The development and testing of a module on child functioning for identifying children with disabilities on surveys. I: Background

Predictive factors for the development of depression in children and adolescents: a clinical study

Background

The prevalence of depression among adolescents has been gradually increasing with the COVID-19 pandemic, and the purpose of this study was to develop and validate logistic regression models to predict the likelihood of depression among 6-17 year olds.

Methods

We screened participants from the National Center for Health Statistics (NCHS) in 2022. Independent risk factors were identified via univariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) for feature screening. Area under the curve (AUC) and decision curve analysis (DCA) were used to compare the predictive performance and clinical utility of these models. In addition, calibration curves were used to assess calibration.

Results

Multivariate logistic regression analyses revealed that risk factors for depression included girls, higher age, treated/judged based on race/ethnicity, ever lived with anyone mentally ill, experienced as a victim of/witnessed violence, and ever had autism, ever had attention-deficit disorder (ADD), etc. Afterwards, the results are visualized using a nomogram. The AUC of the training set is 0.731 and the AUC of the test set is 0.740. Also, the DCA and calibration curves demonstrate excellent performance.

Conclusion

Validated nomogram can accurately predict the risk of depression in children and adolescents, providing clues for clinical practitioners to develop targeted interventions and support.

Women with disabilities' use of maternal care services in sub-Saharan Africa

Background

Quality maternal health care is central to the Sustainable Development Goals efforts to reduce maternal mortality, yet there remain limited quantitative data on maternal care inequities for women with disabilities in sub-Saharan Africa.

Objectives

This study aims to understand the differences in maternal care providers for women with and without disabilities.

Method

We used Multiple Indicator Cluster Surveys from 13 sub-Saharan African countries conducted between 2017-2020. We used logistic and multinomial logistic regression to examine the relationship between disability (Washington Group definition) and antenatal care attendance and the type of care provider for antenatal care, skilled birth attendance, and postnatal and postpartum checks. All analyses were adjusted for age, wealth, country, and location.

Results

The sample included 10 021 women, including 306 (3.1%) women with disabilities. There were small absolute and no relative differences in antenatal care attendance, qualified antenatal care provider, postnatal, and postpartum checks, for disabled and women without disabilities. Women with disabilities had some evidence of higher odds of having a doctor at their birth compared to women without disabilities (aOR = 1.52, 95% CI: 0.99-2.33).

Conclusion

This study shows small absolute and no relative differences between women with and without disabilities for antenatal access and provider types for maternal care, though these findings are limited by a small sample and no data on care quality, acceptability, or outcomes. More research on care quality and outcomes is needed.

Contribution

This study is the first quantitative, multi-country study in sub-Saharan Africa to examine maternal care seeking patterns, demonstrating important data on maternal health indicators for women with disabilities.

Suicidal Ideation and Attempts Among Youth With Physical-Mental Comorbidity in Canada: Proposal for an Epidemiological Study

BACKGROUND

Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality.

OBJECTIVE

This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only).

METHODS

Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design.

RESULTS

Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life.

CONCLUSIONS

Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels-information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57103.

Occurrence of major infectious diseases and healthcare seeking among young children with disabilities in Sierra Leone using cross-sectional population-based survey data

BACKGROUND

Children with disabilities are at risk of worse health outcomes compared to children without functional difficulties. Sierra Leone has one of the world's highest prevalences of functional difficulties among children, but little is known about the co-occurrence of major infectious diseases and healthcare-seeking behaviours among children with disabilities.

METHODS

We used household survey cross-sectional data on children 2-4 years old and logistic regression models estimating ORs between functional difficulties and symptoms of infectious diseases including diarrhoea, fever and acute respiratory infection (ARI), adjusted for sex, age and stunting. We also examined whether caregivers sought advice or treatment for the illness from any source and if the child was given any treatment for the illness.

RESULTS

There was an increased risk of fever among children with functional difficulty (adjusted OR (AOR)=1.3, 95% CI 1.1 to 1.8) and children with severe functional difficulty (AOR=1.6, 95% CI 1.0 to 2.7). Children with severe functional difficulty were also at increased risk of diarrhoea (AOR=1.8, 95% CI=1.1 to 3.3). There were no significant differences in seeking advice or treatment for diarrhoea, fever or ARI symptoms between the groups.

CONCLUSIONS

In Sierra Leone, children with functional difficulties, especially severe functional difficulties, more often have symptoms of major childhood diseases that are known to increase under-5 mortality.

Are children with disabilities more likely to be malnourished than children without disabilities? Evidence from the Multiple Indicator Cluster Surveys in 30 countries

Introduction

A key Sustainable Development Goal target is to eliminate all forms of malnutrition. Existing evidence suggests children with disabilities are at greater risks of malnutrition, exclusion from nutrition programmes and mortality from severe acute malnutrition than children without disabilities. However, there is limited evidence on the nutritional outcomes of children with disabilities in large-scale global health surveys.

