model disability survey general results ziarat … · for persons with disability in pakistan. the...
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MODEL DISABILITY SURVEY
GENERAL RESULTS
ZIARAT DISTRICT, BALOCHISTAN
PROVINCE, PAKISTAN
Table of Contents 1 Introduction ....................................................................................................... 2
1.1 How does the MDS measure disability? .......................................................... 2 1.2 What were the objectives of the implementation in Baluchistan? ....................... 3
2 Core results ....................................................................................................... 4 2.1 Households ................................................................................................. 4 2.2 Demographic characteristics ......................................................................... 5 2.3 Disability .................................................................................................... 6 2.4 Most affected daily life areas ......................................................................... 8 2.5 Health ...................................................................................................... 22 2.6 Work ....................................................................................................... 24 2.7 Education ................................................................................................. 25 2.8 Environmental factors ................................................................................ 26 2.9 Health care responsiveness ......................................................................... 33 2.10 Well-Being ............................................................................................. 35
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1 Introduction The Model Disability Survey (MDS) is a survey questionnaire used to collect data about
disability in a country or country region. The MDS was developed by the World Health Organization (WHO) and the World Bank in 2012, in consultation with international
organisations, leading researchers, and DPOs.
The survey helps countries authorities, NGOs and DPOs better understand the situation of people who have disability, especially their unmet needs as well as the barriers that they
face in daily life.
Governments use the data to develop disability policies and national or regional disability
action plans that are based on the real-life situation of people who have disability. They also use the data to monitor and report on the implementation of the Convention on the Rights of Persons with Disabilities and the indicators of the Sustainable Development Goals.
NGOs and DPOs use the data to advocate for what is needed to ensure that people who have disability can enjoy their human rights fully on an equal basis with others.
1.1 How does the MDS measure disability?
The MDS takes a broad approach by measuring disability taking into account health
conditions (e.g. depression or diabetes) or impairments (e.g. vision or hearing loss) people have and the context in which they live. The context includes:
- Barriers faced in the community, for instance being able to access public spaces;
- Attitudes of others, for instance being treated with respect or considered able to work;
- Social support received, for instance having family or friends one can count on;
- Easiness of access to health care, for instance being able to see a family doctor;
- Easiness of access to assistive products of good quality, such as a cane or wheelchair;
- Laws in place that ensure rights, such the right to receive an education in regular schools.
As a result of the interaction between health conditions or impairments and the context in which a person lives, disability might be faced in daily life, including:
- impairments, such as pain, loss of cardiovascular function or loss of muscle power;
- limitations in activities, such as moving around in the neighbourhood, eating or to tidying
up oneself, and restrictions in participation in society, such as problems to work or to
participate on community activities.
The MDS approach also understands disability as a continuum that ranges from no disability to very high levels of disability, depending on the health conditions and the context of the
person. Disability is a matter of degree, and no, mild, moderate or severe levels of disability can be differentiated for policy purposes.
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The level of disability in countries and regions is influenced therefore not only by trends in health conditions and impairments but also by physical, human-built, attitudinal and socio-
political barriers or facilitators.
Natural disasters, such as long drought periods, conflict situations, such as war, or the number of traffic accidents, will affect disability levels in a population both by changing the
prevalence of impairments and by creating physical barriers.
1.2 What were the objectives of the implementation in Baluchistan?
Pakistan faces several challenges that are frequently associated with high levels of disability, such as a high prevalence of polio, insufficient maternal health care, problems with health
care accessibility, chronic poverty, frequent natural disasters, and ongoing war on terror.
Additionally, persons with severe impairments, such as paralysis or amputations, face overwhelming barriers in all aspects of life including education, livelihood, health care and
skills development, and there is a lack of adequate legislation, policies and programming for persons with disability in Pakistan.
The Taraqee Foundation is a non-governmental and non-profit national level organization working in Pakistan since 1994. It has implemented several small and large scale projects to assist marginalized communities in far flung areas of Baluchistan and other provinces of
Pakistan. The Taraqee Foundation has vast experience of working on disability in the province and specifically in the district Ziarat, where has had a partnership with the Pakistan
Poverty Alleviation Fund in the scope of disability interventions for the last decade.
The Taraqee Foundation supported a regional implementation of the MDS in the district Ziarat of Baluchistan to estimate how many people have severe, moderate and mild
disability, and to identify the unmet needs as well as the barriers and inequalities faced by these persons in daily life. The data should be used to better plan services and policies for
persons with disability and to advocate for a national data collection in Pakistan.
Therefore, the objectives of the MDS in the Ziarat District, Balochistan, Pakistan are:
1. To estimate the prevalence of disability;
2. To determine the current disability distribution of the population; 3. To identify needs, barriers and inequalities faced by persons with different levels
of disability; 4. To provide the information necessary for the development of future policy
priorities to improve the lives of the population with disability in the Ziarat
District.
The sample size was extimated using the sample size determination formula for Lorenz's
cross-sectional studies and a total minimum of 545 individual participants was set as the target sample.
