Introduction
Globally, approximately 1.3 billion people, about 16% of the population live with some form of disability1, and around 190 million experience significant functional limitations2. The majority (about 80%) of people with disabilities (PWDs) reside in low- and middle-income countries, often referred to as the Global South. Although medical advances have improved life expectancy, rising non-communicable diseases, natural disasters, and conflicts have contributed to a growing number of PWDs, often with reduced health-quality of life (HQOL)3, 4–5.
Disability is a multifaceted condition resulting from the interaction between an individual’s health conditions and contextual factors, such as environmental barriers and social determinants6. One critical dimension affected by disability is HRQOL, which reflects an individual’s perceived physical, mental and social well-being in the context of their health status. For PWDs, HRQOL is often reduced due to chronic pain, limited mobility, mental health conditions, social exclusion and restricted participation in daily and social activities7, 8, 9–10.
The World Health Organization (WHO) defines QOL as an individual’s perception of their position in life in the context of their culture, goals, expectations and value systems11. HRQOL is partciualry relevant for PWDs who face peristent challenges in physical functioning, mental health. social participation and access to services. studies have shown the factors such as social isolation, stigma, inaccessible healthcare, and limited rehabilitation services are the major contributors to poor HRQOL among PWDs12,13.
Additionally, many PWDs face barriers to education, employment, and financial freedom14, which further restricts access to healthcare and reduce life satisfaction. These social determinants combined with the high burden of comorbid mental health and chronic conditions intensify the risk of poor HRQOL15,16. The WHO reports that PWDs generally experience significantly lower HRQOL than the general population due to systemic barriers in healthcare, education, employment, and social inclusion7,17.
In Ethiopia, PWDs experience persistent marginalization, emotional distress, and difficulties in daily activities and participating in broader social roles18. Barriers such as negative attitudes, inaccessible infrastructure, limited assistive technology, and low economic status19, low enforcement of disability rights20 further exacerbate their disadvantage. Moreover, comorbid conditions and physical inactivity often worsen physical function and diminish HQO21. Studies have highlighted the importance of social determinants, such as access to healthcare, economic opportunity and community support in shaping the health-related quality of life (HRQOL) of PWDs22. For example, a longitudinal study in Australia found that physical inactivity among adults with disabilities was associated with a significant decline in HRQOL7.
Although global studies have identified various factors influencing HRQOL among PWDs, evidence-specific to HRQOL among PWDs in the Ethiopia remains limited. HRQOL is an essential measure of the impact of disability on physical and psychological functioning and reflects the effectiveness of healthcare system in meeting the complex needs of PWDs. The country’s unique socio-economic conditions, healthcare access barriers, and cultural-context present distinct experiences for PWDs, which are not adequately captured in international literature. This study is therefore needed to generate context-specific evidence on the HRQOL and influencing factors among PWDs in Ethiopia. Such evidence is vital to inform inclusive policies, improve disability services, and promote the physical and psychological well-being of the marginalized population.
Methods
Study design and setting
The community-based cross-sectional study was conducted to assess the quality of life of people with disabilities from January to June 2016. The study was conducted central and north Gondar zones, the sites of University of Gondar community based rehabilitation program sites, Northwest Ethiopia.
Inclusion and exclusion criteria
All people with disabilities residing the Central and North Gondar zones both supported by the CBR program of the University of Gondar.
Individuals with disabilities who had resided in the area for less than six months during the data collection period were excluded from the study.
Sample size determination
All PWDs living in the Central and North Gondar zones were considered the source population for this study. The sample size was calculated by using a single proportion formula, based on the following assumptions: a 65.9% prevalence of good QOL among PWDs as reported by a previous study conducted in Southern Nations, Nationalities, and people’s Region of Ethiopia23, a 95% confidence interval, and a 4.5% margin error. The formula used was:
Where: n = required sample size, p = estimated prevalence (0.659), Z = standard normal value at 95% CI interval (1.96) and d = margin of error.
After accounting for a 4.5% non-response rate and applying a design effect of 1.5, the final sample size was adjusted to 668.
