INTRODUCTION
The Arab world comprises 22 countries in the Middle East and North Africa, namely, Algeria, Bahrain, Comoros Islands, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Mauritania, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. According to The World Bank (2022), the Arab world had a combined population of 464.7 million. The prevalence of disability in the Arab countries ranges from 0.2% in Qatar to 5.1% in Morocco ( UN Economic and Social Commission for Western Asia, 2018). These statistics are lower than the World Health Organization’s estimate of 16% of the world’s population experiencing significant disability ( World Health Organization, 2023, March 7). The low rates in Arab countries may be attributed to methodological issues in the data collection and the social stigma associated with disability ( UN Economic and Social Commission for Western Asia, 2018). Negative attitudes towards persons with disabilities are prevalent in the Arab region ( Al-Hendawi et al., 2022). Persons with disabilities often face disadvantages in terms of education, health, employment, and their participation in political and public life ( United Nations Economic and Social Commission for Western Asia et al., 2023).
The disability movement in Arab countries has been advocating for the rights of persons with disabilities in the region, aiming to overcome discriminatory attitudes towards persons with disabilities ( Arab Organisation of Persons with Disabilities, 2020). These rights are outlined in the Convention on the Rights of Persons with Disabilities ( United Nations, 2006). All Arab countries have ratified the Convention, with the exception of Lebanon, which is currently in the process of ratifying it ( UN Economic and Social Commission for Western Asia, 2021). The Convention on the Rights of Persons with Disabilities ( United Nations, 2006) is an international agreement that seeks “to promote, protect, and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote and respect for their inherent dignity” (p. 4).
There have been increased initiatives to promote intergovernmental and civil society cooperation on disability issues in the region ( Sargent, 2021). The period from 2004 to 2013 was declared as the Arab Decade of Disabled Persons ( UN Economic and Social Commission for Western Asia, 2012). Arab countries have been undertaking reforms in their disability policies ( UN Economic and Social Commission for Western Asia, 2012). The national disability strategies in the Arab region demonstrate a growing commitment to a human rights-based approach to disability and ensuring inclusion ( UN Economic and Social Commission for Western Asia, 2021).
However, Arab countries face challenges that include accurate data on persons with disabilities, insufficient funding for disability services, inadequate implementation and monitoring of law and policies, prevailing social stigma surrounding disability, and a lack of accessibility ( United Nations Economic and Social Commission for Western Asia et al., 2023).
With the growing focus on disability rights in Arab countries, it is crucial to have related and relevant research within these countries. Research on disability plays a significant role in enhancing our understanding of various aspects of disability, such as health and education. It also contributes to improving the lives of persons with disabilities and promoting inclusion. Furthermore, research helps in developing evidence-based policies, programmes, and services. Given that Arab countries have unique cultural, religious, and social contexts that shape the perceptions of disability, it is important to conduct research that explores specific local issues and situations. The objective of this bibliometric review is to examine the research conducted on disability within Arab countries.
METHODS
On 16 December 2023, we conducted a systematic search in the Web of Science database for publications related to disability in Arab countries from inception. The Web of Science database is a widely citation database for calculating bibliometric statistics and has been commonly utilised in bibliometric studies (e.g., Zyoud et al., 2017; González-Serrano et al., 2019; Yang et al., 2021).
The search strategy comprised two categories, namely, Arab countries (Algeria OR Bahrain OR Comoros OR Djibouti OR Egypt OR Iraq OR Jordan OR Kuwait OR Lebanon OR Libya OR Mauritania OR Morocco OR Oman OR Palestine OR Qatar OR Saudi Arabia OR Somalia OR Sudan OR Syria OR Tunisia OR “United Arab Emirates” OR UAE OR Yemen) and disability (disab* OR handicap* OR impair* OR paralys* OR blind OR “low vision” OR “vision disorder*” OR deaf* OR “hearing disorder*” OR “spinal cord injur*” OR parapleg* OR quadripleg* OR tetrapleg* OR dwarf* OR amputee* OR “muscular dystrophy” OR “spinal bifida” OR “movement disorder*” OR sclerosis OR autism OR “Down syndrome” OR Asperger OR dyslexia OR “attention deficit disorder” OR “attention deficit hyperactivity disorder” OR ADHD OR “cerebral palsy” OR “musculoskeletal disorder” or “musculoskeletal injur*” OR “cognitive dis*” OR “neurological dis*” OR “neurodegenerative dis*”).
