Socioeconomic gradient in functional difficulties by domain among youth: evidence from Egypt.

This study aims to measure inequalities in the distribution of functional difficulties and their different domains among youth aged 15-29 years in Egypt, according to selected socioeconomic characteristics (e.g. wealth quantiles and education level of the head of the household). The data come from the nationally representative survey, 'Household Observatory Survey', with 10,405 persons aged 15-29 years representing the study sample population. The survey identifies individuals with disabilities using the Washington Group Short questions. Inequalities in disability distribution have been measured by the concentration index (CI). The results indicate that functional difficulties have been concentrated among the poorest youth and households headed by illiterate persons. Rural areas have the highest concentration of disabilities among youth, with the lowest wealth and the lowest educational level of the head of the household. The CI suggests the existence of socioeconomic inequalities in all functional difficulties except for seeing difficulties. Understanding which factors more substantially contribute to inequalities is critical for advancing policies devoted to enhancing the quality of life for individuals with disabilities.

Disability-free life expectancy at old ages in Egypt.

This study aimed to estimate among the older population in Egypt (aged 60 years and over): 1) disability prevalence rates, their levels of severity and the common types and 2) disability-free life expectancy (DFLE) by sex, age and disability type. Data were from the nationally representative 2016 Household Observatory Survey (HOS-2016), with 4658 persons aged 60+ constituting the study sample population. To identify individuals with disabilities, the HOS asked respondents a short set of questions on functional difficulties, as suggested by the United Nations Washington Group on Disability Statistics. The DFLE was estimated using the Sullivan method. Older (60+) women reported a higher prevalence of disability than older men. Women had longer DFLEs and longer disabled life expectancies (DLEs) than men but had lower proportions of DFLE to their total lifetime. The findings suggest that, at age 60, around 30% of life expectancy in Egypt can be expected to be with limitations in mobility and vision. Men, although they live for fewer years than women, can expect to have a greater proportion of their life expectancy free of disability. The findings of the study suggest that the contextual differences in how the process of ageing is experienced need to be considered by decision-makers when designing gender-responsive health policies.

The recent increase in contraceptive discontinuation in Egypt.

This study sought to establish whether recent changes in discontinuation of contractive use and switching in Egypt can be considered an important cause of the unexpected increase in overall fertility and slight fall in contraceptive prevalence in the country. The analysis was based on calendar data from the 2008 and 2014 Egyptian DHS. Single/multiple decrement life tables were built to calculate contraceptive discontinuation rates and examine these by reasons for discontinuation focusing on three methods: IUDs, pills and injectables. The unit of the analysis was 'segment of use', defined as a continuous period of use/non-use of a contraceptive method (in months). It was found that over the period 2008-2014 the rise in the 'all method' discontinuation rate was mainly due to the shift away from IUDs to hormonal methods, which have higher discontinuation rates. Segments of use were more likely to be discontinued for 'method/service-related' reasons than for 'reduced need' reasons. This was due to an increase in contraceptive failure and side-effect/health concerns. Also, 'the desire to get pregnant' increased to become the second highest reason-specific discontinuation rate. This has coincided with a recent increase in ideal family size in Egypt. About half of the women who reported discontinuing for reasons related to method/services switched to another method, while the rest became subject to the risk of an unintended pregnancy. The rate of switching, rather than stopping use, increased for IUDs, remained the same for pills and increased slightly for injectables, indicating an improvement in switching behaviour. However, a marked high percentage of switchers moved to less-effective methods. If these issues are not addressed, many women in Egypt have an unmet need for contraception, leading to an increase in unintended pregnancies. Specific interventions that would greatly benefit the family planning programme in Egypt include improvement in counselling at the time of IUD insertion and removal and the reduction in failure rates for hormonal methods.