Thirteen kebeles from the Central and North Gondar zones were selected using a stratified sampling techniques. A total of 1537 PWDs were identified in these selected kebeles. The sample was proportionally allocated to each kebele based on the number of PWDs in that area.
Participants were then selected using a computer generated simple random lottery method in each kebele. Subsequently, every second individual (K = 2) was selected systematically until the required sample size was reached. This ensured participants were approached at regular intervals following the randomly selected starting point in each kebele.
Data collection tools and procedure
The data collection tool comprises the two main components; sociodemographic and service-related information, the assessment of quality of life 8 dimensions (AQOL-8D) questionnaire. The AQO-8D was used to assess the HRQOL of PWDs in Central and North Gondar zones. It is a generic tool, valid instrument deigned to measure HRQOL of across diverse cultural contexts24,25. The AQOL- 8D assess HRQOL across eight domains: Independent living, happiness, mental health, coping, relationships, self-worth, pain and senses. It consists of 35 items, with response option varying from 1 to 4, 1 to 5 and 1 to 6. The total score ranges from 35 to 177. The scoring system has an inverse relationship with HRQOL: higher scores indicate a greater negative impact across the domains, this reflecting poor HRQOL. Participants who scored 70 and below were considered to have good HRQOL, while those who scored above 70 were considered to have poor HRQOL.
Data quality assurance
The questionnaire was initially prepared in English, then translated into Amharic, and then back-translated into English to ensure consistency. To enhance cultural appropriateness and clarity in the Ethiopian context, the AQOL-8D was adapted through expert consultation, back-translation, and pre-testing. Minor linguistic modifications were made to improve clarity and contextual relevance.
Data collectors and supervisors was received training on the study objectives and data collection procedures. The data collection tool was pre-tested on 5% of the total sample to assess clarity, and appropriateness, and necessary amendments were made based on the findings.
The principal investigator checked the data for completeness and accuracy, while supervisors provided daily oversight and feedback. Data consistency was monitored throughout data collection, entry and analysis phases.
Data analysis
Data were entered into the household registration system (V-2.1), and the survey data were entered and analyzed using STATA (v.12) software. During data cleaning and organization, a few incomplete or uncleaned items were returned to the study site for further clarification and completion. Descriptive statistics, such as means, percentages, and standard deviations, were employed to describe the characteristics of the study population. Tables and figures were used to present both aggregated and disaggregated data as appropriate. Binary logistic regression was conducted to assess factors associated with the prevalence of disability. First, univariate analysis was carried out, and variables with p-values of < 0.2 were included in the multivariable analysis to control for confounding factors. Results were considered statistically significant at p-value ≤ 0.05. The crude odds ratio (COR) and the adjusted odds ratios with the corresponding 95% Confidence Interval (CI) were used to show the strength of association between independent variables i.e. sociodemographic and service related variable a and dependent i.e. QOL of PWDS in the multivariable logistic regression analysis.
Result
Sociodemographic characteristics of PWDs in North West Ethiopia
A total of 631 participants (mean age of 45.22 14.08 years) were included. Over half (52.3%) were male, and the majority (91.4%) identified as Orthodox Christians. Most participants were single were single (65.3%). In terms of education, 24.2% had no formal education, 47.5% had completed primary education, and the rest had attained secondary or higher education levels. Nearly half (49%) were students and nearly one-third (30%) were unemployed. Income vulnerability was high: 78.9% reported extremely low monthly income, and 13.7% reported low income. Furthermore, nearly half (49%) were students, and 42.5% lived with their parents and relied on others basic needs, indicating widespread financial dependence that may influence various aspects of HRQOL. See Table 1.
Table 1. Sociodemographic characteristics of PWDs in northwest, ethiopia, (n = 631).