To retrieve publications specific to disabilities in Arab countries, we refined our search by excluding the following terms using the Boolean operator NOT in the title: veteran* OR war* OR soldier* OR “impaired glucose” OR “blind spot” OR “Jordan’s principle” and in all fields: astronomy OR astrophysics OR plant OR agriculture OR anthropology OR zoology OR entomology OR veterinary.
This search yielded 1205 results, which were transferred to an Excel sheet for further analysis and calculations.
RESULTS
Overall trend
There has been an increase in the number of publications over the years (see Fig. 1). Starting with the first article published in 1974 (Reeducation of deaf and dumb in Tunisia by H. Fayal), there were a maximum of 10 publications per year until 2004. However, in the last 20 years, there has been a steady increase in the number of publications, with the highest number observed in 2022 ( n = 157). Notably, there are no recorded publications for the years 1975 and 1999, and half of the publications were published in the last 6 years.
Most of the publications were articles ( n = 894) and were published in English ( n = 1178). Other popular document types were meeting abstracts ( n = 186), conference proceeding papers ( n = 33), and review articles ( n = 32). Additionally, there were publications in other languages such as French ( n = 24), German ( n = 2), and Russian ( n = 1).
A total of 4438 authors contributed to the publications, including 190 single-author publications. The most prolific author, R. Alroughani from Amiri Hospital, Kuwait, has 35 publications. Following closely is J. Al-Hashel from Kuwait University with 22 publications. It is worth noting that R. Alroughani was a co-author in all of Al-Hashel’s publications. Their publications focus on multiple sclerosis in Kuwait.
Each article was categorised based on the country and type of disability mentioned in the titles, which represents the location and focus of the research. The country with the highest number of publications is Saudi Arabia ( n = 393), accounting for 32.6% of all publications. The other countries in the top five are Egypt, Jordan, Kuwait, and the United Arab Emirates, with 128, 107, 79, and 67 publications, respectively. Three Arab countries, namely, Comoros, Djibouti, and Mauritania, did not have any publications in record.
Ten of the most prolific institutions account for nearly half (47.47%) of the total publications. The institution with the highest publication output is King Saud University in Saudi Arabia, with 92 publications. Five out of the top 10 most prolific institutions are based in Saudi Arabia, representing almost a fifth (19.64%) of the total publications. The remaining institutions are from Jordan, Kuwait, Lebanon, Oman, and the United Arab Emirates, with one institution from each country. Please refer to Table 1 for further details.
Top 10 most prolific institutions.
| Institution | n | % of publications |
|---|---|---|
| King Saud University, Saudi Arabia | 92 | 7.65 |
| King Saud Bin Abdulaziz University for Health Science, Saudi Arabia | 64 | 5.32 |
| Kuwait University, Kuwait | 56 | 4.66 |
| King Abdulaziz University, Saudi Arabia | 48 | 3.99 |
| King Khalid University, Saudi Arabia | 36 | 2.99 |
| Sultan Qaboos University, Oman | 35 | 2.91 |
| United Arab Emirates University, UAE | 33 | 2.74 |
| Imam Abdulrahman Bin Faisal University, Saudi Arabia | 32 | 2.66 |
| University of Jordan, Jordan | 31 | 2.58 |
| American University of Beirut, Lebanon | 29 | 2.41 |
In terms of the type of disability, the most extensively studied disability is multiple sclerosis ( n = 221), followed by autism ( n = 149) and visual impairment ( n = 122). These are the only disabilities that have been the subject of over 100 publications. Hearing impairment, attention deficit hyperactivity disorder, and intellectual disability are the next most studied disabilities, each with between 50 and 75 publications.
