incomes.3 According to the UN Convention on the Rights of Persons with Disabilities, disabilities are “long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder [a person's] full and effective participation in society on an equal basis with others.”5 Article 7 of this Convention draws attention to the rising profile of childhood disability and the need “to ensure the full enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis with other children.”5 This view of disability is consistent with UNICEF's focus on protection of children with disabilities against discrimination6 and with the framework of the International Classification of Functioning, Disability and Health, in which disability is regarded as an interaction between individual health conditions or abilities and contextual factors such as social support, culturally influenced perceptions of disability, and access to nutrition and education.7
In response to the need for information about children with disabilities in countries with low and middle incomes, UNICEF has recommended inclusion of the Ten Questions screen for child disability (panel) as an optional module in its Multiple Indicator Cluster Survey (MICS) programme. We present results of the disability module from 18 countries (figure 1) that participated in the third round of MICS (MICS3) in 2005–06. Specifically, we aimed to estimate the percentage of children who screened positive for or were considered at risk of disability in these countries, and to assess the association between disability screening results and nutritional variables, exposure to early-learning activities, and school attendance.
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Study design
MICS is a household survey programme that was developed by UNICEF to assist with monitoring of the health of women and children in countries with low and middle incomes. It is intended to measure progress towards an internationally agreed set of goals with use of uniform measures across countries. UNICEF provides training, materials, and support for standard methods of data collection across participating countries, although implementation of MICS3, including sample-size determination,
Results
Primary caregivers of 191 199 children completed the Ten Questions screen in 25 languages across 18 countries. Table 1 shows the characteristics of all children (aged 2–9 years) who were screened, by country. Boys and girls, and both age groups (2–4 and 6–9 years), were nearly evenly represented. The percentage of children residing in urban areas was highest in Thailand and lowest in Bangladesh (table 1). The median percentage of children meeting criteria for stunting was lowest in Montenegro
Discussion
Inclusion of the Ten Questions child disability module in UNICEF's MICS3 has provided population-based information from many countries with low and middle incomes about the proportion of young children (aged 2–9 years) screening positive for or at high risk of disability. Screening results vary across countries, with more than 10% of children screening positive for disability in 17 of the 18 countries, with a median prevalence of about one in four children. These findings are higher than are
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