Neuropsychiatric disease and treatment · 2026
Functional Disability Among People with Schizophrenia in East Africa: A Systematic Review with Evidence Predominantly from Ethiopia.
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Ndunguru Esterius Rabanus, Vivalya Bives Mutume Nzanzu, Posite Charles Malisaba, Usman Comfort Ojochenemi, Muhidin Hussen Abdu, Adeniyi Ismahil Adekunle, Eze Ejike Daniel, Usman Ibe Michael
Аннотация
BACKGROUND: Schizophrenia causes substantial impairment in social, occupational, family, and everyday functioning. East African evidence is dispersed across disability scales, quality-of-life measures, employment outcomes, longitudinal studies, rehabilitation trials, and qualitative research. This review synthesized the magnitude, domains, correlates, measurement approaches, and rehabilitation evidence for functional disability among people with schizophrenia in East Africa.
METHODS: We conducted a PRISMA 2020 systematic review of studies involving people with schizophrenia in eight East African countries. Outcomes included disability, social and occupational functioning, activities of daily living, participation, functional recovery, and quality of life. We extracted study characteristics, outcomes, correlates, intervention findings, and qualitative themes, and assessed methodological quality using design-specific Joanna Briggs Institute checklists.
RESULTS: Fifteen publications from 2005 to 2025 were included; 14 (93.3%) were from Ethiopia and one (6.7%) from Rwanda, with no eligible publications identified from the other six prespecified East African countries. Cross-sectional studies predominated. Measures included WHOQOL-BREF, 36-item and 12-item WHODAS 2.0, SF-36, SOFAS, employment status, and qualitative approaches. Six publications had low risk-of-bias concern, eight had moderate concern, and one had high concern for causal or effect inference. Direct WHODAS evidence showed substantial disability, while longitudinal studies demonstrated persistent social and physical impairment. Negative symptoms, joblessness, prolonged untreated illness, substance use, weak social support, medication-related problems, and socioeconomic disadvantage were recurrent correlates. Community-based rehabilitation reduced disability in the cluster-randomized RISE trial. The available regional evidence is therefore heavily concentrated in Ethiopia.
CONCLUSION: Functional impairment is multidimensional and extends beyond symptoms to work, social participation, daily activities, and quality of life. Integrated care should combine symptom management with rehabilitation, livelihood support, social inclusion, adherence support, and early treatment. Because the evidence is geographically concentrated in Ethiopia and uses heterogeneous measures, regional generalization should be cautious. Harmonized functional-outcome measurement and prospective multicountry research across East Africa are priorities.
METHODS: We conducted a PRISMA 2020 systematic review of studies involving people with schizophrenia in eight East African countries. Outcomes included disability, social and occupational functioning, activities of daily living, participation, functional recovery, and quality of life. We extracted study characteristics, outcomes, correlates, intervention findings, and qualitative themes, and assessed methodological quality using design-specific Joanna Briggs Institute checklists.
RESULTS: Fifteen publications from 2005 to 2025 were included; 14 (93.3%) were from Ethiopia and one (6.7%) from Rwanda, with no eligible publications identified from the other six prespecified East African countries. Cross-sectional studies predominated. Measures included WHOQOL-BREF, 36-item and 12-item WHODAS 2.0, SF-36, SOFAS, employment status, and qualitative approaches. Six publications had low risk-of-bias concern, eight had moderate concern, and one had high concern for causal or effect inference. Direct WHODAS evidence showed substantial disability, while longitudinal studies demonstrated persistent social and physical impairment. Negative symptoms, joblessness, prolonged untreated illness, substance use, weak social support, medication-related problems, and socioeconomic disadvantage were recurrent correlates. Community-based rehabilitation reduced disability in the cluster-randomized RISE trial. The available regional evidence is therefore heavily concentrated in Ethiopia.
CONCLUSION: Functional impairment is multidimensional and extends beyond symptoms to work, social participation, daily activities, and quality of life. Integrated care should combine symptom management with rehabilitation, livelihood support, social inclusion, adherence support, and early treatment. Because the evidence is geographically concentrated in Ethiopia and uses heterogeneous measures, regional generalization should be cautious. Harmonized functional-outcome measurement and prospective multicountry research across East Africa are priorities.