The focus of the publications is also reflected in the journals in which they have been published. The Multiple Sclerosis Journal ( n = 41) and the Saudi Medical Journal ( n = 34) are the top two journals in terms of publications. This is understandable considering that multiple sclerosis is the most researched disability and Saudi Arabia is the country with the highest number of publications. Among the top 10 journals, there is another journal that specialises in multiple sclerosis ( Multiple Sclerosis and Related Disorders) and another journal from Saudi Arabia ( Annals of Saudi Medicine). Publications in the Saudi Medical Journal have the highest number of citations ( n = 363), resulting in an average of 10.68 citations per publication. The journal with the highest average citation per publication is the Journal of the Neurological Sciences, with an average of 12.79 citations per publication. Please refer to Table 2 for further details.
Top 10 most prolific Web of Science indexed journals.
| Journal | TP | TC | C/P |
|---|---|---|---|
| Multiple Sclerosis Journal | 41 | 178 | 4.34 |
| Saudi Medical Journal | 34 | 363 | 10.68 |
| Cureus Journal of Medical Science | 29 | 52 | 1.79 |
| Journal of the Neurological Sciences | 24 | 307 | 12.79 |
| Neurosciences | 20 | 89 | 4.45 |
| Research in Developmental Disabilities | 19 | 237 | 12.47 |
| Multiple Sclerosis and Related Disorders | 17 | 81 | 4.76 |
| Neurology | 17 | 50 | 2.94 |
| International Journal of Environmental Research and Public Health | 16 | 94 | 5.88 |
| Annals of Saudi Medicine | 14 | 156 | 11.14 |
Abbreviations: TP, total publications; TC, total citations; C/P, citation per publication.
Only 269 publications acknowledged funding, with King Saud University ( n = 17) funding the highest number of publications. The other funding agencies supported <10 publications each. The funding sources included both local and international agencies. Local funders primarily consisted of universities, research institutes (e.g. Qatar National Research Fund), and ministries (e.g. Ministry of Education, Saudi Arabia). International funders included UK Research Innovation, United States Department of Health Human Services, and National Institutes of Health, USA.
The top 10 most cited publications are presented in Table 3. These publications were published between 1983 and 2021. The most cited publication is “Severe childhood muscular dystrophy affecting both sexes and frequent in Tunisia” by Ben Hamida et al. (1983) with 159 citations. It is the oldest publication on the list. The publication with the highest average citation per year is the most recent publication, “Stress and emotional wellbeing of parents due to change in routine for children with Autism Spectrum Disorder (ASD) at home during COVID-19 pandemic in Saudi Arabia” by Alhuzimi (2021), with an average of 27.67 citations per year. The high number of citations may be attributed to the relevance of the COVID-19 pandemic.
Top cited publications based on total citations.
| Publication | Total citations | Average citation per year |
|---|---|---|
| 1. Ben Hamida M., Fardeau M. and Attia N. (1983). Severe childhood muscular dystrophy affecting both sexes and frequent in Tunisia. Muscle Nerve, 6(7), 469-480. | 159 | 3.88 |
| 2. Al Rajeh S., Bademosi O., Ismail H., Awada A., Dawodu A., Al-Freihi H., et al. (1993). A community survey of neurological disorders in Saudi Arabia: the Thugbah study. Neuroepidemiology, 12(3), 164-178. | 137 | 4.22 |
| 3. Obeid R., Daou N., DeNigris D., Shane-Simpson C., Brooks P.J. and Gillespie-Lynch K. (2015). A cross-cultural comparison of knowledge and stigma associated with autism spectrum disorder among college students in Lebanon and the United States. J. Autism Dev. Disord., 45(11), 3520-3536. | 85 | 9.44 |