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2 Core results
2.1 Households
The mean, median and range of the number of people living in the 450 participating households by age category are given in Table 1. Table 1: Basic statistics of the number of people living in each household by age category
Age group Mean (SD) Median Range
Children up to 5 0.7622 (0.99) 0 0 - 4
Children between 5 and 18 2.331 (2.15) 2 0 - 12
Adults between 19-40 years old 2.596 (1.83) 2 0 - 11
Adults between 41-60 years old 0.8711 (0.84) 1 0 - 7
Adults older than 60 years old 0.5067 (0.69) 0 0 - 3
Total persons living in the household 7.067 (2.75) 7 2 - 15
The age and gender distribution of the people living in the selected households is visualized in Figure 1. Figure 1: Age and gender distribution of the of the people living in the selected households.
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2.2 Demographic characteristics
The demographic characteristics of the sample of 450 individuals living in the Ziarat District are given in Table 2. The sample included 300 men and 150 women. While women were balanced distributed regarding age, the large majority of men (62.5%) were aged 18 to 39
years old. While almost all men were working (89%), the large majority of women didn’t work for pay (78%). The percentage of persons without any education in mucher higher in
women (82%) than in men (22.3%). Given the large sex differences in the sample, results will be presented separately for men and women. Table 2: Demographic characteristics of the sample.
Total sample Men Women
Characteristic N % N % N %
Age group (years)
18-39 233 52.5 185 62.5 48 32.4
40-59 139 31.3 84 28.4 55 37.2
>60 72 16.2 27 9.1 45 30.4
Total 444 100% 296 100% 148 100%
Work status
Not working 150 33.3 33 11 117 78
Working 300 66.7 267 89 33 22
Total 450 100% 300 100% 150 100%
Education level
No education 190 42.2 67 22.3 123 82
Elementary 17 3.8 16 5.3 1 0.7
Vocational 41 9.1 34 11.3 7 4.7
Secondary 122 27.1 117 39 5 3.3
Higher 76 16.9 64 21.3 12 8
Other 4 0.9 2 0.7 2 1.3
Total 450 100% 300 100% 150 100%
Marital status
Single 83 18.4 72 24 11 7.3
Married or legal cohabitation
318 70.7 227 75.7 91 60.7
Widowed 49 10.9 1 0.3 48 32
Total 450 100% 300 100% 150 100%
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2.3 Disability
Disability is the outcome of the interaction between health conditions or impairments and features of the physical, human-built, attitudinal and socio-political environment in which
the person lives. Disability is also understood in the survey as a continuum, ranging from very low to severe levels of disability.
Figure 2 shows the continuum of disability in Ziarat, in a metrical scale ranging from low levels of disability (zero) to very high levels (100). This figure shows that the majority of
the sample experience moderate disability. However, important sex differences are observed in Figure 3: while the proportion of men with severe disability levels (dark blue)
is very small in the distribution for males, it is very high for females. Results presented in Table 3 corroborate these observations. Figure 2: Disability continuum for the Ziarat District
Figure 3: Disability continuum for the Ziarat district by sex
Men (N=300) Women (N=150)
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Table 3 shows the proportions of the sample with mild, moderate and severe disability, for
the total sample and by sex. Results are dramatically different for men and women. The severe disability rate is 16.2% for the complete sample, coming close to the 15% global estimate of WHO. However, wenn disagreggated by sex, the rate of severe disability is very
low for men, 3.3%, and very high for women, 42%. While approximately 60% of men have no or mild disability levels, only approximately 5% of the women included in this sample
have no or mild levels of disability. Indeed, the proportion of women with moderate or severe disability amounts to approximately 95%. Due to these very large differences, all results will be presented separately for men and women.
Table 3: Absolute numbers and percentages of persons with no, mild, moderate and severe disability, by gender.
Total sample Men Women
Disability level N % N % N %
No disability 51 11.3 51 17 0 0
Mild disability 136 30.2 128 42.7 8 5.3
Moderate disability 190 42.2 111 37 79 52.7
Severe disability 73 16.2 10 3.3 63 42
Total 450 100% 300 100% 150 100%
Table 4 shows the demographic characteristics of men and women by disability level.
Only 10 men (3.3%) had severe disability. This must be taken into account when interpreting results of this implementation. Comparing the 37% of men with moderate
disability to the men with no to mild disability, we observe: - No age-associated differences between the groups; - The higher the disability level, the higher the proportion of males not working;
- That males with severe disability have lower educational outcomes.
Only eight women (5.3%) had mild disability and no one had no disability. Comparing the
42% of women with severe disability to the 52.7% with moderate disability, we observe that: - Women with severe disability are older and more frequently widows;
- More women with severe disability do not work, but differences are not large; - No differences regarding education. Table 4: Demographic characteristics by disability level for men and women. No women had no
disability.
