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Bransfield RC, Mao C, Greenberg R. Microbes and Mental Illness: Past, Present, and Future. Healthcare (Basel) 2023; 12:83. [PMID: 38200989 PMCID: PMC10779437 DOI: 10.3390/healthcare12010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
A review of the association between microbes and mental illness is performed, including the history, relevant definitions, infectious agents associated with mental illnesses, complex interactive infections, total load theory, pathophysiology, psychoimmunology, psychoneuroimmunology, clinical presentations, early-life infections, clinical assessment, and treatment. Perspectives on the etiology of mental illness have evolved from demonic possession toward multisystem biologically based models that include gene expression, environmental triggers, immune mediators, and infectious diseases. Microbes are associated with a number of mental disorders, including autism, schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders, as well as suicidality and aggressive or violent behaviors. Specific microbes that have been associated or potentially associated with at least one of these conditions include Aspergillus, Babesia, Bartonella, Borna disease virus, Borrelia burgdorferi (Lyme disease), Candida, Chlamydia, coronaviruses (e.g., SARS-CoV-2), Cryptococcus neoformans, cytomegalovirus, enteroviruses, Epstein-Barr virus, hepatitis C, herpes simplex virus, human endogenous retroviruses, human immunodeficiency virus, human herpesvirus-6 (HHV-6), human T-cell lymphotropic virus type 1, influenza viruses, measles virus, Mycoplasma, Plasmodium, rubella virus, Group A Streptococcus (PANDAS), Taenia solium, Toxoplasma gondii, Treponema pallidum (syphilis), Trypanosoma, and West Nile virus. Recognition of the microbe and mental illness association with the development of greater interdisciplinary research, education, and treatment options may prevent and reduce mental illness morbidity, disability, and mortality.
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Affiliation(s)
- Robert C. Bransfield
- Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA
- Hackensack Meridian School of Medicine, Nutey, NJ 07110, USA
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Koum DCK, Enyama D, Foko LPK, Noukeu D, Nguedia B, Mbono R, Eposse C, Eboumbou PE, Engome CB, Mapoure YN. Diagnosis and treatment challenges of autism spectrum disorder at a reference hospital in Douala, Cameroon. BMC Pediatr 2023; 23:459. [PMID: 37704945 PMCID: PMC10498515 DOI: 10.1186/s12887-023-04242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/10/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disability associated with deficiency in social interaction, unusual development of social communication, and restricted or repetitive behaviors, interests and activities. This study aimed to describe management of pediatric ASD in Cameroon, a resource-constrained Central Africa country. METHODS A retrospective study was conducted between December 2021 and May 2022 at the Pediatrics department of a reference hospital in the town of Douala. Data of interest of children with ASD were collected through eligible medical records and telephone discussions with their parents/guardians. RESULTS Medical records of 145 children with ASD aged 2-15 years were included in the study, giving a hospital ASD prevalence of 3.7%. Time delay between parental concerns and hospital management was specified in 69 (47.58%) children, and among them 38 (55.07%) had a mean delay ± SD was less than five months. Children were mainly males (76%) and aged 4-5 years (37.93%), with mean age ± SD of 44.4 ± 22.2 months old. The main consultation reason was delayed language development (100%). Mean time delay between parental concerns and the first medical consultation was 18 months (range 1-60 month). Attention deficit hyperactivity disorder were found in 68.18% of children aged ≥ 6 years old. Neuropsychology (66.2%) was the most frequently used intervention. Some children were treated using traditional medicine. CONCLUSIONS Management of pediatric ASD is strongly influenced by socioeconomic and cultural context. It is crucial to implement behavioral change campaigns in community, organize training sessions to medical staff on diagnosis and treatment of ASD, and provide specialized centers with skilled staff and equipped material.
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Affiliation(s)
| | - Dominique Enyama
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Douala Gyneco-Obstetrics and Pediatrics Hospital, Douala, Cameroon
| | | | - Diomede Noukeu
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Douala Gyneco-Obstetrics and Pediatrics Hospital, Douala, Cameroon
| | - Belviane Nguedia
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O Box: 8037, Douala, Cameroon
| | - Rhita Mbono
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O Box: 8037, Douala, Cameroon
| | - Charlotte Eposse
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O Box: 8037, Douala, Cameroon
| | - Patricia Epee Eboumbou
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O Box: 8037, Douala, Cameroon
| | - Cathy Bebey Engome
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O Box: 8037, Douala, Cameroon
| | - Yacouba Njankouo Mapoure
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, P.O Box: 8037, Douala, Cameroon
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Mutiso VN, Ndetei DM, Muia EN, Masake M, Alietsi RK, Onsinyo L, Musyimi C, Mamah D. Risk of autism spectrum disorder and association of its symptoms with psychiatric and substance use disorders in non-clinical student sample in Kenya: cross-sectional study. BJPsych Open 2023; 9:e160. [PMID: 37605834 PMCID: PMC10486240 DOI: 10.1192/bjo.2023.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The prevalence and patterns of autism spectrum disorder (ASD) symptoms/traits and the associations of ASD with psychiatric and substance use disorders has not been documented in non-clinical students in Sub-Saharan Africa, and Kenya in particular. AIMS To document the risk level of ASD and its traits in a Kenyan student population (high school, college and university) using the Autism-Spectrum Quotient (AQ); and to determine the associations between ASD and other psychiatric and substance use disorders. METHOD This was a cross-sectional study among students (n = 9626). We used instruments with sufficient psychometric properties and good discriminative validity to collect data. A cut-off score of ≥32 on the AQ was used to identify those at high risk of ASD. We conducted the following statistical tests: (a) basic descriptive statistics; (b) chi-squared tests and Fisher's exact tests to analyse associations between categorical variables and ASD; (c) independent t-tests to examine two-group comparisons with ASD; (d) one-way analysis of variance to make comparisons between categorical variables with three or more groups and ASD; (e) statistically significant (P < 0.05) variables fitted into an ordinal logistic regression model to identify determinants of ASD; (f) Pearson's correlation and reliability analysis. RESULTS Of the total sample, 54 (0.56%) were at high risk of ASD. Sociodemographic differences were found in the mean scores for the various traits, and statistically significant (P < 0.05) associations we found between ASD and various psychiatric and substance use disorders. CONCLUSIONS Risk of ASD, gender characteristics and associations with psychiatric and substance use disorders are similar in this Kenyan sample to those found in Western settings in non-clinical populations.
