National Disability Survey Research Articles

Gender and socio-economic inequalities in health and living conditions among co-resident informal caregivers: a nationwide survey in Spain.

To explore the associations between social determinants, caregiver's network support, burden of care and their consequences in health and living conditions of informal caregivers. The socio-demographic trends regarding population ageing and changes in family models trigger an increased demand for care. Cross-sectional study based on the 2008 edition of the National Disability, Independence and Dependency Situations Survey (DIDSS-2008) conducted by the National Statistics Institute in Spain. Analyses focused on persons identified as primary caregivers who co-reside with the dependent person. The associations between social determinants of caregivers, burden of care, support network and problems attributed to informal care (impaired health, depression, professional, economic and personal issues) were estimated by fitting robust Poisson regression models. Analyses were conducted separately for women and men. The study sample included 6923 caregivers, 73% of women and 27% of men. Gender and socio-economic inequalities were found in assumption of responsibilities and burden of caring for dependents, which tend to fall more on women and persons of lower socio-economic level, who in turn have less access to formal support. These aspects translate into a higher prevalence of health, professional, economic and personal problems. The study highlights gender and socio-economic inequalities in informal caregiving and its negative consequences. These findings may be useful in the design of policies and support programmes targeting the most affected groups of informal caregivers.

Prevalence of Traumatic Brain Injury (TBI) disability: A national population-based survey

Traumatic Brain Injury (TBI) epidemiological literature lacks information on prevalence of TBI-related disability, and on its long-term consequences on a population-based scale. A National Disability and Health Survey was conducted in French households and institutions in 2008–2009. Participants were 33,896 adults representative of 49 million individuals. Face-to-face interviews addressed medical conditions including sequelae from TBI, impairments, activities and participation, health and use of health services. Disability levels of persons with TBI were derived from the Glasgow Outcome Scale. Weighted analyzes were computed including comparisons adjusted on age and gender between persons with or without TBI. Prevalence of self-reported TBI sequelae was 0.7%. Persons with TBI sequelae were men for 62%; median age was 50; median time since injury was 13.9 years. Their disability level was vegetative state for 0.2%, severe disability for 22%, moderate disability for 37%, good recovery for 41%. For all items included in the Brief International Classification of Functioning Core Set for TBI, they declared higher impairments than the no-TBI population, with odds ratios ranging from 1.7 (behavioural difficulties) to 8.6 (motor difficulties). Rates of cardiovascular, respiratory, musculoskeletal, digestive, urological, neurological, and psychiatric conditions were all higher in the TBI population than in the no-TBI population, with highest odds ratios for the last two domains. Use of health care services was higher in the TBI population, and women with TBI had high rates of unmet needs for health services. Chronic sequelae from TBI are frequent and responsible for important disability in the general population. Associations with many other conditions justify lifelong specialized care.

Disability related to road traffic crashes among adults in Spain

BackgroundRoad traffic accidents cause substantial morbidity and disease burden; few studies have examined their impact on disability. ObjectiveTo estimate the magnitude and distribution of disability due to road traffic accidents according to socio-demographic variables, and its main socioeconomic and health determinants. MethodsA cross-sectional study was conducted in community-dwelling participants in the “2008 Spanish National Disability Survey”, a representative sample of 91,846 households with 20,425 disabled persons older than 15 years; 443 had disability due to road traffic accidents. ResultsThe prevalence was 2.1 per 1000 inhabitants (95% CI:1.8-2.3), with no differences by sex. Risk was highest among persons aged 31 to 64 years, and onset of disability showed a sharp inflection point at age 16 years in both sexes. Odds ratios (ORs) were higher (OR=1.3; 95% CI:1.1- 1.7) for participants with secondary education than for those with the lowest educational levels and were lower (OR: 0.5; 95% CI:0.3-0.8) for participants with the highest household income levels than for those with lowest. Only 24% of disabled participants were gainfully employed. As compared to other sources of disability, traffic crashes caused greater disability in terms of mobility (OR=3.1;p<0.001), a greater need for health/social services (OR=1.5;p=0.003), and more problems with private transportation (OR=1.6;p<0.001), moving around outside the home (OR=1.6;p<0.001) and changes in economic activity (OR=2.4;p<0.001). ConclusionsThe prevalence of disability due to road traffic accidents in Spain is lower than in other developed countries, with middle-aged and socio-economically underprivileged persons being the most affected. Disability due to road traffic accidents is related to a greater demand for social/health care support, problems of accessibility/commuting, and major changes in economic activity.