| 4. Alhuzimi T. (2021). Stress and emotional wellbeing of parents due to change in routine for children with Autism Spectrum Disorder (ASD) at home during COVID-19 pandemic in Saudi Arabia. Res. Dev. Disabil., 108, 103822. | 83 | 27.67 |
| 5. El-Salem K., Al-Shimmery E., Horany K., Al-Refai A., Al-Hayk K. and Khader Y. (2006). Multiple sclerosis in Jordan: a clinical and epidemiological study. J. Neurol., 253(9), 1210-1216. | 81 | 4.5 |
| 6. Alroughani R., Ahmed S.F., Behbehani R., Khan R., Thussu A., Alexander K.J., et al. (2014). Increasing prevalence and incidence rates of multiple sclerosis in Kuwait. Mult. Scler. J., 20(5), 543-547. | 76 | 7.6 |
| 7. Al-Salehi S.M., Al-Hifthy E.H. and Ghaziuddin M. (2009). Autism in Saudi Arabia: presentation, clinical correlates and comorbidity. Transcult. Psychiatry, 46(2), 340-347. | 75 | 5 |
| 8. Al-Farsi O.A., Al-Farsi Y.M., Al-Sharbati M.M. and Al-Adawi S. (2016). Stress, anxiety, and depression among parents of children with autism spectrum disorder in Oman: a case–control study. Neuropsychiatr. Dis. Treat., 12, 1943-1951. | 74 | 9.25 |
| 9. Al-Din A.N., Khogali M., Poser C.M., Al-Nassar K.E., Shakir R., Hussain J., et al. (1990). Epidemiology of multiple sclerosis in Arabs in Kuwait: a comparative study between Kuwaitis and Palestinians. J. Neurol. Sci., 100(1-2), 137-141. | 74 | 2.18 |
| 10. Alshubaili A.F., Alramzy K., Ayyad Y.M. and Gerish Y. (2005). Epidemiology of multiple sclerosis in Kuwait: new trends in incidence and prevalence. Eur. Neurol., 53(3), 125-131. | 68 | 3.58 |
Among the most cited publications, autism and multiple sclerosis are the most studied disabilities, with four publications each, and Kuwait and Saudi Arabia are the most studied countries, each with three publications. The most prolific authors, R. Alroughani and J. Al-Hashel, have a joint publication on the list titled “Increasing prevalence and incidence rates of multiple sclerosis in Kuwait”, which has garnered 76 citations.
We utilised VOSviewer to visualise research clusters among authors, countries, and institutions. VOSviewer is a scientific knowledge mapping analysis software tool developed by van Eck and Waltman (2010). By using the default VOS clustering, different colours were assigned to represent different clusters. To identify strong relationships, we set the minimum thresholds of 5 publications for authors, 5 for countries, and 10 for institutions. The minimum number of citations was set at 0. Figure 2 displays the clusters of authors. Three distinct clusters were identified. The largest cluster, represented by red colour, consists of 12 authors, while the smallest cluster, represented by blue colour. The primary focus of the blue and green clusters is related to multiple sclerosis. Meanwhile, the red cluster explores various disabilities.
The co-authorship between countries is depicted in Figure 3. The thickness of the lines connecting the countries indicates the number of author collaborations. The connections reveal that publications arise from collaborations both within the Arab countries and beyond the region. Six distinct clusters have been identified. The red cluster is primarily led by Saudi Arabia, which collaborates with Jordan, Palestine, Turkey, United Arab Emirates, Australia, and the United Kingdom. The presence of a thick line between Saudi Arab and Egypt suggests a significant level of collaboration between these two countries. Two clusters comprise exclusively Arab countries. The main countries in the yellow cluster include Egypt, Kuwait, and Oman, while the light blue cluster consists of Lebanon and Libya. The blue cluster involves Iraq, Sudan, Syria Germany, and the United States. The purple cluster is centred around Qatar and Canada. Lastly, the green cluster involves Algeria, Bahrain, Morocco, Tunisia, and France as the primary countries.