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Affiliation(s)
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Esther N. Muia
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Monicah Masake
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Rita K. Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Lydia Onsinyo
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St Louis, Missouri, USA
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Zeleke WA, Hughes TL, Kanyongo G. Assessing the Effectiveness of Professional Development Training on Autism and Culturally Responsive Practice for Educators and Practitioners in Ethiopia. Front Psychiatry 2021; 11:583674. [PMID: 33708144 PMCID: PMC7940830 DOI: 10.3389/fpsyt.2020.583674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022] Open
Abstract
This study examines the effect of professional development training on educators' and practitioners' knowledge of Autism and the use of culturally responsive practices. Using a single group, pre-post design, data was gathered from 34 educators and health professionals (i.e., teachers, counselors, psychologists, therapists, therapeutic care workers, social workers, and nurses) in Ethiopia. A week-long training covering ASDs and culturally responsive evidence-based training was provided to participants. Results showed significant improvement in participants' knowledge about ASD symptoms, nature, characteristics, as well as intervention selection. Participants' use of culturally informed approaches, in their area of professional service, showed a high level of participants' knowledge and low-level use of culturally responsive practices, policies, and procedures. Recommendations for addressing cultural factors impacting the diagnosis and treatment-seeking approaches to ASD in Africa are provided.
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Affiliation(s)
- Waganesh A. Zeleke
- Department of Counseling, Psychology and Special Education, Duquesne University, Pittsburgh, PA, United States
| | - Tammy L. Hughes
- Department of Counseling, Psychology and Special Education, Duquesne University, Pittsburgh, PA, United States
| | - Gibbs Kanyongo
- Department of Educational Foundations and Leadership, Duquesne University, Pittsburgh, PA, United States
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Sala R, Amet L, Blagojevic-Stokic N, Shattock P, Whiteley P. Bridging the Gap Between Physical Health and Autism Spectrum Disorder. Neuropsychiatr Dis Treat 2020; 16:1605-1618. [PMID: 32636630 PMCID: PMC7335278 DOI: 10.2147/ndt.s251394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
Autism spectrum disorder (ASD) is a highly complex and heterogeneous developmental disorder that affects how individuals communicate with other people and relate to the world around them. Research and clinical focus on the behavioural and cognitive manifestations of ASD, whilst important, have obscured the recognition that ASD is also commonly associated with a range of physical and mental health conditions. Many physical conditions appear with greater frequency in individuals with ASD compared to non-ASD populations. These can contribute to a worsening of social communication and behaviour, lower quality of life, higher morbidity and premature mortality. We highlight some of the key physical comorbidities affecting the immune and the gastrointestinal systems, metabolism and brain function in ASD. We discuss how healthcare professionals working with individuals with ASD and parents/carers have a duty to recognise their needs in order to improve their overall health and wellbeing, deliver equality in their healthcare experiences and reduce the likelihood of morbidity and early mortality associated with the condition.
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Affiliation(s)
- Regina Sala
- Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry Queen Mary University of London, London, UK
| | | | | | - Paul Shattock
- Education & Services for People with Autism, Sunderland, UK
| | - Paul Whiteley
- Education & Services for People with Autism Research, Sunderland, UK
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Samia P, Kanana M, King J, Donald KA, Newton CR, Denckla C. Childhood autism spectrum disorder: insights from a tertiary hospital cohort in Kenya. AFRICAN JOURNAL OF HEALTH SCIENCES 2020; 33:12-21. [PMID: 33343175 PMCID: PMC7746135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is characterized by impairments in behavior, social communication, and interaction. There is little data on ASD from sub-Saharan Africa (SSA) describing clinical characteristics in large cohorts of patients. Preliminary studies report a high male sex ratio, excess of nonverbal cases, possible infectious etiologies, and comorbidities e.g. epilepsy. OBJECTIVE To describe the clinical characteristics of children diagnosed with ASD in an African context. METHODS A retrospective medical chart review identified 116 children diagnosed with ASD according to DSM-5 criteria at a pediatric neurology clinic in Nairobi, Kenya. RESULTS The male to female ratio was 4.3:1. The median age at presentation was 3 years with speech delay as the most common reason for presentation. Expressive language delay was observed in 90% of the population. Sixty percent who obtained imaging had normal MRI brain findings. Only 44% and 34% of children had access to speech therapy and occupational therapy respectively. Epilepsy and ADHD were the most prevalent comorbidities. CONCLUSION An early median age at presentation and preponderance of male gender is observed. Access to speech therapy and other interventions was low. A prospective study would help determine outcomes for similar children following appropriate interventions.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - Maureen Kanana
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - Julie King
- School of Public Health, Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kirsten A Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | | | - Christy Denckla
- School of Public Health, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Nnamani A, Akabogu J, Otu MS, Uloh-Bethels AC, Ukoha E, Iyekekpolor OM, Omile JC, Obiezu MN, Dike AE, Ike CV, Otu FM, Eseadi C. Using rational-emotive language education to improve communication and social skills of adolescents with autism spectrum disorders in Nigeria. Medicine (Baltimore) 2019; 98:e16550. [PMID: 31374019 PMCID: PMC6708801 DOI: 10.1097/md.0000000000016550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVE Studies show the need for improved communication and social skills of adolescents with autism spectrum disorders (ASDs). Therefore, the present study aimed to analyze the effect of using rational-emotive language education (RELE) to pursue this need for adolescents in Nigeria. METHODS The design of the study was a group randomized trial, with pretest, post-test, and follow-up. Sixty-eight adolescents with ASDs participated in the study. Autism Communication and Social Skills Scale for Adolescent (ACSSSA) was used for data collection. The method of data analysis in the study was repeated measures ANOVA procedure, with Partial eta squared ((Equation is included in full-text article.)), adjusted R, mean, standard deviation, and upper/lower limit. RESULTS The RELE program significantly improved communication and social skills of adolescents with ASDs exposed to the treatment intervention when compared with waitlist control group. CONCLUSION Exposure to RELE significantly improved communication and social skills of adolescents with ASDs in this study. Therefore, we recommend that language educators, speech pathologists, language therapists, special educators and counsellors, and other professionals involved in the treatment and caring for ASDs patients be trained on the application of the RELE technique so as to enable them to employ the program in their professional practices.
