Skip to main content

Table 3 Primary studies of household SEC of children with disabilities

From: Childhood disability and socio-economic circumstances in low and middle income countries: systematic review

Author/year/country Study design Population & sample Disability measure Measure of household SEC Summary of results
[Odds ratios (OR) with 95% CIs where available]
Anselmi et al, 2008
Brazil 16
Prospective cohort study 601 children of 634 randomly selected from the Pelotas birth cohort & followed up between the ages of 4 & 12 years. Emotional and behavioural problems measured using the Child Behavior Checklist (CBCL) administered at 4 & 12 years of age Family income Externalising (OR .72(.52,.96)) and internalising (OR .68(.47,.98)) behaviours and attention problems (OR .57(.39,.84)) at age 12 years were significantly associated with low family income at 4 years
Bashir et al, 2002 Pakistan 17 Prospective cohort study 772 children aged 4-6 years of age out of 1476 births enrolled in a birth cohort in 4 areas of Lahore with contrasting socio-economic characteristics Mild Mental Retardation (MMR) measured as IQ in the range 50-69 measured using WISC & Griffiths tests among those initially identified using the Ten Question screening test Four socio-economically distinct areas - village, periurban slum, urban slum & upper middle class area. [no individual or household level SES data reported] MMR prevalence:
Upper middle class 1.4%
Village 4.8%
Urban slum 6.1%
Periurban slum 10.5%
Bastos et al, 1995
Tanzania 18
Cross-sectional survey 854 children aged 6 to 16 years in schools in the Moshi and Munduli districts of northern Tanzania Hearing loss measured by pneumotoscopy and screening audiometry Urban v. Rural areas Hearing loss in speech frequency range more common in urban (37%) compared with rural (18%) and high frequency loss also more common in urban compared with rural
Durkin et al, 1998
Pakistan 19
Cross-sectional population survey 6,365 2-9 year old children in Greater Karachi screened in phase 1 of the survey using TQQ; 818 screening positive and 545 of those screening negative assessed in phase 2 Identification of mental retardation by: Phase 1: TQQ screen Phase 2: clinical assessment using Stanford-Binet IQ test & adaptive behaviour scale developed for Pakistani children Maternal education level (Some v. None)
Urban v. Rural
Mild Retardation (IQ 50-70): No education OR 3.08(1.85,6.14) Rural OR 2.33(1.33,2.75)
Serious Retardation (IQ < 50): No education OR 3.25(1.86,8.43) Rural OR 2.21(0.87,5.57)
Filmer 2005
9 low & middle income countries (Jamaica, Romania, Cambodia, Indonesia, Mozambique, Burundi, Myanmar, Mongolia and Sierra Leone) 20
11 Nationally representative cross-sectional household surveys in 9 countries - 3 Living Standards Measurement Studies; 3 national socio-economic status surveys; 4 MICS 2 surveys; 1 DHS survey Children & young people aged 6-17 years - population samples ranged from 1,649 in Jamaica (2000) to 64,136 in Indonesia (2000) Impairment definitions of disability consistent with ICF's 'body functioning & structure' domain - range of different questions used Quintiles of Household per capita consumption expenditure in LSMS & SES surveys
Quintiles of index of household consumer assets & housing characteristics in DHS & MICS2
Prevalence higher in poorest quintile compared with richest in all countries except Burundi, Cambodia, Mongolia and Mozambique - only Indonesia shows a clear social gradient across quintiles
Filmer 2008
13 low & middle income countries
(Jamaica, Romania, Cambodia, Indonesia, Mozambique, Burundi, Mongolia, South Africa, Chad, India, Colombia, Bolivia and Zambia) 4
[NB: some overlap with Filmer 2005] 20
14 Nationally representative cross-sectional household surveys in 13 countries - 2 Living Standards Measurement Studies; 5 national socio-economic status surveys; 2 MICS 2 surveys; 5 DHS surveys Children & young people aged 6-17 years - population samples ranged from 5,865 in Burundi (2000) to 140,297 in India (1992) Impairment definitions of disability consistent with ICF's 'body functioning & structure' domain - range of different questions used Quintiles of Household per capita consumption expenditure in LSMS & SES surveys
Quintiles of index of household consumer assets & housing characteristics in DHS & MICS2
Only Indonesia & India show clear differences in disability prevalence between poorest & richest quintiles - otherwise non-significant differences
Grut & Ingstad, 2006
Yemen 21
Qualitative study 28 interviews involving 38 individuals in households with disabled people, & one group interview in an institution for disabled girls [15 children; 20 adults; 2 Disabled People's Organisations] Range of disabilities including physical, intellectual, hearing & visual
[interviews of those with intellectual impairments conducted with parents in presence of the disabled person]
Specific measures not used but study does examine the impact of disability on the lives of households with disabled members particularly children and explores the association of poverty & disability Complex relationship between disability and poverty demonstrated with insights into how disability and poverty interact to limit life chances