Screening for cervical cancer: What are the determinants among adults with disabilities living in institutions? Findings from a National Survey in France

ObjectivesTo explore the rate and determinants of the likelihood of cervical cancer screening participation among disabled women living in institutions in France. MethodsThe data source was the French national Health and Disability Survey—Institutions Section, 2009. Disability severity was assessed by scoring mobility and cognitive limitations. Chi-square tests revealed the significant factors associated with the screening rates; these factors were used in a multivariate logistic regression of Pap-test use within the 3 years prior to the interview (n=1052, women aged 20–65 years living in institutions for disabled adults). ResultsThe cervical cancer screening rate was particularly low in this population. After adjusting for all other covariates, women with more severe degrees of mobility or cognitive limitations had a lower likelihood of receiving a Pap test. Our findings also showed that being socially isolated, illiterate or underweight significantly decreased screening participation. ConclusionEven in institutions, disability severity remains a barrier to cancer screening. Given the increasing prevalence of disabling conditions and cancers, and the lack of previous studies on this specific topic, our findings are highly important from a policy point of view. These findings should alert health authorities to increase their efforts to provide medical care for institutionalized people with disabilities.

The effects of obesity and mobility disability in access to breast and cervical cancer screening in france: results from the national health and disability survey.

ObjectivesWe aimed to disentangle the effects of obesity and mobility limitation on cervical and breast cancer screening among community dwelling women.MethodsThe data source was the French national Health and Disability Survey - Household Section, 2008. The Body Mass Index (BMI) was used to categorize obesity status. We constructed a continuous score of mobility limitations to assess the severity of disability (Cronbach's alpha = 0.84). Logistic regressions were performed to examine the association between obesity, mobility limitations and the use of Pap test (n = 8 133) and the use of mammography (n = 7 561). Adjusted odds ratios were calculated (AOR). Interaction terms between obesity and the disability score were included in models testing for effect modifications.ResultsCompared with non-obese women, the odds of having a Pap test in the past 3 years was 24% lower in obese women (AOR = 0.76; 95% CI: 0.65 to 0.89), the odds of having a mammogram in the past 2 years was 23% lower (AOR = 0.77; 95% CI: 0.66 to 0.91). Each time the disability score was 5 points higher, the odds of having a Pap test decreases by 20% (AOR = 0.96; 95% CI: 0.94 to 0.98), the odds of having a mammogram decreases by 25% (AOR = 0.95; 95% CI: 0.94 to 0.97). There was no significant interaction between obesity and disability score.ConclusionObesity and mobility limitation are independently associated with a lower likelihood of cervical and breast cancer screening. Protective outreach and follow-up are necessary to reduce inequalities and thus to reduce health disparities in these vulnerable and high-risk populations of obese women with disabilities.

The effects of obesity and mobility disability in access to breast and cervical cancer screening in France: results from the National Health and Disability Survey

Objectives We aimed to disentangle the effects of obesity and mobility limitation on cervical and breast cancer screening among community dwelling women. Methods The data source was the French national Health and Disability Survey - Household Section, 2008. The Body Mass Index (BMI) was used to categorize obesity status. We constructed a continuous score of mobility limitations to assess the severity of disability (Cronbach's alpha = 0.84). Logistic regressions were performed to examine the association between obesity, mobility limitations and the use of Pap test (n = 8 133) and the use of mammography (n = 7 561). Adjusted odds ratios were calculated (AOR). Interaction terms between obesity and the disability score were included in models testing for effect modifications. Results Compared with non-obese women, the odds of having a Pap test in the past 3 years was 24% lower in obese women (AOR = 0.76; 95% CI: 0.65 to 0.89), the odds of having a mammogram in the past 2 years was 23% lower (AOR = 0.77; 95% CI: 0.66 to 0.91). Each time the disability score was 5 points higher, the odds of having a Pap test decreases by 20% (AOR = 0.96; 95% CI: 0.94 to 0.98), the odds of having a mammogram decreases by 25% (AOR = 0.95; 95% CI: 0.94 to 0.97). There was no significant interaction between obesity and disability score. Conclusion Obesity and mobility limitation are independently associated with a lower likelihood of cervical and breast cancer screening. Protective outreach and follow-up are necessary to reduce inequalities and thus to reduce health disparities in these vulnerable and high-risk populations of obese women with disabilities.

