Olayinka Omigbodun

Child and adolescent mental health worldwide: evidence for action

Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability in this age group and their longlasting effects throughout life, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. In this report we review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems. We also discuss barriers to, and approaches for, the implementation of such strategies in low-resource settings. Action is imperative to reduce the burden of mental health problems in future generations and to allow for the full development of vulnerable children and adolescents worldwide.

Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations.

Shekhar Saxena and colleagues summarize the recent WHO Mental Health Gap Action Programme (mhGAP) intervention guide that provides evidence-based management recommendations for mental, neurological, and substance use (MNS) disorders.

Psychosocial issues in a child and adolescent psychiatric clinic population in Nigeria

Psychosocial issues and interventions play a very important role in the aetiology, course and prognosis of several child psychiatric disorders. Psychosocial problems in a child and adolescent psychiatric clinic population in Nigeria were documented as a preliminary step towards the planning and development of this new facility. A standardised assessment procedure was integrated into the routine at the clinic when services commenced. Psychosocial stressors and life events were measured using the interview method so that in–depth information could be obtained. Over the 3-year period of study, 79 (62.2%) of the 127 new referrals to the clinic had significant psychosocial stressors in the year preceding presentation. Problems with primary support, such as separation from parents to live with relatives, disruption of the family, abandonment by mother, psychiatric illness in a parent and sexual/physical abuse, occurred in 50 (39.4%) of the subjects. Problems with social environment occurred in 11 (8.7 %), 39 (30.7 %) had educational problems, 5 (3.9%) had economic problems and 15 (11.8%) of the children had ‘other’ psychosocial stressors. Significantly more children and adolescents with disruptive behaviour disorders and disorders like enuresis, separation anxiety and suicidal behaviour had psychosocial stressors when compared to children with psychotic conditions, autistic disorder and epilepsy (χ2 = 9.6; p = 0.048). The importance of the psychosocial diagnostic dimension in routine practice is illustrated in this study. Some psychosocial factors identified are cultural practices. The effects of these practices on child mental health require further study.

Developing child mental health services in resource-poor countries.

Despite significant gains in tackling the major causes of child mortality and evidence of an urgent need for child mental health services, resource-poor countries continue to lag behind in child and adolescent mental health service development. This paper analyses possible barriers to the development of child mental health services in resource-poor countries and attempts to proffer solutions. Obstacles identified are the magnitude of child mental health problems that remain invisible to policy makers, an absence of child mental policies to guide the process of service development, and overburdened child mental health professionals. The belief systems about mental illness also prompt help seeking in alternative health systems, thereby reducing the evidence for the burden associated with health seeking. Solutions that may support child mental health service development are the provision of adequate advocacy tools to reveal the burden, poverty alleviation, health awareness programmes, enforcing legislation, training centred within the region, and partnerships with professionals in developed countries. These solutions require simultaneous approaches to encourage service development and utilization. Reductions in child mortality in resource-poor countries will be even more dramatic in the years to come and preparations need to be made to take care of the mental health needs of the children who will survive.

GENDER AND RURAL–URBAN DIFFERENCES IN THE NUTRITIONAL STATUS OF IN-SCHOOL ADOLESCENTS IN SOUTH-WESTERN NIGERIA

This study assessed gender and rural/urban differences in height and weight, and the prevalence of stunting, underweight and overweight of school-going adolescents in south-west Nigeria, using 2007 WHO reference values for comparison. The influence of sexual maturity and the socio-demographic correlates of growth performance were also examined. In this cross-sectional study, 924 male (51.4%) and 875 female (48.6%) students (1799 in total) aged 10-19 years from eighteen schools in Ibadan (five rural, nine urban public and four urban private) were interviewed and examined. Although males were significantly taller than females (p<0.05), stunting was more pronounced for males, who were 7.5 cm shorter than the 2007 WHO reference, compared with females who were 3.5 cm shorter. Body mass index (BMI) for girls was also greater than for boys (p<0.05). Rural adolescents had lower heights and BMIs compared with those in urban areas. The mean height of male adolescents in rural schools fell below 2 SDs of the 2007 WHO reference between 14 and 17 years, while heights of males and females in private schools were similar to the median 2007 WHO standard. Low height-for-age was observed in 282 adolescents (15.7%), which, after multivariate analysis, was significantly associated with school type, gender, number of mothers children and puberty onset. Adolescents in rural schools were much more likely to be stunted than those in urban private schools (AOR 13.1; 95% CI 5.2-33.2) and males were three times more likely to be stunted compared with females (AOR 3.3; 95% CI 2.4-1.4). Low BMI-for-age was observed in 240 adolescents (18.9%), with correlates similar to stunting. Adolescents at the pre-puberty stage were twice as likely to have low BMI-for-age (OR 2.0; 95% CI 1.6-2.5) than those with signs of puberty. There were 2.3% overweight adolescents, who were significantly more likely to be female, in private school and post-pubertal. Innovative interventions for Nigerian adolescents, especially rural inhabitants and males, are needed to reduce the prevalence of stunting and underweight.

