Characterizing functional disability in African informal settlements

Ifeoluwa Albert

doi:10.17918/00011596

Background: An estimated 1.3 billion people worldwide experience disability, and over one billion live in slums, with sub-Saharan Africa projected to see the largest growth in informal settlements. Despite this, functional disability among slum residents remains understudied, limiting service planning and rights protections for this population. This dissertation aimed to characterize functional disability in African informal settlements by estimating disability prevalence and drivers; identifying strengths and limitations of utilized measures; and understanding how disability is experienced, understood, and negotiated by residents themselves. Methods: Using cross-sectional secondary data collected from 2018-2019 by the Improving Health in Slums Research Collaborative, functional disability prevalence was estimated across six health-status-based measures among adults in five African informal settlements in Nigeria and Kenya (N=5,081) and identified sociodemographic predictors using chi-square tests and multivariable logistic regression. Qualitative data was then collected from disabled residents of one of those communities (Bariga, Lagos, Nigeria) in 2024. Eight focus groups were conducted to assess face validity of the quantitative measures and understand participants' definitions and preferred measurement strategies for disability. Finally, Hermeneutic interpretive phenomenological interviews with ten disabled residents of the same community (up to five interviews each) explored lived experiences and meaning-making of slum residents with disabilities. Results: Disability prevalence ranged from 3.47% (mental health) to 17.96% (role limitations), with role limitations also showing the strongest resonance with focus group participants. Age was the strongest predictor of severe disability; education and employment were protective, and women had higher odds of severe disability compared to men. Focus groups found that visibility, functional limitation, and dependence on others most strongly anchored residents' understanding of disability, with participants favoring direct observation and community-identification over standardized instruments. Phenomenological interviews revealed that participants' lives were characterized by ongoing precarity and volatility across their bodies, finances, relationships, and physical environment, which participants navigated through sustained cognitive, physical, and emotional overlabor. This process fueled ongoing rejection of disability as a label and a resistance of "true disability," which participants equated with helplessness, and a north star of reliance on and surrender to God. Conclusions: Functional disability is common and most likely severely under-documented among African slum residents, and main demographic drivers of disability align with those of other populations: old age, unemployment, little or no education, and female gender. Standardized measures only partially reflect residents' own conceptions of disability. Findings suggest that service delivery should rely on functional, community-informed identification rather than imported standardized instruments alone, and that eligibility and outreach should accommodate residents' rejection of the disability label. Programs should also build in mechanisms for ongoing reassessment given the volatility of participants' circumstances. The dissertation calls for expanded research attention and urgent, disability-inclusive planning and social protection given worsening conditions and structural violence - including conflict, food insecurity, and eviction pressures - facing slum communities across the continent.

Characterizing functional disability in African informal settlements

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Characterizing functional disability in African informal settlements

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