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Affiliation(s)
| | | | | | | | | | | | - Jacinta Chinwe Omile
- Department of English and Literary Studies, Federal College of Education Technical Umunze
| | - Maureen Nnenna Obiezu
- Department of English and Literary Studies, Federal College of Education Technical Umunze
| | | | - Chioma Vivian Ike
- Department of English and Literary Studies, Federal College of Education Ehamufu, Eha Amufu, Nigeria
| | | | - Chiedu Eseadi
- Department of Educational Foundations, University of Nigeria, Nsukka
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Oshodi YO, Campbell EA, Lesi FEA. Strategies for Autism Diagnosis and Care in Resource Deprived Settings in Africa: An Overview. ADOLESCENT PSYCHIATRY 2019. [DOI: 10.2174/2210676609666181220125513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and Goals:
Autism Spectrum Disorders (ASDs) exist in Africa as
they do everywhere in the world. Historically they have been under recognized and under
studied. The aim of this paper is to review the existing challenges of ASD care and diagnosis
in Africa, with a view to describing workable unique strategies deployable within the
continent.
Methods:
We present an overview of the existing medical literature and summarize key
findings in relation to the topic of ASD in Africa. First, as a preliminary step, we highlight
key findings from previous epidemiological surveys. Second, we undertook a review of
relevant available evidence from the various African regions. When the authors were familiar
with additional local or regional scientific works, these were also used and referenced.
Discussion:
There has been a growing awareness of the extent to which ASDs exist and have
an impact on affected individuals and their families. There are many barriers to diagnosis and
effective interventions. These include lack of trained personnel, stigma and cultural beliefs
regarding etiology, disparities in resources between urban and rural areas, and poverty.
Nonetheless, partnerships to support research and the development of culturally appropriate
interventions can be developed and strengths exist in the communities that can be harnessed
to improve care.
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Carter CJ. Autism genes and the leukocyte transcriptome in autistic toddlers relate to pathogen interactomes, infection and the immune system. A role for excess neurotrophic sAPPα and reduced antimicrobial Aβ. Neurochem Int 2019; 126:36-58. [PMID: 30862493 DOI: 10.1016/j.neuint.2019.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
Prenatal and early childhood infections have been implicated in autism. Many autism susceptibility genes (206 Autworks genes) are localised in the immune system and are related to immune/infection pathways. They are enriched in the host/pathogen interactomes of 18 separate microbes (bacteria/viruses and fungi) and to the genes regulated by bacterial toxins, mycotoxins and Toll-like receptor ligands. This enrichment was also observed for misregulated genes from a microarray study of leukocytes from autistic toddlers. The upregulated genes from this leukocyte study also matched the expression profiles in response to numerous infectious agents from the Broad Institute molecular signatures database. They also matched genes related to sudden infant death syndrome and autism comorbid conditions (autoimmune disease, systemic lupus erythematosus, diabetes, epilepsy and cardiomyopathy) as well as to estrogen and thyrotropin responses and to those upregulated by different types of stressors including oxidative stress, hypoxia, endoplasmic reticulum stress, ultraviolet radiation or 2,4-dinitrofluorobenzene, a hapten used to develop allergic skin reactions in animal models. The oxidative/integrated stress response is also upregulated in the autism brain and may contribute to myelination problems. There was also a marked similarity between the expression signatures of autism and Alzheimer's disease, and 44 shared autism/Alzheimer's disease genes are almost exclusively expressed in the blood-brain barrier. However, in contrast to Alzheimer's disease, levels of the antimicrobial peptide beta-amyloid are decreased and the levels of the neurotrophic/myelinotrophic soluble APP alpha are increased in autism, together with an increased activity of α-secretase. sAPPα induces an increase in glutamatergic and a decrease in GABA-ergic synapses creating and excitatory/inhibitory imbalance that has also been observed in autism. A literature survey showed that multiple autism genes converge on APP processing and that many are able to increase sAPPalpha at the expense of beta-amyloid production. A genetically programmed tilt of this axis towards an overproduction of neurotrophic/gliotrophic sAPPalpha and underproduction of antimicrobial beta-amyloid may explain the brain overgrowth and myelination dysfunction, as well as the involvement of pathogens in autism.
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Affiliation(s)
- C J Carter
- PolygenicPathways, 41C Marina, Saint Leonard's on Sea, TN38 0BU, East Sussex, UK.