Counting disability: global and national estimation

Purpose: How many people with disabilities are in the world? How is disability defined? How can we measure disability in an accurate and comparable way? These are some of the key questions which the recently published World Bank/WHO World Report on Disability (WRD) addresses.Method: Multiple data sources and methods were used by WHO and the World Bank to estimate a global figure, with the ICF as the underlying data standard. Key international data sources were the World Health Survey of 2002–2004 and the 2004 updates from the Global Burden of Disease study. The World Report on Disability also includes a compilation of country-reported prevalence from census and surveys. This paper presents and discusses key findings of the Irish National Disability Survey (2006) to illustrate the value of the ICF framework for disability statistics and most especially the environmental factors component.Results: The World Report estimates that globally one billion people or 15% of the world’s population experience disabilities. Between 110–190 million people (2% of the world’s population) experience severe or extreme difficulties in functioning. Definitions and measures of disability vary widely across countries. The Irish Disability Survey shows the substantial impact of environmental factors on people’s functioning. For example, attitudes, and the presence or absence of facilitating equipment, support services, flexible working arrangements and transport significantly affect participation of people with disabilities in Irish society.Conclusions: To improve the quality of disability information, the World Report recommends the use of a common definition and concepts of disability based on WHO’s International Classification of Functioning Disability and Health (ICF). Furthermore, disability measurement needs to apply a multidimensional approach, in particular, measuring disability in terms of the level of difficulty a person is experiencing in multiple areas of life, rather than head counting severe impairment types in a dichotomous way. Environmental factors have significant effects on individual functioning and should be considered as an integral part in disability measurement.Implications for RehabilitationRehabilitation practitioners and researchers can be part of the international work towards an epidemiology of functioning and disability, by using a common language and frame of reference – the ICF – and by gathering and sharing information and statistics as recommended by the World Report on Disability.Better comparability between clinical or case based data and population data will also enable analyses which serve to improve the health of populations globally.Environmental factors – physical, social and attitudinal – must be recorded or measured as part of the context which influences the experience and level of functioning and can offer useful information to guide positive interventions.

A framework for collecting inclusive design data for the UK population

Successful inclusive product design requires knowledge about the capabilities, needs and aspirations of potential users and should cater for the different scenarios in which people will use products, systems and services. This should include: the individual at home; in the workplace; for businesses, and for products in these contexts. It needs to reflect the development of theory, tools and techniques as research moves on.And it must also to draw in wider psychological, social, and economic considerations in order to gain a more accurate understanding of users' interactions with products and technology. However, recent research suggests that although a number of national disability surveys have been carried out, no such knowledge currently exists as information to support the design of products, systems and services for heterogeneous users. This paper outlines the strategy behind specific inclusive design research that is aimed at creating the foundations for measuring inclusion in product designs. A key outcome of this future research will be specifying and operationalising capability, and psychological, social and economic context measures for inclusive design. This paper proposes a framework for capturing such information, describes an early pilot study, and makes recommendations for better practice.

Planning dementia services: new estimates of current and future prevalence rates of dementia for Ireland.

The paper provides new estimates of dementia prevalence at a national and local level in Ireland and new projections of future numbers of people with dementia. The prevalence of dementia at a national and local level has been calculated by applying European Collaboration on Dementia (EuroCoDe) prevalence rates to data from the Census of Population 2006. The National Disability Survey has been used to estimate the number of people with Down syndrome and dementia. Projections of future numbers of people with dementia have been calculated by applying EuroCoDe prevalence rates to the most recently available population projections from the Central Statistics Office (CSO). It is estimated that there were 41 740 people with dementia in Ireland in 2006. Estimates show that there are clear regional differences in prevalence of dementia across Ireland, with the largest proportion of people with dementia in the West of Ireland, and the Dublin North Eastern region having the lowest share of dementia. Our best estimate is that there are 700 people with Down syndrome and dementia in Ireland. Applying EuroCoDe prevalence rates to the most recent CSO population projections shows that the prevalence of dementia in Ireland will increase to between 67 493 and 70 000 in 2021 and to between 140 580 and 147 000 in 2041. Although there are several limitations to these estimates, the data provide timely and useful information for planning effective health and social care services, as well as raising public and professional awareness about dementia at a national level.

