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A survey of children with chronic health conditions Introduction: Currently there is great deal of uncertainty and confusion about

the prevalence of disability in India. The problem is particularly acute in case of children. The confusion arises at a number of fundamental levels of enquiry. At the primary level, the problem is a conceptual one, in that there is lack of clarity in defining what is meant by disability. This is then compounded by methodological difficulties in operationalising the concepts in a way that the proposed concepts can be captured. At the third level there is problem in e ecuting the capture process efficiently, reliably and comprehensively. At the definitional level, there is now general agreement that there can be no single, universal definition of disability. Although intuitively disability appears to be a fairly straightforward idea and we may feel that we should have no difficulty in deciding if a person is disabled or not, at practical level the problem of deciding who is and who is not disabled is far more comple . At its most basic and also the oldest level historically, disability is conceptualised as difficulty in !"# seeing, !$# hearing, !%# speaking, !&# using arms or legs or !'# in mental health or mental ability. These are in fact the concepts of disability as formulated by the Indian Census, $((" and the )ational *ample *urvey, $(($, '+th round. ,ecause these individual categories of difficulty in hearing, seeing, speaking etc, are all on a continuum from normality to profound difficulties, it becomes immediately apparent that we need some kind of a qualifier to decide where normality ends and disability begins. There is no intrinsically right or wrong way of deciding where this dividing line should be. The decision is largely dependent on the purpose for which disability is being defined. -or e ample, if we are trying to find out the number of cases of children with hearing disability with a view to making provision for appropriate therapeutic services for these children, then it is essential that we define disability in a way to capture all children with moderate to severe motor difficulties. It is not necessary, and in fact it can be a positive disadvantage to include children with minimal or mild physical difficulties in this count as this may overwhelm our capacity for service provision or more to the point, gratuitously label a child as disabled. .n the other hand, if we are studying the epidemiology of cerebral palsy in a community, then we do need to define the problem in such a way that we can capture all probable cases of cerebral palsy, even the mild ones because the /near miss0 cases may tell us as much about the likely causes cerebral

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