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Behavior Problems in Physically Ill Children in Rwanda. J Dev Behav Pediatr 2019; 40:642-650. [PMID: 31369465 PMCID: PMC6824509 DOI: 10.1097/dbp.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Childhood behavior problems are underidentified in low- and middle-income countries. This study sought to systematically screen for behavior problems among children receiving medical care in Rwanda and investigate factors associated with behavior problems in this cohort. METHODS The Pediatric Symptom Checklist (PSC) was translated into Kinyarwanda, following best practices. Children aged 5.9 to 16 years admitted to the inpatient ward of a referral hospital or seen in the outpatient department (OPD) were screened using the PSC. All PSC-positive children and every third PSC-negative child were referred for definitive assessment by a child mental health specialist. RESULTS Among 300 eligible children, 235 were recruited; none refused. PSC scores were positive in 74 of 234 cases (32%, 95% confidence interval 26%-38%); a total of 28 of 74 (40%) PSC-positive children completed mental health assessments. Of these, 16 (57% of those assessed, and 7% of the 235 who were screened) required treatment or further assessment; none of the PSC-negative children did. Screening sensitivity was 100%, and specificity was 71%, with favorable receiver operating characteristics curve and internal consistency. In a multivariate analysis, higher PSC scores were associated with OPD care, central nervous system trauma or infection, and indices of malnutrition and with the use of traditional, complementary, and alternative medicine (TCAM). CONCLUSION Behavior problems are common among Rwanda children seen in a referral hospital, particularly in the OPD, and are associated with use of TCAM. The Kinyarwanda PSC showed favorable screening characteristics and resulted in some 7% of children accessing needed mental health care.
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Sampson WG, Sandra AE. Comparative Study on Knowledge About Autism Spectrum Disorder Among Paediatric and Psychiatric Nurses in Public Hospitals in Kumasi, Ghana. Clin Pract Epidemiol Ment Health 2018; 14:99-108. [PMID: 29785200 PMCID: PMC5897989 DOI: 10.2174/1745017901814010099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/05/2018] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
Abstract
Background Despite the existence of autism spectrum disorder in Ghana, few studies have provided the necessary information on the phenomenon. These studies have mostly focused on speech and language therapy for children and modification of classroom environment for children with autism spectrum disorder. This approach has resulted in a paucity of knowledge on nurse's knowledge of autism spectrum disorder in Ghana. Objective The study sought to assess the knowledge of paediatric and psychiatric on autism spectrum disorder. Method In this study, 130 paediatric and 93 psychiatric nurses sampled from five public hospitals in the Kumasi Metropolis participated in the survey. The Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire was employed to assess their knowledge of autism spectrum disorder. Results It emerged from the study that psychiatric nurses were more knowledgeable on autism spectrum disorder than paediatric nurses in general and specifically on each of the four domains on the KCAHW questionnaire. However, the level of knowledge on autism spectrum disorder among both groups of nurses remains low. Apart from the previous encounter, there were no significant differences between paediatric and psychiatric nurses' gender, age, marital status, working experience and their knowledge. Conclusion In view of the findings, it will be appropriate for autism spectrum disorder to be included in the clinical training curriculum as well as the continuous professional education for both paediatric and psychiatric nurses. This will go a long way in helping paediatric and psychiatric nurses to increase their knowledge of autism spectrum disorder.
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Franz L, Chambers N, von Isenburg M, de Vries PJ. Autism spectrum disorder in sub-saharan africa: A comprehensive scoping review. Autism Res 2017; 10:723-749. [PMID: 28266791 PMCID: PMC5512111 DOI: 10.1002/aur.1766] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 01/17/2017] [Accepted: 01/30/2017] [Indexed: 12/18/2022]
Abstract
Autism spectrum disorder (ASD) is recognized as a global public health concern, yet almost everything we know about ASD comes from high-income countries. Here we performed a scoping review of all research on ASD ever published in sub-Saharan Africa (SSA) in order to identify ASD knowledge gaps in this part of the world. Fifty-three publications met inclusion criteria. Themes included the phenotype, genetics and risk factors for ASD in SSA, screening and diagnosis, professional knowledge, interventions for ASD, parental perceptions, and social-cognitive neuroscience. No epidemiological, early intervention, school-based or adult studies were identified. For each identified theme, we aimed to summarize results and make recommendations to fill the knowledge gaps. The quality of study methodologies was generally not high. Few studies used standardized diagnostic instruments, and intervention studies were typically small-scale. Overall, findings suggest a substantial need for large-scale clinical, training, and research programmes to improve the lives of people who live with ASD in SSA. However, SSA also has the potential to make unique and globally-significant contributions to the etiology and treatments of ASD through implementation, interventional, and comparative genomic science. Autism Res 2017, 10: 723-749. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Lauren Franz
- Division of Child and Family Mental Health and Developmental Neuroscience, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Nola Chambers
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | | | - Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Bello-Mojeed MA, Omigbodun OO, Bakare MO, Adewuya AO. Pattern of impairments and late diagnosis of autism spectrum disorder among a sub-Saharan African clinical population of children in Nigeria. Glob Ment Health (Camb) 2017; 4:e5. [PMID: 28596906 PMCID: PMC5454767 DOI: 10.1017/gmh.2016.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/11/2016] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex group of neurodevelopmental disorders. Studies conducted among Africans living outside the continent indicate that African children are more likely than Caucasian children to have a late diagnosis of ASD. There is a dearth of information on this topic among children with ASD living in Africa. METHODS To determine the pattern of impairments and age at diagnosis in ASD, sixty Nigerian children with a diagnosis of ASD were recruited from a neurodevelopmental clinic. DSM-V criteria were used to make a diagnosis of ASD, while a symptom checklist for ASD was used to determine the pattern of impairments in ASD. RESULTS Ages of the children ranged from 2 to 17 years with a mean age of 9.45 ± 4.33 years with the majority of them (75%) being 12 years or younger. All the children (100%) with ASD exhibited poor eye contact, difficulty in mixing with other children and inability to consistently respond to his/her name. More than a half of them (55%) lack verbal communication. Impairments that were uncommon are in the areas of object attachment (20.0%), odd postures (26.7%) and inappropriate facial expression (30.0%). Mean age at the observation of ASD features was 17.0 ± 6.7 months. Mean age at diagnosis of ASD was 9.00 ± 4.30 years. The mean time lag from a parental concern of ASD features to seeking specialist care was 85 months and to diagnosis was 91 months. CONCLUSIONS Core symptoms/impairments of ASD are present in Nigerian children but a late diagnosis is common.