Variables | Category | n (%) |
---|---|---|
Gender | Male | 330(52.3) |
Female | 301(47.7) | |
Age | < `15 | 16 (2.5) |
15–24 | 336 (53.2) | |
25–54 | 254(40.2) | |
> 54 | 25(4) | |
Residence | Urban | 310 (49.1) |
Rural | 321(50.9) | |
Religion | Orthodox | 577(91.4) |
Muslim | 47(7.4) | |
Others (protestant, catholic) | 7(1.2) | |
Marital status | Single | 412(65.3) |
Married | 160(25.4) | |
Widowed | 59(9.4) | |
Educational status | No formal education | 153(24.2) |
Primary | 300(47.5) | |
Secondary | 129(20.4) | |
Diploma and above | 49(7.8) | |
Work status | Not employed | 189(30) |
Student | 309(49) | |
Private | 66(10.5) | |
Governmental employee | 67(10.6) | |
Family monthly income | Extremely low income | 498(78.9) |
Low income | 84(13.7) | |
Middle income | 49(7.8) | |
With whom living with | Living alone | 150(23.8) |
With parents | 150(23.8) | |
With only one parents | 118(18.7) | |
With spouse | 96(15.2) | |
With relatives | 117(18.5) |
Healthcare and service-related factors among PWDs in northwest, Ethiopia
Physical (164) and visual (145) impairments were the most commonly reported types of disability. Nearly half of the study participants (49.8%) had experience receiving CBR services. More than half (59.6%) reported that health service costs were moderate, while 13.8% considered them very costly. Most participant (92.7% reported health services welcoming; however, nearly one-third (29.6%) felt that service clarity was poor, and 40.3% reported having no communication with healthcare professionals. See Table 2.
Table 2. Healthcare service-related factors among PWDs in northwest, ethiopia, (n = 631).
Variables | Category | N (%) |
---|---|---|
Types of disability | Cognitive | 26 |
Epilepsy | 21 | |
Hearing | 43 | |
Multiple disabilities | 11 | |
Physical | 164 | |
Vision | 145 | |
Supported by CBR | Yes | 314(49.8) |
No | 317(50.2) | |
Proximity to the health center | Very close | 149(23.6) |
Close | 219(34.7) | |
Moderate distance | 161(25.5) | |
Far | 19 (3.0) | |
Very far | 83 (13.2) | |
Cost of health services | Not at all costive | 56(8.9) |
Somewhat costive | 112(17.7) | |
Moderate cost | 376(59.6) | |
Very costive | 87(13.8) | |
Is the health service welcoming | Yes | 585(92.7) |
No | 46(7.3) | |
Clear service provided by a healthcare professionals | Not at all | 187(29.6) |
Bad | 40(6.3) | |
Moderate | 166(26.3) | |
Good | 193(30.60 | |
Very good | 41(6.5) | |
Communication with healthcare professionals | Not at all | 254(40.3) |
Bad | 58(9.2) | |
Moderate | 113(17.9) | |
Good | 128(20.3) | |
Very good | 74(11.7) | |
Depressive symptoms | Yes | 324(51.3) |
No | 307(48.7) |
Prevalence of HRQOL among PWDs in Northwest Ethiopia
The overall proportion of people with disabilities who reported a HRQOL was 41.0% (95% CI: 37.1, 44.8).
Factors associated with HRQOL among PWDs
In the multivariable logistic regression analysis, several factors were significantly associated with better HRQOL, including age, educational level, occupational status, living arrangements, access to CBR services, the welcoming nature of healthcare facilities, and independence in ADL. Participants aged 18–25 and 26–59 were 1.73 times (AOR: 1.73, 95% CI: 1.001–2.99) and 2.97 times (AOR: 2.97, 95% CI: 1.48–5.99) more likely to have good HRQOL, respectively, compared to those under 18. Those with primary education had 2.04 times higher odds of having good HRQOL (AOR: 2.04, 95%CI: 1.14–3.20) than those with no formal education. Participants with private jobs (AOR: 2.16, 95%CI: 1.08–4.30) and government jobs (AOR: 2.93, 95%CI: 1.33–6.43) also reported better HRQOL compared to the unemployed. Additionally, access to CBR services (AOR: 2.18, 95%CI: 1.44–329), perceiving healthcare facilities as welcoming (AOR: 3.96 (95% CI: 1.78–8.77), and independent in ADL (AOR: 5.84 (95%CI: 3.89, 8.76) were significantly associated with better HRQOL. See Table 3.
Table 3. Bivariable and multivariable logistic regression analysis result of QOL and associated factors among PWDs in, northwest, ethiopia, (n = 631).