Methods

We analysed Multiple Indicator Cluster Survey data from 30 low and middle-income countries to compare nutritional outcomes for children aged 2-4 years with and without disabilities. We estimated the adjusted prevalence ratios for stunting, wasting and underweight comparing children with and without disabilities by country and sex, using quasi-Poisson models with robust SEs. We accounted for the complex survey design, wealth quintile, location and age in the analyses. We meta-analysed these results to create an overall estimate for each of these outcomes.

Results

Our analyses included 229 621 children aged 2-4 across 30 countries, including 15 071 children with disabilities (6.6%). Overall, children with disabilities were more likely to be stunted (adjusted risk ratio (aRR) 1.16, 95% CI 1.11 to 1.20), wasted (aRR 1.28, 95% CI 1.18 to 1.39) and underweight (aRR 1.33, 95% CI 1.17, 1.51) than children without disabilities. These patterns were observed in both girls and boys with disabilities, compared with those without.

Conclusion

Children with disabilities are significantly more likely to experience all forms of malnutrition, making it critical to accelerate efforts to improve disability inclusion within nutrition programmes. Ending all forms of malnutrition will not be achievable without a focus on disability.

Do children with disabilities have the same opportunities to play as children without disabilities? Evidence from the multiple indicator cluster surveys in 38 low and middle-income countries

Background

Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown.

Methods

Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported Multiple Indicator Cluster Survey (2017-2020). Disability was assessed by the Washington Group-Child Functioning Module. Logistic regression models were applied to investigate the relationship between disability and play opportunities, controlling for age, sex, and wealth status. Meta-analysis was used to pool the estimates (overall, and disaggregated by sex), with heterogeneity assessed by Cochran's Q test.

Findings

Children with disabilities have approximately 9% fewer play opportunities than those without disabilities (adjusted RR [aRR] = 0.88, 95% CI = 0.82-0.93), and this varied across countries. Mongolia and Democratic Republic of São Tomé and Príncipe had the lowest likelihood of play opportunities for children with disabilities ((aRR = 0.26, 95% CI = 0.09-0.75; aRR = 0.46, 95% CI = 0.23-0.93, respectively). Moreover, children with disabilities are 17% less likely to be provided with opportunities to play with their mothers (aRR = 0.83, 95% CI: 0.73-0.93), which is further reduced for girls with disabilities (aRR = 0.74, 95% CI: 0.60-0.90) compared to their peers without disabilities. The associations varied by impairment type, and children with communication and learning impairments are less likely to have opportunities for play with aRR of 0.69 (95% CI: 0.60-0.79) and 0.78 (95% CI: 0.71-0.86), compared to those without disabilities, respectively.

Interpretation

Children with disabilities are being left behind in their access to play and this is likely to have negative impacts on their overall development and well-being.

Funding

HK and TS are funded by HK's NIHR Global Research Professorship (NIHR301621). SR is funded by a Rhodes Scholarship. This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office.

Parental Report of Signs of Anxiety and Depression in Children and Adolescents with and Without Disability in Middle- and Low-Income Countries: Meta-analysis of 44 Nationally Representative Cross-Sectional Surveys

Population-based studies undertaken in high-income countries have indicated that children and adolescents with disabilities are more likely than their non-disabled peers to experience emotional difficulties such as anxiety and depression. Very little is known about the association between disability and emotional difficulties among children growing up in low and middle-income countries (LMICs). We aimed to estimate the strength of association between disability and two forms of emotional difficulties (anxiety, depression) in a range of LMICs and to determine whether the strength of this relationship was moderated by child age and gender. Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys undertaken in 44 LMICs (combined n = 349,421). Data were aggregated across countries by both mixed effects multi-level modelling and restricted maximum likelihood meta-analysis. Young people with disabilities, when compared with their non-disabled peers, were approximately two and a half times more likely to be reported by parents to show daily signs of either anxiety or depression. The level of risk among young people with disabilities was highest in upper middle-income countries and lowest in low-income countries. We estimated that approximately 20% of young people with frequent anxiety or depression also had a disability. All approaches to mental health interventions (from primary prevention to clinical interventions) need to make reasonable accommodations to their services to ensure that the young people with emotional difficulties who also have a disability are not 'left behind'.

What cut-off(s) to use with the Washington Group short set of questions?

The Washington Group short set (WG-SS) questions are increasingly integrated into national household surveys, censuses, and international survey programs. They enable the monitoring of disability rights and the production of internationally comparable statistics. Disability statistics on prevalence and inequalities can be estimated using different cut-offs on the degree of functional difficulties based on the WG-SS. This commentary discusses what cut-offs to adopt for the purpose of investigating and monitoring disability gaps. We recommend a three-way disaggregation comparing persons with (a) no difficulty, (b) some difficulty and (c) a lot of difficulty or unable to do. In cases where sample sizes are small for disaggregated analysis, we recommend comparing persons with no difficulty to persons with any level of difficulty (i.e. persons with any disability).

Prevalence of children under five with disabilities in Sierra Leone in 2017: Insights from a population-based multiple indicator cluster survey

BACKGROUND

Children with disabilities have been low on the agenda of child health, including in Sierra Leone, and there are still many gaps in our knowledge and understanding of the issue.

