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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