The MICS module on disability (also called The Ten Question module) is based on a two-stage questionnaire that has been designed to identify children – in any cultural and social setting -- who have congenital and developmental disabilities. This screening instrument was developed by a team of scientists and its validity has been tested in different epidemiological surveys involving screening and clinical assessments of more than 22,000 children (between 2 and 9 years of age) in Bangladesh, Jamaica and Pakistan. These surveys have generated estimates of total prevalence rates that range from 1 per cent to 4.4 per cent in the case of severe disabilities, and up to 20 per cent for mild disabilities. Indeed, the sensitivity of this module has proved to be higher for serious cognitive, motor and seizure disabilities, lower for vision or hearing disabilities (unless previously identified) and for mild disabilities. The total percentage of disabled children may vary from 7 per cent to 19 per cent in the general population, but it can be higher in the clinical or risk population.
The disability module provides data mostly on the type of impairments children have (e.g. seeing, hearing, muscle movement impairments, language production and reception, etc.) or on health conditions (e.g. epilepsy). A few questions ask about activity limitations (difficulties doing activities required or desired for everyday living, e.g. walking, learning).
On the basis of Ten Questions, each child is classified as screened positive if he/she presents one or more of the problems inquired about or negative if no problem is reported. Questions are presented as a personal interview with a parent or the caretaker who knows the child being screened. The interviewee is asked to provide a personal assessment of both the physical and mental conditions of the child, and to indicate the existence of impairments considered to be disabling. Answers can therefore be affected by subjective perception, deliberate omission, or unawareness, and are likely to be influenced by the social milieu in which the household lives.
To reduce the risk of subjective bias, the questionnaire used during the implementation of MICS2 entailed a second stage, in which all children who screened positive and a random sample of about 10 per cent of those screened negative were asked to be referred for medical and psychological assessment. The clinical evaluation was meant to provide a basis for detecting whether or not a child was actually disabled and for estimating overall prevalence of disability coming from the interviews. Unfortunately, the second-stage study was not conducted in a single country implementing the disability module in MICS2, mainly due to lack of planning, as well as for logistic reasons and budget limitations. This second-stage screening was not requested in MICS3 but is currently being implemented in a few countries participating in MICS4.
MICS data on disability refer therefore to the percentages of children who screened positive on at least one of these ten questions and have to be considered as an indication of the percentages of children who are likely to have a disability. These children may require further medical and developmental assessment.
Chamie, M., ‘Can Childhood Disability Be Ascertained Simply in Surveys?’, Epidemiology, 5(3), 1994, pp. 273-275.
Durkin, M. S. et al., ‘Validity of the Ten Questions Screen for Childhood Disability: Results from population-based studies in Bangladesh, Jamaica and Pakistan’, Epidemiology, 5(3), 1994, pp. 283-289.
Durkin, M. S. et al., ‘Validity of the Ten Questions for Screening Serious Childhood Disability: Results from urban Bangladesh’, International Journal of Epidemiology, 19(3), 1990, pp. 613-620.
Durkin, M. S. et al., ‘Evaluating a Ten Questions Screen for Childhood Disability: Reliability and internal structure in different cultures’, Journal of Clinical Epidemiology, 48(5), 1995, pp. 656-666.
Durkin, M. S. et al., 1995, op. cit.