OBJECTIVE

To estimate the prevalence of children with disabilities in Sierra Leone using functional difficulty as a proxy and to understand the factors associated with disabilities among children two to four years living in Sierra Leone.

METHODS

We used cross-sectional data from the Sierra Leone 2017 Multiple Indicator Cluster Survey. Disability was defined using a functional difficulty definition with additional thresholds used to define children with severe functional difficulty and multiple disabilities. Logistic regression models estimated odds ratios (ORs) of childhood disability and how they were associated with socioeconomic factors and living conditions.

RESULTS

Prevalence of children with disabilities was 6.6% (95% confidence interval (CI) 5.8-7.6%) and there was a high risk of comorbidity between different functional difficulties. Children with disabilities were less likely to be girls (adjusted odds ratio (AOR) 0.8 (CI 0.7-1.0) and older (AOR 0.3 (CI 0.2-0.4)), but more prone to be stunted (AOR 1.4 (CI 1.1-1.7)) and have younger caregivers (AOR 1.3 (CI 0.7-2.3)).

CONCLUSION

The prevalence of disabilities in young Sierra Leonean children was comparable to other countries in West and Central Africa when using the same measure of disability. Preventive as well as early detection and intervention efforts are recommended to be integrated with other programs, e.g vaccinations, nutrition, and poverty reducing programs.

Association between disability status and health care utilisation for common childhood illnesses in 10 countries in sub-Saharan Africa: a cross-sectional study in the Multiple Indicator Cluster Survey

BACKGROUND

Approximately 70 million children in sub-Saharan Africa (SSA) are disabled, yet little is known about the prevalence of and care-seeking patterns for common childhood illnesses, such as acute respiratory infection (ARI), diarrhoea, and fever.

METHODS

Data were from 10 SSA countries with data available from 2017 to 2020 in the UNICEF-supported Multiple Indicator Cluster Survey (MICS) online repository. Children aged 2-4 years who completed the child functioning module were included. Using logistic regression, we examined the association between disability and ARI, diarrhoea and fever in the past two weeks and care-seeking behaviour for these illnesses. Using multinomial logistic regression, we examined the association between disability and the type of health care providers from which caregivers sought care.

FINDINGS

There were 51,901 children included. Overall, there were small absolute differences in illnesses between disabled and non-disabled children. However, there was evidence disabled children had a greater odds of ARI (aOR = 1.33, 95% C.I 1.16-1.52), diarrhoea (aOR = 1.27, 95% C.I. 1.12-1.44), and fever (aOR = 1.19 95% CI 1.06-1.35) compared to non-disabled children. There was no evidence that caregivers of disabled children had a greater odds of seeking care for ARI (aOR = 0.90, 95% C.I 0.69-1.19), diarrhoea (aOR = 1.06, 95% C.I. 0.84-1.34), and fever (aOR = 1.07, 95% C.I 0.88-1.30) compared to caregivers of non-disabled children. Caregivers of disabled children had a higher odds of seeking care from a trained health worker for ARI (aOR = 1.76, 95% C.I. 1.25-2.47) and fever (aOR = 1.49, 95% C.I. 1.03-2.14) or non-health professional (aOR = 1.89, 95% C.I. 1.19-2.98) for ARI than from an unspecified health facility worker compared to caregivers of non-disabled children, but no associations were not seen for diarrhoea.

INTERPRETATION

While the data showed relatively small absolute differences, disability was associated with ARI, diarrhoea and fever and caregivers of disabled children sought care from trained health workers for ARI and fever more than non-disabled children. The overall small absolute differences show closing gaps in illness and access to care may be possible, but highlights that more research on illness severity, care quality, and outcomes should be conducted to further assess health inequities for disabled children.

FUNDING

SR receives funding from the Rhodes Trust.

Anxiety and Depression Signs Among Adolescents in 26 Low- and Middle-Income Countries: Prevalence and Association With Functional Difficulties

PURPOSE

The aim of this study is to describe the occurrence of signs of depression and anxiety among adolescents from 26 low- and middle-income countries and explore the extent to which these are associated with difficulties across other functional domains.

METHODS

We analyzed randomly selected, nationally representative data from 26 countries with a total sample size of 123,975 adolescents aged 10-17 years. Data on functional difficulties, including signs of depression and anxiety, were collected by the Child Functioning Module, an instrument validated to identify the population of children with disabilities through household surveys. We estimated percentages and 95% confidence intervals of adolescents with difficulties across 11 domains of functioning, and of signs of depression and/or anxiety. We used multinomial regressions to estimate the association between difficulties in the different domains and having signs of depression only, signs of anxiety only, and signs of both depression and anxiety, relative to not presenting signs of depression or anxiety.

RESULTS

In total, 5.5% of adolescents were reported to have had signs of anxiety, 3.1% signs of depression, and 2.3% co-occurring signs of anxiety and depression. Compared to adolescents without functional difficulties, those with difficulties in one or more domains were three times more likely to have signs of depression and anxiety. The likelihood of presenting signs of depression only or signs of both depression and anxiety was significantly higher across all domains, and the highest among adolescent with difficulties to self-care and communicating. The likelihood of presenting signs of anxiety only was significantly higher across all domains except seeing and hearing, and the highest among adolescent with difficulties communicating and accepting changes.