Characteristic
Men (N=300) Women (N=150)
Disability level Disability level
No Mild Moderate Severe Mild Moderate Severe
N % N % N % N % N % N % N % Age (years) 17-39 40 78.4 83 65.9 58 53.2 4 40 6 85.7 34 43.6 8 12.7
40-59 9 17.6 35 27.8 37 33.9 3 30 0 0 29 37.2 26 41.3
>60 2 3.9 8 6.3 14 12.8 3 30 1 14.3 15 19.2 29 46
Work status
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Characteristic
Men (N=300) Women (N=150)
Disability level Disability level
No Mild Moderate Severe Mild Moderate Severe
N % N % N % N % N % N % N %
Not working 1 2 11 8.6 15 13.5 6 60 4 50 58 73.4 55 87.3
Working 50 98 117 91.4 96 86.5 4 40 4 50 21 26.6 8 12.7
Education
No education 10 19.6 24 18.8 29 26.1 4 40 3 37.5 65 82.3 55 87.3
Elementary 2 3.9 7 5.5 7 6.3 0 0 0 0 1 1.3 0 0
Vocational 5 9.8 9 7 18 16.2 2 20 0 0 4 5.1 3 4.8
Secondary 24 47.1 58 45.3 33 29.7 2 20 1 12.5 2 2.5 2 3.2
Higher 10 19.6 29 22.7 23 20.7 2 20 4 50 5 6.3 3 4.8
Other 0 0 1 0.8 1 0.9 0 0 0 0 2 2.5 0 0
Marital status
Single 19 37.3 29 22.7 22 19.8 2 20 2 25 2 2.5 7 11.1
Married or legal
cohabitation
32 62.7 98 76.6 89 80.2 8 80 6 75 57 72.2 28 44.4
Widowed 0 0 1 0.8 0 0 0 0 0 0 20 25.3 28 44.4
The general severe disability prevalence for Ziarat District is 16.2%.
Extreme sex differences are observed: severe disability prevalence for Ziarat District is
3.3% in men and 42% in women.
2.4 Most affected daily life areas In the MDS disability is estimated based on problems reported in 17 functioning domains: mobility, hand and arm use, self-care, seeing, hearing, pain, sleep and energy, breathing,
affect, interpersonal relationships, handling stress, communication, cognition, household tasks, community and citizenship participation, caring for others and work and schooling.
Each domain is assessed with several questions covering different areas and presented in graphs in the next pages for men (blue graphs) and women (red graphs).
Extreme problems with mobility are presented in Figure 4 and are one of the most affected
life areas both for men and women. Considering males, extreme problems are overwhelmingly reported by the men with severe disability. Considering females, although women with severe disability report considerable more frequently extreme problems, many
mobility areas are very problematic for women with moderate disability.
Extreme problems with self-care are overwhelmenly reported by persons with severe disability (Figure 5) but also considerably affect women with moderate disability.
Extreme problems with seeing and hearing are shown in Figure 6. More women than men report extreme problems, except for hearing in a noisy room. Pain, sleep and lack of energy
(tiredness) affect mostly men with severe disability (Figure 7) while in women, extreme problems with pain, sleep and lack of energy (tiredness) are observed across disability levels
(Figure 7).
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Considerably more persons with severe levels of disability experience extreme problems
with breathing: approximately 40% men and 36.5% of the women report extreme problems with coughing or wheezing (Figure 8).
Extreme problems with interpersonal relationships mostly affect women with moderate and severe disability (Figure 9) and the same pattern is observed for depressive and anxiety
feelings (Figure 10). Extreme problems with communication are relatively seldom and mostly reported by women
with severe disability (Figure 11) while extreme problems with cognition are observed across disability levels overwhelmingly in women (Figure 12).
Regarding household tasks, managing money and providing care, mostly men and women with severe disability face extreme problems (Figure 13). The same pattern is observed for
participation in society (Figure 14).
Men face extreme problems applying for and getting a job, independently of their level of disability, as do almost all women with moderate or severe disability (Figure 15).
The proportions of men facing extreme problems applying for and getting a job is very high and independent of the level of disability, ranging from 83% to 95% (Figure 15). Similarly,
almost all women with moderate or severe disability face extreme problems applying for and getting a job (Figure 15). Regarding getting things done at work, the same pattern is
observed for men and women: the higher the level of disability, the higher the proportion of persons facing problems (Figure 15).
Almost all persons with severe disability face extreme problems to get an education and to get things done at school (Figure 15).
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Mobility Figure 4: Percentages of men (blue) and women (red) rating mobility domains as very problematic or extremely problematic, by disability level.
