The Circumstances of Children with and without Disabilities or Significant Cognitive Delay Living in Ordinary Households in 30 Middle- and Low-Income Countries
Abstract
:1. Introduction
2. Experimental Section
2.1. Child Disability and Significant Cognitive Delay
- Literacy-numeracy: Can the child: (1) identify/name at least ten letters of the alphabet; (2) read at least four simple, popular words; (3) name and recognize the symbols of all numbers from 1 to 10?
- Learning: Can the child: (4) follow simple directions on how to do something correctly; (5) when given something to do, do it independently?
2.2. Other Child Demographics
2.3. Indicators of Household Circumstances
2.3.1. Household Wealth
2.3.2. Urban/Rural Location
2.3.3. Household Composition
2.3.4. Maternal/Caretaker Characteristics
2.3.5. Parenting Practices
2.3.6. Attitudes toward Intimate Partner Violence
2.4. Child Access to Pre-School Education
2.5. Country Characteristics
2.6. Approach to Analysis
3. Results
3.1. Prevalence of Child Disability
3.2. Association between Child Disability, Significant Cognitive Delay and Home Circumstances
4. Discussion
- Across all three country economic classification groups, children with disabilities and children with significant cognitive delay were more likely than their peers to be living in relative household poverty and in rural areas, to have a mother with only primary level education, to live in households where intimate partner violence was considered acceptable by the child’s mother and to be less likely to be receiving any pre-school education;
- In the majority of country economic classification groups, children with disabilities and children with significant cognitive delay were more likely than their peers to have a mother with disabilities and to receive low levels of parental stimulation;
- Across all three country economic classification groups, children with disabilities were more likely than their peers to be exposed to violent parental discipline;
- For many of these indicators of poorer home circumstances (e.g., household poverty, rural location, low maternal education, and low stimulation), the level of risk was notably higher for children with significant cognitive delay than for children with disabilities.
4.1. Implications
4.2. Limitations
4.3. Future Research
5. Conclusions
- Adverse family circumstances have a negative impact on the well-being of children. They may also reduce the effectiveness of home-based early intervention programs unless they are specifically tailored to the level of resources available.
- We undertook secondary analysis of nationally representative data collected in 30 middle- and low-income countries involving over 100,000 children with/without disabilities or significant cognitive delay.
- Children with disabilities and/or significant cognitive delay were more likely than their peers to:
- ○
- Be living in relative household poverty and in rural areas;
- ○
- Have a mother with only primary level education;
- ○
- Live in households where intimate partner violence was considered acceptable by the child’s mother;
- ○
- Be less likely to be receiving any pre-school education;
- ○
- Have a mother with disabilities;
- ○
- Receive low levels of parental stimulation;
- ○
- Be exposed to violent parental discipline.
- Interventions are needed to reduce the risk of exposure of children with disabilities to these adversities.
