Survey on Living Conditions Among People with Activity Limitations 2002-2003
Disability and society: The last 20–30 years have seen an important change in our understanding of disability. From a previous individual perspective on causes and interventions, a social and civil rights approach has taken over. Much of the focus is now on the human and physical environment and how this might reduce or enhance an individual’s level of activity and social participation.
National policy development aimed at improving living conditions in general and among people with disabilities in particular is dependent on the availability of quality data. In many countries these have been lacking, and both the United Nations and National authorities have emphasised the need for this information in order to further develop disability policies.
Information about people with disabilities and their living conditions has the potential for contributing to an improvement of the situation faced by this group in many low-income countries, as has been demonstrated in high-income countries. The Studies on Living Conditions Among People with Activity Limitations in Developing Countries have been applied to inform policy development, for capacity building, awareness creation, and in specific advocacy processes to influence service delivery.
The studies have demonstrated that level of living conditions among disabled people is systematically lower than among non-disabled people. This implies that people with disabilities are denied the equal opportunities to participate and contribute to their society. It is in this context that people with disabilities are denied their human rights.
In Zimbabwe, the developmental objective for this project has been to contribute to the improvement of disabled people's living conditions, including also their level of social participation.
Specific aims include:
- To carry out representative nation-wide studies on living conditions among people with disabilities in Namibia and Zimbabwe
- To lay the groundwork for repeated and long-term data collections on living conditions among people with disabilities in the two countries
- To assist in capacity building among disabled peoples' organisations and among relevant professionals at ministerial level
- To assist the Southern African Federation of Disabled People in the establishment of The Disability Resource Centre for Southern Africa through training and technical assistance
For the study on living conditions, specific objectives or research topics have been:
- Development of an adapted design for studies on living conditions among people with disabilities in Southern Africa
- Establishment of a baseline on the level of living of people with disabilities in Zimbabwe
- Description and analyses of living conditions among people with disabilities in Zimbabwe
- Comparison of living conditions among people with and without disabilities
- Analyses of socio-demographic distribution of living conditions among disabled and non-disabled
- Applying components from the International Classification of Functioning, Disability and Health (ICF) in order to test their applicability in the context of a low-income country5
- Analyse the relationship between ICF components and standard of living.
In Zimbabwe, the study has been carried out as three consecutive surveys in three regions covering 44 % of the population. The reason for this step-wise procedure is found in the rather difficult political and economic situation in Zimbabwe during the research period. Due to time and financial constraints, the entire country could not be surveyed. Although this is a weakness as compared to a full National study, it is reassuring that the results from the three regional studies are for the most part similar. It is thus likely that including more regions in the study would not uncover new patterns, particularly not with respect to the main results.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Three regional areas: Matabeleland,Manicaland and Midlands.
Unit of Analysis
The target population for sampling was all private households in Zimbabwe excluding institutionalised and homeless people.
Producers and sponsors
Authoring entity/Primary investigators
The Foundation for Scientific and Industrial Research - SINTEF Unimed
Southern Africa Federation of Disabled People (SAFOD)
Norwegian Federation of Organisations of Disabled People (FFO)
National Council of Disabled Persons of Zimbabwe
Departments of Psychiatry and Rehabilitation
University of Zimbabwe
Ministries of Health and Child Welfare and Social Welfare
Government of Zimbabwe
Norwegian Agency for Development Cooperation
A two-stage cluster sampling procedure was applied using the National sampling frame in each country, in close collaboration with the National statistical offices who also did sample size calculations to ensure representativity at regional/provincial level. A required number of geographical units (often called Enumeration Areas, EAs) are thus sampled, with all households in these areas included in the first stage of the sampling. Then follows screening where all households in the selected areas are interviewed (normally the head of the household) using the WG 6 screening instrument.
Sampling in Zimbabwe:
A two-stage stratified sampling was carried out with enumeration areas as strata. A total of 1943 households with disabled members and 1958 households without disabled members were sampled in three regional areas: Matabeleland,Manicaland and Midlands. A total of 21712 individuals in the 3901 households were sampled within the three regions. These three regions cover 5 out of 10 Provinces in the country and approximately 44 % of the total population of Zimbabwe. The total population of the three regions is 5.1 million. The population of the selected enumeration areas in the three regions is 69821.
The second step in the sampling procedure was screening for disability by interviewing primarily the heads of all households in the sampled enumeration areas. This exercise (termed "listing") was also carried out by Central Statistical Office. A common approach to screening for disabilities in the censuses of many low-income countries is by asking for specific impairments. The approach used in this survey was, however, based on an understanding of disability as difficulties in doing day-to-day activities and/or as restrictions in social participation.
