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Profile of Disability in Selected Districts in Rwanda

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Profile of Disability in Selected Districts in Rwanda Profile of Disability in Selected Districts in Rwanda Urimubenshi G., Sagahutu J.B. , Kumurenzi A., Nuhu A., Tumusiime D., Kagwiza J. Department of Physiotherapy, College of Medicine and Health Sciences, University of Rwanda Correspondence Gerard Urimubenshi, Department of Physiotherapy, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286 Kigali, Rwanda • E-mail: [email protected] SUMMARY Disability prevalence data are important to improve efforts to remove or minimize disabling barriers and provide services to allow people with disabilities to take part in community life. There is however a lack of reliable data on disability in the districts of Rwanda. This study aims to describe the profile of disability in terms of prevalence, age, gender distribution as well as activity limitation in Rwanda. A door-to-door survey was conducted in all the households in villages from three districts selected through a multi-stage sampling procedure. Identified persons were assessed for activity limitations using instruments developed from domains in the International Classification of Functioning, Disability and Health (ICF). Data were analysed descriptively and presented by district, age, gender, and activity limitation. Disability prevalence rates of 10.1% (Ruhango), 9.1% (Kayonza), and 6.0% (Nyagatare) were obtained. An overall average prevalence of disability in the three districts was 8.3%. The prevalence of disability was higher in adults than in children in all the three districts with Ruhango having 13.6% vs 7.0%; Kayonza,12.4% vs 6.4%; and Nyagatare, 8.9% vs 2.8%. The main activity limitations experienced by children with disability were sitting, seeing, and crawling, while adults with disabilities had difficulties mainly in seeing and walking. Persons identified with disability in this study from three districts in Rwanda have various activity limitations. The findings provide a useful resource for planning rehabilitation services and to direct future enquiry into the epidemiology of disability in other districts of Rwanda. KEY WORDS: disability, prevalence, ICF, Rwanda INTRODUCTION Although disability is a public issue, the resources to Disability is a global problem affecting both developed and manage it are not equitably allocated (Kelemen et al., developing countries. Worldwide, people with disability are 2013). Among developing countries, it is estimated that estimated to be more than one billion, and nearly 200 only 2% of people with disability receive any rehabilitation million of them experience considerable difficulties in whatsoever (Department for International Development functioning (World Health Organization (WHO), 2011). (DFID), 2004). In Africa, there are only 6 physician specialists in physical and rehabilitation medicine, whereas In 2006, the United Nations (UN) adopted the regions such as China have up to 10,000 specialists (Haig International Convention on the Rights of People With et al., 2009). The reasons for the mis-allocation of Disabilities (PWDs). Now, many governments and resources are many and complex. However one probable international development agencies are turning their reason is difficulty in obtaining information on the extent attention to the goal of including PWDs in development and cost of disability in low-resource regions (Kelemen et (Mont, 2007). al., 2013). AJPARS Vol. 7, Nos. 1 & 2, June 2015, pp. 25 - 31 • http://dx.doi.org/10.4314/ajprs.v7i1-2.5 25 Urimubenshi, Sagahutu, Kumurenzi, Nuhu, Tumusiime, Kagwiza The World Report on Disability emphasizes the population density of 695/sq km to those with low density importance of disability prevalence data to “improve efforts such as Kayonza and Nyagatare with 179 and 243 per sq to remove disabling barriers and provide services to allow km respectively (NISR, 2012). People with disability are people with disabilities to participate" (WHO, 2011) in not likely to migrate at the same rate as people without community life. Recommendation 8 of this report is disability, and hence there may be lower disability “Improve Data Collection” [p.267], a clear indication of prevalence in the newly-populated regions. There are two lack of data and the priority nature of research. Similarly, other shortcomings in the previous study by M’kumbuzi et the United Nations Children's Fund (UNICEF) State of the al. (2014). First, although “hearing” limitation was found World’s Children Report emphasizes the importance and to be significant among PWDs in various countries complexity of data collection related to disability (UNICEF, (Njelesani et al., 2011), it was not assessed while screening 2011). activity limitations among adults with