Severe disability and its prevalence and causes in northwestern Ethiopia: evidence from Dabat district of Amhara National Regional State. A community based cross-sectional study
Authors: Abebe Solomon Mekonnen , Abera Mikyas , Nega Ansha , Gizaw Zemichel , Bayisa Mulugeta , Fasika Solomon , Belay Molalign , Fekadu Abel , Wakene Wondwossen 
Published: January 2021

Abstract
Background: Disability is the social outcome of unfavorable interactions between individuals’ impairments, on the one hand, and inaccessible physical spaces, disenabling cultural environment and negative attitudes towards disability and persons with disabilities, on the other. Despite the fact that it directly affects 15% of Ethiopians as well as families and communities, policy-relevant studies on disability and the conditions of persons with disabilities are lacking. The Dabat Demographic Health Surveillance System (DHSS) was established to collect vital statistics in Dabat district, Amhara region. But it did not collect data on disability types, causes and community responses. With this drawback in DHSS, this study aimed at assessing the prevalence, types and major causes of severe disability in Dabat district. Method: A community-based cross-sectional study design was employed and covered 17,000 households residing in 13 Kebeles of Dabat district. The study was conducted in 2018 utilizing the modified 12-item World Health Organization’s Disability Assessment Schedule (WHODAS 2.0) and 7-item WHO Minimal Generic Set of Domains of Functioning and Health to collect data on disability in the district. The data were organized and presented as frequencies and percentages in table and figures. Relevant variables were used to construct a logit model that predicts the likelihood of disability whereby P-value < 0.05 was considered as statistically significant. Results: This study found that the overall prevalence of disability in Dabat district was 2.14% [95% CI: 2.03, 2.24]. About 8.3% of households reported at least one member with disability. Visual impairment was the most commonly reported impairment (51%) while 8.19% had multiple impairments. Eighty-three percent of immediate the causes of disability were modifiable – specifically, illness (36.93%), injury (17.81%), and congenital (10.86%). The aged [AOR=1.0; 95% CI: 1.03, 1.04], those unable to read or write illiterate [AOR=1.57; 1.15, 2.14], the unmarried/single [AOR=1.39; 95% CI: 185,2.47] and the separated [AOR=2.78; 95% CI: 4.14,6.19] were more likely to risk disability in the population.Conclusion: This study reported an increased likelihood of impairment among those with advanced ages. The proportion of households with PwDs was also high. While most disabilities were visual, there were significant numbers with mobility impairments and hard of hearing. Most school-age PwDs did not complete secondary education, while employment was significantly limited. The findings indicated that most causes of disability were reversible if impairments were screened or identified early and preventive or medical treatments were sought. Without undermining the role of specialized medical treatments, this study underlines the significance of early screening and preventive community interventions through CBR programs and rehabilitation workers in lowering disability rates in the district.