0 0 0 0 0 0 2
9.8
0.8 0 0.8 03.9
0.8 1.6
20.6
8.1
16.2
2.7 4.5
27.9
5.4 4.5
48.2
70
60
80
60
90
80
60
80
0
10
20
30
40
50
60
70
80
90
100
Standing up Standing for 30minutes
Getting out ofyour home
Walking 100m Walking 1 km Engaging invigorousactivities
Getting whereyou want to go
Using public orprivate
transportation
No Mild Moderate Severe
0 0
25
0 0 0 0
12.5
21.5 22.8 22.829.1
40.5
12.7
32.9
47
73
84.1 84.181 81
74.679.4
84
0
10
20
30
40
50
60
70
80
90
100
Standing up Standing for 30minutes
Getting out ofyour home
Walking 100m Walking 1 km Engaging invigorousactivities
Getting whereyou want to go
Using public orprivate
transportation
Mild Moderate Severe
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Self-care
Figure 5: Percentages of men (blue) and women (red) rating self-care aspects as very problematic or extremely problematic, by disability level.
0 0 0 0 00 0 0 0 00 0 0.93.6 3.6
60
20
70
60
80
0
10
20
30
40
50
60
70
80
90
100
Being clean anddressed
Eating Toileting Cutting your toenails Looking after yourhealth
No Mild Moderate Severe
0 0 0 0 0
17.7
6.3
26.6
10.1
19
76.2
41.3
77.8
54
60.3
0
10
20
30
40
50
60
70
80
90
100
Being clean anddressed
Eating Toileting Cutting your toenails Looking after yourhealth
Mild Moderate Severe
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Seeing and hearing Figure 6: Percentages of men (blue) and women (red) rating seeing and hearing as very problematic or extremely problematic, by disability level.
0 0 0 21.6 0 0 1.6
6.4 5.50
9
30
20
10
40
0
10
20
30
40
50
60
70
80
90
100
Seeing at a distance Seeing at arm's length Hearing in a quiet room Hearing in a noisy room
No Mild Moderate Severe
0 0 0 0
7.6 8.93.8
7.6
33.3 34.9
27 25.4
0
10
20
30
40
50
60
70
80
90
100
Seeing at a distance Seeing at arm's length Hearing in a quiet room Hearing in a noisy room
Mild Moderate Severe
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Pain and daily life energy Figure 7: Percentages of men (blue) and women (red) rating pain, sleep and feeling tired as very problematic or extremely problematic, by disability level.
0 0
5.9
0 0.83.9
7.2 912.6
40
50
60
0
10
20
30
40
50
60
70
80
90
100
Pain Sleep Feeling tired
No Mild Moderate Severe
12.5 12.5
0
27.8 30.436.7
58.7
46
63.5
0
10
20
30
40
50
60
70
80
90
100
Pain Sleep Feeling tired
Mild Moderate Severe
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Breathing
Figure 8: Percentages of men (blue) and women (red) rating breathing as very problematic or extremely problematic, by disability level.
0 00 02.7 1.8
10
40
0
10
20
30
40
50
60
70
80
90
100
Shortness of breath Coughing or wheezing
No Mild Moderate Severe
0 0
7.6 6.3
31.736.5
0
10
20
30
40
50
60
70
80
90
100
Shortness of breath Coughing or wheezing
Mild Moderate Severe
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Interpersonal relationships Figure 9: Percentages of men (blue) and women (red) rating areas of interpersonal relationships as very problematic or extremely problematic, by disability level.
0 0 0 00.8 0.8 0.8 00.9
8.1 6.3 5.90
30
10 11.1
0
10
20
30
40
50
60
70
80
90
100
Getting along with peopleclose to you
Dealing with people you donot know
Initiating and maintainingfriendships
Intimate relationships
No Mild Moderate Severe
0 0 0 0
16.9 19.2 21.116.9
47.6
61.3
45.741.2
0
10
20
30
40
50
60
70
80
90
100
Getting along with peopleclose to you
Dealing with people you donot know
Initiating and maintainingfriendships
Intimate relationships
Mild Moderate Severe
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Handling stress and emotional functions
Figure 10: Percentages of men (blue) and women (red) rating handling stress and emotional functions as very problematic or extremely problematic, by disability level.
7.82 0 01.6 1.6 0.8 1.6
11.7
2.7 1.87.2
30 30
50
60
0
10
20
30
40
50
60
70
80
90
100
Handling stress Coping with all the thingsyou have to do
Feeling sad, low ordepressed
Feeling worried or nervous
No Mild Moderate Severe
12.5
25
12.5
25
44.339.2
46.8
65.8
74.6
66.7
79.484.1
0
10
20
30
40
50
60
70
80
90
100
Handling stress Coping with all the thingsyou have to do
Feeling sad, low ordepressed
Feeling worried or nervous
Mild Moderate Severe
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Communication Figure 11: Percentages of men (blue) and women (red) rating communication as very problematic or extremely problematic, by disability level.
0 00 00 0.9
10 10
0
10
20
30
40
50
60
70
80
90
100
Being understood Understanding others
No Mild Moderate Severe
0 0
7.63.8
25.428.6
0
10
20
30
40
50
60
70
80
90
100
Being understood Understanding others
Mild Moderate Severe
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Cognition Figure 12: Percentages of men (blue) and women (red) rating cognition areas as very problematic or extremely problematic, by disability level.
