Smythe Tracey, Chen Shanquan, Rotenberg Sara, Unger Marianne, Miner Emily, Seghers Frederic, Servili Chiara, Kuper Hannah
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel st, WC1E 7HT, London, UK.
Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, 8000, South Africa.
EClinicalMedicine. 2023 Dec 12;67:102361. doi: 10.1016/j.eclinm.2023.102361. eCollection 2024 Jan.
Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown.
Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported Multiple Indicator Cluster Survey (2017-2020). Disability was assessed by the Washington Group-Child Functioning Module. Logistic regression models were applied to investigate the relationship between disability and play opportunities, controlling for age, sex, and wealth status. Meta-analysis was used to pool the estimates (overall, and disaggregated by sex), with heterogeneity assessed by Cochran's Q test.
Children with disabilities have approximately 9% fewer play opportunities than those without disabilities (adjusted RR [aRR] = 0.88, 95% CI = 0.82-0.93), and this varied across countries. Mongolia and Democratic Republic of São Tomé and Príncipe had the lowest likelihood of play opportunities for children with disabilities ((aRR = 0.26, 95% CI = 0.09-0.75; aRR = 0.46, 95% CI = 0.23-0.93, respectively). Moreover, children with disabilities are 17% less likely to be provided with opportunities to play with their mothers (aRR = 0.83, 95% CI: 0.73-0.93), which is further reduced for girls with disabilities (aRR = 0.74, 95% CI: 0.60-0.90) compared to their peers without disabilities. The associations varied by impairment type, and children with communication and learning impairments are less likely to have opportunities for play with aRR of 0.69 (95% CI: 0.60-0.79) and 0.78 (95% CI: 0.71-0.86), compared to those without disabilities, respectively.
Children with disabilities are being left behind in their access to play and this is likely to have negative impacts on their overall development and well-being.
HK and TS are funded by HK's NIHR Global Research Professorship (NIHR301621). SR is funded by a Rhodes Scholarship. This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office.
玩耍对所有儿童的认知、社交和情感发展至关重要。残疾儿童在玩耍机会方面可能存在差异，而这种不平等的程度尚不清楚。
在联合国儿童基金会支持的多指标类集调查（2017 - 2020年）中，收集了38个低收入和中等收入国家212,194名2至4岁儿童的数据。残疾状况通过华盛顿小组儿童功能模块进行评估。应用逻辑回归模型来研究残疾与玩耍机会之间的关系，并控制年龄、性别和财富状况。采用荟萃分析汇总估计值（总体以及按性别分类），通过 Cochr an Q检验评估异质性。
残疾儿童的玩耍机会比非残疾儿童少约9%（调整后相对风险[aRR]=0.88，95%置信区间=0.82 - 0.93），且各国情况有所不同。蒙古和圣多美和普林西比民主共和国残疾儿童获得玩耍机会的可能性最低（分别为aRR = 0.26，95%置信区间=0.09 - 0.75；aRR = 0.46，95%置信区间=0.23 - 0.93）。此外，残疾儿童与母亲一起玩耍的机会减少了17%（aRR = 0.83，95%置信区间：0.73 - 0.93），与非残疾同龄人相比，残疾女孩的这一比例进一步降低（aRR = 0.74，95%置信区间：0.60 - 0.90）。这种关联因损伤类型而异，与非残疾儿童相比，有沟通和学习障碍的儿童获得玩耍机会的可能性较小，aRR分别为0.69（95%置信区间：0.60 - 0.79）和0.78（95%置信区间：0.71 - 0.86）。
残疾儿童在玩耍机会方面被落下，这可能对他们的整体发展和福祉产生负面影响。
HK和TS由香港国家卫生研究院全球研究教授职位（NIHR301621）资助。SR由罗德奖学金资助。本研究由英国外交、联邦和发展办公室的残疾行动证据计划（PENDA）资助。
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