Innovation summary

Late diagnosis and interventions have characterized neurodevelopmental disorders (NDD) in children living in Sub-Saharan Africa, despite usual early parental concern about development.1-2 As a result of late interventions for children with NDD in the region, their optimal functioning is not achieved as depicted by many of them not having access to any form of education and impairment in expressive language ability.3-4 This innovation will measure impact of early screening in improving identification and instituting early interventions to improve prognosis. The program approach consists of: 

  • Integrating screening and core packages of information for parents into routine primary health care
  • Improving children’s access to evidence-based care by trained health providers
  • Incorporating functional impairment and disability into assessment       
 

Impact summary

  • 3,011 children screened for NDD through the National Programme on Immunization (NPI) clinics at primary care level.  
  • 0.9% of these screened positive for one or more diagnoses of NDD    
  • $270,000 CAD funded over a two year period

“All the world is full of suffering. It is also full of overcoming. When valued equally, included in their environments, allowed to cultivate strengths, and given the opportunity to overcome limitations, children with disabilities thrive — and so too do their families, communities, and countries.”

 

– Helen Keller, American author

This innovation is funded by Grand Challenges Canada. 

Innovation details

The project seeks to introduce and incorporate routine surveillance and screening for childhood NDD into the National Programme on Immunization (NPI), an already well established program at primary health care (PHC) levels in Nigeria and other Sub-Saharan African countries. Through this, the project will:

Integrate Screening and Core Packages of Services into Routine PHC

The project will introduce the surveillance and screening for childhood NDD into already existing NPI at PHC level in selected Local Government Areas (LGAs) of Lagos State and will produce interventions for the affected parents about NDDs.

Improve Children’s Access to Evidence-Based Care by Trained Health Providers

The project proposes training for PHC workers and multi-disciplinary professionals at tertiary care centre with the objectives of improving their knowledge and skills on early recognition of NDD before the age of 3 years and providing Individualized family service plan (IFSP) and process of care coordination for affected parents and children with NDD.

Incorporate Functional Impairment and Disability into Assessment

During surveillance/screening and evaluation/Individual tailored interventions, disability assessment tools will be used to assess functional impairment and disability both at baseline and at various stages of interventions.

Nature of the Target Population and Rationale for the Region Selected

The primary target population for this project is the subset of children undergoing Immunization Schedules under NPI at PHC level in two selected Local Government Areas (LGA) in Lagos State, Nigeria. Lagos State is the second most populous state in Nigeria out the 36 States and Federal Capital Territory in Nigeria. The location of the project in Lagos State will benefit from the already existing infrastructure and human resources both at the primary and tertiary care levels, subsequently leading to an improvement in accessibility to services.

Screening

Screening for childhood NDD at PHC Level (NPI Clinics) will occur at particular stages of screening (four stages based on children’s age-related visits): 3 to 6 Months, 6 to 12 Months, 18 to 24 Months, 24 to 36 Months.

“Definitive Evaluation”

Clinicians will evaluate the following components when children are brought in for their assessments:

  • Developmental Trajectory/Developmental Milestone
  • Cognitive Trajectory/ Education Needs Assessment
  • Adaptive Functioning
  • Biomedical Profile
  • Physical Health Problems
  • Nutritional Components

Interventions

Interventions for each child and family will be individualized based on available facilities. Facilities will provide an Individualized Family Service Plan (IFSP) developed through the results of the Definitive Evaluation of the child. Interventions may include educating affected parents about NDD, counselling and support for the family by establishment of Family Support Groups where parents can share their apprehension and concerns before referral to tertiary care centre for further evaluation and specific interventions.

Key drivers

Involvement and Cooperation of Stakeholders

The local government authority and the Lagos State PHC Board provide the structural facilities at immunization clinics at the PHC center. They also provide human resources, who receive stipends from the project in addition to their regular income. 

Commitment of PHC Workers  

The PHC workers are committed to the project as they have an arrangement to receive an extra stipend for the additional work they do. In addition, they seem to be keen to expand their knowledge about childhood NDDs.       

Challenges

Low Rate of Reporting due to Nigeria Medical Association Industrial Action

Out of a total of 18 mothers and children referred from the PHC center, only five (27.8%) reported to the tertiary care center for further evaluation and interventions. The low rate is attributed to the unforeseen Nigerian Medical Association (NMA) industrial action that took place between June 1 - August 8, 2014. The NMA would have been involved in the evaluation and interventions for children with NDD at the tertiary care center, however, due to the industrial action, mothers were not able to bring their children for evaluation as the NMA was not functioning.

