Community health worker–reported observations of physical and mental disabilities among children in rural setting in Rwanda

Abstract

Physical and mental disabilities in childhood affect growth, development, and social participation, particularly in rural, low-resource settings where access to early diagnosis, care, and support systems is limited. Globally, 10–11% of children aged 0–17 years live with moderate-to-severe disabilities, more than half of whom reside in Sub-Saharan Africa and South Asia. In Rwanda, reported prevalence remains low, suggesting potential under-identification. Community Health Workers (CHWs) play a key role in identifying children with disabilities and facilitating referral to care. However, their capacity to identify physical and mental disabilities remains poorly understood. This study describes CHW-reported observations of childhood disabilities and examines factors associated with these observations. We conducted a quantitative study using secondary data from 358 CHWs. CHWs reported whether they had observed at least one child with a physical or mental disability (yes/no) in their communities. Descriptive statistics summarized CHW characteristics and reported observations. Bivariate and multivariable logistic regression analyses were used to examine factors associated with CHWs’ observation of childhood disabilities. Among 358 CHWs (median age 45 years; 57.7% female), 63.6% reported observing at least one child with a disability. Frequently reported physical disabilities included genou valgum (38.3%), clubfoot (36.1%), and hearing impairment (34.0%). Commonly reported mental disabilities included developmental delay (40.1%) and epilepsy (21.7%). Most CHWs (94.6%) reported referring cases to health facilities. Female CHWs were more likely to report identifying disabilities than males (AOR = 2.03, 95% CI: 1.27–3.23; p  = 0.003), while CHWs with 11–15 years of experience had higher odds of reporting childhood disabilities than those with less than 5 years of experience (AOR = 2.22, 95% CI: 1.08–4.56; p  = 0.030). CHWs play a critical role in community-based identification and referral of children with disabilities. Gender and experience influence observation patterns. Strengthening CHW capacity through targeted training, screening tools, and improved referral systems may enhance early identification and equitable access to care in rural settings.