0 0 01.6 0 0.8
17.1
2.75.4
30 30
20
0
10
20
30
40
50
60
70
80
90
100
Forgetfulness Remembering to do important things inday-to-day life
Finding solutions to day-to-dayproblems
No Mild Moderate Severe
37.5
25 25
39.2
55.7
48.1
76.2 77.8 77.8
0
10
20
30
40
50
60
70
80
90
100
Forgetfulness Remembering to do important things inday-to-day life
Finding solutions to day-to-dayproblems
Mild Moderate Severe
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Handling household tasks
Figure 13: Percentages of men (blue) and women (red) rating household tasks, managing money and providing care areas as very problematic or extremely problematic, by disability level.
03.9 20.8
70.8
4.5
20.7
11.7
80
70
77.8
0
10
20
30
40
50
60
70
80
90
100
Household tasks Managing money you have Providing care to others
No Mild Moderate Severe
12.5
50
0
29.1
50.6
26.6
82.576.2
72.6
0
10
20
30
40
50
60
70
80
90
100
Household tasks Managing money you have Providing care to others
Mild Moderate Severe
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Participation in society
Figure 14: Percentages of men (blue) and women (red) rating participation areas as very problematic or extremely problematic, by disability level.
0 04.2
00.8 0
11.2
05.5 5.4
31.4
4.5
50
6055.6
40
0
10
20
30
40
50
60
70
80
90
100
Doing things for relaxationor pleasure
Joining community activities Engaging in local or nationalpolitics or civil society
organizations
Voting in last election
No Mild Moderate Severe
0
12.5
50
2519
33.3 35.5
5052.4
77.4
69
80
0
10
20
30
40
50
60
70
80
90
100
Doing things for relaxationor pleasure
Joining community activities Engaging in local or nationalpolitics or civil society
organizations
Voting in last election
Mild Moderate Severe
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Work and Education
Figure 15: Percentages of men (blue) and women (red) rating work and education areas as very problematic or extremely problematic, by disability level.
89.5
4
38.7
0
94.4
6.8
31.4
18.8
95
35.6
44
14.3
83.3
50
100
0
10
20
30
40
50
60
70
80
90
100
Applying for and getting a job Getting things done at work Getting an education Getting things done at school
No Mild Moderate Severe
40
14.3
25 25
100
50
42.946.7
9591.4
88.9
100
0
10
20
30
40
50
60
70
80
90
100
Applying for and getting a job Getting things done at work Getting an education Getting things done at school
Mild Moderate Severe
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2.5 Health
2.5.1 Health conditions and impairments
Figure 16 shows the prevalence of self-reported health conditions or impairments by disability level, for men (blue) and women (red).
The top most common self-reported health conditions or impairments for men are: - Severe disability: depression, hypertension, diabetes, arthritis/arthrosis, back pain,
stroke, anxiety and skin diseases; - Moderate disability: depression, anxiety, vision loss, hypertension, kidney diseases; - Mild disability: vision loss, kidney diseases, anxiety, gastritis and hypertension.
The top most common self-reported health conditions or impairments for women are:
- Severe disability: depression, back pain, hypertension, kidney diseases, vision loss, hearing loss, arthritis/arthrosis, heart diseases, diabetes;
- Moderate disability: back pain, kidney diseases, hypertension, depression, vision loss,
arthritis/arthrosis, hearing loss; - Mild disability: back pain, hypertension, kidney diseases, arthritis/arthrosis, diabetes,
gastritis, migraine, asthma. Important to note are the very high prevalences of depression, back pain, hypertension and
kidney diseases across disability levels. All these prevalences are much higher in women than in men.
Figure 16: Self-reported health conditions or impairments, by disability level, for men (blue) and
women (red).
37.8
18
3.68.1
14.4
4.5
27
3.6
26.1
1.8
92.7 2.7 4.5 5.4
18
40
30 30
20 20 20 20 20
10 10 10 10 10 10 10 10 10
0
10
20
30
40
50
60
70
80
90
100
Mild Moderate Severe
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2.5.2 Capacity Capacity, or health state, is defined as the synthesis of all intrinsic physical and mental
capacities of a person, determined solely by his or her health conditions or impairments. A capacity score is estimated for every respondent based on difficulties in 17 functioning
domains (module 5000). Table 5 shows the proportions of the sample with mild, moderate and severe capacity
difficulties. Estimates are very similar to the disability estimates and show that the impact of the environment is not facilitating but hindering.
Table 5: Distribution of sample by capacity level
Total sample Men Women
Capacity level N Percentage* N Percentage* N Percentage*
No difficulties 88 19.6 88 29.3 0 0 Mild difficulties 103 22.9 98 32.7 5 3.3 Moderate difficulties 188 41.8 104 34.7 84 56 Severe difficulties 71 15.8 10 3.3 61 40.7
Total 450 100% 300 100% 150 100% *Weighted percentage takes into account the sampling weight.