Continuation

This project will offer a prototype framework of how surveillance and screening for childhood NDD can be introduced and incorporated into already existing immunization programs in Nigeria. Thus, adaptation of the procedure for wider implementation and scaling in low resource settings is feasible. 

Partners

Delivery Partners

​​Funders

Evaluation methods

Data Audit and Evaluation of the Project

Data audit and evaluation will be conducted at various NPI Clinics that will be involved in the project. The same evaluation and data audit will be conducted at the tertiary care center. Evaluators will seek data on how many children were screened positive for developmental concerns at PHCs and how many undergo further evaluation and interventions at the tertiary care center. The final impact of interventions will be assessed using the Clinical Global Impression Scale.

Reports will be generated upon data analysis for both the primary care services at various NPI Clinics and also for the tertiary care service.

Evaluation of Service Satisfaction

Evaluation of service satisfaction at both the primary and tertiary care centers will be conducted among the parents of children using the services, during the period of the project. The Client Satisfaction Questionnaire, CSQ-8 will be used in evaluating the service delivery satisfaction.5  

Cost of implementation

The total cost of the research project is $270,000 CAD over a two year period

Impact details

As of November 2016, 3,011 Children have been screened for NDD through the National Programme on Immunization (NPI) clinics at primary care level. Of these, 0.9% screened positive for one or other diagnosis of NDD 

Further expectations include:

  • Ten primary care staff and two supervisory nurses will acquire knowledge about NDD and learn the application of screening tools to be used during screening & surveillance through a training workshop conducted by an external resource person from LEND Boston
  • 13 tertiary care staff will acquire knowledge about NDD and improved skills on evaluation and provision of interventions
  • About 20 children under the age of 3 years, who have co-morbid disorders, will undergo evaluation and intervention at the tertiary care centre. Counselling information will be provided to the mothers on long term educational opportunity and community inclusion

  
 
 

References

  1. Bello-Mojeed MA et al. (2011) Late identification of autistic disorder in Nigeria: an illustration with 2 case reports. Nig J Psychiatry, 9 (2), 31-35.
  2. Bakare MO et al. (2011) Autism spectrum disorders (ASD) in Africa: a perspective. African Journal of Psychiatry, 14(3); 208 – 210.
  3. Bakare MO et al. (2011) Excess of non-verbal cases of autism spectrum disorders presenting to orthodox clinical practice in Africa - a trend possibly resulting from late diagnosis and intervention; S Afr J Psychiatr, 17(4):118-120.
  4. Bakare MO et al. (2014) Public health and research funding for childhood neurodevelopmental disorders in Sub-Saharan Africa: a time to balance priorities. Healthcare in Low-Resource Settings, 2(1).
  5. Attkisson C. (2012) Client Satisfaction Questionnaire.

Research

Tools

Multimedia

Associates

Muideen Bakare
How useful did you find this content?: 
0
Your rating: None
0
No votes yet
Log in or become a member to contribute to the discussion.

Submit your innovation

Create your own page to tell the MHIN community about your innovation.

Country

Nigeria

Similar content

node teaser-image

Partners in Health Lesotho Mental Health Integration Program

Mental health integration into primary care and services for MDRTB/HIV/AIDs in Lesotho.
Region: 
Africa
Population: 
Maternal and neonatal health
Children and adolescents
Adults
Disorder: 
Child behavioural and developmental disorders
Depression/anxiety/stress-related disorders
3468 reads
node teaser-image

School Health Implementation Network in the Eastern Mediterranean Region (SHINE)

The adaptation and implementation of WHO’s School Mental Health Program through an online training platform and chat-bot for school teachers in Pakistan.
Region: 
Middle East
Asia
Population: 
Children and adolescents
Disorder: 
Depression/anxiety/stress-related disorders
1771 reads
node teaser-image

Smart care to expand the access to services of children with ASD in Vietnam

An integrated and scalable package based on web-based and mobile platforms to support children with autism spectrum disorder
Region: 
Asia
Population: 
Children and adolescents
Disorder: 
Child behavioural and developmental disorders
1413 reads
node teaser-image

Using mobile mental health clinics to expand access to services in post conflict rural areas

Use of mobile clinics, service user owned pharmacies, and Psychological First Aid to increase access to mental health services
Region: 
Africa
Population: 
Humanitarian and conflict health
Disorder: 
Epilepsy/seizures
Alcohol/drug use disorders
3734 reads