Prevention of childhood disability in the People's Republic of China

Summary With a dramatic decrease in infant mortality, an emerging challenge facing modern medicine in China is chronic disabling conditions in infants and young children. According to the results of a national sampling survey in 1987, it is estimated that there are over 51 million people of all ages with disabilities, which accounts for 4·9% of the total population. One out every five families in China has a member who is disabled. For children under 14 years of age, the overall prevalence rate of disability is 2·66%. The prevalence rate of mental retardation is 1·8% which accounts for 66% of all disabled children. Mental retardation is the most frequent childhood disability. Research on factors contributing to disability indicates the complexity of the problem. The etiology of 47% of cases is unknown, 21% of cases result from damage prenatally, 3% are due to perinatal factors, 29% are acquired during infancy and early childhood. Efforts to prevent developmental disabilities among children can be classified in terms of primary, secondary and tertiary activities. The most important primary prevention activities consist of genetic counselling, immunization programmes, improved prenatal, perinatal and postnatal health care, and legislation. On the secondary preventive level, focus is primarily on prenatal diagnosis and newborn screening. Tertiary preventive efforts include special education and comprehensive rehabilitation services. While these prevention efforts have been established, they are insufficient to meet the the needs of disabled children and their families. In the context of the one child per family policy in China, much more is needed, much more can be done to reduce childhood disability. In addition to strengthening prevention efforts at all 3 levels, special emphasis should be placed on (a) intervention programmes remains an essential issue for the future’ (Guralnick & Bennett 1987). At one level, the need for professionals having the clinical skills of their own discipline and the specialist knowledge of children with disabilities, continues to increase with the growing number of disabled children and diversity of service programmes. At another level, training teachers in early childhood and special education is particularly pressing and there is a need to establish the credentials and training programmes for professions in this field. Health professions at all levels should be trained to identify developmental disabilities in individual children. Early diagnosis and management of disabilities is crucial to maximize the full growth potential of disabled children. The basic techniques of developmental surveillance and screening should be incorporated into the training curriculum of health workers. Courses for early intervention at the college level or graduate level should be developed. An underlying consideration in regard to training, however, is to balance the need for speciality preparation with the need for widely available services. This is a concern for any country but which may vary in its expression depending upon whether it is a western country such as Germany (Schindele 1985) or an eastern country such as China.