Perspectives on Disabilities in Sierra Leone

Abstract

Most disability research originates from high-income countries, masking important cultural variability in how disability is conceptualized. Through 199 interviews with people living in Sierra Leone, we investigated the following research questions: (1) what are the experiences of community members with people with disabilities?; (2) what employment options or other resources are available for people with disabilities?; and (3) how do community members perceive people with disabilities? We used a mixed-method approach to data analysis by quantitizing the qualitative responses to further examine whether participants’ responses differed by urbanicity, age, or level of education. The results of this study provide insight into how disability is understood in a low-income country and reveal important directions for future research.

A Meta-Synthesis of Disability Research in Western Africa

“…Furthermore, very few studies focused on emotional and behavior disorders, autism spectrum disorder, attention deficit hyperactivity disorder, specific learning disabilities, developmental disabilities, and traumatic brain injury, indicating a lack of understanding of these types of disabilities. This finding corroborates prior research that found disabilities in Western Africa are often understood according to the dichotomous categorization of “physical” or “mental” (Morin et al, 2021), with less known about other types of disabilities. As such, it is possible that studies describing participants as “mentally ill” or “crazy” were referring to people, not with mental health disorders as they are understood in the Western world, but instead with disabilities such as autism, attention-deficit hyperactivity disorder, emotional and behavior disorders, and others that are not as well known in Western Africa.…”

“…This finding supports previous reviews that found disabilities that are not readily apparent based on a person’s outward appearance, such as autism spectrum disorder, were rarely studied in sub-Saharan Africa (Franz et al, 2017). Mental health disorders were the focus of the largest number of studies; however, many studies referred to individuals with this disability as being “mentally ill” or “crazy,” demonstrating the intense stigma surrounding disabilities that are understood differently in Western Africa (see Baffoe, 2013; Morin et al, 2021). Furthermore, very few studies focused on emotional and behavior disorders, autism spectrum disorder, attention deficit hyperactivity disorder, specific learning disabilities, developmental disabilities, and traumatic brain injury, indicating a lack of understanding of these types of disabilities.…”

“…Because there are differences in definitions between high-income countries and LMICs for “multiple disabilities” and “other health impairments,” we did not include these disabilities in our coding scheme. In addition to the codes based on IDEA (2004), we created two variable codes to capture studies that defined disability more broadly, as is often the case in LMICs (see Morin et al, 2021): (a) general term of disability, and (b) mental health disorders. Finally, epilepsy was coded as its own topic due to the sizable amount of research on this disability in LMICs.…”

“…Disability is conceptualized differently around the world (Morin et al, 2021); however, the preponderance of disability research originates from the United States and Europe, despite these two areas comprising <15% of the world’s population (Saxena et al, 2006). This overrepresentation of disability research in high-income countries is problematic given that there are clear differences in how disability is perceived in high- versus low- and middle-income countries (LMICs).…”

“…For example, the medical model, which posits that people with disabilities suffer from inherent deficits in need of treatment or remediation (Kirby, 2017), is the prevailing view of disability in the United States as evidenced by the criteria used to diagnose disabilities outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ; American Psychiatric Association, 2013). Many people from LMICs, however, perceive disability through a cultural lens, with wide variations in what constitutes a disability (Morin et al, 2021). Furthermore, people with disabilities in LMICs are often ostracized due to a different cultural understanding of the causes of disability, with many people believing that disabilities have spiritual causes (Koszela, 2013; Stone-MacDonald & Butera, 2012).…”