0
37.5
12.5 12.5 0 0 12.5 0 12.5 0 0 0
12.5 12.5
0 0 0 12.5
35.4
45.6
38 39.2
24.1
11.4
24.1
5.18.9
5.1 2.5 2.5 0
1.3
1.3 0 1.3
3.8
65.1
57.1
49.244.4
38.1
23.8
23.8
22.2 20.6
9.5 4.8 4.8
3.2
1.6 1.6
1.61.6
00
10
20
30
40
50
60
70
80
90
100
Mild Moderate Severe
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2.6 Work
Approximately 28% of the men with severe disability are not working, compared to 0.8%
of the men with mild disability, and the higher the disability level, the lower the rates of men working for wages (Figure 17).
Approximately 70% of the women with severe disability and 40% of the women with moderate disability are not working, compared to 33.3% of the women with mild disability.
No women with severe disability is working for wages while approximately 7% work as unpaid family member (Figure 17). Figure 17: Work status of those who have ever worked, by disability level, for men (blue) and women (red).
0.8
41.2
21.8
35.3
0 0.80
26.720.8
47.5
0 0
28.6
14.3 14.3
28.6
14.3
00
10
20
30
40
50
60
70
80
90
100
Not working Working for wages Self-employed Working unpaidfamily member
Retired, healthcondition
Retired, age
Mild Moderate Severe
33.3
50
0
16.7
0
43.237.8
0
18.9
0
71.4
07.1
14.3
7.1
0
10
20
30
40
50
60
70
80
90
100
Not working Working for wages Working for wages, onleave
Self-employed Working unpaid familymember
Mild Moderate Severe
MODEL
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2.7 Education
Figure 18 shows highest educational achievement. For men, the highest the level of disability, the higher the proportion of men with no education: from all men with no
education, approximately 43.3 % have moderate disability. For women, allmost all women with no education have either moderate or severe disability.
Figure 18: Highest level of education achieved, by disability, for men (blue) and women (red).
14.912.5
14.7
20.5
15.6
35.8
43.8
26.5
49.6
45.343.3 43.8
52.9
28.2
35.9
6
0
5.9
1.7 3.1
0
10
20
30
40
50
60
No education Elementary Vocational Secondary Higher
No Mild Moderate Severe
0 0 0 0 02.4 0 0
20
33.3
52.8
100
57.1
40 41.744.7
0
42.9 40
25
0
20
40
60
80
100
120
No education Elementary Vocational Secondary Higher
No Mild Moderate Severe
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2.8 Environmental factors
Environment is broadly defined in the MDS as the external factors that contribute to the lived experience of the individual, such as the availability of assistive devices, a supportive
family structure, the attitudes of peers, accessibility to health care or accessibility of transportation. Environmental factors disclosure needs, inequalities and barriers.
2.8.1 General environment
Very high proportions of men and women with any level of disability, but mostly the ones with severe disability, experience the physical environment as hindering or very hindering (Figure 19). Transportation, health facilities, workplace or school, and shops, banks and
post offices in the neighborhood are among the most hindering ones. Figure 19: Percentages of persons reporting that aspects of the general physical environment are hindering or very hindering, by disability level, for men (blue) and women (red).
0.0
11.8
0.0
13.77.8
2.0 2.07.8
11.9
29.7
7.9
43.0
0.8
15.6
8.6 8.6
34.4
27.5
49.5
20.7
63.1
36.0
4.5
11.7
24.3
0.9
85.790.0
50.0
88.9
30.0
90.0
60.0 60.0
40.0
20.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
workplace orschool
health facilities places tosocialize
shops, banks,post offices
places ofworship
transportation dwelling toilet of thedwelling
temperature,terrain and
climate
lightning, noiseand crows
No Mild Moderate Severe
50.0
12.5
0.0
16.7
0.0
12.5 12.5
0.0 0.0 0.0
68.2
38.0 39.7 39.6
8.3
46.2
8.9
31.636.7
7.6
90.5
78.7 81.4
88.9
37.3
82.5
50.0
79.4
69.8
50.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
workplace orschool
health facilities places tosocialize
shops, banks,post offices
places ofworship
transportation dwelling toilet of thedwelling
temperature,terrain and
climate
lightning, noiseand crows
Mild Moderate Severe
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27
2.8.2 Personal assistance
A total of 26 men (70% with severe disability) and 57 women (58.7% with severe disability) report having personal assistance, mostly unpaid assistants (Table 6).
Of those, eight men (75% with severe disability) and 16 women (29.7% with severe disability) respond that they would need more assistance. Altogether 27 men and 7 seven
women report having no personal assistance but needing it. Table 6: Percentage of persons reporting personal assistance, by disability and sex.