Variables | Category | Frequency | HRQOL | AOR( 95%CI) | p-value | |
---|---|---|---|---|---|---|
Good | Poor | |||||
Sex | Male | 330(52.3) | 144(43.6) | 186(56.4) | 1.43 (0.95, 2.14) | 0.086 |
Female | 301(47.7) | 115(38.2) | 186(61.8) | 1 | ||
Age | Below 18 | 184(29.2) | 59(32.1) | 125(67.9) | 1 | |
18–25 | 191(30.3) | 71(37.2) | 120(62.8) | 1.73(1.001, 2.99) | 0.05 | |
26–59 | 240(380 | 122(50.8) | 118(49.2) | 2.97(1.48, 5.99) | 0.002 | |
60 and above | 16 (2.5) | 7(43.8) | 9(56.2) | 3.50(0.79, 15.38) | 0.097 | |
Residence | Urban | 310(49.1) | 107(34.50 | 203 (65.5) | 1 | |
Rural | 321(50.9) | 152(47.4) | 169 (52.6) | 1.42(0.75, 2.69) | 0.279 | |
Marital status | Single | 412(65.3) | 156(37.9) | 256(62.1) | 1.62(0.73, 3.63) | 0.238 |
Married | 160(25.4) | 85(53.1) | 75(46.9) | 1.08(0.44, 2.69) | 0.859 | |
Widowed | 59(9.4) | 18(30.5) | 41(69.5) | 1 | ||
Education | No formal education | 153(24.2) | 53 (34.5) | 100(65.5) | 1 | |
Primary education | 300(47.5) | 130(43.3) | 170(56.7) | 2.04(1.14, 3.201) | 0.017 | |
Secondary education | 129(20.4) | 42(32.6) | 87(67.4) | 1.60(0.895, 3.66) | 0.174 | |
Diploma and ab | 49(7.8) | 34(69.4) | 15(30.6) | 2.36(0.92, 6.07) | 0.074 | |
Occupation | Not employed | 189(30) | 65(34.4) | 124(65.6) | 1 | |
Student | 309(49) | 110(35.6) | 199(64.4) | 1.03(0.55,1.93) | 0.92 | |
Private | 66(10.5) | 38(57.6) | 28(42.4) | 2.16(1.08, 4.30) | 0.029 | |
Governmental | 67(10.6) | 46(68.7) | 21(31.3) | 2.93(1.33, 6.43) | 0.007 | |
With whom living with | Living alone | 150(23.8) | 110(73.3) | 40(26.7) | 1 | |
With parents | 268(42.5) | 120(44.28 | 148(55.2) | 2.16 (1.29, 3.61) | 0.003 | |
With spouse | 96(12.5) | 23(24) | 73(76) | 0.95(0.49, 1.85) | 0.87 | |
With relatives | 117(18.5) | 76(65) | 41(35) | 3.88(2.04, 7.40) | 0.000 | |
Supported by CBR | Yes | 314(49.8) | 152(48.4) | 162(51.6) | 2.18 (1.44, 3.29) | 0.000 |
No | 317(50.2) | 107(33.8) | 210(66.2) | 1 | ||
Proximity to health service | Very close | 149(23.6) | 71(47.7) | 78(52.3) | 1 | |
close | 219(34.7) | 97(44.3) | 122(55.7) | 1.62 (0.80, 3.28) | 0.179 | |
Moderate distance | 161(25.5) | 58 (36) | 103 (64) | 1.42(0.73, 2.79) | 0.304 | |
Far | 19 (3.0) | 8 (42.1) | 11(57.9) | 0.97(0.47, 1.96) | 0.928 | |
Very far | 83 (13.2) | 25(30.1) | 58(69.9) | 1.49 (0.45, 5.00) | 0.51 | |
Cost of health services | Not at all costive | 56(8.9) | 29(51.8) | 27(48.2) | 2.05(0.90, 4.67) | 0.086 |
Somewhat costive | 112(17.7) | 51(45.5) | 61(54.5) | 1.28(0.64, 2.56) | 0.48 | |
Moderate cost | 376(59.6) | 150(39.9) | 226 (60.1) | 1.23(0.69, 2.21) | 0.49 | |
Very costive | 87(13.8) | 29 (33.3) | 58 (66.7) | 1 | ||
Is the health service welcoming? | Yes | 585(92.7) | 249(42.6) | 336(57.4) | 3.96(1.78,8.77) | 0.001 |
No | 46(7.3) | 10(21.7) | 36(78.3) | 1 | ||
ADL | Dependent | 247(39.1) | 155(62.8) | 92(37.2) | 1 | |
Independent | 384(60.9) | 104(27.1) | 280(79.2) | 5.84(3.89, 8.76) | 0.000 |
Discussion
This community-based cross-sectional study investigated the HRQOL and its associated factors among PWDs in Central and North Gondar zones, Northwest, Ethiopia. The findings showed that 41.0% of PWDs reported having a good HRQOL. The proportion is lower than reported in previous Ethiopian study (65.9%)23. A possible explanation for this discrepancy may be the difference in measurement tools. The previous study employed the WHO CBR indicator survey, which is primarily deigned to monitor and evaluate CBR programs, focusing on access to services, participation and rights. In contrast, our study used the AQOL-8D tool, which directly measures individuals’ perception of their physical, mental and social well-being (i.e. HRQOL).