Figure 4 illustrates the collaborations between universities, identifying nine clusters with the most active university in each cluster. The yellow cluster is led by the King Saud University in Saudi Arabia, which maintains strong collaborations with the King Abdulaziz University and the King Faisal University, both also located in Saudi Arabia. The green cluster highlights robust collaborations between institutions from Saudi Arabia (the King Khalid University) and Egypt (the Assiut University and the Cairo University). The orange cluster represents a collaborative network between Kuwait University and hospitals within the country, including Amiri Hospital and Ibn Sina Hospital. The red cluster is characterised by the main institutions: the Ain Shams University, the Lebanese University, and the United Arab Emirates University. These institutions engage in collaborations with renowned universities in the United Kingdom, such as the Cambridge University, the King’s College London, and the Oxford University.
DISCUSSION
We conducted a bibliometric analysis to systematically evaluate research conducted on disability in Arab countries. Starting from the first study on “Reeducation of deaf and dumb in Tunisia” in 1974, the number of publications remained relatively low until 2009, when it increased to more than 20 publications per year. This increase could be attributed to the adoption of the United Nations Convention on the Rights of Persons with Disabilities in 2006, which set standards for the rights of persons with disabilities.
Saudi Arabia emerged as the country with the most research on disability, followed by Egypt, Jordan, Kuwait, and the United Arab Emirates. These countries also rank highly in research publications across various fields ( Ahmad et al., 2021; Siddique et al., 2021; Machaalani et al., 2022; Al Rousan et al., 2023). On the other hand, Comoros, Djibouti, and Mauritania did not have any publications on disability, consistent with previous bibliometric research indicating a low publication output from these countries ( Ahmad et al., 2021; Machaalani et al., 2022). Similar findings were observed in the research output on mental health in the Arab world ( Jaalouk et al., 2012).
Research productivity may be influenced by factors such as funding and government policies. The most prolific university, the King Saud University in Saudi Arabia, also provided the most funding for research. Government policies and priorities related to disability, such as Saudi Arabia’s Vision 2030, which emphasises equal opportunities for persons with disabilities, including education and job opportunities, may contribute to research productivity ( Kingdom of Saudi Arabia, 2016).
Multiple sclerosis emerged as the most studied disability, as evidenced by the presence of four publications on this topic among the top 10 most cited publications. The rise in multiple sclerosis cases in Arab countries in recent years has likely driven increased research in that area ( Taslim et al., 2022). Prevalence rates of multiple sclerosis have increased across the Eastern Mediterranean region, including Arab countries, according to a report by The Multiple Sclerosis International Federation (2020). The increasing prevalence of multiple sclerosis in these countries is a cause for concern.
The most cited publication by Ben Hamida et al. (1983) received 159 citations, which is comparable to citation counts in other fields. For example, the most cited article on solid waste in Arab countries received 165 citations ( Zyoud et al., 2015), and an orthopaedics study received 124 citations ( Emara et al., 2016).
Two out of three co-research clusters were related to multiple sclerosis, which aligns with the high number of publications in this area. Researchers on disablity in Arab countries collaborated not only within the region but also with researchers outside. Collaborations with countries such as Australia, Canada, France, Germany, the United Kingdom, and the United States were observed. Research in the field of disability was funded by both local and inernational agencies, with universities being the primary funding source.
While our study provides valuable insights into disability research conducted in Arab countries, there are a few limitations to consider. Our search and inclusion criteria were based on publications indexed in the Web of Science database, potentially excluding relevant publications not included in the database, particularly those in Arabic. Therefore, relevant publications not indexed in the Web of Science especially from non-English sources were not included. This might not give a complete analysis of disability research conducted in Arab countries.
It is hoped that our research will guide researchers and funding agencies to proliferate disability research in Arab countries. This bibliometric analysis highlights trends and gaps in research. Despite the overall increase in the number of publications over the years, Comoros, Djibouti, and Mauritania still lack related publications. Additionally, certain disabilities remain under-researched. This highlights the need for further research in the under-researched countries and on disabilities to have an impact on policy and programming. Researchers, funding agencies, and policymakers can utilise the findings from this review to allocate resources more strategically. Allocating more resources to under-researched topics and countries would be valuable in tackling significant societal challenges. This is crucial for achieving the Sustainable Development Goals, particularly Goal 10, which aims to reduce inequality within and among countries.