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Getting started Objectives Definition Screening for disability Building Tools Training Sample frame Challenges Prevalence: How many?
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3. Definition (i)
No international agreement on definition Definition influences prevalence
Ex.: In Afghanistan: 3 (UNDP/NRVA) - 8% (NGO survey Kabul); Sierra Leone: 2.4% (census) to 23% (UNICEF/SL Stats)
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3. Definition (iii)
Screening questions based on body functions and structures component of the ICF and on the Capability Approach (A. Sen) Improvement of health services + better social awareness Inclusion of less severe difficulties in functioning Higher prevalence
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3. Definition (iv)
Strict but comprehensive definition of disability inspired by the ICF and the CA: Interaction between an individual impairment in functioning and the community and social resources, beliefs and practices that enable or prevent a person from participating in all spheres of social life and taking decisions that are relevant to his/her own future
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Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s):
Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s): Indicator(s): Question(s):
5. Tools
5 other modules in Afghan study (4 in Darfur study): Household characteristics (15 Q.: demographic and socioeconomic background of members; 32Q in Darfur study) Health situation (25 Q./3Q access to health, quality of services, expenditure..) Education situation (14 Q./66Q: access to education, barriers, quality education) Employment situation (35 Q./19Q.: activities, unemployment) Income (18 Q./5Q.: earnings, donations, loans) Livelihoods (35 Q./10Q.: water and sanitation, lighting, cooking, dwelling, assets, land) Self perception, social status and social inclusion (57 Q./23Q.: self perception, rights, violence, care) Final questions (6Q.: food intake, love, disability cause) Questionnaires designed to collect this information: One for adult (>15) one for child (<15) in Afghanistan, only for children in Darfur Different modules for men and women for social status and inclusion in Afghanistan
Sampling stage 2: Random sample of clusters 31 provinces covered by the census: 164 clusters randomly selected using probability proportional to size method. 3 remaining provinces: 6 clusters in Helmand, 3 in Paktika and 2 in Zabul At least 1 village/town block randomly selected from each district
Sampling stage 3: Random sample of households -In each cluster 30 households randomly selected (5130 households and 38320 individuals recorded): -All disabled respondents selected and interviewed (958) -1 non-disabled respondent selected in the same household matching the disabled respondent in age and gender (958) -1 non disabled respondent randomly selected in every 5th non disabled household (780)
2.253.081 persons in 5 districts selected (= sampling sites) West: - Western Area Urban (Freetown): 1,173,022 (3) - Western Area Rural: 174,249 (2) North: - Koinadugu district: 265,765 (2) South: - Bo district: 515,945 (4)
2.250.891 persons not included Reasons for exclusion: - not living in surveyed sampling site - household did not want to participate (1 household)
We Proceded as follows
Village of Wala
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Village of Wala
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Village of Wala
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30 Village of Wala
25
15
10
1 5
20
Follow this through The village numbering the houses until The end of the village Or till you reach 30 HHs
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30 Village of Wala
25
15
20
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30 X X X
From this house Proceed to the House with the Nearest front door 1 5
30 Village of Wala
25
15
10
25
X X X
30 Village of Wala
25
15
10
1 5
20
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25
X X X
30 Village of Wala
25
15
10
1 5
20
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25
X X
X X
30
X X X
30 Village of Wala
25
15
10
1 5
Continue to the next Closest HH until All 30 HHs have been done
20
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Village of Wala
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x x x
x x x x x
Continue to the Next nearest Village and nearest Door to get all 30 HHs
Village of Wala
x x 30
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2.7 % 0.2 % (CI) 675,000 people (based on an estimated 25 M. Afghans) Lower than expected but in line with previous estimates
1999 2003 UNDP/UNOPS MICS 3% 2.5 % 3% 2% 1% (1-4 years old) (7-17 years old) (physical disability) (mental disability)
2003
NRVA
On average 1 household out of 5 has 1 PwD High level of mental distress (2.1%) Slide 35
9. Prevalence (ii)
Looking at the continuum: where do we place the threshold?
Prevalence threshold with regards to the Screening questionnaire: 27 questions in Afghanistan.
2.7%
4.6%
Threshold 1 At least 1 YES to section A, and/or At least 2 YES in anyone of sections B-E
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Threshold 2 At least 1 YES to section A, and/or At least 1 YES in anyone of sections B-E
9. Prevalence (iii)
2.2%
10.8%
36.7%
58.9%
Threshold 1
9.70% 25.50%
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9. Geographic Distribution
Proportion of Households with PwD by Major Areas
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9. Geographic Distribution
Proportion of PwDs by Major Areas
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Female 48.9 %
Female 41.0 %
Male 51.1 %
Male 59.0 %
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20
percentage
15
10
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Half the population < 16 Low proportion of PwDs between 0-4 Highest proportion of PwDs between 5-14 Over-representation of PwDs after 40
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
Slide50-54 43 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
95+
10.8%
Herat mosque