Challenges for assessing disability prevalence: the case of Afghanistan = Les défis de la mesure de la prévalence du handicap : le cas de l’Afghanistan

This article attempts to examine the methodological intricacies of measuring prevalence rate of disability through a population based survey using the International Classification of Functioning, Disability and Health of the WHO and the Capability framework, developed by Amartya Sen and others. After a rapid overview of the Afghan context and the process leading to the research programme, it presents the example of the methodology used in the NDSA and the survey protocol. The authors argue that prevalence rates can be measured using different instruments in terms of impairments, activity limitations or in terms of well-being. Thus, the disability experience is measured through a multidimensional approach. The article concludes that whatever the conceptual framework adopted, understanding the situation of persons with disability requires to go beyond measurement of disability prevalence. It implies to look at the links between disability prevalence and the persons’ valuable functioning’s and social agency, in a given environment, using other variables made available by the survey

Vulnerability and mental health in Afghanistan: Looking beyond war exposure

This study examined the prevalence of mental distress among groups in Afghanistan considered to be at risk. Data were drawn from a representative cross-sectional disability survey carried out in Afghanistan including 5,130 households in 171 clusters throughout the 34 provinces of the country. The sample included 838 non-disabled control participants aged above 14, and 675 disabled participants. Results showed that various vulnerable groups (disabled people, the unemployed, the elderly, minority ethnic groups, as well as widowed, divorced or separated women) were at higher risk of experiencing mild to severe mental health problems. The adjusted odds ratio for war-related disability compared to non-disabled was 4.09 (95% confidence interval 2.09 to 7.99) for mild mental distress-disorders, and 7.10 (3.45-14.5) and 14.14 (3.38-59.00) for moderate or severe mental distress-disorders, respectively. Women with disabilities (whatever the cause of impairment) when compared with non-disabled men, as well as poorer segments of society compared to the richest, had a higher prevalence of mental health problems. Women with non-war-related disabilities compared with non-disabled men were respectively 3.35 (1.27-8.81) and 8.57 (3.03-24.1) times more likely to experience mild or moderate mental distress-disorders. People who experience multiple vulnerabilities are more at risk of deteriorating mental health in conflict zones. The study shows that mental health, in times of war, is influenced by a combination of demographic and socioeconomic characteristics linked to social exclusion mechanisms that were in place before the conflict began and that are re-defined in relation to the changing social, cultural, and economic contexts. Mental health policies and programmes remain must prioritise the most vulnerable segments of Afghan society

Challenges for assessing disability prevalence: the case of Afghanistan = Les défis de la mesure de la prévalence du handicap : le cas de l’Afghanistan

This article attempts to examine the methodological intricacies of measuring prevalence rate of disability through a population based survey using the International Classification of Functioning, Disability and Health of the WHO and the Capability framework, developed by Amartya Sen and others. After a rapid overview of the Afghan context and the process leading to the research programme, it presents the example of the methodology used in the NDSA and the survey protocol. The authors argue that prevalence rates can be measured using different instruments in terms of impairments, activity limitations or in terms of well-being. Thus, the disability experience is measured through a multidimensional approach. The article concludes that whatever the conceptual framework adopted, understanding the situation of persons with disability requires to go beyond measurement of disability prevalence. It implies to look at the links between disability prevalence and the persons’ valuable functioning’s and social agency, in a given environment, using other variables made available by the survey

\u27Delivering\u27 Education; Maintaining Inequality. The case of children with disabilities in Afghanistan

Education for children with disabilities in Afghanistan, particularly disabled girls, continues to lag behind despite laudable efforts of the Ministry of Education to promote universal access for all. The opportunity for education constitutes not just a means of achieving learning outcomes but also a space for social interaction, individual development and psychosocial support, which are paramount in Conflict Affected Fragile States (CAFS). However, many persisting barriers still need to be overcome in Afghanistan to allow education for all and change negative attitudes towards education of children with disabilities. In this paper we argue that viewing education as a basic commodity, which is the widespread practice in CAFS, is not conducive to expanding human freedoms and capabilities. More specifically, through analyses of a national survey, we demonstrate that despite considerable resources, increasing access to education in Afghanistan has maintained processes of marginalization of the already excluded

Le teorie della Disabilità: una Reinterpretazione Attraverso l'Approccio delle Capability Amartya Sen

This paper introduces a framework based on the capability approach of Amartya Sen aiming at helping policy makers to formulate policies for disabled persons and bridging the gap between research and policy implementation. The proposed framework focuses on vulnerability in an inclusive, empowerment and dynamic perspective. It reviews the interaction between the individual and social models of disability, acknowledges human diversity, and looks at vulnerability as a multidimensional dynamic phenomenon with different types of limitations to the ‘capability’ to achieve various ‘beings and doings’ that the vulnerable person values.Disability Studies; Capability Approach

The impact of a community based rehabilitation program in Afghanistan: A longitudinal analysis using propensity score matching and difference in difference analysis

