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ANALYSIS

Disability Trends in Saudi Arabia Prevalence and Causes

ABSTRACT

Al-Jadid MS: Disability trends in Saudi Arabia: prevalence and causes. Am J Phys Med Rehabil 2014;93(Suppl):S47YS49.

Disability is a major challenge for the Saudi healthcare sector. Data about the inci-

dence and prevalence of impairment and disability and sociodemographic cha-

racteristics of people with disabilities are scarce and incomplete and probably

underestimate the actual burden of disability. Policies and legislation have supported

the equal rights of persons with disabilities, but ineffective implementation of these

laws has created a gap between the intended aims and the actual provision of

services. Clearly, more research is needed to plan for appropriate management

programs, effective implementation of primary prevention strategies, and proper

allocation of health resources in this area.

Key Words: Rehabilitation, Persons with Disability, Epidemiology, Policy

The Kingdom of Saudi Arabia is the biggest country in the Middle East, occu- pying most of the Arabian Peninsula in southwest Asia, and has a population of approximately 28,376,355. As per the World Bank, Saudi Arabia has been catego- rized in the Bupper middle income[ group, which would increase the assumption that there is a fairly high standard of living within the Kingdom. However, the country’s healthcare sector faces many challenges, and disability is a great social and economic problem in the Kingdom. Despite the magnitude of the issue, awareness of and scientific information on disability issues are deficient.

WHAT IS THE PROBLEM?

Burden of Disability Disability prevalence estimates vary with the definition used to assess disability.

A study found the prevalence of major disabilities as affecting 3.7% of the Saudi population.1 The national census, however, reported only 135,000 people with disability, corresponding to 0.8% of the total Saudi population.2 Probably, both estimates underreport the real burden of disability in Saudi Arabia.

The major causes of chronic disability in Saudi Arabia are road traffic accidents, cerebrovascular accidents, cerebral palsy, head and spinal cord injuries, infection, and inflammation. According to the World Health Organization, road traffic accident deaths reached 5233 or 6.0% of total deaths in Saudi Arabia. In addition, consan- guineous marriages are frequently reported (56%) in Saudi Arabia, increasing the risk for genetic-associated disabilities.3 Another major reason of disability is that

Author: Maher Saad Al-Jadid, MD, MBBS, DMR, JBPM&R, FAFRM (Hon)

Affiliations: From the Department of Rehabilitation Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Correspondence: All correspondence and requests for reprints should be addressed to: Maher Saad Al-Jadid, MD, MBBS, DMR, JBPM&R, FAFRM (Hon), Department of Rehabilitation Medicine, Prince Sultan Military Medical City, PO Box 14126, Riyadh 11424, Saudi Arabia.

Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

0894-9115/14/9301(Suppl)-S47/0 American Journal of Physical Medicine & Rehabilitation Copyright * 2013 by Lippincott Williams & Wilkins

DOI: 10.1097/PHM.0000000000000022

www.ajpmr.com Disability Trends in Saudi Arabia S47

Saudi mothers tend to give birth at a later age (after 40 yrs), and older mothers have a greater risk for having babies with severe birth defects such as Down syndrome.4

In Saudi Arabia, there is limited research related to prevalence and incidence of disability, and most disability research has been done on children with disability.5 A study from Qaseem6 reported that the incidence of physical disability (1.7%) was higher than that of mental retardation (1.4%). A national survey that was conducted among 60,630 children reported that 6.3% of the children had a disability. The survey also showed that the highest rate of chil- dren with disability was in the Jazan region (9.9%) and the lowest rate was in Riyadh (4.4%). The most common disability type was physical (3%), followed by learning disability (1.8%).5 In addition, the highest proportion of disability was found among children of parents with disability, later-in-life pregnancies, and mothers who had not received medical care and required vaccination during pregnancy.5

Recently, the occurrences of neurologic disor- ders in Saudi children were evaluated in 45,682 Saudi children. In that study, 313 had chronic neu- rologic disorders, representing a prevalence of 68.5 per 10,000 children, which is the highest among all chronic diseases in children. The prevalence rate of mental retardation was 26.3 of 10,000; and of cerebral palsy, 23.4 of 10,000. In general, the major neurologic disorders in the population were pediatric chronic diseases.7 A cross-sectional study reported that trauma, as an etiology of disability, was found to be more com- mon than nontraumatic incidents among males and middle-aged individuals (16Y45 yrs). Traumatic accidents mostly resulted in quadriplegia (72.8%).8

Need for Rehabilitation It is estimated that the need for medical reha-

bilitation services ranges from 10% to 30% of the total number of admissions to the hospitals.2 If the authors consider that, recently, 3,027,575 persons were admitted to Saudi hospitals, a conservative es- timate would show that at least 302,757 persons needed some type of medical rehabilitation service. However, currently, there are only approximately 700 beds available for medical rehabilitation in Saudi Arabia. Although some patients may have exposure to rehabilitation services such as physical therapy or speech language therapy, an estimation of no more than 1% of them received appropriate services. The authors believe that there is a need for at least 30 rehabilitation beds per 100,000 inhabitants. This translates into an estimated need for 8,000 active rehabilitation beds in Saudi Arabia.