DISCUSSION

Adolescents with functional difficulties in all domains analyzed, across different contexts, are more likely to experience depression and anxiety signs than those without such difficulties. Increasing the availability of population-level data on adolescent functional difficulties, including those related to depression and anxiety, is important in promoting inclusivity, participation, and the right of children to equal opportunities.

The association between household wealth and the prevalence of child disability and specific functional limitations: Analysis of nationally representative cross-sectional surveys in 40 low- and middle-income countries

BACKGROUND

It is commonly stated that people with disabilities are at significantly greater risk of living in poverty than their non-disabled peers. However, most evidence supporting this assertion is drawn from studies in high-income countries and studies of adults. There is relatively little robust evidence on the association between poverty/wealth and the prevalence of child disability in low- and middle-income countries (LMICs).

OBJECTIVE/HYPOTHESIS

To estimate the strength of association between an indicator of wealth (household assets) and the prevalence of disability among children in a range of LMICs.

METHODS

Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys. Nationally representative data were available for 40 countries with a total sample size of 473,578 children aged 2-17. Disability was ascertained by responses to the Washington Group for Disability Statistics module on functional limitations.

RESULTS

There were significant dose-dependent relationships between household wealth quintile and the prevalence of disability and 13 of the 15 specific functional difficulties associated with disability. Children living in the poorest 20% of households were 35% more likely to have a disability than children living in the most affluent 20% of households. The strength of the association between household wealth and the prevalence of child disability was markedly lower in low-income countries than in middle-income countries. r CONCLUSIONS: Our results provide robust evidence that in LMICs the prevalence of child disability is disproportionately concentrated in poorer households. Further research is required to better understand why this association appears to be weaker in low-income countries. c.

Global and regional prevalence of disabilities among children and adolescents: Analysis of findings from global health databases

Objective

The United Nations' Sustainable Development Goals (SDGs) require population-based data on children with disabilities to inform global policies and intervention programs. We set out to compare the prevalence estimates of disabilities among children and adolescents younger than 20 years as reported by the world's leading organizations for global health statistics.

Methods

We purposively searched the disability reports and databases of the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), the World Bank and the Global Burden of Diseases (GBD) Study. We analyzed the latest disability data reported by these organizations since 2015. We examined the methodologies adopted in generating the reported prevalence estimates and evaluated the degree of agreement among the data sources using Welch's test of statistical difference, and the two one-sided t-test (TOST) for statistical equivalence.

Results

Only UNICEF and GBD provided the most comprehensive prevalence estimates of disabilities in children and adolescents. Globally, UNICEF estimated that 28.9 million (4.3%) children aged 0-4 years, 207.4 million (12.5%) children aged 5-17 years and 236.4 million (10.1%) children aged 0-17 years have moderate-to-severe disabilities based on household surveys of child functional status. Using the UNICEF estimated prevalence of 10.1%, approximately 266 million children aged 0-19 years are expected to have moderate-to-severe disabilities. In contrast, GBD 2019 estimated that 49.8 million (7.5%) children aged under 5 years, 241.5 million (12.6%) children aged 5-19 years and 291.3 million (11.3%) children younger than 20 years have mild-to-severe disabilities. In both databases, Sub-Saharan Africa and South Asia accounted for more than half of children with disabilities. A comparison of the UNICEF and GBD estimates showed that the overall mean prevalence estimates for children under 5 years were statistically different and not statistically equivalent based on ±3 percentage-point margin. However, the prevalence estimates for children 5-19 years and < 20 years were not statistically different and were statistically equivalent.

Conclusion

Prevalence estimates of disabilities among children and adolescents generated using either functional approach or statistical modeling appear to be comparable and complementary. Improved alignment of the age-groups, thresholds of disability and the estimation process across databases, particularly among children under 5 years should be considered. Children and adolescents with disabilities will be well-served by a variety of complementary data sources to optimize their health and well-being as envisioned in the SDGs.

Anxiety and depression symptoms among children before and during the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic caused disruptions to children's daily lives due in part to stay-at-home orders and school closures, reducing interactions with both peers and extended family. Yet, few studies with nationally representative data have explored the potential association of the COVID-19 pandemic and children's mental health.

METHODS

The current study analyzed data from the 2019 and 2020 National Health Interview Survey (NHIS) to describe changes in the prevalence of symptoms of anxiety and depression before and during the first year of the pandemic among children aged 5-17 years. Changes in prevalence by child- and family-level characteristics were also examined.

RESULTS

During the COVID-19 pandemic, nearly one in six children aged 5-17 years had daily or weekly symptoms of anxiety or depression, a significant increase from before the COVID-pandemic (16.7% (95% CI:15.0-18.6) versus 14.4% (95% CI:13.4-15.3)). Males, children 5-11 years, non-Hispanic children, children living in families in large metropolitan areas, incomes at or below the federal poverty level, and whose highest educated parent had more than a HS education, also showed statistically significant increases in anxiety and depression symptoms.