Road traffic disability in China: prevalence and socio-demographic disparities

Road traffic injuries are a population health problem worldwide especially in less-developed countries; however, little is known about road traffic disability (RTD). This study aims to estimate RTD prevalence and to explore RTD socio-demographic disparities if any within China. The 2006 China national disability survey was employed to derive a nationally representative sample. Trained physicians used consensus manuals to confirm physical disabilities that resulted from road accidents. Population-weighted prevalence was calculated. Multivariate logistic regression stratified by age was used to assess adjusted odds ratio (OR) and 95% confidence interval (CI). A weighted total of 1.5 million Chinese with RTD was identified, corresponding to a population-weighted prevalence of 1.12 (95% CI: 1.07-1.17) per 1000. The RTD prevalence was 0.13 (95% CI: 0.10-0.16) per 1000 among children aged 0-17 years compared with that of 1.44 (95% CI: 1.38-1.51) per 1000 among adults aged 18+ years. Elevated RTD odds were associated with increasing age in children, male gender, rural residence, lacking home ownership, not possessing electrical appliances, low education, lacking employment or low family income. The findings demonstrate RTD were commonplace among Chinese residents and highlight existing socio-demographic disparities. Road safety initiatives are warranted to prevent RTD in China.

Diagnostic status, functional status and complexity among Canadian children with neurodevelopmental disorders and disabilities: a population-based study

Purpose: To identify and describe selected key characteristics of children with neurodevelopmental disorders and disabilities (NDD/D) in a national disability survey database. Method: Secondary analysis of data on children aged 5–14 years in the Canadian Participation and Activity Limitation Survey (PALS). Children with NDD/D were ascertained from ICD-10 diagnoses “fine-tuned” with functional limitation information, and classified into six predetermined NDD/D subtypes by independent expert evaluators. Results: Children with NDD/D accounted for 73.5% of children with disabilities. Amongst children with a single NDD/D type, 28.8% were in the Cognition-Learning subgroup, 22.2% Psychological, 19.9% Social interactive, 13.3% Sensory, 10.6% Motor and 5.2% Speech-Language disorders/disabilities. Complexity, both diagnostic (more than one ICD-10 diagnosis) and functional (more than one parent-identified functional limitation), was encountered frequently though variably across NDD/D subtypes. In aligning parent-identified functional limitation information with researcher-ascertained assignment of children to NDD/D subgroups, matching with additional limitations (61.3% of children) occurred far more commonly than simple 1:1 matches (14.0%) or non-matching (24.7%). Conclusions: Conceptual, definitional and terminology issues affect population-based research on children with NDD/D. Ascertainment methods can use diagnostic as well as functional information. Diagnostic information alone is likely to under-represent the complexity and needs of children with NDD/D and their families.Implications for RehabilitationIdentification of children with neurodevelopmental disorders and disabilities (NDD/D) in population-based studies can include diagnostic and functional information.Diagnostic and functional complexity are both common amongst children with NDD/D.Diagnostic information alone tends to under-describe the functional complexity of children with NDD/D; comprehensive rehabilitation planning needs to consider functional complexity.

Prevalence and features of ICF-disability in Spain as captured by the 2008 National Disability Survey

BackgroundSince 1986, the study of disability in Spain has been mainly addressed by National Disability Surveys (NDSs). While international attempts to frame NDS designs within the International Classification of Functioning, Disability and Health (ICF) have progressed, in general, the ICF has hardly been used in either the NDS or epidemiological studies. This study sought to identify ICF Activity- and Participation-related content in the most recent Spanish NDS, the 2008 Survey on Disabilities, Independence and Dependency Situations (Encuesta sobre discapacidades, autonomía personal y situaciones de Dependencia - EDAD 2008), and estimate the prevalence of such ICF-framed disability.MethodsEDAD 2008 methods and questions were perused. Of the 51 EDAD items analysed, 29 were backcoded to specific d2-d7 domains of the ICF Checklist and, by rating the recorded difficulty to perform specific tasks with or without help, these were then taken as performance and capacity respectively. A global ICF score was also derived, albeit lacking data for d1, "Learning and applying knowledge", d8, "Major Life Areas" and d9, "Community, Social and Civic Life". Data were grouped by sex, age, residence and initial positive screening, and prevalence figures were calculated by disability level both for the general population, using the originally designed weights, and for the population that had screened positive to disability. Data for institutionalised persons were processed separately.ResultsCrude prevalence of ICF severe/complete and moderate disability among the community-dwelling population aged ≥6 years was 0.9%-2.2% respectively, and that of severe/complete disability among persons living in sheltered accommodation was 0.3%.Prevalence of severe/complete disability was: higher in women than in men, 0.8% vs. 0.4%; increased with age; and was particularly high in domains such as "Domestic Life", 3.4%, "Mobility", 1.8%, and "Self-care", 1.9%, in which prevalence decreased when measured by reference to performance. Moreover, global scores indicated that severe/complete disability in these same domains was frequent among the moderately disabled group.ConclusionsThe EDAD 2008 affords an insufficient data set to be ICF-framed when it comes to the Activity and Participation domains. Notwithstanding their unknown validity, ratings for available ICF domains may, however, be suitable for consideration under the ADL model of functional dependency, suggesting that there are approximately 500,000 persons suffering from severe/complete disability and 1,000,000 suffering from moderate disability, with half the latter being severely disabled in domains capable of benefiting from technical or personal aid. Application of EDAD data to the planning of services for regions and other subpopulations means that need for personal help must be assessed, unmet needs ascertained, and knowledge of social participation and support, particularly for the mentally ill, improved. International, WHO-supported co-operation in ICF planning and use of NDSs in Spain and other countries is needed.