- In addition, these aspects of family context need to be considered when designing home-based early intervention programs to support children with disabilities to reach their developmental potential.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Country | Region | Year of Survey | Under 5 Response Rate | Sample Size |
---|---|---|---|---|
Upper-Middle-Income | ||||
Costa Rica | LAC | 2018 | 86.9% | 2137 |
Montenegro | ECA | 2018/19 | 60.7% | 634 |
Cuba | LAC | 2019 | 98.5% | 3141 |
Turkmenistan | ECA | 2019 | 97.0% | 1963 |
Serbia | ECA | 2019 | 84.2% | 1059 |
North Macedonia | ECA | 2018/19 | 90.0% | 855 |
Suriname | LAC | 2018 | 82.1% | 2389 |
Iraq | MENA | 2018 | 99.1% | 8452 |
Georgia | ECA | 2018 | 84.7% | 1405 |
Kosovo | ECA | 2019/20 | 78.2% | 827 |
Tonga | EAP | 2019 | 96.0% | 734 |
Lower-Middle-Income | ||||
Algeria | MENA | 2018 | 94.5% | 5785 |
Mongolia | ECA | 2018 | 95.5% | 3485 |
Tunisia | MENA | 2018 | 96.3% | 1466 |
Kiribati | EAP | 2018/19 | 98.2% | 1137 |
Ghana | SSA | 2017/18 | 99.2% | 4788 |
Sao Tome and Principe | SSA | 2019 | 97.9% | 1065 |
Zimbabwe | SSA | 2018/19 | 96.1% | 3473 |
Bangladesh | SA | 2019 | 93.0% | 11,671 |
Lesotho | SSA | 2018 | 87.5% | 1845 |
Kyrgyz Republic | ECA | 2018 | 98.4% | 1901 |
Nepal | SA | 2019 | 98.4% | 3901 |
Low-Income | ||||
Guinea-Bissau | SSA | 2018/19 | 99.1% | 3987 |
The Gambia | SSA | 2018 | 96.1% | 5302 |
Chad | SSA | 2019 | 99.4% | 11,006 |
Togo | SSA | 2017 | 96.4% | 2660 |
Madagascar | SSA | 2018 | 94.1% | 6617 |
DR Congo | SSA | 2017/18 | 99.8% | 10,305 |
Sierra Leone | SSA | 2017 | 99.6% | 6119 |
Central African Republic | SSA | 2018/19 | 96.7% | 4366 |
Total | 114,475 |
Indicator | Overall Prevalence for Children with Disability | Overall Prevalence for Children without Disability | Adjusted Prevalence Rate Ratio | Overall Prevalence for Children with Developmental Delay | Overall Prevalence for Children without Developmental Delay | Adjusted Prevalence Rate Ratio |
---|---|---|---|---|---|---|
Living in poorest 20% of households | 25.7% (23.9–27.5) (n = 1644) | 22.4% (21.6–23.2) (n = 16,626) | 1.36 *** (1.20–1.54) (n = 18,270) | 39.1% (32.6–45.9) (n = 630) | 22.3% (20.6–24.2) (n = 16,487) | 1.55 *** (1.36–1.76) (n = 17,117) |
Living in rural area | 42.2% (34.6–50.2) (n = 1644) | 38.2% (35.8–40.8) (n = 16,626) | 1.06 (0.92–1.22) (n = 18,270) | 40.7% (33.7–48.1) (n = 630) | 39.0% (36.1–41.9) (n = 16,487) | 1.29 *** (1.15–1.45) (n = 17,117) |
Natural mother living in household | 97.5% (95.8–98.6) (n = 1644) | 97.2% (96.2–98.6) (n = 16,621) | 1.00 (0.93–1.08) (n = 18,265) | 99.3% (97.5–99.8) (n = 630) | 97.2% (96.3–97.9) (n = 16,487) | 1.02 (0.94–1.11) (n = 17,108) |
