Gauri Divan1, Supriya Bhavnani1, Kathy Leadbitter2, Ceri Ellis2, Jayashree Dasgupta1, Amina Abubakar3, Mayada Elsabbagh4, Syed Usman Hamdani5,6, Chiara Servili7, Vikram Patel8, Jonathan Green9,10. 1. Child Development Group, Sangath, Bardez, Goa, India. 2. Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK. 3. Institute of Human Development, Aga Khan University, Nairobi, Kenya. 4. Montreal Neurological Institute, McGill University, Montreal, QC, Canada. 5. Human Development Research Foundation, Punjab, Pakistan. 6. University of Liverpool, Liverpool, UK. 7. Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland. 8. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. 9. Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK. 10. Royal Manchester Children's Hospital, Manchester, UK.
Abstract
BACKGROUND: Autism presents with similar prevalence and core impairments in diverse populations. We conducted a scoping review of reviews to determine key barriers and innovative strategies which can contribute to attaining universal health coverage (UHC), from early detection to effective interventions for autism in low- and middle-income countries (LAMIC). METHODS: A systematic literature search of review articles was conducted. Reviews relevant to the study research question were included if they incorporated papers from LAMIC and focused on children (<eight years old) with autism or their caregivers. The database search was supplemented with bibliographic search of included articles and key informant suggestions. Data were extracted and mapped onto a Theory of Change model toward achieving UHC for autism in LAMIC. RESULTS: We identified 31 articles which reviewed data from over fifty countries across Africa, Latin America, Middle East, and Asia and addressed barriers across one or more of four inter-related domains: (a) the social context and family experience for a child with autism; (b) barriers to detection and diagnosis; (c) access to appropriate evidence-based intervention; and (d) social policy and legislation. Key barriers identified included: lack of appropriate tools for detection and diagnosis; low awareness and experienced stigma impacting demand for autism care; and the prevalence of specialist models for diagnosis and treatment which are not scalable in LAMIC. CONCLUSIONS: We present a Theory of Change model which describe the strategies and resources needed to realize UHC for children with autism in LAMIC. We highlight the importance of harnessing existing evidence to best effect, using task sharing and adapted intervention strategies, community participation, and technology innovation. Scaling up these innovations will require open access to appropriate detection and intervention tools, systematic approaches to building and sustaining skills in frontline providers to support detection and deliver interventions embedded within a stepped care architecture, and community awareness of child development milestones.
BACKGROUND: Autism presents with similar prevalence and core impairments in diverse populations. We conducted a scoping review of reviews to determine key barriers and innovative strategies which can contribute to attaining universal health coverage (UHC), from early detection to effective interventions for autism in low- and middle-income countries (LAMIC). METHODS: A systematic literature search of review articles was conducted. Reviews relevant to the study research question were included if they incorporated papers from LAMIC and focused on children (<eight years old) with autism or their caregivers. The database search was supplemented with bibliographic search of included articles and key informant suggestions. Data were extracted and mapped onto a Theory of Change model toward achieving UHC for autism in LAMIC. RESULTS: We identified 31 articles which reviewed data from over fifty countries across Africa, Latin America, Middle East, and Asia and addressed barriers across one or more of four inter-related domains: (a) the social context and family experience for a child with autism; (b) barriers to detection and diagnosis; (c) access to appropriate evidence-based intervention; and (d) social policy and legislation. Key barriers identified included: lack of appropriate tools for detection and diagnosis; low awareness and experienced stigma impacting demand for autism care; and the prevalence of specialist models for diagnosis and treatment which are not scalable in LAMIC. CONCLUSIONS: We present a Theory of Change model which describe the strategies and resources needed to realize UHC for children with autism in LAMIC. We highlight the importance of harnessing existing evidence to best effect, using task sharing and adapted intervention strategies, community participation, and technology innovation. Scaling up these innovations will require open access to appropriate detection and intervention tools, systematic approaches to building and sustaining skills in frontline providers to support detection and deliver interventions embedded within a stepped care architecture, and community awareness of child development milestones.
Authors: Sayyed Ali Samadi; Roy McConkey; Hana Nuri; Amir Abdullah; Lizan Ahmad; Barez Abdalla; Cemal A Biçak Journal: Int J Environ Res Public Health Date: 2022-04-11 Impact factor: 4.614
Authors: Amina Abubakar; Joseph K Gona; Patricia Kipkemoi; Kenneth Rimba; Dennis Amukambwa; Charles R J C Newton Journal: Afr J Disabil Date: 2022-02-23
Authors: Zsofia Szlamka; Charlotte Hanlon; Bethlehem Tekola; Laura Pacione; Erica Salomone; Chiara Servili; Rosa A Hoekstra Journal: PLoS One Date: 2022-09-28 Impact factor: 3.752