Disability is part of a human condition that can be experienced by any person at some point in life, temporarily or permanently. As a concept, it has been used to alternatively refer to physical impairments, activity limitations, or participation restrictions. Currently, the WHO-ICF definition of disability is widely adopted i.e. a person is considered to have a disability if and when his/her activity performances in his/her usual environment are limited in nature, function, or quality . Hence, it includes physical or learning and intellectual disability that cause functional limitations. consistently related to human dignity and inclusion.
The World Health Organization (WHO) and the World Bank (WB) estimated that about 80% of the global 1 billion persons with disabilities (PwDs) currently live in developing countries where rehabilitation services are poor or non-existent. These numbers are increasing – both globally and in developing countries – due to population growth, man-made and natural disasters, war, accidents and aging.
On the other hand, data on the proportion of PwDs in Ethiopia is highly fragmented or sometimes misleading and contradictory. For example, based on the 2007 Population and Housing Census, Ethiopian Central Statistical Authority (2007) reported that there were less than 1 million Ethiopians with disability i.e. 1.2%. Conversely, WHO’s World Disability Report (2011) indicates that the national prevalence of disability in Ethiopia is around 17% The in-congruence between the two sources of disability statistics could be explained by the multidimensional of disability that makes its measurement variable. The World Disability Report explains, “Operational measures of disability vary according to the purpose and application of the data, the conception of disability, the aspects of disability examined, the definitions, question design, reporting sources, data collection methods, and expectations of functioning” (1). In Ethiopia, many are skeptical about the census statistics on disability that could have been affected by “under-reporting, the way the census questions were formulated, lack of disability awareness among enumerators and data managers and use of a narrow definition of disability” in the census. Others have argued the census figure actually reveals the number of PwDs in Ethiopia has not been identified yet.
Despite their inconsistencies and contradictions, literature and statistical reports on disability in Ethiopia identify mobility, visual and hearing impairments as the top-three most prevalent forms of disabilities, in that order. The prevalence and types have also been reported to be similar in North Gondar Administrative Zone of the Amhara National Regional State (ANRS), Ethiopia.
Reliable statistics on disability is a requirement to promote inclusive and sustainable development. It will furnish data on the level of functioning in the population, the need for rehabilitation services and equalization of opportunity by helping identify the barriers to PwDs’ inclusion and participation in community affairs. PwDs have the rights to equal opportunities to schooling and employment as well as access to health and other services. In recent years, national and global actors have pushed the issue of disability to the center and front of policies, programming and service provision to ensure the effective inclusion of PwDs in development.
The causes and impacts of disability on people are numerous and complex. In Africa, nonetheless, it is evident that the major causes of disability are communicable diseases, war, accidents, and inadequate prenatal and neonatal health-care services. Studies have also shown that disability is strongly linked to underlying and basic problems of poverty, poor nutrition and restricted access to basic services such as health and schooling. These factors are also relevant to the Ethiopian context where the list of causes/factors include low standard of living, malnutrition, natural and man-made disasters, accidents, infectious and non-infectious diseases, intermittent wars and violence.
Negative attitudes and limited understanding around disability and people with disabilities can contribute to poor mental health and well-being, and, lead to societal exclusion across many life domains. But persons with disabilities do not form a homogenous group. Alongside a variety of different types of impairments (e.g. physical, psycho-social, sensory, intellectual, neurological), people with disabilities live in a variety of contexts with different intersecting identities. This may include gender, age, education status, employment and economic status, and, geographical location. How these contexts and different characteristics intersect, lead to very different experiences of disability [15]. In Ethiopia, for instance, about 46% of PwDs are women and they carry the double burden of stereotypes, discrimination and economic challenges associated with their gender and disability. Age is also a factor whereby children with disabilities (CwDs) are less likely to attend schooling or access healthcare services leaving them vulnerable to poverty and poor health that substantially reduce their quality of life [17, 18]. As a group, without underplaying these variations within, PwDs are still among the most disadvantaged segment of the society.
With existing and emerging man-made and natural disasters, technological changes and global communications, disability statistics and surveillance are necessary to assess and examine trends on the conditions of PwDs to inform policies and strategies on inclusive and sustainable development as well as programming for delivery of social- and healthcare- services. Specifically, disability statistics and surveillance furnish empirical and reliable data on needs, priorities, strategies and resources that promote the effectiveness of interventions to meet the challenges of PwDs. By doing so, they will contribute to filling the existing knowledge gap on disability – its magnitude, types, effects, trends, etc. – in Ethiopia at policy, research and programming levels.
Researches have documented the complicated relationship among disability, its social and health outcomes and national and contextual realities; and, the provision of long-term everyday care for PwDs is becoming a major problem on public health policy and programming especially in developing countries where resources, qualified personnel and rehabilitation centers and services are very limited. It is against this backdrop that University of Gondar (UoG) launched the Dabat Health Surveillance System (DHSS) in 1995 to collect, organized and disseminate regular and up-to-date information on the health conditions of the population (including PwDs) in Dabat district, northwestern Ethiopia. Nonetheless, with the focus of Dabat Research Center being on general health and demography, it only started to collect data on disability recently and even that did not employ robust, internationally-validated disability measurement tools to assess the status of disability in the district. As a result, the Center reports significantly low disability prevalence in the district. This study, hence, aimed at assessing the prevalence, types and causes of disability on residents of the Dabat district employing a disability measurement tool containing items from WHO Disability Assessment Schedule (WHODAS 2.0) and the International Classification of Functioning, Health and Disability (ICF).