Natural father living in household | 73.6% (65.1–80.7) (n = 1637) | 81.4% (76.0–85.8) (n = 16,580) | 0.97 (0.89–1.05) (n = 18,217) | 89.6% (79.2–95.1) (n = 629) | 81.4% (76.5–85.4) (n = 16,429) | 1.00 (0.92–1.09) (n = 17,058) |
Mother has no or only primary education | 19.0% (14.3–24.8) (n = 1639) | 14.8% (11.6–18.7) (n = 16,596) | 1.17 (0.95–1.45) (n = 18,235) | 28.4% (19.8–38.9) (n = 629) | 14.9% (11.7–18.8) (n = 16,456) | 1.90 ** (1.30–2.76) (n = 17,085) |
Mother/caretaker has a disability | 13.1% (9.2–18.3) (n = 1613) | 3.8% (3.3–4.4) (n = 16,180 | 2.80 *** (2.15–3.64) (n = 17,793) | 3.5% (2.1–5.7) (n = 618) | 4.2% (3.7–4.9) (n = 15,301) | 0.88 (0.21–3.74) (n = 15,919) |
Mother under 18 at birth of target child | 2.8% (1.3–5.8) (n = 1614) | 3.3% (2.9–3.7) (n = 16,211) | 0.64 (0.39–1.03) (n = 17,825) | 4.6% (2.6–8.2) (n = 619) | 3.4% (2.9–3.9) (n = 15,981) | 0.73 (0.47–1.15) (n = 16,600) |
Low stimulation | 45.2% (38.6–50.9) (n = 1638) | 40.3% (38.6–42.0) (n = 16,592) | 1.23 * (1.00–1.52) (n = 18,230) | 74.9% (70.2–79.1) (n = 626) | 39.9% (38.0–41.8) (n = 16,455) | 1.46 * (1.08–1.98) (n = 17,081) |
Violent parental discipline | 26.0% (21.9–30.5) (n = 1643) | 19.5% (18.3–20.8) (n = 16,625) | 1.29 *** (1.13–1.47) (n = 18,268) | 16.7% (6.5–36.7) (n = 630) | 11.4% (8.4–15.3) (n = 16,486) | 0.76 (0.23–2.46) (n = 17,116) |
Social acceptability of IPV | 25.6% (19.3–33.0) (n = 1502) | 26.0% (22.0–30.4) (n = 14,532) | 1.17 * (1.02–1.36) (n = 16,034) | 46.3% (38.2–54.6) (n = 600) | 26.2% (22.4–30.4) (n = 14,567) | 1.07 (0.95–1.22) (n = 15,167) |
Child currently attending pre-school education | 33.6% (24.8–43.7) (n = 1162) | 50.6% (46.3–54.9) (n = 11,622) | 0.87 (0.72–1.05) (n = 12,824) | 23.8% (16.5–33.0) (n = 618) | 50.4% (46.0–54.7) (n = 15,952) | 0.64 * (0.45–0.91) (n = 16,570) |
Indicator | Overall Prevalence for Children with Disability | Overall Prevalence for Children without Disability | Adjusted Prevalence Rate Ratio | Overall Prevalence for Children with Developmental Delay | Overall Prevalence for Children without Developmental Delay | Adjusted Prevalence Rate Ratio |
---|---|---|---|---|---|---|
Living in poorest 20% of households | 25.7% (23.9–27.5) (n = 1888) | 22.4% (21.6–23.2) (n = 34,125) | 1.16 ** (1.06–1.28) (n = 36,013) | 33.2% (30.5–36.0) (n = 1755) | 21.2% (20.4–22.1) (n = 25,345) | 1.50 *** (1.31–1.71) (n = 27,100) |
Living in rural area | 60.8% (57.1–64.4) (n = 1888) | 56.8% (55.5–58.2) (n = 34,125) | 1.05 (0.98–1.13) (n = 36,013) | 67.1% (63.9–70.1) (n = 1755) | 55.7% (54.3–57.1) (n = 25,345) | 1.18 ** (1.07–1.30) (n = 27,100) |
Natural mother living in household | 91.0% (89.2–92.6) (n = 1887) | 93.9% (93.5–94.3) (n = 34,116) | 1.01 (0.96–1.06) (n = 36,003) | 93.4% (91.8–94.6) (n = 1753) | 93.1% (92.6–93.5) (n = 25,324) | 1.00 (0.95–1.05) (n = 27,077) |
