Categories, classes and criteria in childhood disability--experience from a survey in Jamaica

This paper reports a new classification and criteria for disabilities and handicaps used in a survey of childhood disability in Jamaica. Part of the International Classification of Impairments, Disabilities and Handicaps was used, with an alternative classification for disabilities similar to that of impairment, and with a complete set of criteria for levels of severity. For handicaps, the set proposed in the WHO manual, Training Disabled People in the Community, was used. No difficulties were encountered in the use of definitions or severity criteria. The inter-rater reliability for disability as a whole by community workers was 79% (kappa statistic 0.58), and for the physician and psychologist 90 and 100%. The handicap classification was easy to use but there was some confusion with resulting poor inter-rater reliability for some questions. This could be corrected by clarification of the meaning of the questions during training. We recommend use of this classification and criteria as being simple and realistic for surveys of childhood disability conducted by community workers.