# Level of disability and associated factors among stroke survivors in Ethiopia: a multicenter cross-sectional study

## TL;DR

This study finds that many stroke survivors in Ethiopia experience moderate to severe disability, with factors like age, rural residence, and comorbidities playing a role.

## Contribution

The study provides new data on disability levels and associated factors among stroke survivors in Ethiopia, a region with limited prior research.

## Key findings

- Over 80% of stroke survivors in Ethiopia had moderate or severe disability.
- Age over 50, rural residence, and comorbidities were strongly linked to higher disability levels.
- Stroke survivors in early recovery and those using assistive devices faced greater disability.

## Abstract

Stroke is a leading cause of long-term disability worldwide, significantly affecting the physical, cognitive and emotional well-being of stroke survivors. Post-stroke disability often leads to limitations in daily activities, reduced social participation, and decreased quality of life. These result from complex interactions between an individual’s health condition and their environments. Despite this substantial burden, limited data exist on the severity of disability among stroke survivors in Ethiopia. Therefore, this study aims to assess the level of disability among stroke survivors in Ethiopia.

A multicenter institutional-based cross-sectional study was conducted from July 1 to August 31, 2024 in five public hospitals in Amhara Regional State. A total of 292 participants were selected using systematic random sampling. Disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0). Ordinal logistic regression was performed to identify factors associated with the level of disability.

Of the 292 stroke survivors, 17.5% of participants (95% CI: 13.0- 21.9) had mild, 43.8% (95% CI: 38- 49.7) moderate, and 38.7% (95% CI: 32.9–44.5) severe disability. Factors significantly associated with higher disability included age above 50 years (AOR = 2.87; 95% CI: 1.71–4.79), rural residence (AOR = 3.49; 95% CI: 1.65–7.40), stroke onset less than six months (AOR = 2.81; 95% CI: 1.69–3.45), presence of comorbidities (AOR = 1.94; 95% CI: 1.08–3.45), use of assistive devices (AOR = 2.69; 95% CI: 1.61–4.52), and longer hospitalization (AOR = 2.07; 95% CI: 1.22–3.52).

A high burden of moderate to severe disability was reported among stroke survivors. Older adults, individuals residing in rural areas, those in the early stage of recovery, those with comorbid conditions, those rely on assistive devices for mobility, and those with prolonged hospitalization require particular attention. These findings highlight the need for disability-inclusive public health strategies, expanded rehabilitation services, and equitable access to care, particularly in rural and resource-limited settings. Future studies with larger sample sizes, longitudinal designs, and community-based approaches are recommended to better understand disability trajectories and inform targeted interventions.