Natural father living in household | 68.2% (64.9–71.3) (n = 1874) | 77.5% (75.8–79.2) (n = 33,935) | 0.97 (0.91–1.03) (n = 35,809) | 75.2% (71.9–78.2) (n = 1737) | 76.5% (74.6–78.3) (n = 25,150) | 1.01 (0.96–1.07) (n = 26,887) |
Mother has no or only primary education | 42.4% (39.3–45.6) (n = 1887) | 32.0% (29.2–35.0) (n = 34,123) | 1.15 * (1.03–1.28) (n = 36,010) | 50.5% (45.3–55.7) (n = 1755) | 32.1% (29.0–35.4) (n = 25,342) | 1.41 *** (1.32–1.51) (n = 27,097) |
Mother/caretaker has a disability | 10.9% (8.6–13.8) (n = 1775) | 3.7% (3.4–4.1) (n = 32,971) | 2.12 *** (1.64–2.75) (n = 34,746) | 5.0% (3.8–6.4) (n = 1637) | 3.9% (3.6–4.3) (n = 23,641) | 1.30 * (1.04–1.62) (n = 25,287) |
Mother under 18 at birth of target child | 3.6% (2.7–4.9) (n = 1765) | 3.7% (3.1–4.3) (n = 32,901) | 1.10 (0.86–1.42) (n = 34,666) | 3.9% (2.9–5.3) (n = 1628) | 3.7% (3.1–4.5) (n = 23,536) | 0.88 (0.68–1.14) (n = 25,191) |
Low stimulation | 66.6% (63.0–70.0) (n = 1866) | 52.7% (48.4–56.9) (n = 33,778) | 1.09 ** (1.03–1.16) (n = 35,644) | 64.4% (58.7–69.7) (n = 1734) | 51.1% (46.5–55.7) (n = 25,148) | 1.21 *** (1.14–1.28) (n = 26,882) |
Violent parental discipline | 42.8% (39.7–46.1) (n = 1887) | 31.9% (28.7–35.3) (n = 34,116) | 1.14 ** (1.05–1.23) (n = 36,003) | 36.1% (31.9–40.5) (n = 1755) | 35.1% (31.4–39.0) (n = 25,341) | 0.96 (0.88–1.05) (n = 27,096) |
Social acceptability of IPV | 35.5% (32.2–39.1) (n = 1539) | 30.0% (28.7–31.3) (n = 29,984) | 1.06 (0.97–1.17) (n = 31,523) | 40.5% (37.3–43.8) (n = 1412) | 29.4% (28.0–30.8) (n = 21,052) | 1.25 *** (1.12–1.40) (n = 22,464) |
Child currently attending pre-school education | 43.4% (39.0–48.0) (n = 1188) | 42.4% (41.3–43.5) (n = 21,568) | 0.73 ** (0.60–0.89) (n = 22,756) | 22.3% (19.6–25.2) (n = 1669) | 43.6% (42.6–44.7) (n = 24,108) | 0.53 *** (0.44–0.64) (n = 25,777) |
Indicator | Overall Prevalence for Children with Disability | Overall Prevalence for Children without Disability | Adjusted Prevalence Rate Ratio | Overall Prevalence for Children with Developmental Delay | Overall Prevalence for Children without Developmental Delay | Adjusted Prevalence Rate Ratio |
---|---|---|---|---|---|---|
Living in poorest 20% of households | 25.7% (23.9–27.5) (n = 4289) | 22.4% (21.6–23.2) (n = 36,290) | 1.04 (0.93–1.17) (n = 40,579) | 30.4% (28.3–32.7) (n = 7632) | 21.8% (20.4–23.3) (n = 29,460) | 1.27 *** (1.22–1.33) (n = 37,092) |
Living in rural area | 72.0% (68.1–75.6) (n = 4289) | 67.2% (63.7–70.6) (n = 36,290) | 1.04 (0.98–1.10) (n = 40,579) | 77.3% (74.2–80.1) (n = 7632) | 66.0% (62.5–69.4) (n = 29,460) | 1.11 *** (1.06–1.17) (n = 37,092) |
Natural mother living in household | 89.8% (88.5–91.0) (n = 4289) | 89.4% (88.7–90.1) (n = 36,285) | 1.00 (0.97–1.04) (n = 40,574) | 89.6% (88.4–90.6) (n = 7629) | 88.7% (87.9–89.4) (n = 29,447) | 1.00 (0.98–1.03) (n = 37,076) |