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Affiliation(s)
- M. A. Bello-Mojeed
- Child and Adolescent Mental Health Service Centre, Federal Neuro-Psychiatric Hospital, Lagos, Nigeria
- Childhood Neuropsychiatric Disorders Initiatives, Nigeria
| | - O. O. Omigbodun
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - M. O. Bakare
- Childhood Neuropsychiatric Disorders Initiatives, Nigeria
- College of Medicine, Enugu State University of Science and Technology (ESUT), Enugu, Nigeria
- Child and Adolescent Unit, Federal Neuro-Psychiatric Hospital, New Haven, Enugu, Nigeria
| | - A. O. Adewuya
- Department of Behavioural Medicine, Lagos State University College of Medicine, Lagos, Nigeria
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Oshodi YO, Olagunju AT, Oyelohunnu MA, Campbell EA, Umeh CS, Aina OF, Oyibo W, Lesi FE, Adeyemi JD. Autism Spectrum Disorder in a Community-based Sample with Neurodevelopmental Problems in Lagos, Nigeria. J Public Health Afr 2016; 7:559. [PMID: 28299159 PMCID: PMC5345404 DOI: 10.4081/jphia.2016.559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/01/2017] [Indexed: 11/23/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a globally prevalent neurodevelopmental disorder for which early diagnosis and intervention is the mainstay of management. In the African continent, limited data is available regarding the non-clinic based samples. Lack of information available to caregivers and inadequate skilled manpower often limit early detection and access to the few available though under resourced services in the community. Community based screening can be an important drive to create awareness and improve information dissemination regarding services available for those living with this disorder. This is a descriptive cross-sectional study utilizing data obtained from participants of a community-based autism screening exercise. The surveillance exercise was part of the annual Orange Ribbon initiative for autism awareness and screening held in 2014. Data was obtained from 85 participants involved in the Autism Surveillance screening exercise within the Lagos community. Community public service radio announcements state wide and word of mouth were used to invite and enroll eligible participants to the screening and consultation exercise. A second stage screening and a brief sociodemographic questionnaire followed by a third stage clinical interview and evaluation using the Diagnostic and Statistical Manual of Mental Disorders - 5 Edition (DSM 5) were used. Appropriate consultation and referrals to services in the community were given. Participants had a mean age of 7.53 years (SD 4.35). Twenty-nine (34.5%) met the diagnosis of ASD. Other diagnosis included attention deficit hyperactivity disorder (ADHD), language and speech disorder, intellectual disability (8.3%) and learning disorders (9.5%). Main health concerns to caregivers were poor language development in all (100%), of which 11 (40.7%) were non-verbal; gaze avoidance was seen in 14 (48.3%) and challenging behavior in 12 (42.9%). Comorbidities included seizure disorders (3.4%) and ADHD (6.9%). Persons with autism had history of ASD behavior more often when compared to the other neurodevelopmental disorders and these findings were statistically significant. Referrals were given to caregivers to engage in services within the community. As seen in this study, community understanding of ASD is poor in such locations, in which many persons with other neurodevelopmental disorders are often presented as having autism. Caregivers in the study location are distressed by many symptoms associated with autism and their comorbid conditions. Currently there is an evident role for frequent large scale community based screening and autism awareness exercises possibly using inter-sectoral collaboration as a strategy.
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Affiliation(s)
| | | | | | | | | | | | - Wellington Oyibo
- Departments of Medical Microbiology and Parasitology, University of Lagos, Nigeria
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Abubakar A, Ssewanyana D, Newton CR. A Systematic Review of Research on Autism Spectrum Disorders in Sub-Saharan Africa. Behav Neurol 2016; 2016:3501910. [PMID: 27872512 PMCID: PMC5107214 DOI: 10.1155/2016/3501910] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022] Open
Abstract
The burden of autism spectrum disorders (ASDs) in sub-Saharan Africa (SSA) is not well known. We carried out a systematic review of the literature to identify published work from SSA. We have systematically searched four databases, namely, Medline, PsycINFO, CINAHL, and Child Development & Adolescent Studies, through EBSCO and identified studies from across SSA. Based on predefined inclusion criteria, 47 studies were included in this review. Most of the identified studies (74%) were conducted in only 2 African countries, that is, South Africa and Nigeria. Additionally, most of these studies (83%) were carried out in the last decade. These studies had four major themes: development of measurement tools of ASD in Africa, examining the prevalence of ASD, identifying risk factors and risk markers, and examining psychosocial issues. We identified only a single population level study aimed at documenting the prevalence of ASD and could not identify a single case-control study aimed at examining a comprehensive set of potential risk factors. All intervention studies were based on very small sample sizes. Put together, our findings suggest that current evidence base is too scanty to provide the required information to plan adequately for effective intervention strategies for children with ASD in Africa.
