In sub-Saharan Africa, very little research has been conducted on moderate to severe disabilities affecting mobility, communication and mental function in elderly people living at home. The studies that have been conducted have not always described the broader social context, a key factor for understanding and interpreting results. This study was conducted in Burkina Faso and was designed to fill the gaps in our understanding of disability in these areas. A cross-sectional descriptive study was conducted in Bobo-Dioulasso among the elderly population (aged 60 and above). Functional status was assessed using the Functional Autonomy Measurement System (SMAF). Data analysis was performed using Stata software. Interviews were conducted with a systematic random sample of 351 elderly adults. Moderate to severe functional disability or the need for supervision or assistance were related to mobility in 10 % of cases, to mental function in 28 % of cases and to communication in 37 % of cases. The need for assistance varied according to the different activities or items in each domain. The rates of disability in this study were higher than those found in previous studies, which have often assessed severe disabilities. All individuals affected by disability stated that they had a stable support network to manage their disability. Families were found to be the primary source of support. The results can be explained by the social context. A good visibility of moderate to severe disabilities should contribute to the development of effective policies to provide care and support to the elderly.