CONCLUSIONS

NHIS data may be used to monitor this increase in mental health symptomatology and assist in identifying children at risk.

Cerebral palsy and developmental intellectual disability in children younger than 5 years: Findings from the GBD-WHO Rehabilitation Database 2019

Objective

Children with developmental disabilities are associated with a high risk of poor school enrollment and educational attainment without timely and appropriate support. Epidemiological data on cerebral palsy and associated comorbidities required for policy intervention in global health are lacking. This paper set out to report the best available evidence on the global and regional prevalence of cerebral palsy (CP) and developmental intellectual disability and the associated "years lived with disability" (YLDs) among children under 5 years of age in 2019.

Methods

We analyzed the collaborative 2019 Rehabilitation Database of the Global Burden of Disease (GBD) Study and World Health Organization for neurological and mental disorders available for 204 countries and territories. Point prevalence and YLDs with 95% uncertainty intervals (UI) are presented.

Results

Globally, 8.1 million (7.1-9.2) or 1.2% of children under 5 years are estimated to have CP with 16.1 million (11.5-21.0) or 2.4% having intellectual disability. Over 98% resided in low-income and middle-income countries (LMICs). CP and intellectual disability accounted for 6.5% and 4.5% of the aggregate YLDs from all causes of adverse health outcomes respectively. African Region recorded the highest prevalence of CP (1.6%) while South-East Asia Region had the highest prevalence of intellectual disability. The top 10 countries accounted for 57.2% of the global prevalence of CP and 62.0% of the global prevalence of intellectual disability.

Conclusion

Based on this Database, CP and intellectual disability are highly prevalent and associated with substantial YLDs among children under 5 years worldwide. Universal early detection and support services are warranted, particularly in LMICs to optimize school readiness for these children toward inclusive education as envisioned by the United Nations' Sustainable Development Goals.

Energy Costs Impact on Disabled Children’s Rehabilitation Opportunities in Kazakhstan

This article examines the costs for families raising disabled children, who, in world social policy, belong to socially vulnerable groups of the population. The purpose of this article is to assess the impact of energy consumption on the ability of a family to provide rehabilitation for a disabled child in the present and the possibility of his independent life in the future. A sociological survey was administered to respondents in five regions of Kazakhstan, with subsequent processing of the results obtained by statistical methods. The survey was based on a methodological approach in accordance with the identification of four types of restrictions: direct childcare costs; indirect family costs, i.e., losses (household energy consumption aspect); assessment of the opportunity to work; and assessment of the parents’ ability to stay healthy. The PLS–PM model-based structural modeling was carried out. In the model, four types of constraints as dependent variables were accepted. In the course of the model application, three hypotheses regarding energy costs were confirmed. The significance of energy costs in the system of restrictions for families with disabled children was determined. In conclusion, the qualitative characteristics of the relationships allowed identification of the problems in the current support system for families with disabled children in Kazakhstan, which is focused on the partial compensation of direct costs. Energy consumption was determined to be sufficiently important. This results in the misuse of benefits for the rehabilitation of a child because parents, especially from incomplete and low-income families, are forced to choose between paying utility bills and rehabilitating a child. Energy costs also limit the family’s ability to meet the direct costs of the child and long-term savings related to the child’s future. We propose the subsidization of energy utilities for families with disabled children, partially replacing targeted social assistance with vouchers for the purchase of household electrical appliances and rehabilitation equipment with energy-saving characteristics. In further studies, issues regarding the use of tax deductions and tax credits as an alternative support measure, which is currently not used in Kazakhstan, will be investigated.

Mental Health Surveillance Among Children - United States, 2013-2019

Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

2022 Para Report Card on Physical Activity of Israeli Children and Adolescents With Disabilities

Children and adolescents with disabilities (CAWD) represent 11% of Israeli children and adolescents. The 10 core indicators of the Global Matrix on Para Report Cards of physical activity (PA) of CAWD were used to create the 2022 Israeli Para Report Card. A panel of four experts reviewed resources and synthesized evidence of PA behaviors and policies for CAWD in Israel, converted the data to grades, and charted subcategories of language, sex, and disability across population. Data sources were surveys, reports, and memberships in sport federations and clubs. Among CAWD, levels of participation in daily PA were poor (<20%; Grade F), and participation of CAWD in sports was even lower (<10%; Grade F). A lack of environmental infrastructure may explain the low levels of participation. Females, Arabic speakers, and physiological CAWD need particular attention. Establishing governmental policies and interventions is required to increase overall PA and participation in sports among CAWD.

Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children

INTRODUCTION

Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages.

METHODS

A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty.

FINDINGS

Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty.

INTERPRETATION

Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood.