disabilities. Secondly, Despite the magnitude of the issue, both awareness of fits and strange behaviour were not distinguished in one of and scientific information on disability are lacking. Various the two districts. This might have resulted in publications show disability figures, but these figures vary underestimating the prevalence of disability. significantly in both developed and developing countries. This study is aimed at addressing such limitations to This variation can be attributed to several factors including establish the profile of disability in three different districts differing definitions of disability, different methods of data of Rwanda. It is envisaged that this paper will provide collection, and variation in the quality of design of studies public, private, national, local and international investigating disability (Mont, 2007). organizations, and the organizations of PWDs with baseline Rwanda is one such country in which disability data to improve efforts to prevent disability, and plan prevalence varies significantly. The 2002 census conducted services allowing PWDs to take part in community life. The in Rwanda, which used household questionnaires, revealed findings may provide insight for other low-income countries that the prevalence of disability was 3.9% (National like Rwanda. Institute of Statistics of Rwanda (NISR), 2005). The recent census conducted in 2012 showed a prevalence of disability METHODS 5% (NISR, 2012). Study Setting, Population and Sampling However, given Rwanda’s history of genocide against This study was the second phase of the programme by the the Tutsi in 1994 and the poor economy, a more realistic prevalence of disability may be closer to the worldwide Department of Physiotherapy of the University of Rwanda estimation of 15% (WHO, 2011). Underestimating the to establish the country’s profile of disability, being number of PWDs is likely, due to the stigma attached to conducted in one district each year. The districts of disability in the Rwandan society, where some households Musanze in the northern province and Bugesera in the may not declare members as having a disability (Thomas, eastern province of Rwanda were covered during the first 2005). In addition, the assessment procedures may be phase of the programme as described by M’kumbuzi et al. another reason for the underestimated prevalence of (2014). disability in Rwanda. This second phase of the programme was conducted in In response to the unavailability of reliable data about Kayonza and Nyagatare districts in the eastern province, disability in Rwanda, a door-to-door survey was conducted and Ruhango district in the southern province of Rwanda. using an instrument based on the International Classification A multi-stage sampling method was employed. Baseline of Functioning, Disability, and Health (ICF). The surveys were conducted as a preliminary step to framework yielded a disability prevalence of 11.5% implementing community-based rehabilitation (CBR). Thus, (M’kumbuzi et al., 2014). However, as pointed out purposive sampling of the eastern and southern provinces previously, the study by M’kumbuzi et al. (2014) was was done. Subsequently, further purposive sampling was carried out in only two districts – Musanze and Bugesera – employed to select two districts in the eastern province, and and the results cannot be generalized for all the districts. one district in the southern province. Kayonza district was On another hand, it is most likely that there has been selected through the initiative of Handicap International- internal migration from districts such as Musanze with high Rwanda in order to support its current project in 26 AJPARS Vol. 7, Nos. 1 & 2, June 2015, pp.25–31 Profile of Disability in Selected Districts in Rwanda conjunction with the Ministry of Local Government practice in Rwanda. Community consent for the door-to- (MINALOC). The Nyagatare programme was initiated by door survey was obtained at a community meeting prior to nuns from Matimba through the AGAHOZO Association. the survey. Data were collected between 21 and 25 May The last district in this phase, Ruhango District, was 2012 in Kayonza, 29 April and 3 May 2013 in Nyagatare, selected because of the willingness expressed by Gatagara 5 and 9 May 2014 in Ruhango District. Rehabilitation Centre to meet the needs of PWDs through After obtaining permission from local authorities and an organized programme. In each programme, the district consent from the population, the community was engaged hospitals were expected to sustain the CBR programme by in a ‘social mobilization and awareness raising campaign’. providing technical support and willingly integrating PWDs This included discussions, demonstrations, and drama into their developmental activities. The process of sample illustrating and defining disability,
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