Socioeconomics and Major Disabilities: Characteristics of Working-Age Adults in Rwanda.
BACKGROUND
Disability affects approximately 15% of the world's population, and has adverse socio-economic effects, especially for the poor. In Rwanda, there are a number of government compensation programs that support the poor, but not specifically persons with disability (PWDs). This study investigates the relationship between poverty and government compensation on disability among working-age adults in Rwanda.


METHODS
This was a secondary analysis of 35,114 adults aged 16 to 65 interviewed in the 2010/2011 Rwanda Household Wealth and Living Conditions survey, a national cross-sectional two-stage cluster survey, stratified by district. This study estimated self-reported major disability, and used chi-square tests to estimate associations (p<0.1) with income, government compensation, occupation type, participation in public works programs, and household poverty status. Non-collinear economic variables were included in a multivariate logistic regression, along with socio-demographic confounders that modified the relationship between any economic predictor and the outcome by 10% or more. All analyses adjusted for sampling weights, stratification, and clustering of households.


RESULTS
Over 4% of working-age adults reported having a major disability and the most prevalent types of disability in order were physical, mental, and then sensory disability. In bivariate analysis, annual income, occupation type, and poverty status were associated with major disability (p<0.001 for all). Occupation type was dropped because it was collinear with income. Age, education, and urban/rural residence were confounders. In the multivariate analysis, adults in all income groups had about half the odds of disability compared to adults with no income (Rwf1-120,000 OR = 0.57; Rwf120,000-250,000 OR = 0.61; Rwf250,000-1,000,000 OR = 0.59; Rwf1,000,000+ OR = 0.66; p<0.05 for all), and non-poor adults had 0.77 the odds of disability compared to poor adults (p = 0.001).


CONCLUSIONS
Given that personal income rather than government programming is associated with disability in Rwanda, we recommend deliberately targeted services to those with disability via cash transfers, placements in disability-appropriate employment, and micro-savings programs.
University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
Joshua
J
Kiregu
University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
Nathalie K
NK
Murindahabi
University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
David
D
Tumusiime
University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
Dana R
DR
Thomson
University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.|Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, United States of America.
Bethany L
BL
Hedt-Gauthier
Rwanda Biomedical Centre, Injuries and Disabilities Unit, Kigali, Rwanda.
Anita
A
Ahayo
D000328:Adult; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012432:Rwanda; D057566:Self Report; D012959:Socioeconomic Factors; D014942:Workers' Compensation / Q000331:legislation & jurisprudence*; D055815:Young Adult