Children and adolescents with neurodevelopmental disorders show cognitive heterogeneity and require a person-centered approach

We aimed to identify patterns of cognitive differences and characterize subgroups of Mexican children and adolescents with three neurodevelopmental disorders (NDD): intellectual disability (ID), autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD). The sample included 74 children and adolescents 6–15 years; 34% had ID, ASD or ADHD, 47% had ID in comorbidity with ASD, ADHD or both, 11% had ASD + ADHD, 8% were children without NDD. We applied WISC-IV, Autism Diagnostic Interview-Revised, Mini-International Neuropsychiatric Structured Interview, Child Behavior Checklist, and UNICEF Child Functioning Module. We evaluated the normality of the WISC-IV sub-scales using the Shapiro-Francia test, then conducted a latent class analysis and assessed inter-class differences in terms of household, parent and child characteristics. The following four-class solution best fit the data: “Lower Cognitive Profile” (LCP), “Lower Working Memory” (LWM), “Higher Working Memory” (HWM), “Higher Cognitive Profile” (HCP). LCP included most of the children with ID, who had a low Working Memory (WM) index score. LWM included mainly children with ASD or ID + ADHD; their Perceptual Reasoning (PR) and Processing Speed (PS) index scores were much higher than those for Verbal Comprehension (VC) and WM. HWM included children with ASD or ADHD; their scores for PR, PS and VC were high with lower WM (although higher than for LWM). HCP included children without NDD and with ASD or ADHD or both and had the highest scores on all indices. Children with NDD show cognitive heterogeneity and thus require individualized treatment plans.

Measuring child functioning: Assessing correlation and agreement between caregiver and child responses at the Iganga-Mayuge health and demographic surveillance site in Uganda

INTRODUCTION

Empirical data is scare on assessment of concordance between caregiver-child responses on child functioning.

OBJECTIVE

To assess correlation and agreement between children (11-17 years old) and their caregivers' responses to the UNICEF/Washington Group Child Functioning Module (CFM) at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda.

METHODS

CFM with 24-questions corresponding to 13 domains of functioning was administered to children between 11 and 17 years of age and their caregivers. Descriptive analyses of the child/caregiver responses were conducted. Correlation and agreement between caregiver and child responses were assessed.

RESULTS

Of the 217 caregiver/child pairs eligible for this study, 181 pairs agreed to participate (83.4%). The mean age of children was 13.9 ± 1.9 years, and 56.4% were males. Cronbach's alpha was 0.892 and 0.886 for the caregiver and child versions of CFM respectively, showing good internal consistency in both. There was a significant overall agreement between mean score of caregiver (5.36 ± 5.63 out of 39) and child (5.45 ± 5.34) pairs. Spearman's rank correlation between the pairs was 0.806 (strong positive correlation). Bland-Altman plots for CFM scores showed greater agreement between caregiver and child at lower scores. Percentage agreement between the pairs for overall disability was greater for mild (83.53%) and moderate (79.37%) categories as compared to the severe (66.67%) category. There was substantial agreement (kappa 0.623) for overall disability between the pairs.

CONCLUSION

This study indicates that there is significant correlation and agreement between self-reported caregiver-child pair responses, opening the way for considering children as CFM respondents, when possible.

The exposure of children with and without disabilities to violent parental discipline: Cross-sectional surveys in 17 middle- and low-income countries

BACKGROUND

Children with disabilities in high-income countries are more likely than their peers to be exposed to violence. To date, only two studies have reported nationally robust data on the association between child disabilities and exposure to violent parental discipline.

OBJECTIVE

To estimate prevalence rates and adjusted rate ratios of exposure to violent parental discipline among children with and without disabilities in middle- and low-income countries.

PARTICIPANTS AND SETTING

Nationally representative samples involving a total of 206,147 children aged 2-14 from 17 countries.

METHODS

Secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys.

RESULTS

Children with disabilities were at significantly greater risk of exposure than children without disabilities to all eight forms of violent parental discipline and the total number of forms they were exposed to. For what could be considered the most abusive form of violent discipline (beating a child up 'as hard as one could') they were 71 % more likely to have been exposed in the previous month than other children (age and gender adjusted prevalence rate ratio = 1.71 (95 %CI 1.64-1.78), p < 0.001). Children with functioning difficulties related to poorer mental health or cognitive functioning were at significantly greater risk of exposure to violent parental discipline. In contrast, children with impairments related to sensory functioning, mobility and expressive communication were at no greater risk of exposure than children without disabilities.

CONCLUSIONS

Children with disabilities are at greater risk of exposure to all forms of violent parental discipline than children without disabilities in middle- and low-income countries.

Intra-Rater Test-Retest Reliability of a Modified Child Functioning Module, Self-Report Version

Determining disability prevalence is a growing area for population statistics, especially among young adolescents. The Washington Group on Disability Statistics is one source of reporting disabilities through functional difficulties. Yet, young adolescents self-reporting through this measure is in its infancy. The purpose of this study was to carry out an intra-rater test-retest reliability study on a modified set of items for self-reporting functional difficulties. Young adolescents (N = 74; boys = 64%; age M = 13.7, SD = 1.8) with special educational needs in Finland completed a self-reported version of the Child Functioning Module in a supervised classroom. The second administration took place two weeks later. Intraclass correlation coefficient (ICC) and Kappa (k) statistics were used to test the reliability of the items, and interpretation took place through Landis and Koch, and Cohen, respectively. The majority of items had substantial or moderate agreement, although there was only fair agreement for self-care (ICC = 0.59), concentration (ICC = 0.50), and routine changes (ICC = 0.54). Kappa statistics of behavior control were interpreted to be large (k = 0.65), and seeing (k = 0.49), walking (k = 0.49), and speaking (k = 0.49) difficulties were moderate. The majority of the items in the self-reported version of the Child Functioning Module can be used in a scale format, although some caution may be required on items of self-care and concentration when used as a dichotomous variable.

