Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Modern Scientist Global, St. Catharines, Ontario, Canada.
BMJ Open. 2023 Jan 30;13(1):e062362. doi: 10.1136/bmjopen-2022-062362.
The needs of people with disability in Afghanistan are not well understood. We describe the characteristics, healthcare utilisation patterns, and experience of care among Afghan adults with moderate or severe disability (MSD) by disability type.
We mapped 47 questions related to functional disability in the cross-sectional Model Disability Survey of Afghanistan (MDSA) 2019 into 7 disability domains based on the WHO Disability Assessment Schedule 2.0. We conducted multivariable hierarchical logistic regression to identify drivers of high disability burden.
The MDSA primary sampling unit were villages in rural areas and neighbourhoods in urban areas, and the secondary sample units were the settlements within districts.
The MDSA collected data for 14 520 households across all 34 provinces. The adult tool of the survey was administered to a randomly selected household member aged 18 years or older.
The main outcome measured was moderate or severe disability (MSD), which was estimated using a Rasch composite score.
MSD prevalence was upwards of 35% in 6/7 domains. Across most disability types, being a woman, older age, residing in rural areas, being uneducated, non-Pashtun ethnicity, being unmarried, living in a household in the low-income tertiles and a non-working household had the highest levels of MSD (p<0.05). Determinants of MSD varied by domain; however, variables including better access to health facilities and better experience of care (higher satisfaction with time spent and respect during visits) were generally protective. People with MSD in the self-care and life activities domains had the highest and lowest healthcare utilisation, respectively.
Disability in Afghanistan is at public health crisis levels, with vulnerable populations being impacted most severely. To ensure progress towards Afghanistan's 2030 Sustainable Development Goals, targeted interventions for disability types based on population risk factors should be implemented.
阿富汗残疾人的需求尚未得到充分了解。我们根据世界卫生组织残疾评估表 2.0，将 2019 年阿富汗横断面模型残疾调查（MDSA）中与功能残疾相关的 47 个问题映射到 7 个残疾领域，描述了不同残疾类型的中度或重度残疾（MSD）成年人的特征、医疗保健利用模式和护理体验。
我们将 MDSA 2019 年的 47 个与功能残疾相关的问题映射到 7 个残疾领域，根据世界卫生组织残疾评估表 2.0 进行划分。我们进行了多变量分层逻辑回归分析，以确定导致高残疾负担的因素。
MDSA 的初级抽样单位是农村地区的村庄和城市地区的社区，次级抽样单位是各地区的定居点。
MDSA 在全国 34 个省份共收集了 14520 户家庭的数据。该调查的成人工具被随机分配给年龄在 18 岁或以上的家庭中的一个成员。
主要结果是中度或重度残疾（MSD），这是使用 Rasch 综合评分来估计的。
在 6/7 个领域中，MSD 的患病率超过 35%。在大多数残疾类型中，女性、年龄较大、居住在农村地区、未受过教育、非普什图族裔、未婚、生活在低收入三分位数的家庭和非就业家庭的 MSD 水平最高（p<0.05）。MSD 的决定因素因领域而异；然而，包括更好地获得卫生设施和更好的护理体验（对就诊时间和尊重的满意度更高）等变量通常具有保护作用。在自我护理和生活活动领域有 MSD 的人，医疗保健利用率最高和最低。
阿富汗的残疾问题已达到公共卫生危机水平，弱势群体受影响最为严重。为了确保阿富汗在 2030 年可持续发展目标方面取得进展，应根据人口风险因素针对残疾类型实施有针对性的干预措施。