BACKGROUND: The 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health Organization Community based rehabilitation (CBR) matrix: health, education, livelihood, social and empowerment. CBR programs specifically aim to deliver such comprehensive interventions. In the present study, we investigate the impact of a CBR program in Afghanistan on all these components. METHODS: We enrolled 1861 newly recruited CBR participants with disabilities in the study, from 169 villages between July 2012 and December 2013 as well as 1132 controls with disabilities randomly selected through a two-stage process within 6000 households from 100 villages in the same provinces but outside the catchment area of the CBR program. We interviewed them again after one (midline) and two (end-line) years in the study. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR on outcomes of interest, namely mobility, activities of daily living, communication, participation in social and community life, emotional well-being and employment. RESULTS: Three years on average into the CBR program, participants showed a significant and close to medium effect size reduction in emotional (Cohen\u27s d = - 0.48, 95%CI[- 0.58--0.38]), and social participation challenges (Cohen\u27s d = - 0.45, 95%CI[- 0.53-- 0.36]); small to medium effect size reduction in unemployment (Cohen\u27s d = - 0.21, 95%CI[- 0.33--0.10]), activities of daily living (Cohen\u27s d = - 0.26, 95%CI[- 0.35--0.18]), mobility (Cohen\u27s d = - 0.36, 95%CI[- 0.44--.29]) and communication challenges (Cohen\u27s d = - 0.38, 95%CI[- 0.46--0.3]). CONCLUSIONS: Our study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context, and improve overall well-being of all participants with disabilities, whatever their impairment, individual characteristics and the CBR matrix components considered. TRIAL REGISTRATION: ISRCTN, ISRCTN50214054 . Registered August 5th 2020 - retrospectively registered

Education of children with disabilities in New Delhi: When does exclusion occur?

In the new Sustainable Development Goal 4, quality of education defined as equity and inclusion alongside traditional learning outcomes, has replaced the narrow goal of access to primary education stipulated in the Millennium Development Goal 2. Since 2000, considerable progress has been made towards improving access to school for children in India, yet questions remain regarding not just children with disabilities\u27 access and acquisition of basic learning skills, but also completion of learning cycles. Methods and findings Between November, 2, 2011 and June 20th 2012, we interviewed 1294 households about activity limitations and functioning difficulties associated with a health problem among all family members using a validated screening instruments, as well as questions about access, retention and barriers to education. We found that vulnerable children, particularly children with disabilities are less likely to start school and more likely to drop out of school earlier and before completing their high school education than non-disabled children, showing that the learning process is not inclusive in practice. The gap is wider for girls, economically deprived children, or children from households where the head is uneducated. Conclusions Firstly, in order to fill the existing knowledge gap on education of children with disabilities in line with SDG4, not only is there a necessity for relevant data with regards to learning outcomes, but also an urgent requirement for more innovative information pertaining to relational aspects of learning that reflect inclusion. Secondly, a stronger understanding of the implications of early assessment would further promote equity in education. Finally, research should tackle learning as a complex and dynamic phenomenon. Education needs to fulfil its instrumental value, but must also re-claim its intrinsic value that often gets watered down in the journey from policies to implementation

Development and Validation of the 34-Item Disability Screening Questionnaire (DSQ-34) for Use in Low and Middle Income Countries Epidemiological and Development Surveys

Background: Although 80% of persons with disabilities live in low and middle-income countries, there is still a lack of comprehensive, cross-culturally validated tools to identify persons facing activity limitations and functioning difficulties in these settings. In absence of such a tool, disability estimates vary considerably according to the methodology used, and policies are based on unreliable estimates Methods and Findings: The Disability Screening Questionnaire composed of 27 items (DSQ-27) was initially designed by a group of international experts in survey development and disability in Afghanistan for a national survey. Items were selected based on major domains of activity limitations and functioning difficulties linked to an impairment as defined by the International Classification of Functioning, Disability and Health. Face, content and construct validity, as well as sensitivity and specificity were examined. Based on the results obtained, the tool was subsequently refined and expanded to 34 items, tested and validated in Darfur, Sudan. Internal consistency for the total DSQ-34 using a raw and standardized Cronbach’s Alpha and within each domain using a standardized Cronbach’s Alpha was examined in the Asian context (India and Nepal). Exploratory factor analysis (EFA) using principal axis factoring (PAF) evaluated the lowest number of factors to account for the common variance among the questions in the screen. Test-retest reliability was determined by calculating intraclass correlation (ICC) and inter-rater reliability by calculating the kappa statistic; results were checked using Bland-Altman plots. The DSQ-34 was further tested for standard error of measurement (SEM) and for the minimum detectable change (MDC). Good internal consistency was indicated by Cronbach’s Alpha of 0.83/0.82 for India and 0.76/0.78 for Nepal. We PLOS ONE | DOI:10.1371/journal.pone.0143610 December 2, 2015 1 / 14 OPEN ACCESS Citation: Trani J-F, Babulal GM, Bakhshi P (2015) Development and Validation of the 34-Item Disability Screening Questionnaire (DSQ-34) for Use in Low and Middle Income Countries Epidemiological and Development Surveys. PLoS ONE 10(12): e0143610. doi:10.1371/journal.pone.0143610 Editor: Philip C Hill, University of Otago, NEW ZEALAND Received: May 29, 2015 Accepted: November 6, 2015 Published: December 2, 2015 Copyright: © 2015 Trani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The authors received no specific funding for this work. Competing Interests: The authors have declared that no competing interests exist. confirmed our assumption for EFA using the Kaiser-Meyer-Olkin measure of sampling well above the accepted cutoff of 0.40 for India (0.82) and Nepal (0.82). The criteria for Bartlett’s test of sphericity were also met for both India (\u3c .001) and Nepal (\u3c .001). Estimates of reliability from the two countries reached acceptable levels of ICC of 0.75 (p\u3c0.001) for India of 0.77 for Nepal (p\u3c0.001) and good strength of agreement for weighted kappa (respectively0.77 and 0.79). The SEM/MDC was 0.80/2.22 for India and 0.96/2.66 for Nepal indicating a smaller amount of measurement error in the screen. Conclusions: In Nepal and India, the DSQ-34 shows strong psychometric properties that indicate that it effectively discriminates between persons with and without disabilities. This instrument can be used in association with other instruments for the purpose of comparing health outcomes of persons with and without disabilities in LMICs