Author: Centre for Information and Statistics on Labour and Social Affairs
Many of the sources of data on children with disabilities (CWDs) in Vietnam are similar to, or the same as, the sources of information for all persons with disabilities. Despite the extensive amount of disability data collected, much of the data are of questionable quality, accuracy, and completeness. The data are rarely analyzed in-depth. Very little documentation is provided on the methodology (e.g., sampling procedures, definitions used, duration and context of interviewer training, and supervision and daily quality control measures during fieldwork, editing, coding, and data processing). The data are not often shared or disseminated.
Purpose / Objective
The objective of the survey was to collect recent information on the prevalence and types of child disability, the causes of child disability, the socio-demographic characteristics of children with disabilities, and the patterns of utilization of rehabilitation services and the social and economic circumstances of CWDs. The patterns and norms of government and community support for functional rehabilitation, education, vocational training, and job opportunities for children with disabilities, and their level of integration in daily life in the community were also assessed in the survey.
A community-based sample survey of 1,148 children with disabilities living in households in 16 provinces/cities covering all eight economic regions of the country and an institution-based survey of 230 children with disabilities living in eight institutions were conducted in late 1998 under the direction of MOLISA, with financial and technical support from UNICEF.
In the community-based survey, a multi-stage stratified random sampling procedure was used to produce representative estimates of the prevalence of child disability for eight regions, for urban and rural areas and, after statistical adjustments, for the country as a whole.
Surveys of CWDs living in eight institutions were also conducted. Among the 16 selected provinces, seven of the provinces have social institutions caring for children with disabilities. Whenever possible, the interviewers directly interviewed the CWD of father, mother, or other relative of the disabled children at the institutions. A total of 2340 interviews were completed for eligible children with disabilities at the eight institutions and these data were analysed.
Key Findings and Conclusions
The generalized weighted child disability prevalence estimates for the country as a whole was 3.1 percent of children aged 0-17 years old, implying that there are about 1 million children with disabilities living in Vietnam today. The two most prevalent types of child disabilities reported in the community-based survey were movement disabilities (22.4 percent of all reported disabilities) and speech disabilities (21.4 percent of all reported child disability).
From the community-based survey, the main causes of disabilities in children were congenital birth defects (55.0 percent of all reported causes of child disabilities) and diseases (29.1 percent of all reported causes). These were also the two main causes of disabilities reported among children with disabilities living in institutions, with congenital defects accounting for almost two-thirds (64.6 percent) of all reported causes, and diseases accounting for almost one-fourth (23.5 percent) of all reported causes of disabilities among children living in institutions.
In the community-based survey, half of all reported disabilities in children were classified as severe disabilities. In the survey of eight institutions, the vast majority of children with disabilities (90 percent) who were living in the institutions had severe disabilities. Multiple disabilities were fairly common in children with disabilities. The average number of disabilities in CWDs was 1.48 disabilities per CWD living in households and 1.64 disabilities per CWD living in an institution. Hearing and speech disabilities tended to often occur together in the same child, as did speech disabilities and fits/strange behavior disabilities.
Female children generally had lower reported disability prevalence rates than male children. This finding may be the result of both lower risks among female children for some specific disabilities and also possible underreporting of disabilities in female children.
The education level of children with disabilities was generally very low. In the community-based survey, almost half of the school-age children (aged 6-17) years old) with disabilities were illiterate (45.5 percent). Over one-third of CWDs aged 6-17 had never attended school and another one-sixth of the school-aged CWDs had dropped out. In the institution-based survey, the education situation of CWDs was somewhat better. Only five percent of the CWDs had never attended school, although over one-fourth of the CWDs in institutions had dropped out of school. In the institutions, 85 percent of children with disabilities aged 15-17 had not finished primary school. Very low proportions of the old CWDs living in households or in institutions had completed secondary school. For both CWDs living in households and those living in institutions, non-attendance at school and dropping out of school appear to be mostly a function of family poverty, lack of education programs for CWDs, inaccessibility of schools to CWDs, and feeling ashamed or lacking confidence because of the disability.
From both the community-based survey and the institution-based survey results, it appears that vocational training for children with disabilities and employment opportunities for older CWDs are quite limited. Apparently, in many regions, inadequate attention and resources have been allocated to appropriate vocational training and job creation programs to meet the needs of the vast majority of CWDs who have employment aspirations for the future. For both CWDs living in the community and those living in institutions, the rate of vocationally-trained disabled children was very low. In the community, it was found that tailoring was one of the few professions some children with disabilities were able to pursue successfully. The fact that over 90 percent of CWDs hope to have a meaningful job in the future, highlights the need to greatly increase the opportunities and provide the means for them to achieve their life goals, and help integrate them more into the community.