Hackett et al, 1999
India 22
Random cluster sampling for cross-sectional survey 1326 children aged 8-12 years in 2 local government districts outside the city of Calicut, Kerala State, India Child psychiatric disorder identified in 2 phases:
Phase 1: Screening interviews using various instruments including Rutter's A2 scale plus Rutter teacher completed B2 scale
Phase 2: detailed psychiatric assessment of screen positive & 93 screen negative
Poverty index based on eight household characteristics
Father's occupation in 5 categories from professional to unskilled
Parental education level - age ceased formal education
Externalising behaviours: associated with low occupation group, low parental education & poverty
Internalising behaviours: associated with low parental education
Ingstad & Grut, 2007
Kenya 23
Qualitative study 42 interviews (27 individual; 4 group; 11 secondary information) including 16 children in 7 strategically chosen districts of Kenya Range of disabilities including physical (33), intellectual/mental (9), hearing (8) & visual (5) Specific measures not used but study does examine the impact of disability on the lives of households with disabled members particularly children and explores the association of poverty & disability Complex relationship between disability and poverty demonstrated with insights into how disability and poverty interact to limit life chances
Kandamuthan, 1997
India 24
Case-control study nested within Health and Disability cross-sectional survey of 9652 households in 1983 in an area of Trivandrum, Kerala State. 180 children aged 0-14 years with identified disability compared with 900 controls. Questionnaire & clinical assessment: 8 outcomes studied: total disabled; fits; speech & hearing disability; visual impairment; learning disability; strange behaviour; locomotor disability; other 20 SES measures used but not fully stated in the paper. Following univariate analysis, maternal education, family size and absence of latrine retained in multi-variate analysis Total disability associated with: Low maternal education - adjusted OR 2.46 (1.03,5.89); Family size > 5 - adjusted OR 3.71(2.44,5.63); have latrine - adjusted OR 0.59(0.41,0.84)
Kuklina, 2006
Guatemala 25
Cross-sectional study nested within a birth cohort including all pregnancies between 1996 & 1999 385 children at 6 months of age; 342 at 24 months of age and 404 at 36 months of age in 4 villages in Eastern Guatemala Neurodevelopment measured using the Mental Development and the Psychomotor Development indices of the Bailey Scales of Infant Development Maternal education and household SES based on household characteristics and possessions Maternal education & SES were not associated with child neurodevelopment
Loaiza & Cappa, 2005
7 low/middle income countries 26
Cross-sectional MICS2 surveys in Cameroon, Iraq, Jamaica, Lesotho, Madagascar, Sao Tome & Principe, and Suriname during the period 1999-2001 Children 2-9 years - sample sizes not stated TQQ Rural v. Urban
Maternal education
Wealth quintiles
Disability prevalence - tends to be higher in rural areas although varies by country; tends to be higher among less educated mothers but variable; variable relationship with wealth index - Suriname & Madagascar show social gradients in the expected direction but no significant differences in the other 5 countries
Meeks Gardner et al, 1995 & 1999
Jamaica 27, 28
[2 papers combined as same study described]
Nested randomised control trial within a larger study 78 stunted children & 26 non-stunted children in poor neighbourhoods of Kingston Jamaica - data collected at 12 & 24 months of age Mental age measured using the Griffiths Global Development scores Housing quality - measured by quality of sanitation & water supply and overcrowding
Caldwell HOME inventory - quality of home environment
Maternal score on Peabody Picture Vocabulary Test (PPVT) of verbal reasoning
Mental age at 12 & 24 months associated with maternal PPVT
Not associated with housing quality or HOME score
Mung'ala-Odera et al, 2006
Kenya 29
Cross-sectional survey 10218 out of 11416 children aged 6-9 years in the Kilifi district of Kenya (one of the poorest districts in the country - mainly subsistence farmers) Neurological impairment measured in 2 phases: Phase 1 - TQQ screen
Phase 2 - psychological & neurological assessment undertaken by trained researchers among all screen +ve & similar number of screen -ve children
Maternal education
Mother not involved in economic activity
Father not involved in economic activity
Moderate/severe impairment NOT associated with any of the SES measures on univariate analysis
Natale et al, 1992
India 30
Cross-sectional survey 640 children aged 2-9 in households randomly sampled from 2 urban areas of Madurai, Tamil Nadu with contrasting socio-economic characteristics TQQ screen with additional probe questions to ensure that only chronic conditions identified. TQQ responses grouped into 4 subscales - sensory; neuromotor; cognitive; verbal Residence in one of 2 urban areas: one a slum area with residents of the lowest SES (monthly family income 10-15 US$/month); the other a slightly higher SES area (monthly family income 32-42 US$) Overall disability: 17.4% in lowest SES area v. 8.2% in next lowest SES area
