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

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.