Adaptation and validation of UNICEF/Washington group child functioning module at the Iganga-Mayuge health and demographic surveillance site in Uganda

BACKGROUND

The UNICEF/Washington Group Child Functioning Module (CFM) assesses child functioning among children between 5 and 17 years of age. This study adapted and validated the CFM at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda.

METHODS

This cross-sectional study was conducted between September 2018-January 2019 at the IM-HDSS. Respondents were caregivers of children between 5 and 17 years of age who were administered modified Washington Group short set (mWG-SS) and CFM. The responses were recorded on a 4-point Likert scale. Descriptive analysis was conducted on child and caregiver demographic characteristics. Exploratory factor analysis (EFA) assessed underlying factor structure, dimensionality and factor loadings. Cronbach's alpha was reported as an assessment of internal consistency. Face validity was assessed during the translation process, and concurrent validity of CFM was assessed through comparison with disability short form.

RESULTS

Out of 1842 caregivers approached, 1439 (78.1%) participated in the study. Mean age of children was 11.06 ± 3.59 years, 51.4% were males, and 86.1% had a primary caregiver. Based on EFA, vision, hearing, walking, self-care, communication, learning, remembering, concentrating, accepting change, behavior control, and making friends loaded on factor 1 - "Motor and Cognition," while anxiety and depression loaded on factor 2 - "Mood". Cronbach's alpha for the overall CFM was 0.899 (good internal consistency). Cronbach's alpha for each extracted factor was excellent, motor and cognition (0.904), and mood (0.902). CFM had acceptable face validity. Spearman's rank correlation between scores of CFM and modified WG short set was 0.51 (p-value < 0.001). The overall mean CFM score was 2.47 ± 3.82 out of 39. The mean score for Mood (1.35 ± 1.42 out of 6) was higher compared to Motor and Cognition (1.12 ± 3.06 out of 33). Comparing modified WG short set and CFM Likert responses, the percent agreement was greatest for "cannot do at all."

CONCLUSION

CFM is a two-factor, valid and reliable scale for assessing disability in Uganda and can be applied to other similar settings to contribute towards disability data from the region. It is an easy-to-administer tool that can help in deeper understanding of context-specific burden and extent of disability in children between 5 and 17 years of age.

Identifying children at risk of intellectual disability in UNICEF's multiple indicator cluster surveys: Cross-sectional survey

BACKGROUND

Research on intellectual disability has been criticized for primarily addressing the situation of people in high-income countries.

OBJECTIVE

/Hypothesis. To determine whether MICS6 data on 'functional difficulty associated with learning' (FDAL) in low- and middle-income countries could be used as a proxy indicator for intellectual disability.

METHODS

Secondary analysis of nationally representative data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys (MICS) on 244,915 children in 18 middle- and low-income countries.

RESULTS

The prevalence of FDAL in middle- and low-income countries was broadly similar to the estimated prevalence of intellectual disability in high-income countries. The association between risk of FDAL and household wealth was weak, with alternative measures of developmental delay showing significantly stronger associations with household wealth. The risk of making potential false negative errors in identifying FDAL increases as household wealth and level of maternal education decrease. The risk of making potential false positive errors in identifying FDAL is greater among more highly educated respondents, although this association is only statistically significant among older children.

CONCLUSIONS

The use of FDAL as a proxy indicator for intellectual disability cannot be recommended given: (1) it would probably underestimate the overall prevalence of intellectual disability in middle and low income countries; and (2) it is likely to be overestimate prevalence among families with higher socio-economic position (SEP) and underestimate prevalence among families with lower SEP.

Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments

BACKGROUND

Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children <15 years with disabilities from the Global Burden of Disease Study 2004.

METHODS

We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed.

RESULTS

Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9-335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged <1 year to 13.9% among adolescents aged 15 to 19 years. A total of 275.2 million (94.5%) lived in low- and middle-income countries, predominantly in South Asia and sub-Saharan Africa. The top 10 countries accounted for 62.3% of all children and adolescents with disabilities. These disabilities accounted for 28.9 million YLD or 19.9% of the overall 145.3 million (95% UI: 106.9-189.7) YLD from all causes among children and adolescents.

CONCLUSIONS

The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.

