Documentation for the Workshop / Country Papers : Afghanistan

COUNTRY REPORT

AFGHANISTAN

Workshop on Improving Disability Data for Policy Use, 23-26 September 2003, Bangkok

Collaborators:

Afghanistan Ministry of martyrs and disabled
Afghanistan Ministry of health
U.S Centers for Disease Control and prevention
UNICEF
Mine Clearance Planning Agency - Afghanistan
International Rescue Committee (IRC)
Vietnam Veterans of America Foundation

Objectives

Highlight the magnitude and scope of injury and disability among children in Afghanistan.
Provide estimates of immunization coverage
Describe the leading causes of injury and non injury death among children
Assist the Afghanistan government in policy and planning of related prevention programs
Assist aid agencies to determine need for resources for prevention programs.

Methods

Multi - stage cluster design

District
- Probability of selection based on population size
Village
- Random selection
Households

Data collection

August 2002 to November 2002
Structured interview with head of household

Preliminary Analysis

Epi Infor 2002 ( C- Sample) to account for complex design

Data Collection

Male and female interviewers.

Listed all household members since March 2001.

Age and Sex
Current status(alive, dead, missing)
Cause of death with modified verbal autopsy.
If injured completed relevant section.

Study Sample

49 clusters/Villages.
707 households
6026 persons.

3577 children.

< 18 years

59.8% of sample

Household Characteristics

Displacement

37% currently displaced

Source of drinking water.

75% from unsafe source.

Accessible healthcare.

27% had accessible healthcare

Demographics of Children

Sex.

Majority females (50.2%)

Age

Average age= 8 years (range<1-18 years)

Age Distribution of Children

Age	Number	Percent (95% ( CI)
< 1 year	31	0.37 (0.0-0.8)
1-4 years	1009	28.3 (23.9-34.9)
5-9 years	1178	32.8 (30.6-36.0)
10-14 years	844	22.3 (19.1-25.5)
15-18 years	515	16.2 (12.5-19.8)

Injury Prevalence

Injury prevalence

overall = 4.3%
Children = 1.1%

War-Related injury Prevalence

Overall = 3.2%
Children = 0.5%

Injuries among children

All injuries= 15%

War-related injuries = 10%

War-Related injury among children
84% of kinjuries due to bombs or grenades
13% due firearms
3% due to landmines/UXO

Impact of war-Related injury on children

Case-fatality ratios

Adults=4:1
Children= 1.3:1

Children are 19 times more likely than adults to die from a war - related injury

Landmine/UXO Injuries

Over 70% of victims were civilian

16% had received mine risk education prior to injury

6% were recently returned refugees

Disability Among Children

Prevalence

1.3% of children disabled

Forms

paralysis= 38%
Deaf=24%
Cognitive= 21%
Amputee= 11%
Blind = 8%

Causes of Disability Among Children

32 % of disability due to disease
29% the result of injury

22 % of childhood disability is congenital

Causes of Disease - Related Disability Among Children

Polio = 32%
Mental Health = 27%
Tuberculosis = 11%

Causes of Injury - Related Disability Among Children

Falls = 27%
Road Injuries = 26%
War = 25%
Fire = 10%

Vaccination Coverage

Measles	Number	Percent
Overall Coverage	1620	94.1
Coverage (6 -59Months)	583	93.3
Coverage (5 - 12 Years)	1071	94.4
OPV
Coverage (5 Years)	889	94.2
Vitamin A
Coverage (6 - 59 Month)	756	83.5

Causes of Death for Children (<5Years of age)

Cause of Death	percent(%)
Respiratory Illness	31.3
Watery Diarrhea	27.2
Bloody Diarrhea	26.5
Measles	2.1
Tetanus	1.3
Meningitis	6.7
Scurvy	0.3
Other	4.5

Conclusions

War - Related Injury is a signification cause of injury and death among children in Afghanistan
- Children are more likely to as a result of war - related injuries than adults
- Most injuries due to bombs or grenades
1 in 100 children are disabled
- Most commonly due to disease

Conclusions

Immunization Coverage is very high among age - eligible children for certain antigens
Diarrheal disease and respiratory illness are the leading causes of non -injury death among children under 5 years of age.

Use of the findings

Guide public health programs
- Victims assistance
- Mine risk education
Target donor aid
Provide baseline for surveillance
Allow evaluation of programs

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