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Affiliation(s)
- Amina Abubakar
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Derrick Ssewanyana
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
| | - Charles R. Newton
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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Mpaka DM, Okitundu DLEA, Ndjukendi AO, N'situ AM, Kinsala SY, Mukau JE, Ngoma VM, Kashala-Abotnes E, Ma-Miezi-Mampunza S, Vogels A, Steyaert J. Prevalence and comorbidities of autism among children referred to the outpatient clinics for neurodevelopmental disorders. Pan Afr Med J 2016; 25:82. [PMID: 28292045 PMCID: PMC5324163 DOI: 10.11604/pamj.2016.25.82.4151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/07/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Autism spectrum disorders (ASD) is a neurodevelopmental disorder that has been rarely diagnosed in Sub-Saharan Africa. Although a proportion of children do present features of ASD in the Democratic Republic of Congo (DRC), little is known about it prevalence. Often, the co-morbidities constitute the upfront symptoms and therefore may it recognition and management difficult, aggravating as such the prognosis. The present study therefore aimed at studying the clinical profile of autism spectrum disorder (ASD) and the associated morbidities among children and adolescents in outpatient clinics in Kinshasa, the Democratic Republic of Congo. METHODS We conducted a cross sectional study in the three outpatients centers receiving patients referred for neurodevelopmental disorders in Kinshasa, DRC, from June 2008 to June 2010. A total of 450 subjects aged from 1-18 years old were referred and included in the study. The clinical diagnosis for ASD was made using the DSM-IV-R and the ADIR. Co-morbidities were identified using DSM-IV-R criteria together with an extensive clinical interview and observation. All patients were subject to an intellectual quotient evaluation and an electroencephalogram reporting. RESULTS Of the 450 subjects referred, 120 (29.3%) received the diagnosis of ASD, with boys outnumbering girls (OR 3:1. The mean age was 7.9 years (SD 3.4) (p< 0.001). Intellectual disability (75.83 %) and epilepsy (72.50%) were the main co-morbidities significantly associated with autism (p< 0.001). It was also found that co-morbidities were most frequent in subjects with an IQ<70 (p=0.05). CONCLUSION ASD is frequent among patients referred for neurodevelopmental disorders in the three outpatients' centers for neurodevelopmental disorders in Kinshasa. Males seem to be more affected than female. The main co-morbidities were epilepsy and intellectual disabilities. Our findings suggest that it is important to screen for ASD and co-morbidities among all subjects referred for neurodevelopmental disorders and to undertake survey on ASD in various structures of rejected children from the society in Kinshasa DRC. This will help to identify and manage ASD and associated co-morbidities at an early stage for a better prognosis.
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Affiliation(s)
- Davin Mbeya Mpaka
- Department of psychiatry, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Daniel Luwa E-Andjafono Okitundu
- Department of Neurology, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Ally Omba Ndjukendi
- Department of psychiatry, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Adelin Mankubu N'situ
- Department of psychiatry, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Sebastien Yabassi Kinsala
- Department of psychiatry, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Joachim Ebwel Mukau
- National University of Pedagogy and Center for Assessment and Intervention for Children with mental Handicap and/or Autism, Democratic Republic of the Congo
| | - Valentin Malanda Ngoma
- Department of psychiatry, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Espérance Kashala-Abotnes
- Department of Neurology, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo; Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Samuel Ma-Miezi-Mampunza
- Department of psychiatry, Center for Neuro- Psycho- Pathology, School of Medicine, University of Kinshasa, Democratic Republic of the Congo
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Ruparelia K, Abubakar A, Badoe E, Bakare M, Visser K, Chugani DC, Chugani HT, Donald KA, Wilmshurst JM, Shih A, Skuse D, Newton CR. Autism Spectrum Disorders in Africa: Current Challenges in Identification, Assessment, and Treatment: A Report on the International Child Neurology Association Meeting on ASD in Africa, Ghana, April 3-5, 2014. J Child Neurol 2016; 31:1018-26. [PMID: 26979098 PMCID: PMC6858866 DOI: 10.1177/0883073816635748] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
Prevalence of autism spectrum disorders has increased over recent years, however, little is known about the identification and management of autism spectrum disorder in Africa. This report summarizes a workshop on autism spectrum disorder in Africa under the auspices of the International Child Neurology Association and the African Child Neurology Association through guided presentations and working group reports, focusing on identification, diagnosis, management, and community support. A total of 47 delegates participated from 14 African countries. Although there was a huge variability in services across the countries represented, numbers of specialists assessing and managing autism spectrum disorder was small relative to populations served. Strategies were proposed to improve identification, diagnosis, management and support delivery for individuals with autism spectrum disorder across Africa in these culturally diverse, low-resource settings. Emphasis on raising public awareness through community engagement and improving access to information and training in autism spectrum disorder. Special considerations for the cultural, linguistic, and socioeconomic factors within Africa are discussed.