Using the ICF in Ireland

This paper reflects on the use of ICF in Ireland, taking as a case study the experience of the first National Disability Survey (NDS). There were four clear effects in Ireland of using ICF as a framework for the NDS: a) that a broader range of people with disabilities was encompassed; b) that the environmental factors included from the ICF were comprehensive and policy relevant; c) that both barriers and facilitators were incorporated into the model; and d) that a focus on research ethics was encouraged. Some general conclusions regarding the benefits and limitations of ICF based on this experience are also drawn.

Regional variations in and correlates of disability-free life expectancy among older adults in China

BackgroundConsiderable socioeconomic and health inequalities have been reported in China. However, because of a lack of appropriate data, limited research has been conducted on variations in disability-free life expectancy (DFLE) among older adults. This study aimed to use the most up-to-date disability survey data to explore geographical variations in DFLE at age 60 in China and to identify the socioeconomic and health care factors that partially account for these variations.MethodsThis study used 2006 mortality data extrapolated from the 1990 and 2000 Census and disability data from a national disability survey conducted in 2006. Disability was performance based and was diagnosed by trained physicians. DFLE was calculated by region using the Sullivan method. Multiple linear regression models by gender were conducted to explore correlates of DFLE.ResultsDFLE at age 60 varied widely by region, from 11.2 to 20.8 years in 2006. Per capita gross domestic product, proportion of urban residents, and access to health care were the primary factors associated with geographical variations in DFLE.ConclusionThe pattern of differences in DFLE by region mirrors the pattern of regional economic development in China. Countermeasures to decrease regional differences in DFLE include accelerating regional economic development and improving health care distribution.

Towards comparability of data: using the ICF to map the contrasting definitions of disability in Irish surveys and census, 2000–2006

Purpose. To examine how disability was measured and understood within Irish data sources 2000–2006, using the International Classification of Functioning, Disability and Health (ICF) as a guiding framework for a more comprehensive and transformative definition of disability.Method. During the EU-funded Measuring Health and Disability in Europe (MHADIE) project (2003–2006), an audit of data sources which included a disability identifier question was conducted. Thirty Irish data sources were examined in total. An overview of these data sources was provided in ‘Disability Data Sources in Ireland’ (National Disability Authority, unpublished, 2007). Using guidelines developed by Cieza et al. (J Rehabil Med 2002;34:205–210, J Rehabil Med 2002;27:212–218) five data sources were selected for detailed examination and were mapped to the ICF. These were the census (2006), National Disability Survey (2006), National Physical and Sensory Disability Database (2006), Survey of Lifestyles, Attitudes and Nutrition (2002), Euro Student Survey (2003). Subsequent work conducted after the completion of the MHADIE project added to the findings.Results and conclusions. The environmental dimension of disability dominated the data collection exercises which used the ICF as their framework-for the National Disability Survey (NDS) and the National Physical and Sensory Disability Database (NPSDD). Both also had strong focus on activity and participation. When mapped on to the ICF, the data sources which preceded the ICF or did not use it, are shown to focus more on activity and participation data than any other ICF component. Across the five selected data sources, limited information was collected on body function and body structure.

