Prevalence of physical functional impairments and associations with quality of life: a cross-sectional study in Chinese cancer survivors.

Disability is a major and growing global health and development concern. The World Health Organization estimates that approximately 15% (over 1 billion people) of the world’s population lives with some form of disability, with higher absolute burdens in low- and middle-income countries (LMICs) where health systems and social protection are commonly weaker []. People living with disabilities (PLWD) experience intersecting risks for poor health outcomes driven by poverty, social exclusion, and limited access to health and social services [, ]. In Ghana, recent census data indicate that disability affects a sizeable minority of the population and that prevalence varies by type and by urban–rural location []. Despite legal frameworks for disability rights, PLWD continue to experience barriers to healthcare, education, and employment that increase vulnerability to poor nutrition and mental health problems [, ]. Malnutrition and disability are bidirectionally related: malnutrition may contribute to disability (e.g., developmental delays), while disability may increase malnutrition risk (e.g., feeding difficulties or reduced mobility) [–]. The global nutrition landscape has also shifted: many LMIC urban settings now experience the “double burden” of malnutrition — defined as the coexistence of undernutrition and overweight/obesity— within the same communities and even within households [, ]. Ghana is no exception — systematic reviews and national data document rising urban overweight and obesity together with persistent undernutrition in vulnerable groups [, ]. Yet few studies disaggregate these patterns for adults living with disabilities; available evidence tends to focus on children with disabilities or on the general population, leaving a critical knowledge gap for adult disability populations in urban African settings [, ]. Mental disorders — particularly depression and anxiety — are leading contributors to global disability, and are closely associated with social deprivation, chronic physical illness, and reduced functioning [, ]. PLWD are at elevated risk of psychological distress for multiple reasons: stigma, unemployment, reduced social participation, pain, and inadequate access to mental health services [–]. Recent scoping and systematic reviews report substantially higher prevalence of depression among people with disabilities compared with the general population, with prevalence estimates frequently far above national averages, often 2–3 times higher than the general population estimates in LMIC studies [, ]. In Ghana and other parts of sub-Saharan Africa, mental health services are limited, and routine screening for depression and anxiety is not widely available in community disability services [, ].