WHAT HAS BEEN DONE? Policies and Legislation

Society in Saudi Arabia is based on the Islamic Sharia, which emphasizes human rights and the right of persons with disabilities to live with dignity.2

In 1987, the legislation of disability passed as the first legislation for people with disabilities in Saudi Arabia. The legislation of disability contains important pro- visions that protect the rights of persons with dis- abilities to the same degree as those of other people in society.9 In 2000, the disability code approved by the Saudi government pledges that people with dis- abilities have access to free and appropriate medical, psychologic, social, educational, and rehabilitation services through public agencies. These laws, however, were passed a decade ago and have not been imple- mented well. In fact, the lack of effective implemen- tation has created a gap between the framework of these laws and the provision of services, resulting, for instance, in a lack of special education services for persons with disabilities.

Service Delivery Health services in Saudi Arabia are provided

mainly by the government through the Ministry of Health. In 2011, the total number of hospitals in Saudi Arabia was 415, with a total of 58,696 beds. Five additional hospitals were added during the year. Most of the secondary healthcare services were pro- vided by general hospitals.2,10,11 The need for reha- bilitation services is imperative for people who have sustained severe injuries often as a result of trauma, stroke, infection, tumor, surgery, or progressive dis- eases to improve their quality-of-life. The need for rehabilitation is independent of age, although the type, level, and goals of rehabilitation may differ. People with severe impairments, often elder people, have different goals and required different types of therapy than those of younger people.10 In addition, sex is a significant factor that must be considered in Muslim societies. There are separate rehabilitation facilities for males and females, but there are no sta- tistics or data to justify the number or the distribu- tion of these facilities. Many vocational rehabilitation trainees are male, whereas most persons with severe disabilities are female.

During the last 2 decades, the Ministry of Health has established several rehabilitative services for persons with disabilities in the country. Most of these programs offer physical, occupational, speech, and hearing therapy as well as prosthetic and orthotic services, and rehabilitation programs and facilities are now increasingly understood as an integral part of modern healthcare delivery services.

S48 Al-Jadid Am. J. Phys. Med. Rehabil. & Vol. 93, No. 1 (Suppl), January 2014

Modern medical rehabilitation in Saudi Arabia started in the early 1960s after an outbreak of polio- myelitis, with many victims, mainly children. Most of the affected people who survived were left with some sort of disability largely related to mobility. Because there was no medical rehabilitation depart- ment in hospitals at that time, most of the patients were sent abroad by the government for surgical correction of deformity and/or fitting with braces to help improve walking. Others received some phys- iotherapy, but the service was limited to patients living in major cities.10 In the early 1970s, the gov- ernment launched prosthesis and orthotic centers in some of the Ministry of Health hospitals, but the services were limited to braces or caliper fitting. In the beginning of the 1980s, the Ministry of Defense and Aviation commissioned several medical rehabil- itation centers within the Military Hospitals. Some private hospitals also allocated some beds to the re- habilitation of people with work-related disabilities covered by social insurance.

There is still a great need for more rehabilita- tion centers because of a growing population and an increased rate of road traffic accidents with the consequences of traumatic brain injuries, spinal cord injury, amputations, fractures, and others.10,12 In addition, there has been a change in lifestyle, with an increased incidence of diabetes mellitus, hyperten- sion, ischemic heart disease, and stroke,13 and there are more children born with cerebral palsy or hered- itary diseases because of consanguinity.10

Research and Evidence-Based Practice Data about the incidence and the prevalence of

impairment and disability and sociodemographic characteristics of people with disabilities are scarce and incomplete because of the difficulties in con- ducting research on disability-related issues in Saudi Arabia.14 A major issue is that families feel ashamed of having a person with a disability and, as a result, tend to avoid disclosing information related to the beloved ones and participation in such research.

CONCLUSIONS There is a clear lack of published research on

disability in Saudi Arabia. However, this research is greatly needed to plan for appropriate management programs, effective implementation of primary pre- vention strategies, and proper allocation of health resources in this area. To meet the recommendations

of the recently launched World Report on Disability,13

policy, healthcare providers, and research have to bundle and to coordinate their capacities. Moreover, there is a need to include more persons with dis- abilities in these initiatives.

REFERENCES

1. Al-Turaiki M: National Survey of Disability and Re- habilitation in Saudi Society. Riyadh, Kingdom of Saudi Arabia, The Joint Centre for Research in Prosthetics Orthotics, 2000

2. Al-Jadid MS: Disability in Saudi Arabia. Saudi Med J 2013;34:453Y60

3. Al Essa M, Ozand PT, Al-Gain SI: Awareness of inborn errors of metabolism among parents in Saudi Arabia. Ann Saudi Med 1997;17:562Y4

4. El-Mouzan MI, Al-Salloum AA, Al-Herbish AS, et al: Regional variations in the prevalence of consan- guinity in Saudi Arabia. Saudi Med J 2007;28:1881Y4

5. Al-Hazmy MB, Al Sweilan B, Al-Moussa NB: Handicap among children in Saudi Arabia: Prevalence, distribu- tion, type, determinants and related factors [in Arabic]. East Mediterr Health J 2004;10:502Y21

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8. Al-Shehri AS, Farahat FM, Hassan MH, et al: Pattern of disability among patients attending Taif Rehabili- tation Center, Saudi Arabia. Disabil Rehabil 2008; 30:884Y90

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12. Al-Naami MY, Arafah MA, Al-Ibrahim FS: Trauma care systems in Saudi Arabia: An agenda for action. Ann Saudi Med 2010;30:50Y8

13. World Health Organization: World Report on Disability. Geneva, Switzerland, World Health Organization, 2011

14. Al-Gain SI, Al-Abdulwahab SS: Issues and obstacles indisability research in Saudi Arabia. Asia Pac Disabil Rehabil J 2002;13:45Y9