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on disability are essential to policymakers in order to
establish tailored programmes for PWD based on the
specific needs of each category (4).
Moreover, as a developing country, and due to its
demographic transition, with more elderly people,
Morocco has also been facing an epidemiological
transition, with a substantial increase in non-commu-
nicable diseases (5), which has a major effect on the
prevalence of disability (6).
According to the Global Burden of Disease, chronic
health conditions are held accountable for approximately
66.5% of years lived with disability in low- and middle-
income countries (7). A recent survey by the Moroccan
Ministry of Health showed that 18.2% of the Moroc-
can population had at least one chronic disease. This
rate rises to 57.5% among subjects aged 60 years and
more (8), suggesting a potentially higher prevalence of
disability than was found in the 2004 Disability Survey.
The aim of this present national survey, conducted
in 2014, was to establish a new and updated database
on disability in Morocco, in order to measure the pre-
valence of disability among the Moroccan population,
and to determine its characteristics and domains. We
present here the results related to the prevalence of
disability among the adult Moroccan population, and
its variability according to socio-demographic charac-
teristics and geographical distribution.
METHODS
Study design and sampling
The prevalence of disability in Morocco was estimated through
a population-based, cross-sectional survey, based on a 2-stage
stratified random sample design. The target population included
members of Moroccan households spread across the country
(urban and rural areas) in each of the16 administrative regions
of Morocco.
The sampling was realized according to the database from the
latest national census, conducted in 2004, which was adjusted to
fit with the administrative division of 2009. The country was stra-
tified into 16 regions (according to the Moroccan administrative
division). Each region was then stratified into urban and rural areas.
In the urban area, all possible types of housing were considered
(luxury, modern, ancient, affordable and social, precarious and
clandestine), whereas in the rural area, provinces were stratified ac-
cording to their specificity (plain, mountain, plateau, and Saharan).
A first-stage sampling consisted in randomly drawing a
sample of districts from the national census in each considered
stratum. This draw was carried out with a probability proportio-
nal to the number of households within each stratum. Then, the
second-stage sampling consisted in an equal probability random
draw of 20 households within each previously selected district.
According to the previous national study conducted in 2004,
which found a prevalence of disability of 5.2% (9), and taking
into account the regional and living areas (urban/rural) specifici-
ties, the target sample size was determined at 16,044 households,
with a 95% confidence interval (95% CI), 2% margin of error,
and 10% expected non-response.
www.medicaljournals.se/jrm
The study was carried out as part of a governmental popula-
tion census in agreement with Moroccan law and the principles
of the Declaration of Helsinki on protecting human subjects.
All patients included in this study were informed of the study
aims and characteristics and gave their informed consent to
participate. The ethics committee of the Faculty of Medicine
and University Hospital of Fez approved the analysis and use
of the census database.
Procedure
A total of 80 qualified investigators were recruited and mobilized to
conduct the field-survey, which lasted 10 weeks between May and
July 2014. Prior to the survey, all survey team staff were trained
in the survey objectives, interview procedures and data collecting
tools (digital tablets), with real situation simulations. The survey
teams were assigned to cover administrative regions where they
belong, or in which they had worked before, so that they were
aware of the local population cultural and language specificities.
On arriving at the household, the investigator first asked to
talk to the head of the family (usually the father), in order to
explain the survey objectives and to obtain consent to interview
him and the rest of the household members. If the consent was
not obtained, the household was replaced by another one with
the same characteristics (same district, same housing type),
which was usually the next-door neighbours.
All members of each household visited were included in
the survey, and interviewed using 2 questionnaires. A socio-
demographic questionnaire was used to collect information
about each person’s age, sex, marital state, level of education,
and occupation. All household members were then screened for
disability using the Washington Group (WG) Short Set of Ques-
tions on Disability, but we only report the results of the adult
population over 18 years of age. These questions were developed
to identify the majority of the population with functioning dif-
ficulties in basic activities, which might limit independent living
or social integration if appropriate accommodation is not made.
The WG Short Set of Questions on Disability was developed
according to the Fundamental Principles of Official Statistics
to be used in Censuses and Surveys (10). It is consistent with
the International Classification of Functioning, Disability and
Health (ICF), and has been shown to produce internationally
comparable data (11). The Short Set of WG contains 6 questions,
covering 6 core functional domains, administered as follows:
“The next questions ask about difficulties you may have doing
certain activities because of a health problem:
1 – Do you have difficulty seeing even if wearing glasses?
2 – Do you have difficulty hearing, even if using hearing aid?
3 – Do you have difficulty walking or climbing stairs?
4 – Do you have difficulty remembering or concentrating?
5 – Do you have difficulty with self-care (such as washing all
over or dressing)?
6 – Using your usual (customary) language, do you have diffi-
culty communicating (for example, understanding or being
understood by others)?
Each question has 4 response categories: 1 – No, no difficulty;
2 – Yes, some difficulty; 3 – Yes, a lot of difficulty; and 4 – Can-
not do at all.
For a more rigorous identification of PWD, the results were
refined among the population who stated that they had some
difficulty (2) or a lot of difficulty (3) in one or more of the 6
targeted disability domains, by submitting this population to
complementary questions, as suggested by the WG Short Set of