Extending the capability paradigm to address the complexity of disability

Amartya Sen looks at people's well-being in terms of functioning and freedom, rather than in terms of the amount of goods or services consumed. The capability approach, developed by Sen, deals with what people are able to achieve by using these commodities. Concerning disability, he wrote: “We must take note that a disabled person may not be able to do the many things that an able-bodied individual can, with the same bundle of commodities” [Sen, A. K. (1985). Commodities and capabilities. Oxford: Oxford University Press [1999], p. 7]. The capability approach makes it possible to analyse the economic situation of people with disabilities in a different way. What becomes important is their functioning, i.e. what they are able to achieve within a given context. In fact, the capability set includes not only what a person is effectively able to achieve, but also the potential functionings that he/she can choose. This expresses the degree of freedom that a person with disability benefits from in a given environment. The challenge is therefore to reduce the constraints that the environment adds to a person's impairment in order to expand their capability set and to allow them to live a life which they value. This paper reviews the paradigms that address disability and the ways of assessing a person's capability set within this framework. Achieved functionings are easily measured through cross-sectional surveys, using counterfactual analysis to compare the situations of disabled and non-disabled people. This was done in 2005 in Afghanistan when a national disability survey was carried out on a random sample of households. Measuring detailed capabilities, especially their freedom dimension, is quite complex and requires identifying people's potential choices in an ever-changing environment. This implies a need to extend the philosophical framework and to adopt appropriate statistical methodologies.

Trends in Disability-Free Life Expectancy Among Chinese Older Adults

This study evaluates trends in disability-free life expectancy (DFLE) of Chinese adults aged 60 and older. Based on two national disability surveys in 1987 and 2006 as well as mortality data from World Population Prospects, the Sullivan method was used to calculate DFLE. DFLE increased from 13.0 to 13.9 years at age 60 and from 1.2 to 1.5 years at age 90 in 1987 and 2006, respectively. The proportion of DFLE increased after age 75. The proportion of DLE(x) with severe disability decreased while that of least disability increased. Onset of disability was delayed from 0.3 years to 4.7 years across disability types. Trends in DFLE by age and severity of disability as well as the delayed onset of disability provide evidence for the compression of morbidity among the oldest old in China. But a similar trend was not found among the young-old.

Lack of a Will or of a Way? Taking a Capability Approach for Analysing Disability Policy Shortcomings and Ensuring Programme Impact in Afghanistan

The present paper attempts to analyse some of the shortcomings that have impeded efforts in the field of disability policy in Afghanistan. After an overview of recent disability initiatives, this paper attempts to explain why they have had a limited impact. The context of a Conflict-Affected Fragile State makes the development of state capacity to deliver basic services for the population particularly difficult. To help overcome these shortcomings, it is argued that Amartya Sen's Capability Approach constitutes a relevant framework for designing disability policy and implementation. Although the definition of human development has evolved considerably over the past decade, the transition from theory to action has been disappointing. Through the example of the National Disability Survey in Afghanistan we argue that one reason for this is the paucity of knowledge and the insufficient focus placed on enhancing the agency of vulnerable groups.

Speech, hearing, and communication across five national disability surveys: Results of a DISTAB study using the ICF to compare prevalence patterns

This paper describes how the International Classification of Functioning, Disability and Health (ICF) can be used as a statistical tool and addresses the implications of the DISTAB study in which speech, hearing and communication prevalence rates were examined in adults across five countries—Canada, France, the Netherlands, South Africa and the United States. The implications of the study results for hearing and swallowing disorders as well as the methodological issues raised by the DISTAB study are described. The authors also address the role of ICF and related methodologies such as cross-walking and the inclusion of persons with communication disorders in future surveys. They recommend that all areas of functioning covered by communication disorders be fully explored in ICF to maximize the use of ICF as a force for social policy.

Challenges for assessing disability prevalence: The case of Afghanistan

This article attempts to examine the methodological intricacies of measuring prevalence rates of disability through a population-based survey using the WHO's International Classification of Functioning, Disability and Health and the capability framework, developed by Amartya Sen and others. After a rapid overview of the Afghan context and the process leading to the research programme, it presents the methodology used in the National Disability Survey in Afghanistan (NDSA) and the survey protocol. The authors argue that prevalence rates can be measured using different instruments in terms of impairments, activity limitations or in terms of well-being. Thus, the disability experience is measured through a multidimensional approach. The article concludes that whatever conceptual framework is adopted, understanding the situation of persons with disabilities requires going beyond the measurement of disability prevalence. It implies looking at the links between disability prevalence and the persons’ valuable functionings and social agency in a given environment, using other variables measured by the survey.