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Affiliation(s)
- Kavita Ruparelia
- Open University, Milton Keynes, United Kingdom and Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Nairobi, Kenya Department of Culture Studies, Tilburg University, Tilburg, Netherlands Department of Psychology, Lancaster University, Lancaster, UK
| | - Eben Badoe
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Muideen Bakare
- Child and Adolescent Unit, Federal Neuro-Psychiatric Hospital, New Haven, Enugu, Nigeria
| | - Karren Visser
- KEMRI-Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Nairobi, Kenya
| | - Diane C Chugani
- Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
| | - Harry T Chugani
- Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
| | - Kirsten A Donald
- Division of Developmental Pediatrics, Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Jo M Wilmshurst
- Division of Pediatric Neurology, Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | | | - David Skuse
- Behavioural and Brain Sciences, Institute of Child Health, University College London, London, UK
| | - Charles R Newton
- KEMRI-Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Nairobi, Kenya Department of Psychiatry, University of Oxford, Oxford, UK
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Harrison AJ, Long KA, Manji KP, Blane KK. Development of a Brief Intervention to Improve Knowledge of Autism and Behavioral Strategies Among Parents in Tanzania. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:187-201. [PMID: 27268474 DOI: 10.1352/1934-9556-54.3.187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite the global presence of autism spectrum disorder (ASD), a paucity of treatment services exists in Tanzania and other low- and middle-income countries. The effect of delayed or low-quality treatments is enduring and contributes to lifelong variability in ASD-related functional impairments. Service disparities in Tanzania derive in part from a widespread lack of national ASD knowledge. Historically, in Western countries, parents have played a major role in increasing ASD awareness, advancing research, and encouraging empirically supported treatments. In the absence of established treatment services, parents of children with ASD have also learned to implement behavioral interventions to reduce the widening skills gaps. This article describes the development of an intervention designed to inform parents in Tanzania about ASD and empirically supported behavioral strategies. Preliminary data, collected from a clinical implementation with 29 Tanzanian families of children diagnosed with ASD or general developmental delays, support the initial feasibility and acceptability of this intervention. This brief intervention may help to ameliorate treatment disparities due to insufficient regional knowledge, language barriers, or limited service availability and may help improve functional outcomes among Tanzanian children with ASD.
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Affiliation(s)
- Ashley Johnson Harrison
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kristin A Long
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Karim P Manji
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Karyn K Blane
- Ashley Johnson Harrison, The University of Georgia, Athens, Georgia; Kristin A. Long, Boston University, Boston, Massachusetts; Karim P. Manji, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; and Karyn K. Blane, Emma Pendleton Bradley Hospital, Riverside, Rhode Island, and Alpert Medical School of Brown University, Providence, Rhode Island
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Harrison AJ, Zimak EH, Sheinkopf SJ, Manji KP, Morrow EM. Observation-centered approach to ASD assessment in Tanzania. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:330-347. [PMID: 25247726 DOI: 10.1352/1934-9556-52.5.330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Abstract In many lower-income countries, there is a paucity of assessment services for autism spectrum disorders (ASD)., Guidelines will be provided for conducting cross-cultural assessments in the context of limited validated resources in Tanzania. By examining behavioral, social, and adaptive differences we were able to provide differential diagnostic evaluations aligning with best practice standards for 41 children in Tanzania age 2-21 years. We describe the utility of a flexible, behavioral observation instrument, the Childhood Autism Rating Scales, Second Edition (CARS2), to gather diagnostic information in a culturally sensitive manner. We observed that the ASD group was characterized by significantly higher scores on the CARS2, F = 21.09, p < .001, η(2) = .37, than the general delay comparison group. Additional recommendations are provided for making cultural adaptations to current assessment instruments for use in a country without normed instruments, such as Tanzania.
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Bakare MO, Munir KM, Bello-Mojeed MA. Public health and research funding for childhood neurodevelopmental disorders in Sub-Saharan Africa: a time to balance priorities. HEALTHCARE IN LOW-RESOURCE SETTINGS 2014; 2. [PMID: 25309887 DOI: 10.4081/hls.2014.1559] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sub-Saharan African (SSA) population consists of about 45% children, while in Europe and North America children population is 10-15%. Lately, attention has been directed at mitigating childhood infectious and communicable diseases to reduce under-five mortality. As the under-five mortality index in Sub-Saharan Africa has relatively improved over the last two decades, more Sub-Saharan African children are surviving beyond the age of five and, apparently, a sizeable percentage of this population would be living with one or more childhood neurodevelopmental disorders (NDD). The distribution of child mental health service resources across the world is unequal. This manifests in the treatment gap of major childhood onset mental health problems in SSA, with the gap being more pronounced for childhood NDD. It is important to balance the public health focus and research funding priorities in Sub-Saharan Africa. We urgently need to define the burden of childhood NDD in the region for healthcare planning and policy formulation.
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Affiliation(s)
- Muideen O Bakare
- Child and Adolescent Unit, Federal Neuropsychiatric Hospital, Enugu, Nigeria
| | - Kerim M Munir
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
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21
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Bello-Mojeed MA, Bakare MO. Improving treatment of children with autism spectrum disorder in low- and middle-income countries: the role of non-specialist care providers. PLoS Med 2013; 10:e1001573. [PMID: 24358030 PMCID: PMC3866085 DOI: 10.1371/journal.pmed.1001573] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mashudat Bello-Mojeed and Muideen O. Bakare discuss the unmet challenges in care of children with autism spectrum disorders in low- and middle-income countries. Please see later in the article for the Editors' Summary
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Affiliation(s)
| | - Muideen O. Bakare
- Child and Adolescent Unit, Federal Neuro-Psychiatric Hospital, New Haven, Enugu, Nigeria
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22
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Affiliation(s)
- Charles R Newton
- ICNA Executive Board Member; KEMRI-Wellcome Collaborative Programme; Kilifi; Kenya
| | - Diane C Chugani
- Children's Hospital of Michigan Autism Center; Wayne State University School of Medicine; Detroit; MI; USA
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Bakare MO, Munir KM. Autism spectrum disorders (ASD) in Africa: a perspective. ACTA ACUST UNITED AC 2012; 14:208-10. [PMID: 21863205 DOI: 10.4314/ajpsy.v14i3.3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/07/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND The universal occurrence of autism spectrum disorders (ASD) was queried about twenty-six years ago. It was thought to occur only in western industrialized countries with high technological development. Over the last decade, knowledge about ASD and its prevalence has been documented as being on the rise in different regions of the world, with most literature coming from the western world -- the situation in Africa on aspects of ASD remain unclear. METHODS Literature cited in Pubmed over the last decade on aspects of epidemiology, diagnosis, aetiology and knowledge of ASD in the African context were assessed. KEYWORDS autism, diagnosis, aetiology, knowledge and Africa were variously combined in the literature search. RESULTS No study specifically addressed the epidemiology of ASD in Africa. One of the two studies that were relevant addressed epidemiology of ASD in Arab countries, though included two Northern African countries. A higher proportion of non-verbal cases of ASD compared to verbal cases was documented in literature coming from Africa. Associated co-morbid disorders included intellectual disability, epilepsy and oculo-cutaneous albinism. Aetiological factors postulated included post-encephalitic infection, genetic and auto-immune factors, and vitamin D deficiency. Knowledge about ASD in Africa was noted to be low. CONCLUSION There is a need for epidemiological studies in Africa to define the magnitude of the problem of ASD and the characteristics of children affected by ASD in this region. This would help in planning and might be helpful in answering the question of aetiology of ASD. Policy making needs to be directed at issues of childhood developmental disorders in Africa.
