Household survey of locomotor disability caused by poliomyelitis and landmines in AfghanistanBMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7120.1424 (Published 29 November 1997) Cite this as: BMJ 1997;315:1424
- Marie-Laurence Lambert (), research associatea,
- Isabelle François, research associatea,
- Cécile Salort, physiotherapistc,
- Vincent Slypen, programme managerb,
- Françoise Bertrand, research associatea,
- René Tonglet, senior lecturera
- a Epidemiology Unit, School of Public Health, Catholic University of Louvain, Clos Chapelle-aux-Champs 30 (UCL 30-34), B-1200 Brussels, Belgium
- b Handicap International Belgium, Rue de Spa 67, B-1040 Brussels
- c Handicap International Afghanistan, PO Box 477, Quetta, Pakistan
- Correspondence to: Dr Lambert
- Accepted 11 March 1997
After 19 years of civil war and the total collapse of health services, disabled people are numerous in Afghanistan. Injuries caused by landmines are a major cause of disability,1 but data on other causes of disability are lacking. We assessed locomotor disability, rehabilitation needs, and coverage of oral polio vaccine in Kandahar province, a heavily mined area in south west Afghanistan.2
A multistage random cluster sampling was performed in four districts of Kandahar province (population 428 390). A disabled person was defined as someone unable to walk normally without help or unable to move their hands or arms properly for a reason other than age. Poliomyelitis was defined as recommended by the World Health Organisation for lameness surveys.3 Coverage of oral polio vaccine was measured by standard WHO methods for children aged 12–59 months.4 Data were collected in June 1996 and analysed by EpiInfo 6 software; design effect was accounted for in the analysis.5
Overall 12 065 people were surveyed. The global prevalence of locomotor disability was 23 per 1000, but some populations at higher risk of disability were not included (nomads, soldiers, and the residents of a few mined villages). War related injuries were the leading cause of disability, but they affected men almost exclusively. Other causes of disability were medical problems and other traumas. More people had been disabled by poliomyelitis than by landmines (1). Among those <15 years old the leading cause of disability was poliomyelitis (4.8 per 1000). Of the 275 disabled people, 204 (74%) had a disability that required an orthopaedic device. Though the rehabilitation needs of people who had had a limb amputated were adequately covered, the rehabilitation needs of those with other disabilities were not.
Of the 327 children surveyed for vaccination coverage, 11 (3%; 95% confidence interval 1% to 6%) had received three doses of the vaccine according to their immunisation cards and 43 (13%; 7% to 20%) had according to their carer.
The prevalence of disability was three times higher for men than for women and children, whose disabilities are rarely related to war. Women, who spend most of their time indoors, are at less risk from landmines. More people were disabled by poliomyelitis than by landmines, though the difference was not significant and the severity of the disabilities was not compared. Landmines are more likely to kill than to disable.1 Among those <15 years old the prevalence of lameness compatible with poliomyelitis was in the expected range for a country with poor sanitary conditions and a poor immunisation programme.4 Vaccination coverage was low although one third of the population lived in an urban area, where access to immunisation would be above the national average.
We had believed that the largest group of people with disabilities would be those who had had a limb amputated and that they would make up the largest part of the workload for rehabilitation services. However, the need for artificial legs was smaller than the need for orthoses and orthopaedic shoes because people with a wider range of disabilities need them; also, the individual workload tends to be higher for these as more follow up is required (particularly for children). Services in Kandahar do not match the needs of the people. Rehabilitation services provided to disabled people who have not had a limb amputated are largely insufficient and should be developed. The recent emphasis on injuries caused by landmines has probably resulted in more attention being given to rehabilitation services for people who have had a limb amputated than to those with other disabilities.
Poliomyelitis is one of the leading causes of disability in Afghanistan only 4 years before the target set by the WHO for its worldwide eradication; improving polio vaccine coverage should be a high priority. Community mine awareness programmes should not be the priority when considering the health needs of women.
We thank the Afghan survey team for their rigour and commitment, and the staff of Handicap International in Afghanistan and Belgium for their logistical support.
Funding: This study was made possible by the European Community Humanitarian Office (ECHO).
Conflict of interest: None.