State of the World's Children 2013 - Unicef

FOCUS
Lessons learned
Since 1995, UNICEF has supported
countries in tracking
progress in key areas of children’s
and women’s wellbeing
through the Multiple
Indicator Cluster Surveys
(MICS). These nationally
representative household
surveys have been conducted
in more than 100 low- and
middle-income countries, and
some have included a module
designed to screen child disability.
This information is now
being built upon to design an
improved measurement tool
to assess child disability.
Disability became part of the
MICS questionnaires in 2000–
2001 (MICS2). Since then, data
on disability have been collected
through more than 50
surveys, making the MICS the
largest source of comparable
data on child disability in lowand
middle-income countries.
The standard disability module
included in MICS surveys
conducted between 2000 and
2010 is the Ten Questions
Screen (TQ), which was
developed as part of the
International Pilot Study of
Severe Childhood Disability in
1984. Its design reflects how
disability was understood and
measured at the time.
The TQ process starts with
an interview with the primary
caregivers of children aged
2–9 years, who are asked to
provide a personal assessment
of the physical and mental
development and functioning
of the children under their care.
Questions include whether the
child appears to have difficulty
hearing; whether she or he
seems to understand instructions,
has fits or loses consciousness;
and whether she
or he was delayed in sitting,
standing or walking compared
to other children. Response categories
do not accommodate
nuances, and children are classified
as screening positive or
negative to each question.
The validity of the Ten
Questions approach has been
widely tested, but results must
be interpreted with caution.
The TQ is a screening tool, and
requires follow-up medical and
developmental assessment in
order to yield a reliable estimate
of the number of children
in a given population who have
disabilities. Children who have
a serious disability are very
likely to screen positive, but
some who screen positive may
be found to have no disability
on further evaluation. Some
children who screen positive
may do so because of temporary
health conditions that can
be easily treated. Although the
TQ comes with a recommendation
that it be followed by an
in-depth assessment, few countries
have had the budgets or
capacity to conduct the secondstage
clinical assessment to
validate results, and they have
been further hampered by the
lack of a standardized methodology
for conducting the
assessment.
Applying the Ten Questions
Screen during the 2005–2006
MICS yielded a wide range
of results across participating
countries: The percentage of
children who screened positive
for disability ranged from
3 per cent in Uzbekistan to 48
per cent in the Central African
Republic. It was not clear
whether this variance reflected
true differences among the
populations sampled or additional
factors. For instance, the
low reported rate in Uzbekistan
might have reflected, among
other things, a large population
of children with disabilities
living in institutions, which
are not subject to household
surveys.
MEASURING CHILD DISABILITY
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