Awareness of local rehabilitation services was very low among children with disabilities living in households (from the community-based survey). About one third of all CWDs living in households have never sought treatment for their disability. Seeking treatment for child disabilities varied by region and urban-rural residence, with 90 percent of CWDs living in urban areas of the Red River, Delta region seeking treatment, compared to only 29 percent of CWDs living in rural areas of the Central Highlands seeking treatment.
Although about one-fifth of CWDs were found to be using rehabilitative aids and devices such as prosthetics, orthotics, hearing and vision aids, and wheelchairs, the rate of usage of these devices was quite low, considering that half of all CWDs living in households had severe disabilities. The vast majority of devices used were some type of glasses or vision aids. Less than ten percent of children with movement disabilities and less than two percent of children with hearing disabilities used any kind of rehabilitative aid or device whatsoever. The vast majority of rehabilitative devices being used were purchased rather than received through donation.
Only 5 percent of CWDs living in households in urban areas and 10 percent of CWDs living in households in rural areas received any form of financial support from the government and or the community, such as monthly allowances, free or subsidized education, and/or free health cards. The level of support varied by region, with one-fourth of all CWDs in the North West region receiving support compared to only two percent of all CWDs in the South East region receiving support.
There appears to be a general social acknowledgment and/or acceptance of children with disabilities in the general population. The community-based survey found that the vast majority of CWDs living in households reported that local people had positive or favorable attitudes towards them (i.e., they are treated normally or with kindness/sympathy). However, there was some variation in attitudes of local people towards CWDs according to region and urban-rural residence.
ln the institutions, 6.5 percent of the CWDs had been abandoned by their families, another 2.6 percent had no families (orphaned), and 9.1 percent had no contact with their families. However, most of the institutionalized CWDs had weekly contact with family members. Contact with family varied according to type of disability, with more than one-third of children with fits/strange behavior disabilities reporting they had no contact with family members.
Almost one-fifth of the CWDs in institutions said they did not like the institution; the percentages that disliked the institution were higher among the older children with disabilities living in the institutions (e.g. 31 percent of the 15-17 year olds said they disliked the institution). The main reasons for disliking the institution were (1) they missed mother/father (40 percent); (2) they were bullied or made fun of (38 percent); and (3) they were not treated properly (22 percent). The vast majority (four-fifths) of CWDs in the institutions who said they liked the institution said they liked it because (1) they needed to be cared for/looked after (36 percent); (2) the opportunity to make/play with friends at the institution; (3) the opportunity to have state/government benefits (16 percent); (4) the opportunity to be treated by a doctor/specialist (1percent); and (5) all other reasons (12 percent). The vast majority of CWDs living in institutions reported that they were treated well by the institution staff (i.e., treated normally or with kindness and sympathy).
Children with disabilities who were attending school or attending work/vocational training were far more likely to have friends than those CWDs who did not attend school or did not go to work/vocational training. Thus, it seems that fuller participation and greater opportunities for CWDs in education, vocational training, employment and daily community activities will help to minimize their social isolation, maximize their integration in the community, and ultimately lead them to a more fulfilling and economically and socially productive lives.
Unfortunately, the current situation of many CWDs include: poverty-level living conditions, low literacy and education levels, very limited vocational training and employment opportunities, and limited awareness of, and access to, rehabilitative services (and rehabilitative aids and devices), and lack of adequate social integration in the community.
As awareness of, and support for, children with disabilities and a range of rehabilitative services for them are still quite limited, a nation-wide communication campaign on the topic of children with disabilities should be conducted.
Expansion of the MOH's community-based rehabilitation programs and of inclusive education programs are needed so that these programs can be more closely Iinked together and scaled-up nationwide to reach all districts in all provinces.
The Government has decided to pursue more vigorously the inclusive education approach to educating children with disabilities. However, in cases of severe and multiple disabilities, additional special schools may need to be built and existing facilities upgraded, to better meet the needs of children with severe and multiple disabilities. The goal should be that the vast majority of children with disabilities should have at least a primary education. To achieve even this modest goal will require a greater commitment and effort on the part of all those involved.
Quality orthopedic devices and other rehabilitative aids and devices for children with different types of disabilities need to be made much more widely available. Geographic, social and economic access to these devices and aids is uneven.
Because most child disabilities are caused by either congenital defects or diseases that are preventable, much more proactive public health efforts are needed to reduce the incidence of all types of child disabilities in the future.
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Ministry of Labour, Invalids and Social Affairs