Natural father living in household | 68.0% (66.0–69.9) (n = 4278) | 69.8% (68.8–70.7) (n = 36,221) | 0.97 (0.93–1.01) (n = 40,499) | 70.7% (68.9–72.4) (n = 7618) | 70.0% (69.0–70.9) (n = 29,399) | 1.00 (0.97–1.04) (n = 37,017) |
Mother has no or only primary education | 79.2% (76.8–81.3) (n = 4289) | 75.4% (73.7–77.0) (n = 36,282) | 1.02 (0.98–1.05) (n = 40,571) | 81.4% (79.2–83.4) (n = 7630) | 75.3% (73.5–77.0) (n = 29,453) | 1.08 *** (1.04–1.11) (n = 37,083) |
Mother/caretaker has a disability | 12.0% (10.5–13.7) (n = 4081) | 4.5% (4.1–4.9) (n = 34,988) | 2.30 *** (1.78–2.97) (n = 39,069) | 6.3% (5.5–7.3) (n = 6881) | 4.9% (4.5–5.4) (n = 26,645) | 1.12 (1.00–1.25) (n = 33,526) |
Mother under 18 at birth of target child | 8.1% (7.1–9.3) (n = 4068) | 6.6% (6.3–6.9) (n = 34,942) | 1.14 * (1.00–1.29) (n = 39,010) | 7.0% (6.2–7.8) (n = 6856) | 6.5% (6.2–6.9) (n = 26,509) | 1.04 (0.94–1.15) (n = 33,365) |
Low stimulation | 68.4% (65.8–70.8) (n = 4242) | 71.2% (70.0–72.4) (n = 35,888) | 0.97 (0.91–1.04) (n = 40,130) | 77.7% (75.8–79.5) (n = 7539) | 72.0% (70.7–73.3) (n = 29,131) | 1.10 *** (1.07–1.13) (n = 36,670) |
Violent parental discipline | 40.0% (37.8–42.3) (n = 4289) | 39.0% (37.9–40.1) (n = 36,284) | 1.08 (0.99–1.19) (n = 40,573) | 39.1% (37.0–41.2) (n = 7613) | 42.9% (41.8–44.0) (n = 29,457) | 0.91 ** (0.86–0.97) (n = 37,088) |
Social acceptability of IPV | 67.0% (64.6–69.4) (n = 3995) | 59.1% (57.6–60.5) (n = 34,256) | 1.11 ** (1.04–1.17) (n = 38,251) | 64.7% (62.2–67.1) (n = 6717) | 59.5% (58.1–61.0) (n = 26,052) | 1.06 (0.99–1.13) (n = 32,742) |
Child currently attending pre-school education | 8.6% (6.9–10.6) (n = 2381) | 13.7% (12.2–15.4) (n = 18,327) | 0.86 (0.74–1.01) (n = 20,708) | 3.8% (3.0–4.7) (n = 5774) | 15.7% (14.0–17.5) (n = 21,446) | 0.37 ** (0.21–0.67) (n = 27,220) |
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Emerson, E.; Llewellyn, G. The Circumstances of Children with and without Disabilities or Significant Cognitive Delay Living in Ordinary Households in 30 Middle- and Low-Income Countries. Disabilities 2021, 1, 174-186. https://doi.org/10.3390/disabilities1030014
Emerson E, Llewellyn G. The Circumstances of Children with and without Disabilities or Significant Cognitive Delay Living in Ordinary Households in 30 Middle- and Low-Income Countries. Disabilities. 2021; 1(3):174-186. https://doi.org/10.3390/disabilities1030014
Chicago/Turabian StyleEmerson, Eric, and Gwynnyth Llewellyn. 2021. "The Circumstances of Children with and without Disabilities or Significant Cognitive Delay Living in Ordinary Households in 30 Middle- and Low-Income Countries" Disabilities 1, no. 3: 174-186. https://doi.org/10.3390/disabilities1030014