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

BACKGROUND: 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. METHODS AND MATERIALS: 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. RESULTS: 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). CONCLUSIONS AND RECOMMENDATIONS: 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.