Handicap International experience in Afghanistan - CBM

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The proportion of persons with disability is not very high in the earlier stages of life. This can be explainedby various reasons. It is probable that certain forms are not yet detected at an earlier age. Furthermore,bearing in mind the infant mortality rate in the country (115/1000 live births) 12 , that ranks among the worstworldwide, children with disability or those who become disabled at an early stage are more vulnerable andhave lower survival rates than non-disabled infants.More than half the persons with disability are in the Central and Western areas. This can be explained bythe presence of 2 highly populated cities in these areas, i.e., Kabul and Herat. The NDSA results also showthat the proportion of persons with disability is higher in Central, Western and Southern areas and above thenational average prevalence rate. On the other end, in the Eastern, North Eastern and North Western areas,the proportion is below the national average.More than halfthe persons withdisability arein the Centraland Westernareas. This canbe explained bythe presence of 2highly populatedcities in theseareas, i.e., Kabuland HeratIt is challenging to understand what lies behind these differences, as it is often a combination of individual,social and political factors, as a result of which, certain regions have high proportions of Internally DisplacedPersons (IDPs) who moved during various conflicts. The availability and stability of health services could alsoresult in a higher prevalence rate linked to better health care (so persons with disability have better chancesof surviving through illnesses and accidents) as well as better detection.Looking at the Typology of DisabilityIt is important to bear in mind that the results presented concern that 2.7% of the population who weredetected as having severe difficulties in the screening questionnaire. This choice has been made mainlybecause the GoA and other stakeholders are targeting on priority basis persons with severe impairments. It istherefore essential to look at the typology and the profile of this population. The typology, like the definition ofdisability, was based upon difficulties in functioning and was devised after extensive discussion with personswith disability, partners and experts working in the field.Determining Typology: The Various Sections of the Screening ToolThe following disabilities were included in the screening tool of the NDSA. All questions were focused on theability or difficulty to function in everyday life. The various sections were defined according to a wide rangeof criteria.Section A: Physical and Sensorial Difficulties• Lack part of/entire member(s) or functions of the body;• Difficulties that impede movement and mobility;• Visual impairments;• Hearing impairments;• Speech Impairments.Section B: Intellectual and Learning Difficulties• Later/slower speaking patterns compared to other members of the family;• Later/slower walking, mobility development compared to other members of the family;• Behaviour that does not correspond to the given age (child behaving younger than age).Section C: Behavioural and Psychological Difficulties• Difficulty or impossibility in expressing needs, using language that no one understands;• Difficulty or impossibility in being with people who are not familiar;• Difficulty or impossibility in keeping still/ staying in one place;12UNDP (2004), op. cit.10 Understanding the Challenge Ahead
• Difficulty or impossibility in keeping quiet, talking all the time in presence of others or alone;• Violent behaviour regarding oneself (banging head against the wall, self mutilation, biting ownhand...).Section D: Communication and Social Functioning Disorder(linked to no identified reason)• Having repetitive, stereotyped body movements (rocking back and forth);• Showing sudden and unpredictable physically violent behaviour towards other person (hitting, biting,scratching, spitting, pulling hair...);• Showing sudden and unpredictable verbally violent behaviour towards other person (abusing, usingfoul language constantly...);• Getting angry very easily, screaming/yelling without reason when touched.Section E: Epilepsy and Other Seizures 13• Fits/Seizures;• Epilepsy signs;• Fainting or passing out without reason.Figure 5: The Overall Typology• Physical Disability• Sensorial Disability• Mental Disability• Associated Disabilities• Epilepsy/SeizuresThe main type of disability reported in the NDSA was physical disability (36.5%), followed by sensorial forms(25.5%). It is important to note here that multiple physical or sensorial disabilities are included in thesefigures.Mental disability and associated disability (more that one type of disability) account for similar proportions.Epilepsy and seizures seem to affect almost one person with disability out of five. However these estimatesare in line with the proportion found in other countries, which is roughly of 1% of the overall population.Looking more closely at the physical disability category shows that over 46% physically disabled peoplehave multiple physical disability, followed by 29.0% of paralysed and 12.0% each for physical deformityand lacking a limb.The sensorial disabled are divided between visual impaired (32.4%), hearing impaired (25.2%) and speechimpaired (23.0%). Another 15.4% report hearing and speech disability together.13For this section we proceeded with care. On the suggestion of an expert from Health Net International, Dr. Peter Ventevogel, we werecareful with regard to “‘pseudo-epilepsy’ (women who have attacks that somehow resemble epilepsy and are often also called ‘mergi’ butare conversions or, to use an abandoned word, hysterical attacks). This can be quite prevalent in rural areas.” As a result we focused uponhow these attacks impede and affect everyday functioning. We also were attentive to the duration of these attacks and the social settingsof their occurrence. Lastly we were cautious regarding the interpretation of results found in this category.Prevalence and Typology11
Page 3 and 4: Islamic Republic of AfghanistanUNDE
Page 5 and 6: ContentsAcknowledgementsAbbreviatio
Page 8: Figure 25 : Retention, Transition a
Page 11 and 12: AbbreviationsAFAs : AfghanisBPHS :
Page 13 and 14: PrefaceThe National Disability Surv
Page 15: IntroductionAs the process of recon
Page 18 and 19: Figure 1. Sampling Stages of NDSA1s
Page 20 and 21: A variety of subjects and fields ad
Page 22 and 23: • Beliefs and expectations of wha
Page 24 and 25: Prevalence Threshold with Regard to
Page 28 and 29: Mental disability shows a much more
Page 30 and 31: The effectiveprevalencerate of seve
Page 32 and 33: to a maximum of 37.4% unable to coo
Page 34 and 35: Table 3. Proportion of Persons with
Page 36 and 37: Table 4: Proportion of Persons with
Page 38 and 39: Figure 9. Distribution of Persons w
Page 40 and 41: Figure 12: Distribution of Persons
Page 42 and 43: Comparing the situation between mal
Page 44 and 45: Figure 17. Number of Visits to Heal
Page 46 and 47: Table 5: Yearly Average Expenses (A
Page 48 and 49: 32 Understanding the Challenge Ahea
Page 50 and 51: A crucial aspect that influences ac
Page 52 and 53: Table 6 highlights the advantage th
Page 54 and 55: Figure 26: Retention, Transition an
Page 56 and 57: to take this into consideration whe
Page 58 and 59: • Boys with physical disability a
Page 64 and 65: to others: usually they benefit fro
Page 66 and 67: Figure 37: Distribution of Active P
Page 70 and 71: According to NRVA 2003, poverty is
Page 72 and 73: means that the average living space
Page 76 and 77:
Figure 46: Distribution of Househol
Page 78 and 79:
62 Understanding the Challenge Ahea
Page 80 and 81:
The inability tobear children is am
Page 82 and 83:
The situation is somewhat different
Page 84 and 85:
Figure 51: Distribution of Persons
Page 86 and 87:
706050• Landmine/UXO Survivors•
Page 88 and 89:
ConclusionInclusion is a major fact
Page 90 and 91:
of persons with disability 48 . Thi
Page 92 and 93:
GHOSH N., MOHIT A., MURTHY R.S. (20
Page 95:
The National Disability Survey in A
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Handicap International experience in Afghanistan - CBM

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