Men (N=300) Women (N=150)
N No Mild Moderate Severe N Mild Moderate Severe
Persons with personal assistance 26 11.8% 3.1% 8.1% 70% 57 0 25.3% 58.7%
Paid or charity organizations assistants 4 20% 50% 12.5% 14.3% 6 - 10% 10.8%
Unpaid assistants (family members, friends or volunteers)
17 60% 0% 87.5% 100% 55 - 100% 94.6%
Both paid and unpaid assistants 3 20% 0% 12.5% 14.3% 5 - 10% 8.1%
Persons with personal assistance who need more assistance
8 0 0% 22.2% 75% 16 - 23.8% 29.7%
Persons with no personal assistance who need assistance
27 4.3% 7.9% 13.7% 50% 7 0 3.4% 19.2%
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2.8.3 Attitudes of others
Extreme problems with attitudes of others are experienced by relatively high proportions of persons across disability levels (Figure 20 and Figure 21). However, persons with severe disability are frequently worst off: not being able of making big decisions in life is an extreme
problem for 60% of men with severe disability, while people not expecting much of oneself is a problem for 54% of women with severe disability. Women have more problems with
attitudes, across disability levels.
Figure 20: Percentage of persons endorsing mostly or completely to questions about attitudes of others, by disability level, for men (blue) and women (red).
52.9
3.9 3.9
21.625.5 23.5
28.9
13.3
3.9
30.527.3
9.411.7
38.7
3.6
17.1
42.3
10.8
30
10
40
30
60
20
0
10
20
30
40
50
60
70
80
90
100
Getting involved insociety
Being treatedunfairly
Considering oneselfa burden to society
People becomeimpatient with you
People don't expectmuch from you
Living with dignityis a problem
No Mild Moderate Severe
0 0 0 0
25
0
16.522.8
8.913.9
22.8
13.9
34.941.3
34.928.6
54
39.7
0
10
20
30
40
50
60
70
80
90
100
Getting involved insociety
Being treatedunfairly
Considering oneselfa burden to society
People becomeimpatient with you
People don't expectmuch from you
Living with dignityis a problem
Mild Moderate Severe
MODEL
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Figure 21: Percentage of persons endorsing no or not at all to questions about attitudes of others, by disability, for men (blue) and women (red).
11.8 11.817.6
13.7
27.9
13.3 14.1
5.5 3.98.1 9.9 9.9 8.1
3.6
20 20
60
10
20
0
10
20
30
40
50
60
70
80
90
100
Participate in familydecisions
Make own choicesabout your day-to-day
life
Make big decisions inyour life
Feel that others acceptyou
Feel that othersrespect you
No Mild Moderate Severe
75 75
50
0 0
51.9
32.9
53.2
21.513.9
47.6
20.625.4
17.511.1
0
10
20
30
40
50
60
70
80
90
100
Participate in familydecisions
Make own choicesabout your day-to-day
life
Make big decisions inyour life
Feel that others acceptyou
Feel that othersrespect you
Mild Moderate Severe
MODEL
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2.8.4 Access to information
Table 7 reports access to information by disability level. The largest proportions of men with no or mild disability have partly access to information while the largest proportions of men with moderate or severe disablity, have a little and not at all access, respectively. Most
women with mild or moderate disability have no access to information while most women with severe disability have partly access. Figure 22 shows the rates of persons with not at
all or little access to information they need or want by disability level and sex. Table 7: Percentage of persons with access to the information (Do you have access to the
information you need or want?) by disability level and sex.
Do you have
access to the
information you
need or want?
Men Women
Disability level Disability level
No Mild Moderate Severe Mild Moderate Severe
Not at all 3.9% 4.7% 5.4% 30% 75% 46.2% 30.2%
A little 15.7% 21.9% 45.9% 20% 0 14.1% 3.2%
Partly 33.3% 50% 36.9% 10% 25% 23.1% 42.9%
To some extend 17.6% 14.1% 9% 20% 0 10.3% 17.5%
Completely 29.4% 9.4% 2.7% 20% 0 6.4% 6.3%
Total 100% 100% 100% 100% 100% 100% 100%
Figure 22: Rates of persons with not at all or little access to information they need or want, by
disability and sex.
19.626.6
51.3 50
75
60.3
33.4
0
10
20
30
40
50
60
70
80
90
100
No Mild Moderate Severe
Men Women
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2.8.5 Regular use of medication
Figure 23 shows regular medicine intake by disability level: as expected, the higher the disability level, the higher the proportion of persons taking medicines, for men and women. Figure 23: Regular medicine intake (percentages of persons) by disability level and sex.
2.8.6 Assistive products and modifications
Figure 24 shows unmet needs of assistive products and facilitators among those who do
not already use products, by disability level and sex.
Figure 24: Percentage of men (blue) and women (red), who do not use products, reporting unmet needs of assistive products and modifications, by disability level.
10.9
34.2
70
25
36.7
68.3
0
10
20
30
40
50
60
70
80
No Mild Moderate Severe
Male Female
1.64.9
0.8 0.8
12.8
70
16.5
23.6
12.117.3
1.8 2.7
33
4044.5
48.2
16.722.2
10 10
28.6
50
60
0
10
20
30
40
50
60
70
80
90
100
Mobility andself-care
Seeing Hearing Cognition Work Education Home Community
Mild Moderate Severe
MODEL
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Very few persons in the sample report the use of assistive technologies, and the most
commonly used ones are for mobility and self-care (11 men and 20 women use them, almost all with severe disability) and seing (10 men and 7 women use them, almost all with severe disability) (Table 8).