It is also lower than the 62.5% reported in India26, possibly due to better access to healthcare and rehabilitation services in India, which play a crucial role in improving the HRQOL of PWDs27. Conversely, our result is higher than the 28.2% reported in Indonesia28. One explanation for this discrepancy is that the Indonesian study focused exclusively on individuals with physical disabilities, who often face significant functional limitations and restricted social participation. These challenges can lead to psychological distress and negatively impact HRQOL29. Physical disabilities also affect mobility and independence, further restricting engagement in occupational and social activities29,30. Additionally, many physical disabilities are acquired, and individuals with acquired disabilities often report lower HRQOL compared to those congenital disabilities, largely due to the psychological and social adjustments required after sudden lifestyle changes30.
Several factors were significantly associated with good HRQOL, including age, educational level, occupational status, living arrangements, access to CBR services, the welcoming nature of healthcare facilities, and independence in ADL. Although depressive symptoms were not statistically significant in the final multivariable model, it is noteworthy that over half (51.3%) of the study participants experiencing reported depressive symptoms. This magnitude indicates a potential influence on HRQOL that may not been captured through direct statistical association in current analysis. Depression may act as a mediator or moderator in the relationship between other factors such as living alone, lower education status, unemployment, reduced independence in ADL and HRQOL. While these factors were significantly associated with good HRQOL in our study, they are also known risk factors for depressive symptoms as supported by previous studies, particularly unemployment31, low educational status32, and impairments in ADL33 have been linked consistently to have depressive symptoms.
Participants aged 18–25 and 26–59 were 1.73 times and 2.97 times more likely, respectively, to report good HRQOL compared to those under 18. This finding aligns with results from the USA, where people in their 20s to 40s experienced variation in HRQOL, but stability is observed in older age groups34. This may be attributed to increased autonomy, social engagement, and economic independence among older adults, in contrast to younger individuals who often face dependency and uncertainty. The transition to adulthood brings the assumptions of enhanced social roles and responsibilities, which can positively influence the well-being of PWDs35. Furthermore, older adults may possess more effective coping strategies and life experiences that facilitate adjustment to disability, whereas younger individuals may struggle with acceptance due to disrupted aspirations and life plans36. However, a study from Brazil reported better HRQOL among younger adults with disabilities, potentially due to greater mobility and fewer comorbid health conditions37.
Educational level was also significantly associated with better HRQOL. PWDs with primary education were 2.04 times more likely to report good HRQOL compared to those with no formal education. This finding is consistent with previous studies from Malaysia38 and Greece39, which also demonstrated a positive association between educational attainment and HRQOL. Education promotes employment opportunities, social participation and access to health-related information, all of which contribute to improved autonomy and HRQOL40,41. However, in the Ethiopian context, many PWDs have not completed their education and face limited employment opportunities in Ethiopia42. Interestingly, no significant association was observed for secondary or higher education. This may be due to unmet expectations among more educated individuals who continues to face barriers to employment and social inclusion, especially in low- and middle-income countries like Ethiopia, where structural inequalities persist43. This findings highlight the complex and context-dependent, relationship between educational attainment and HRQOL in resource-limited settings.
