Pathways to Care for Children with Mental Disorders and Epilepsy Attending Specialist Clinics in Nigeria

Main Article Content

Tolulope Bella – Awusah
Adeola Adebayo
Ikeoluwa Lagunju
Olayinka Omigbodun

Abstract

Aims: This study set out to identify and compare the pathways to care for children and adolescents presenting at child psychiatry and paediatric neurology clinics in South West Nigeria.

Study Design: This was a comparative cross sectional study.

Place and Duration of Study: Departments of Child and Adolescent Psychiatry and Paediatrics, University College Hospital Ibadan, Nigeria between February and May 2017.

Methodology: A sociodemographic questionnaire and the World Health Organization’s (WHO) pathway encounter form were used to assess 114 participants (57 in each group) recruited sequentially into the study. Kaplan meier survival analysis was used to compare time to seeking orthodox and specialist care between the two groups, and Atlas Ti software was used to analyse qualitative responses about barriers to accessing care. 

Results: There were slightly more males than females in both groups, and the mean age of participants was 9.87 years (SD =5.52). Participants in the paediatric neurology group were significantly more likely to access orthodox care at their first level of contact than their child psychiatry counterparts {41 (71.93%) vs. 18 (31.58%); P.<0.001}.  There were significant differences in the median survival time to accessing orthodox medical care between the two groups: {paediatric neurology 8 weeks (IQR =23.79) vs. child psychiatry 192 weeks (IQR =80; P < 0.001}. There was however no siginificant difference in median survival time to specialist care between the two groups. Lack of finances, frequently having to take time off work, and long distances to the hospital were the major barriers to accessing orthodox medical care in both groups.

Conclusions: Our findings suggest a need for continous advocacy to promote better access to orthodox healthcare for youths with psychiatric and neurological disorders in the developing world context.

Keywords:
Pathways to care, children, epilepsy, mental health, Nigeria.

Article Details

How to Cite
Awusah, T. B. –, Adebayo, A., Lagunju, I., & Omigbodun, O. (2020). Pathways to Care for Children with Mental Disorders and Epilepsy Attending Specialist Clinics in Nigeria. International Neuropsychiatric Disease Journal, 14(3), 31-40. https://doi.org/10.9734/indj/2020/v14i330131
Section
Original Research Article

References

Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michuad C et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–2223.

Lopez AD. Disease control priorities project. Global burden of disease and risk factors. New York, NY: Oxford University Press; and Washington, DC: World Bank; 2006.

Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O. Child and adolescent mental health worldwide: evidence for action. The Lancet. 2011;378(9801):1515-1525

Lagunju IA, Bella-Awusah TT, Takon I, Omigbodun OO. Mental health problems in Nigerian children with epilepsy: Associations and risk factors. Epilepsy and Behavior. 2012;25:214–218.

Eseigbe EE, Sheikh TL, Nuhu FT. Childhood epilepsy in a tropical child psychiatric unit. Challenges of providing care in a resource -constrained environment. Ann Afr Med. 2013;12:236-42.

Saxena S, Li S. Defeating epilepsy: A global public health commitment. Epilepsia Open. 2017;2:153-155.

Krishnan RK. Challenges in the management of epilepsy in resource-poor countries. Nat Rev Neurol. 2009;5:323–30.

Eseigbe EE, Sheikh TL, Aderinoye A, Eseigbe P, Nuhu FT, Adebayo O, et al. Factors associated with treatment gap in children and adolescents with epilepsy in a rural Nigerian community. Niger J Paediatr. 2014;41:22-7.

Pal DK, Das T, Sengupta S, Chaushury G. Help-seeking patterns for children with epilepsy in rural India: implications for service delivery. Epilepsia. 2002;43:904–11.

Tanywe A, Matchawe C, Fernandez R. The experiences of people living with epilepsy in developing countries: a systematic review of qualitative evidence. The JBI Database of Systematic Reviews and Implementation Reports. 2016;14(5):136-192.

Gureje O, Lasebikan VO, Ephraim- Oluwanuga O, Olley BO, Kola L. Community study of knowledge of and attitude to mental illness in Nigeria. Brit J Psychiatr. 2005;186:436-41.

Abiodun OA. Pathways to mental health care in Nigeria. Psychiatr Serv. 1995;46:823–826.

Adewuya A, Makanjuola R. Preferred treatment for mental illness among southwestern Nigerians. Psychiatr Serv. 2009;60(1):121-12.

Osungbade KO, Siyanbade SL. Myths, misconceptions, and misunderstandings about epilepsy in a Nigerian rural community: implications for community health interventions. Epilepsy Behav. 2011;21(4):425-429.

Burns JK, Tomita A. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2015;50(6):867-77.

Ogun OC, Owoeye OA, Dada MU, Okewole AO. Factors influencing pathway to child and adolescent mental health care in Lagos, Nigeria. Niger J Psy. 2009;7:16-20.

Bakare MO. Pathway to care: first points of contact and sources of referral among children and adolescent patients seen at neuropsychiatric hospital in South-Eastern Nigeria. Niger J Med. 2013;22(1):52–6.

Abdulmalik JO, Sale S. Pathways to psychiatric care for children and adolescents at a tertiary facility in northern Nigeria. Journal of public health in Africa. 2012;3:e4.

Lagunju IA. Complementary and alternative medicines use in children with epilepsy in Ibadan, Nigeria. Afr J Med Med. Sci. 2013;42(1):15-23.

Omigbodun OO. Psychosocial issues in a child and adolescent psychiatric clinic population in Nigeria. Social Psychiatry and Psychiatric Epidemiology. 2004;39(8):667-672.

Omigbodun O, Dogra N, Esan O, Adedokun B. Prevalence and correlates of suicidal behaviour among adolescents in southwest Nigeria. International journal of social psychiatry. 2008;54(1):34-46.

Gater R, De Almeida e Sousa B, Barrientos G. The pathways to psychiatric care: a cross-cultural study. Psychol Med. 1991;21:761–774.

Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–482. Available:https://doi.org/10.1111/epi.12550

Bifftu BB, Dachew BA, Tiruneh BT, Alemu WG. First choice of treatment place in the pathways to epileptic care at the outpatient department of University of Gondar Hospital, Northwest Ethiopia: Cross-sectional institutional based study. PLOS ONE. 2017;12(8):e0181310.

McHugh JC, Delanty N. Epidemiology and classification of epilepsy: gender comparisons. Int Rev Neurobiol. 2008;83:11-26.

Hauser WA, Nelson KB. Epidemiology of epilepsy in children. Cleve Clin J Med. 1989;56Suppl:S185-94.

Atim P, Ochola E, Ssendagire S, Rutebemberwa E. Health Seeking Behaviours among Caretakers of Children with Nodding Syndrome in Pader District - Northern Uganda: A Mixed Methods Study. PLOS ONE. 2016;11(7):e0159549.

Kisa R, Baingana F, Kajungu R, Mangen PO, Angdembe M, Gwaikolo W, et al. Pathways and access to mental health care services by persons living with severe mental disorders and epilepsy in Uganda, Liberia and Nepal: a qualitative study. BMC Psychiatry. 2016;16:1–10.

World Health Organization‎: mhGAP training manuals for the mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings, version 2.0. World Health Organization; 2017. Available:https://apps.who.int/iris/handle/10665/259161. (accessed 28th May 2020)