Assessment of need for a school-based mental health programme in Nigeria: Perspectives of school administrators

The majority of children in Nigeria are unable to access mental health services. In this resource-poor setting, a school-based mental health service can be used to reach children who would otherwise not have access. An essential first step in the development of a school-based mental health programme is a needs assessment. Key informants (KIs) from southwest Nigeria were interviewed to identify their perspectives on child mental illness and needs for a school mental health programme. Data were analysed using interpretative phenomenological analysis. Although KIs sometimes used derogatory terms to describe mental illness, they were able to give full descriptions of different kinds of mental illnesses in children and a range of causes based on the bio-psychosocial model of disease. KIs acknowledged deficiencies in their training even though they currently use parent, child and environment-centred interventions to deal with mental health problems in school. KIs reported teachers as comfortable with handling mental health issues in children and suggested interventions that included development of basic and ongoing training. Barriers, such as poverty, ignorance and stigma need to be addressed, while government involvement and enlightenment campaigns are critical components of a successful programme.

Psychiatric morbidity in a Nigerian paediatric primary care service: a comparison of two screening instruments

We evaluated the screening properties of the Childrens Behaviour Questionnaire (CBQ) and the Reporting Questionnaire for Children (RQC) in an urban primary care setting in Nigeria. Using various validity indices and the results of Receiver Operating Characteristic analysis, we showed that the two instruments had identical abilities at differentiating children with specific psychiatric disorders from those without. The cut-off threshold for the CBQ in this setting was different from what is commonly reported elsewhere. While the CBQ was able to differentiate between conduct and emotional disorders, the RQC had the advantage of relative brevity.

Nature, prevalence and determinants of common mental health problems and their management in primary health care

Associate Professor and Deputy Director of the Centre for Women’s Health, Gender and Society, University of Melbourne, Australia Senior Scientist, Department of Child and Adolescent Health and Development, World Health Organization, Geneva Technical Analyst, Technical Division, United Nations Population Fund, New York, USA Consultant Psychiatrist, Department of Psychiatry, Chennai and Voluntary Health Services and Director/Founder, SNEHA, Chennai, India Professor, Harvard Medical School, Boston, Massachusetts, USA Associate Professor of Psychiatry, College of Medicine, University of Ibadan, and Consultant Psychiatrist (Child and Adolescent), University College Hospital, Ibadan, Nigeria

Teachers' perspectives of mental health needs in Nigerian schools.

Objective: This study assessed teachers perspectives on childrens mental health needs and the development of school-based mental health programmes in South-West Nigeria. Method: Focus group discussions were held with teachers from randomly selected urban and rural primary schools in Ibadan, Nigeria. Data were analysed using interpretative phenomenological analysis. Results: Teachers identified significant mental health problems in school-age children and described a variety of bio-psychosocial contributing factors. These ranged from problems with primary support systems to poverty, spiritual factors, medical illnesses and genetic vulnerability. The school environment was recognised as an ideal place for dealing with child mental health issues despite deficiencies in teachers knowledge, skills and resources. A school mental health programme that would provide training for teachers and awareness campaigns as well as human, material and financial resources was proposed. Conclusions: The findings from this study provide a background for understanding the current state of interventions to address child mental health problems in a resource poor country in sub- Saharan Africa and specific areas where future program development is most likely to have an impact.

Unmet Need for Sexuality Education among Adolescent Girls in Southwest Nigeria: A Qualitative Analysis

This study utilises a qualitative approach to elicit the reproductive health concerns of girls at a Christian summer camp with a view to making recommendations on how to improve the content and process of future sessions. The girls asked questions anonymously about various aspects of their sexuality, which were analysed to identify emergent themes. There were 75 participants with ages ranging from childhood to late adolescence (7-21 years). The different levels of cognitive development are clearly illustrated in the types of questions asked. The late adolescents focused on coping with relationships and demands for sex. The early and middle adolescents focused on their feelings, relationships, menstruation and breast size. Those in childhood (7-11 years) appeared totally ignorant about parts of their body. Myths and misconceptions were identified in all age groups. Future sessions should address the peculiar needs of these different age groups. Christian and other religious groups should work with health educators to develop realistic teaching guidelines that focus on the everyday concerns of the youth.