Spatial Disparities in Disability Prevalence at the District Level in Sub-Saharan African Countries

The World Health Organization estimates that that the highest prevalence of disability among individuals below age 60 is observed in sub-Saharan Africa. Yet, knowledge of disability remains limited in the region, which is partly due to the lack of robust and comparable measurements of disability. In Sub-Saharan Africa, sub-national and comparable estimates of disability prevalence are limited. This paper aims to use comparable sources of data to estimate and construct an atlas of sub-regional disability prevalence. We take data from the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS) which use the Washington Group on Disability Statistics (WG) short set of questions, which is designed to be a 'culturally neutral' disability screening tool. The questionnaire assesses limitations across six functional domains (seeing, hearing, walking, cognition, communication and self-care). We have data for a total of 26 Sub-Saharan African countries which were collected between 2016 and 2022. We aim to estimate the age-specific prevalence of functional limitation in the population aged 18-49 at the second subnational administrative division level in each country. Given the instability of direct estimates at the subnational level, we use recently developed small area estimation techniques that borrow strength over age and space. From our estimates we compute age standardized prevalences of limitation to facilitate comparison between regions and countries. Preliminary results show large heterogeneity between and within countries, but the amount of within-country differences varies from country to country. Overall, we found 682 subnational entities with age standardized disability prevalence significantly above 2.5%, 233 above 5%, and 31 above 10%. Areas with prevalence significantly above 10% are mainly located along the Ghana-Togo border, the CAR-DRC border, the south of DRC, and parts of Madagascar, underscoring the need for both national and global policymakers to focus efforts on these zones.