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Affiliation(s)
- M O Bakare
- Child and Adolescent Unit, Federal Neuro-Psychiatric Hospital, New Haven, Enugu, Nigeria.
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Elsabbagh M, Divan G, Koh YJ, Kim YS, Kauchali S, Marcín C, Montiel-Nava C, Patel V, Paula CS, Wang C, Yasamy MT, Fombonne E. Global prevalence of autism and other pervasive developmental disorders. Autism Res 2012; 5:160-79. [PMID: 22495912 PMCID: PMC3763210 DOI: 10.1002/aur.239] [Citation(s) in RCA: 1344] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/11/2011] [Indexed: 01/09/2023]
Abstract
We provide a systematic review of epidemiological surveys of autistic disorder and pervasive developmental disorders (PDDs) worldwide. A secondary aim was to consider the possible impact of geographic, cultural/ethnic, and socioeconomic factors on prevalence estimates and on clinical presentation of PDD. Based on the evidence reviewed, the median of prevalence estimates of autism spectrum disorders was 62/10 000. While existing estimates are variable, the evidence reviewed does not support differences in PDD prevalence by geographic region nor of a strong impact of ethnic/cultural or socioeconomic factors. However, power to detect such effects is seriously limited in existing data sets, particularly in low-income countries. While it is clear that prevalence estimates have increased over time and these vary in different neighboring and distant regions, these findings most likely represent broadening of the diagnostic concets, diagnostic switching from other developmental disabilities to PDD, service availability, and awareness of autistic spectrum disorders in both the lay and professional public. The lack of evidence from the majority of the world's population suggests a critical need for further research and capacity building in low- and middle-income countries.
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Affiliation(s)
- Mayada Elsabbagh
- Department of Psychiatry, Montreal Children's HospitalMontrealCanada and Birkbeck, University of LondonLondon, UK
| | | | - Yun-Joo Koh
- The Korea Institute for Children's Social DevelopmentSeoul, South Korea
| | - Young Shin Kim
- Child Study Center, Yale University School of MedicineNew Haven, USA
| | - Shuaib Kauchali
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa and Mailman School of Public Health, Columbia UniversityNew York, NY, USA
| | | | | | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical MedicineLondon, UK and Sangath CentreGoa, India
| | - Cristiane S Paula
- Developmental Disorders Program, Mackenzie Presbyterian UniversitySão Paulo, Brazil
| | - Chongying Wang
- Center for Behavioural Science and School of Medicine, Nankai UniversityTianjin, China
| | | | - Eric Fombonne
- Department of Psychiatry, Montreal Children's HospitalMontreal, Canada
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Desruisseaux MS, Iacobas DA, Iacobas S, Mukherjee S, Weiss LM, Tanowitz HB, Spray DC. Alterations in the Brain Transcriptome inPlasmodium BergheiANKA Infected Mice. ACTA ACUST UNITED AC 2010. [DOI: 10.4303/jnp/n100803] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mahalia S. Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Dumitru A. Iacobas
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sanda Iacobas
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Shankar Mukherjee
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Herbert B. Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David C. Spray
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Bransfield RC. Preventable cases of autism: relationship between chronic infectious diseases and neurological outcome. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/phe.09.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is evidence that chronic infections and the immune reactions associated with them may contribute to causing autism spectrum disorders. These infections include Babesia, Bartonella, Borrelia burgdorferi, Ehrlichia, Human herpesvirus-6, Chlamydia pneumoniae and Mycoplasma (in particular Mycoplasma fermentans). Maternal immune reactions to infections appear to adversely affect fetal brain development and possible pathophysiological mechanisms include both inflammatory cytokines, such as IL-6, and maternal autoantibodies to fetal neural tissue of the same kilodalton mass as those seen with B. burgdorferi and some other chronic infections. The timing of the infection and immune response is critical in determining the pathophysiology. It is advisable to evaluate women who are pregnant or planning on becoming pregnant for chronic infections, especially if they demonstrate symptoms of an infection or a systemic illness with persistent inflammatory symptoms. The mother and the newborn should be treated when indicated.
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Affiliation(s)
- Robert C Bransfield
- Associate Director of Psychiatry Riverview Medical Center, 225 Hwy, 35 Red Bank, NJ 07701, USA
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Abstract
Autism is a neurodevelopmental disorder characterized by a pattern of social and communication deficits. Although it occurs in all cultures and countries, most of the published research has come from Western industrialized countries. In particular, relatively little is known about its clinical correlates and comorbidity in African and Middle Eastern countries. In this paper, we report two cases of G6PD deficiency with autism, recruited as part of a larger study on the occurrence of autism in Saudi Arabia. These findings suggest that a different set of medical conditions may be associated with autism in developing countries.
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