Multidimensional Assessment of Health-Related Quality of Life in Ethiopian Children with Scoliosis: Evidence from WHODAS 2.0 and EQ-5D-Y

Abstract Background: Scoliosis in children leads to complex physical, psychosocial, and functional impairments, yet evidence from low-resource settings is limited. Objective: To evaluate health-related quality of life (HRQoL) in Ethiopian children with scoliosis using WHODAS 2.0 and EQ-5D-Y, and to identify clinical and demographic correlates of disability. Methods: A hospital-based cross-sectional study was conducted at CURE Children’s Hospital of Ethiopia (March 2024–June 2025). Ninety-seven children aged 6–15 years with confirmed scoliosis were assessed. WHODAS 2.0 (36-item) captured disability across six domains, while EQ-5D-Y measured physical, psycho-social, and pain-related HRQoL. Clinical severity indicators (Cobb angle, trunk rotation, thoracic morphomet-rics, anthropometrics) were recorded. Analyses in Python 3.12 included descriptive statistics, correlation, and multiple regression to examine associations between scoliosis severity and HRQoL outcomes. Results: Ninety-seven Ethiopian children diagnosed with scoliosis (mean age 11.4 years, mean Cobb angle 73.5°) were assessed; congenital scoliosis was most common (45.4%), followed by idiopathic (38.1%) and neuromuscular (16.5%). WHODAS 2.0 revealed substantial disability, particularly in mobility (46.4%) and social participation (62.8%), with life activities and participation as the strongest contributors. Greater deformity, younger age, and smaller body size were linked to worse outcomes, with neuromuscular and very severe thoracolumbar cases most affected. EQ-5D-Y showed marked HRQoL impairments across domains, with psychological distress (mean 2.24/3), pain, and self-care limitations emerging as key burdens. The mean EQ score was 8.89/15 (59.2%), indicating reduced quality of life. Regression analyses confirmed pain, psychological distress, and self-care limitations as the strongest predictors, with higher Cobb angle and ATR degree correlating with poorer HRQoL. Conclusions: Ethiopian children with scoliosis experience significant multidimensional impairments in HRQoL, with mobility, social participation, pain, and psychological distress as dominant burdens. WHODAS 2.0 and EQ-5D-Y proved complementary in capturing these impacts, supporting their use for early detection, clinical care, and public health planning in resource-limited settings.