Child Functional Difficulties and Associated Factors among Children Aged 5–17 in Afghanistan: Evidence from the Multiple Indicator Cluster Survey (MICS) 2022–23

Abstract

Child functional difficulties indicate the restriction in the capacities of children to engage in age-appropriate activities across domains such as cognition, behavior, communication, and emotional functioning. These difficulties have been increasingly identified as a significant public health and development concern especially in low- and middle-income and conflict-affected settings. Afghanistan faces several challenges, such as poverty, insecurity, restrained access to health and education services, which can affect child development and functioning. Nevertheless, there is a lack of evidence nationally representative data on prevalence and determinants of child functional difficulties in Afghanistan. The purpose of the study was to estimate the prevalence of functional difficulties in children (5-17 years old) and examine associated socio-demographic and caregiving variables based on the data of the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022-2023. A cross-sectional analytical study was conducted on secondary data of Afghanistan MICS 2022-2023. This analysis involved 20, 068 children aged between 5-17 years old whose caregivers filled the UNICEF/Washington Group Child Functioning Module. Child functional difficulty was used as having “a lot of difficulty” or “unable to do at all” in at least one of the functional domains. Survey-weighted descriptive statistics were used to estimate prevalence and describe functional domains. Bivariate and multivariate Poisson regression models, were conducted to examine the association between the functional difficulty and the explanatory variables, which included child age, sex, region, residence, household wealth, maternal and child education and the care giving practices. The complex survey design was taken into consideration in all analyses. Overall, 35.19% of children aged 5-17 years were reported to have at least one functional difficulty. Difficulties were more commonly observed in cognitive, behavioral, and emotional domains than in physical or sensory domains. The emotional challenges were also remarkable as 45.63% of children seem to have frequent anxiety and 31.01% of children seem to experience frequent sadness or depression. In adjusted analyses, children aged 10-14 years had a slightly higher prevalence of functional difficulties compared with children aged 5-9 years (aPR = 1.03, 95% CI: 1.02-1.05), and girls were marginally more likely to experience functional difficulty than boys (aPR = 1.02, 95% CI: 1.00-1.03). Regional differences were noted as the Western, Central Highlands, and Northern regions showed higher prevalence. Functional difficulties were also reported slightly higher among children in wealthier households. In Afghanistan, functional difficulties affect over a third of children aged 5-17 years which addresses a substantial burden of developmental and emotional challenges. The findings underline that strengthening early identification systems, expanding of inclusive education, and providing access to child development and mental health services is essential. The solution to child functional challenges involves multisectoral interventions that involve the health, education, and social protection systems to enhance inclusive child development and child welfare in Afghanistan.