Employment status emerged as a significant predictors of HRQOL. PWDs who were self-employed or employed in governmental organizations were 2.16 and 2.93 times more likely, respectively, to report good HRQOL compared to those who were unemployed. This finding is consistent with studies conducted in India44, Norway45, and Bangladesh46, where employment was positively associated with both the physical and mental dimension of HRQOL. Similarly, a study in the United States found that individuals with higher employment rates reported better HRQOL than hose with lower employment rates34. Employment enhances financial security, provides a sense of purpose, and fosters social inclusion, all of which contribute to better HRQOL47. Conversely, the lack of employment and educational opportunists may lead to increased stress levels and reduced life satisfaction among PWDs48.
Although income level was not a statistically significant factor in the multivariable analysis, the high proportion participants were in the extremely low income (78.9%) and low income (13.7%) categories, along with nearly half of the study participants living with their parents, indicating financially dependency, suggests a broader context of economic insecurity. Such economic hardship may contribute to lower HRQOL by limiting access to healthcare, assistive devices, and educational or employment opportunities. It is plausible that the effect of income on HRQOR is mediated by other social determinants, such living arrangements and occupational status, both of which were significant associated with HRQOL in our study.
Living arrangements were significantly associated with HRQOL. Individuals living with parents and relatives were 2.16 and 2.93 times more likely, respectively, to report good HRQOL compared to those living alone. This finding is consistent with previous studies from Norway45, and Poland49, which reveals the importance of social support in reducing loneliness and improving mental health among PWDs. Social support systems provide not only practical and financial assistance but also emotional stability, thereby reinforcing psychological resilience and improving overall HRQOL50.
Access to CBR services was another key factor. Participants who received CBR services were 2.18 times more likely to report good HRQOL. CBR programs offer vital services including rehabilitation, education, and employment opportunities, and social inclusion initiatives that address both individual and community-level barriers. This finding is supported by narrative review showing the significant impact of CBR on the lives of PWDs in resource-limited settings51, emphasizing the need for increased investment and expansion of CBR programs in similar context.
The perceived welcoming nature of healthcare facilities was also significantly associated with good HRQOL. The possible explanation could is that welcoming healthcare environments improves access to services, reduce stigma, and foster positive interactions, all which can significantly enhance the healthcare experience of PWDs. This is supported by a previous study conducted, which confirm that respectful and accessible healthcare facilities are critical determinants of HRQOL for PWDs51.
Independence in ADL was the strongest predictor of good HRQOL. Functional independence enhances self-esteem, reduces caregiver dependence, and enable active participation in social and economic activities. This finding is consistent with studies on individuals with chronic conditions such as multiple sclerosis52, stroke53, where higher ADL independence was associated with improved mental and emotional health and better overall HRQOL.
The strength of this study include the use of pretested tool (AQOL-8D), a large sample size, and robust random sampling methods, which enhance the reliability and generalizability of the findings. However, the cross-sectional design limits the ability to establish causal relationships. In addition, use of self-reported data may introduce recall bias and social desirability bias.
As conclusion, this study identified several factors significantly associated with good HRQOL among PWDs, including age, education, employment, living arrangements, access to CBR services, the welcoming nature of healthcare facilities, and independence in ADL. These findings underscore the need for a multi-sectoral approach to improving the HRQOL of PWDs, through expanding educational and employment opportunities, strengthening social support systems, expanding access to CBR services, and ensuring inclusive and respectful healthcare environments. Future research should employ longitudinal designs to better understand casual relationships.
Acknowledgements
Firstly, we would like to express our deepest gratitude to the University of Gondar for funding this work. We extend our thanks to the Central and North Gondar zona administration for their permission conduct this study as well as to all staff of the DHSS and the study participants.
