Disability types, determinants and healthcare utilisation amongst Afghan adults: a secondary analysis of the Model Disability Survey of Afghanistan

Objectives The needs of people with disability in Afghanistan are not well understood. We describe the characteristics, healthcare utilisation patterns, and experience of care among Afghan adults with moderate or severe disability (MSD) by disability type. Design We mapped 47 questions related to functional disability in the cross-sectional Model Disability Survey of Afghanistan (MDSA) 2019 into 7 disability domains based on the WHO Disability Assessment Schedule 2.0. We conducted multivariable hierarchical logistic regression to identify drivers of high disability burden. Setting The MDSA primary sampling unit were villages in rural areas and neighbourhoods in urban areas, and the secondary sample units were the settlements within districts. Participants The MDSA collected data for 14 520 households across all 34 provinces. The adult tool of the survey was administered to a randomly selected household member aged 18 years or older. Main outcome measures The main outcome measured was moderate or severe disability (MSD), which was estimated using a Rasch composite score. Results MSD prevalence was upwards of 35% in 6/7 domains. Across most disability types, being a woman, older age, residing in rural areas, being uneducated, non-Pashtun ethnicity, being unmarried, living in a household in the low-income tertiles and a non-working household had the highest levels of MSD (p<0.05). Determinants of MSD varied by domain; however, variables including better access to health facilities and better experience of care (higher satisfaction with time spent and respect during visits) were generally protective. People with MSD in the self-care and life activities domains had the highest and lowest healthcare utilisation, respectively. Conclusions Disability in Afghanistan is at public health crisis levels, with vulnerable populations being impacted most severely. To ensure progress towards Afghanistan's 2030 Sustainable Development Goals, targeted interventions for disability types based on population risk factors should be implemented.