Table 8: Percentage of persons reporting use and additional need of assistive products and modifications by disability level and sex.
Men Women
N Mild Moderate Severe N Mild Moderate Severe
Mobility and self-care Use 11 10% 33.3% 80% 20 - 30.8% 80%
Use but need more 11 100% 100% 100% 18 - 50% 100%
Seeing Use 10 50% 26.3% 25% 7 - 15.4% 25%
Use but need more 6 50% 60% 100% 4 - 50% 60%
Education Use 1 10% 0% - 0 0% 0% 0%
Use but need more 1 100% - - 0 - - -
Modifications home Use 3 0% 0.9% 20% 1 0% 0% 1.6%
Use but need more 1 - 0% 50% 1 - - 100%
Modifications in the community
Use 4 0.8% 2.7% 0% 0 0% 0% 0%
Use but need more 5 100% 100% - 0 - - -
12.5
0 0 0 0 0 0 0
21.118.2
5.12.5
4.7
0
13.9
8.9
43.8
20.7
9.5
25.4
2.20
14.5
22.2
0
5
10
15
20
25
30
35
40
45
50
Mobility andself-care
Seeing Hearing Cognition Work Education Home Community
Mild Moderate Severe
MODEL
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33
2.9 Health care responsiveness
Figure 25 reports inpatient and outpatient health care utilization and access to care, by disability level and sex. Regarding men, 20% of men with severe disability report that they
didn’t receive the care they needed while 42.9% of the women who needed inpatient care report that they have not received it. Figure 25: Percentage of men (blue) and women (red) who used and didn’t get care by disability level.
Figure 26 shows how satisfied persons are with the health care they receive. A clear
difference between women with mild disability and women with moderate to severe disability is observed, with the latter being considerably less satisfied with all aspects. For
men, the pattern is also observed but less clear, what could be due to the fact that only 3.3% of men have severe disability.
0
100
11.110.9
0
92.2
3.412.2
0
87.8
2.5
60
0
100
20
0
20
40
60
80
100
120
Inpatient care used in thepast 3 years
Inpatient care needed but notreceived
Outpatient care used in thepast year
Outpatient care needed butnot received
No Mild Moderate Severe
0
100
0
10.3
0
74.1
0
28
42.9
70
2.9
0
20
40
60
80
100
120
Inpatient care used in thepast 3 years
Inpatient care needed but notreceived
Outpatient care used in thepast year
Outpatient care needed butnot received
Mild Moderate Severe
MODEL
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Figure 26: Percentages of men (blue) and women (red) endorsing aspects of the health system as good or very good, by disability.
66.7
77.8
88.9
77.8
88.9
77.8 77.8
44.4 44.442.2
84.4
76.681.2
67.2 67.2 67.2
25
37.5
17.8
57.8 55.6 54.448.9 48.9
52.2
11.1
25.6
40
80
30 30
40
70 70
30
20
0
10
20
30
40
50
60
70
80
90
100
Waitingtimes
Beingtreated with
respect
How clearhealth
providersexplainthings
Beinginvolved in
makingdecisions for
yourtreatment
Privacy Easeness ofchoosing ahealth care
provider
Cleanlinessof the health
facility
Satisfactionwith how thehealth careservices are
run inBalochistan
Satisfactionwith how
health carein Pakistan
involves youin deciding
whatservices to
provide andwhere
No Mild Moderate Severe
83.3
66.7
100
66.7 66.7
50
100 100 100
34.5
49.145.6
36.8
49.1 49.156.1
50.9
59.6
20.4
48 4840
4638
4436
44
0
10
20
30
40
50
60
70
80
90
100
Waiting times Being treatedwith respect
How clearhealth
providersexplain things
Being involvedin making
decisions foryour
treatment
Privacy Easeness ofchoosing ahealth care
provider
Cleanliness ofthe health
facility
Satisfactionwith how thehealth careservices are
run inBalochistan
Satisfactionwith how
health care inPakistan
involves you indeciding what
services toprovide and
where
Mild Moderate Severe
MODEL
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35
2.10 Well-Being
The MDS contains eight questions about quality of life, that are suitable for calculating a quality of life score ranging from 8.0 to 40.0, higher scores pointing out higher quality of
life. As shown in Figure 27, the higher the level of disability, the lower the quality of life. Figure 27: Mean quality of life score, by disability level and sex.
Disclaimer
The authors are staff members of the World Health Organization. The authors alone are
responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization.
WHO/NMH/NVI/18.17
© World Health Organization 2018 Suggested citation. Model Disability Survey General Results: Ziarat District, Balochistan
Province, Pakistan. Geneva: World Health Organization; 2018 (WHO/NMH/NVI/18.17). Licence: CC BY-NC-SA 3.0 IGO
34.53
27.64
20.50
28.75
25.97
22.89
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
No Mild Moderate Severe
Male Female