The national listing carried out by the Central Statistical Office in 2002 identified a total of 4133 persons with disabilities among a population of 141 088, giving a disability prevalence of 2.9% within a national sampling frame.
Not all households or individuals identified through the national listing procedure were included in the final survey. Only selected enumeration areas in Matabeleland, Manicaland and Midlands are included in the results presented here. All households with disabled members were included (n=1958). These households were later revisited and comprehensive questionnaire-based interviews were carried out of the person with a disability or a proxy if they were not able to respond due to absence, age, disability or some other factor. During this exercise, the screening procedure was repeated and a total of 2071 individuals with difficulties in carrying out day-today activities were identified, thus qualifying as being disabled. This comprises 50% of those with disabilities listed nationally and 2.7% of the total listed population in the three regions. Among a total listed population in Matabeleland of 36080, 870 individuals were identified with disabilities, yielding a prevalence rate of 2.4%. In Manicaland 665 individuals with disabilities were identified among a listed population of 23319, yielding a prevalence rate of 2.9% and in Midlands 536 individuals were identified among a population of 16416, yielding a prevalence rate of 3.3%.
Due to the disproportionate allocation of the sample points to various strata, sampling weights will be required to correct for differential representation of the sample at national and subnational levels. The weights of the sample are in this case equal to the inverse of the product of the two selection probabilities employed.
Dates of Data Collection (YYYY/MM/DD)
Mode of data collection
Type of Research Instrument
The questionnaires applied in the studies were originally based on two previously applied instruments: A study on living conditions in the general population in Namibia (NPC 2000) and a national disability survey carried out in South Africa (Schneider et. al., 1999). Over the years, and in particular in the first couple of studies in Namibia and Zimbabwe, a lengthy process involving all stakeholders was carried out to align the content of the questionnaires with the context and priorities of particularly the disability movement. A disability-screening instrument was included, in the early phases drawing on the discourse preceding ICF, in later phases using the WG 6 screening instruments directly. The "ICF matrix" on activity limitations, participation restrictions and environmental barriers was also included
Four separate questionnaires are applied:
i) Household study on living conditions - a set of core indicators of living conditions for all permanent members of the household (including control households)
ii) Screening for disability; WG 6
iii) Detailed Questionnaire for people with disabilities including the Activity and Participation Matrix drawn from ICF
iv) Detailed questionnaire to individuals without disability (controls)
The questionnaires are all developed in English language and translated into local language(es)
The generic household questionnaire covered the following topics:
- Demography and Disease burden
- Education and Literacy
- Economic activities of household members
- Reproductive Health of Females aged 12 to 49 years
- Household amenities and housing conditions
- Household access to facilities
- Household asset ownership including land
- Household Income and its main source
- Household food production
- Household monthly Expenditure and rankings
- Death in the households
The detailed Disability Questionnaire covered the following topics:
- Activity Limitations and Participation restrictions
- Environmental factors
- Awareness, need and receipt of services
- Education and employment / income
- Assistive devices and technology
- Accessibility in the home and surroundings
- Inclusion in family and social life
- Health and general well-being
- Knowledge of HIV/AIDS, Malaria, TB and Diabetes.
The Control questionnaire for individuals without disabilities is a reduced version of the questionnaire applied to individuals with disability.
Zimbabwe: Data collection questionnaires that had previously been used in Namibia (on general living conditions – NPC, 2000) and in South Africa (on disability – Schneider et. al., 1999) were combined and adapted for use in Zimbabwe. In addition, a disability-screening instrument was included as well as a matrix on activities and participation developed specifically for this study and drawing on the concepts of the ICF. The design applied in this study in Zimbabwe is similar to the design applied in the previous study in Namibia (Eide, van Rooy & Loeb, 2003), save some minor differences in formulations of certain questions.
After revision, the questionnaire comprised four key elements; i) household study on living conditions, ii) screening for disability, iii) questions to individuals with disabilities including iv) the ICF based matrix on activities and participation. The final version of the questionnaire was developed in English. Simple field tests were carried out during training leading to a few adaptations to local dialects
The research team is responsible for organizing data entry, cleaning and submission of the data file for analyses, which is carried out by SINTEF in collaboration with the local/national research group. A final report is then produced, followed by a dissemination workshop with high-level representation and press coverage.
In Zimbabwe, all questionnaires were controlled and signed by a supervisor after the interview. Completed questionnaires were transported to Harare for data cleaning and entry. Data entry was facilitated by using the EPI INFO 6 (version 6.04b) data entry programme. Upon completion of data entry, the data were relayed to Norway and converted to SPSS format for analysis using SPSS 11.0.
Southern African Federation of the Disabled
Advisor Hanne Witsø
Norwegian Federation of Disabled People (FFO)
Professor Arne H. Eide, Dep. of Living Conditions and Health Services