News Release

Children with nutritional deficiencies and lack of educational access in poorer nations are at increased risk of disability

Peer-Reviewed Publication

The Lancet_DELETED

Use of UNICEF's 'Ten Questions' screen for disability shows a range of factors that make children in low- and middle-income countries more likely to be disabled. The issues are discussed in an Article published in this week's disability special issue of The Lancet, written by Professor Maureen S Durkin and colleagues at the Department of Population Health Sciences and Waisman Center, University of Wisconsin-Madison, WI, USA, and UNICEF.

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. MICS is a household survey programme designed to provide evidence for improved policy formulation, programme planning, and advocacy. MICS supports countries to monitor children's well-being by collecting statistically sound, internationally comparable data in the areas of health, education, child protection, and HIV/AIDS. This also provides countries with the opportunity to monitor progress toward national goals and global commitments, including the Millennium Development Goals (MDGs).

In this study, the authors present results of the disability module from 18 countries** that participated in the third round of MICS surveys in 2005-06. Specifically, the authors estimated 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.

Data for the percentage of children screening positive for or at risk of disability were obtained for almost 200,000 children aged 2-9 years in these 18 countries. The researchers found that a median 23% of children aged 2-4 years screened positive for disability in the 18 participating countries. For children aged 2-4 years, screening positive for disability was significantly more likely in children who were not breastfed versus those who were (36% vs 26%) in eight of 18 countries analysed. Children aged 2—4 years were also more likely to be disabled if they had not received vitamin A supplementation (36%) versus those that had (29%) in five of ten countries assessed. Children in the 2—4 years age group who were underweight were more likely to be disabled than those who were not (36% versus 25%) in seven of 15 countries assessed for nutritional status. Children aged 2—4 uears who participated in few early-learning activities were also more likely to be disabled (31%) versus those who had participated in more (24%). Finally, children aged 6-9 years who did not attend school screened positive for disability more often than did children attending school (29% vs 22%) in eight of 18 countries.

The authors conclude: "The internationally comparable results substantially extend what is known about children at risk of disability in these countries. The significant associations that we report between positive screens for disability and access to nutrition and early-learning opportunities call for further investigation. With the growth of interest in child health and development, we hope to see continued improvements in global health research and policy to both reduce risk of disability and improve opportunities and outcomes for children with disabilities in countries with low and middle incomes."

Professor Durkin adds***: "Child disability is an emerging global health priority coinciding with steep reductions in child mortality in many countries and increased attention to the functioning and quality of life of children who survive."

In an accompanying Comment, Dr Jean-Francois Trani, Leonard Cheshire Centre for Inclusive Development and Disability, Epidemiology, and Public Health, University College London, UK, says: "The disability experience is better understood by shifting the focus from classifying by types of impairment to asking children about the level of difficulty they have in functioning in the various dimensions of wellbeing. If this approach is used, the consequences of living with impairment could be better addressed by increasing choices of opportunities and fostering inclusive policies that are intended to enhance children's wellbeing."

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Professor Maureen S Durkin, Department of Population Health Sciences and Waisman Center, University of Wisconsin-Madison, WI, USA. T) +1 608 263-7507 or +1 608 263-2128 E) mdurkin@wisc.edu

Dr Jean-Francois Trani, Leonard Cheshire Centre for Inclusive Development and Disability, Epidemiology, and Public Health, University College London, UK. E) rmhkjtr@ucl.ac.uk

For full Article and Comment, see: http://press.thelancet.com/childdisab.pdf

Notes to editors: *18 countries: Albania, Bangladesh, Belize, Cameroon, Central African Republic, Georgia, Ghana, Iraq, Jamaica, Macedonia, Mauritania, Mongolia, Montenegro, Sao Tome and Principe, Serbia, Suriname, Thailand, Uzbekistan

**10 Questions:

  1. Compared with other children, did (name) have any serious delay in sitting, standing, or walking? (Developmental milestones)
  2. Compared with other children does (name) have difficulty seeing, either in the daytime or at night? (Vision)
  3. Does (name) appear to have difficulty hearing? (Hearing)
  4. When you tell (name) to do something, does he/she seem to understand what you are saying? (Comprehension)
  5. Does (name) have difficulty in walking or moving his/her arms or does he/she have weakness and/or stiffness in the arms or legs? (Movement)
  6. Does (name) sometimes have fits, become rigid, or lose consciousness? (Seizure)
  7. Does (name) learn to do things like other children his/her age? (Learning)
  8. Does (name) speak at all (can he/she make himself/herself understood in words; can he/she say any recognisable words)? (Speech)
  9. a. Ages 3-9 years: Is (name)'s speech in any way different from normal? b. Age 2 years: Can he/she name at least one object (animal, toy, cup, spoon)? (Speech and communication)
  10. Compared with other children of his/her age, does (name) appear in any way mentally backward, dull, or slow? (Intellectual impairment)

***Quote direct from Professor Durkin and cannot be found in the text of the Article


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