Physical Activity of Adolescents with and without Disabilities from a Complete Enumeration Study (n = 128,803): School Health Promotion Study 2017

Evidence suggests that adolescent males take part in more moderate-to-vigorous physical activity (MVPA) than females, and that adolescents with disabilities participate in even less. Public health data are typically based on the international physical activity (PA) recommendations of at least 60 minutes of MVPA daily. However, it appears that data are lost because a person who reports MVPA 0–6 days a week is grouped together and is considered as ‘inactive’. Therefore, the purposes of this study were to report differences among adolescents with and without disabilities who were ‘active’ and ‘inactive’ and to explore differences by sex. A complete enumeration study (2017 School Health Promotion Survey; n = 128,803) of Finnish adolescents aged between 14–19 years old was conducted. The single item self-report MVPA was used with items from the Washington Group on Disability Statistics. Data were grouped into physiological and cognitive disabilities and were split into active and inactive adolescents based on the PA recommendations; subsequently, binary logistic regression analyses were performed. Data from the inactive participants were analyzed with multivariate analysis of covariance and effect sizes were reported. Approximately 10% of males and 17% of females reported disabilities. There were fewer adolescents with disabilities who took part in daily PA (OR = 0.90, CI = 0.85–0.94), especially among those with cognitive disabilities (OR = 0.86, CI = 0.82–0.91). There were more active male than female adolescents (OR = 1.48, CI = 1.43–1.52). Of the inactive adolescents, females reported similar MVPA to males, with and without disabilities after controlling for age, school type, and family financial situation. Inactive adolescents with walking difficulties reported the least amount of MVPA (males; mean = 2.24, CI = 2.03–2.44, females; mean = 2.18, CI = 1.99–2.37). The difference in means with adolescents without disabilities according to Cohen’s d effect size was medium for males (0.56) and females (0.58). The effect sizes from all other groups of disabilities were small. The difference in PA between males and females has diminished among the inactive groups, yet there is still a need to improve the gap between males and females, especially for those who meet the PA recommendations. More strategies are needed to improve MVPA among adolescents with disabilities, especially those with cognitive disabilities.

How to conduct good quality research on violence against children with disabilities: key ethical, measurement, and research principles

BACKGROUND

Approximately one billion children experience violence every year. Violence against children is an urgent global public health concern and violation of children's rights. It is also a risk factor for serious negative health and social outcomes and is therefore addressed within the Sustainable Development Goals (SDGs). Children with disabilities, who make up one in 20 children worldwide, are particularly vulnerable to violence although good quality data are lacking on causes and means of prevention of violence against children with disabilities. Key challenges exist in the measurement of disability and violence, which in part explains the dearth in evidence. IMPROVING RESEARCH ON VIOLENCE AGAINST CHILDREN WITH DISABILITIES: This paper provides guidance on how to conduct good quality, ethical, and inclusive research on violence against children with disabilities, particularly in low-income settings. The lack of an international agreed 'gold standard' frustrates efforts to measure violence across settings and time. Careful consideration must be given to the design of survey tools. Qualitative and participatory research methods also offer important opportunities to explore children's subjective understanding and experiences of violence. Challenges also exist around the measurement of disability. Disability may be measured by asking directly about disability, through self-reported functioning, or through the presence of impairments or health conditions. These approaches have strengths and limitations and should build on what children are able to do and include appropriate adaptations for specific impairments where necessary. Ethical research also requires adherence to ethical guidelines and approvals, obtaining informed consent, appropriate child protection responses, and careful consideration of interviewer-related issues including their selection, training, and welfare. Key methodological gaps remain - how to include children with severe communication challenges in research; how to respond in instances of weak child protection systems; designing sampling procedures that adequately represent children with disabilities in large-scale violence surveys; and determining how best to ask about violence safely in large-scale surveys and monitoring data. This paper further advocates for the dissemination of research results in inclusive and accessible formats.

CONCLUSION

With careful planning, challenges in collecting data on disability and violence can be overcome to generate evidence in this neglected area.

The UNICEF/Washington Group Child Functioning Module-Accuracy, Inter-Rater Reliability and Cut-Off Level for Disability Disaggregation of Fiji's Education Management Information System

This paper explores the validity (sensitivity and specificity) of different cut-off levels of the UNICEF/Washington Group Child Functioning Module (CFM) and the inter-rater reliability between teachers and parents as proxy respondents, for disaggregating Fiji's education management information system (EMIS) by disability. The method used was a cross-sectional diagnostic accuracy study comparing CFM items to standard clinical assessments for 472 primary school aged students in Fiji. Whilst previous domain-specific results showed "good" to "excellent" accuracy of the CFM domains seeing, hearing, walking and speaking, newer analysis shows only "fair" to "poor" accuracy of the cognitive domains (learning, remembering and focusing attention) and "fair" of the overall CFM (area under the Receiver Operating Characteristic curve: 0.763 parent responses, 0.786 teacher responses). Severe impairments are reported relatively evenly across CFM response categories "some difficulty", "a lot of difficulty" and "cannot do at all". Most moderate impairments are reported as "some difficulty". The CFM provides a core component of data required for disaggregating Fiji's EMIS by disability. However, choice of cut-off level and mixture of impairment severity reported across response categories are challenges. The CFM alone is not accurate enough to determine funding eligibility. For identifying children with disabilities, the CFM should be part of a broader data collection including learning and support needs data and undertaking eligibility verification visits.