In logistic regression model adjusted for age, gender, birth order & number in family OR for lowest 2.39(1.82,3.09)
All subtypes except verbal significantly higher in lowest SES area
Rischewski, 2008
Rwanda 31
Nationwide matched case-control study (adults & children) nested within a national cross-sectional survey 93 cases aged < 15 yrs identified in the national survey matched for age & gender with 146 controls Musculoskeletal impairment (MSI) ranging from knock knees to quadriplegia Per capita household expenditure; x2 household asset possession measures MSI in children < 15 NOT associated any of the household poverty measures
Shawky, 2002
Saudi Arabia 32
Case-control study based on four cross-sectional cohorts 1225 children aged 6-20 years with disabilities identified from specialist centres in Jeddah and 3405 non-disabled school children sampled from 42 boys' and 42 girls' schools Auditory, visual & mental impairment Maternal education; maternal working status No maternal education associated with: auditory impairment OR 13.3 (7.2,27.8); visual impairment OR 3.7 (2.1,6.6); mental impairment OR 5.5 (3.8,8.1) - all adjusted for maternal age at birth, parity, working status, consanguinity & multiparity
Suris & Blum, 1993
> 20 countries - high & low income 33
Secondary data analysis of cross-sectional surveys 10-14 yr olds in 19 countries and 15-19 yr olds in 23 countries - only rates calculated - no numbers given. Data derived from UN International Disability Statistics Database (DISTAT) No specific definition of disability stated - total disability rates as reported to UN % female illiteracy % country level female illiteracy not correlated with disability rates for adolescents in either age group
Izutsu et al, 2006
Bangladesh 34
Cross-sectional survey Random samples of 187 boys & 137 girls from non-slum areas and 157 boys and 121 girls from slum areas of Dhaka aged 11-18 years Mental health problems (Affective, anxiety, somatic, oppositional defiant & conduct problems plus ADHD) assessed using the Youth Self Report questionnaire administered in their homes by trained interviewers Residence in slum or non-slum areas Only conduct problems associated with living in slum areas OR 3.2(1.4,7.2) adjusted for gender, age & school enrolment
Thomas, 2005
Cambodia 35
Qualitative study Key informant interviews at 3 centres for disabled persons in Cambodia - interviews with staff and administrators; focus group interviews - one with 13 disabled adults & one with 4 disabled children; home visits and interviews with four disabled adults and four disabled children & their parents Range of different disabilities Poverty Poverty identified as both cause and consequence of disability - discussion of mechanisms by which poverty impacts on disability and vice versa based on qualitative data
Thomas, 2005
India 36
Qualitative study Field visits to 7 centres for disabled persons. Focus group interviews with 27 at one centre & 12 at another centre. Small number of individual interviews with disabled persons or parents of disabled children Range of different disabilities Poverty Poverty identified as both cause and consequence of disability - discussion of mechanisms by which poverty impacts on disability and vice versa based on qualitative data
Thomas, 2005
Rwanda 37
Qualitative study Key informant interviews at 3 centres for disabled persons in Rwanda - 2 focus group interviews (27 and 20 disabled persons) and 4 individual interviews. No specific reference to interviews with children or parents of children. Range of different disabilities Poverty Poverty identified as both cause and consequence of disability - not specific to children
UNICEF, 2008
18 low/middle income countries 2
MICS3 cross-sectional surveys in Albania, Bangladesh, Belize, Bosnia and Herzegovina, Cameroon, Central African Republic, Georgia, Ghana, Mauritania, Mongolia, Montenegro, Sao Tome & Principe, Serbia, Sierra Leone, Suriname, Thailand, TYFR Macedonia and Uzbekistan during the period 2005-2008 Children aged 2-9 years ranging from 1,537 children in Belize to 58,441 in Bangladesh TQQ screening Household wealth index (60% poorest v. 40% richest)
Maternal education
Rural/urban
Wealth index: only in 6 countries (Bangladesh, Georgia, Mongolia, Serbia, Sierra Leone & Thailand were disabled children at greater risk of living in the poorest 60% of households
Low maternal education: only 6 countries show a greater risk for disabled children of living in households with mothers with low education
Rural v. Urban: very little association of disability with rural living
VanLeit et al, 2007
Cambodia 38
Cross-sectional survey 500 children 0-18 years with disabilities - no controls included in the study Full range of disabilities - objective was to identify the functional status of disabled children in Cambodia Poverty (< 1$/day) 49% of households identified in the survey were living in poverty