Author contributions
SAM: Designed the study, coordinated and supervised the project, analyzed and interpreted the data, and commented the manuscript draftMA: participated in the study design and supervised the draft manuscript. All authors read and approved the final manuscript.GAE : analyzed and interpreted the data, wrote the draft of the manuscript.
Funding
No funding was received to support the publication of this manuscript.
Data availability
All data relevant to our findings are contained within the manuscript. Requests for further details on the dataset and queries concerning data sharing shall be arranged based on a reasonable request to the corresponding author (Getachew Azeze Eriku).
Declarations
Competing interests
The authors declare no competing interests.
Ethical approval and consent to participate
Ethical approval was obtained from ethical review board of the University of Gondar. Written informed consent was provided by each participant in accordance with the Declaration of Helsinki. To maintain confidentiality, personal identifiers was removed from the data.
Abbreviations
ADLActivities of Daily living
AORAdjusted Odds Ratio
AQOLAssessment of the Quality of Life 8-dimensions
CBRCommunity-Based Rehabilitation
CSACentral statistics agency
HDSSHealth and Demographic Surveillance System
HRQOLHealth-related Quality of Life
OROdds Ratio
PWDsPeople with Disabilities
QOLQuality of Life
WHOWorld Health Organization
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Abstract
Disability affects a large proportion of the global population, with the majority living in low- and middle -income countries. In Ethiopia, more than 15% of the population living with a disability. Although disability is a major public health concern and significantly affects health-related quality of life (HRQOOL), evidence in Ethiopia remains limited. This study aimed to assess HRQOL and its associated factors among people with disabilities (PWDs) in the North and Central Gondar zones, Northwestern Ethiopia. A systematic random sampling technique was used to select 631 study participants with disabilities in the North and Central Gondar zones. HRQOL was assessed using the 35-item assessment of quality of life-8 dimensions (AQOL-8D). Multivariable logistic regression analysis was used to identify the factors significantly associated with good HRQOL among PWDs. Only 41% of participants reported good HRQOL. Factors significantly associated with higher odds of good HRQOL included being aged 18–25 years (AOR: 1.73, 95%CI: 1.001–2.99) and 26–59 years (AOR: 2.97, 95%CI: 1.48–5.99) compared to those under 18. Participants with primary education higher odds of good HRQOL (AOR: 2.04, 95%CI: 1.14–3.20) than those with no formal education. Employment in private (AOR: 2.16, 95%CI: 1.08–4.30) and government jobs (AOR: 2.93, 95%CI: 1.33–6.43) was also positively associated with HRQOL compared to those being unemployed. Living with parents (AOR: 2.16, 95%CI: 1.08–4.30) or relatives (AOR: 2.93, 95%CI: 1.33–6.43) was associated with good HRQOL than living alone. Access to CBR services (AOR: 2.18, 95% CI: 1.44–329), welcoming healthcare facilities (AOR: 3.96 (95% CI: 1.78–8.77), and independence in ADL (AOR: 5.84 (95%CI: 3.89–8.76) were also significant predictors of HRQOL. Less than half of the participants reported good HRQOL. Factors significantly associated with good HRQOL included age, education, occupation, living arrangements, access to CBR services, welcoming healthcare facilities, and independence in daily activities. These findings highlight the need to expand educational and employment opportunities, strengthening social support systems, improve access to CBR services, and promote inclusive, and respectful healthcare settings. Future research should employ longitudinal designs to better understand casual relationships.
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Details
1 Institute of Public Health, University of Gondar, Gondar, Ethiopia (ROR: https://ror.org/0595gz585) (GRID: grid.59547.3a) (ISNI: 0000 0000 8539 4635)
2 Department of Sociology, College of Social Science and Humanities, University of Gondar, Gondar, Ethiopia (ROR: https://ror.org/0595gz585) (GRID: grid.59547.3a) (ISNI: 0000 0000 8539 4635)
3 Department of Physiotherapy, School of medicine, College of Medicine and Health Science, University of Gondar, P.O.BOX 196, Gondar, Ethiopia (ROR: https://ror.org/0595gz585) (GRID: grid.59547.3a) (ISNI: 0000 0000 8539 4635)