Self-reported disability in rural Malawi: prevalence, incidence, and relationship to chronic conditions

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi. Methods: This study is nested in the Karonga Health and Demographic Surveillance Site in Malawi; the Washington Group questions were added to the annual survey in 2014. We used cross-sectional data from the 2014 survey to estimate the current prevalence of disability and examine associations of disability with certain chronic conditions. We then reviewed the incidence and resolution of disability over time using panel data from the 2015 survey. Results: Of 10,863 participants, 9.6% (95% CI 9.0-10.1%) reported disability in at least one domain. Prevalence was higher among women and increased with age. Diabetes and obesity were associated with disability among women, and diabetes was also associated with disability among men. Neither hypertension nor HIV were associated with disability. Participants reporting "no difficulty" or "can't do at all" for any domain were likely to report the same status one year later, whereas there was considerable movement between people describing "some difficulty" and "a lot of difficulty". Conclusions: Disability prevalence is high and likely to increase over time. Further research into the situation of this population is crucial to ensure inclusive policies are created and sustainable development goals are met.