Post on 07-Jul-2018
transcript
8/19/2019 Attention Deficit Hyperactivity Symptoms and Disorder Among African Children
http://slidepdf.com/reader/full/attention-deficit-hyperactivity-symptoms-and-disorder-among-african-children 1/5
Attention deficit hyperactivity
symptoms and disorder (ADHD)
among A frican ch ildren: a review of
epidemiology and co-morbidit ies
IVIO Bakare
Child and Adolescent Unit, Federal Neuro-Psychiatric Hospital, New Haven, Enugu, Enugu State, Nigeria
Abstract
Object ive
To review literature from Africa on the epide miolo gy of
DHD
as well attention deficit hyperactivity sym ptom s
associated co-morbid conditions among African children. Method literature search was done through Pubmed/MEDLINE
Goo gle Scholar using then following terms, attention deficit , hyperactivity disorders , epidemiolog y , co-mo rbid conditio
Africa . Nine stud ies m et the inclusion criteria with four stu dies co ming from South Africa, two each from Democratic Repu
of Gongo and Nigeria respectively and one from Ethiopia.
Results
The prev alence of ADHD varie d with rates of betwe en 5
and 8.7%, amongst school children, 1.5% among st children rom he general population between 45.5% to 100.0% among st spe
populations of children with poss ible organ ic brain pathology Gommon as sociated co-mo rbid con ditions were opp ositional de
disorder, conduct disorder as well as anxiety/depressive symptoms. Conclus ion Pub lished data from'Africa is limited.
effective healthc are policy further studies are ne ed ed to define the magn itude an d burd en of ADHD and other childh ood neu
developmental disorders in Africa.
Keywords
Attention deficit; Hyperactivity; Symptoms; Disorders; Africa
Rece ived
20/06/2011
Accepted 25/09/2011
doi http://dx.doi.org/10.4314/ajpsyvl5i5.45
Introduction
A debate exists as to whether attention deficit hyperactivity
diso rder (ADHD) might b e a cultural construct.'-= The opinion
that geog raphical location may have some influence on
epid emio logy of ADHD and Attention Deficit Hyperactivity
Symptoms remains''^, despite a few stu dies h aving
concluded, with some level of caution however, that culture
and geographical location may have little or no influence on
the epidemiology of ADHD world-wide.^''
In their systematic review of literature on the world-wide
prev alen ce of ADHD, Polanczyk et al̂ found a pre valen ce of
about five percent. However, they cautioned against
generalization of their findings, especially in geographical
regions of Africa and Middle East be cau se th ese regions
contributed very few studies to their meta-analysis.^
Though controversy persists about the influence of cu
and geog raphical locations on the epidem iology of ADHD
there has been general agreement amongst studies that
method of assessment, diagnostic criteria employed, sou
of information and inclusion of imp airme nts in functioning
operational definition criteria greatly influence the preva
rates documented in the literatu re. ' '
WhOe chüdhoo d DHD has bee n extensively rese arc
in Europe and North America, very few studies are availa
in the African sub-region. Since the publication on world-
prevalence of
DHD
in 2007^, a num ber of studie s h ad
8/19/2019 Attention Deficit Hyperactivity Symptoms and Disorder Among African Children
http://slidepdf.com/reader/full/attention-deficit-hyperactivity-symptoms-and-disorder-among-african-children 2/5
Afr
Psych ia try 2012 ; 15 :358-361
There ha s be en no prior review of the prevalence of
ADHD symptoms docum ented
in
different
of sub-S aharan Africa. The current content
a
review of past epidemiological
ies on ADHD, Attention Deficit Hyperactivity sym ptom s
ions documented sub-
ew com prised a literature search of the following
- Pubmed/MEDLINE and Google Scholar, using
foüowing term s; attention deficit , hyperactivity
rs , epidemiolog y , co-mo rbid conditions ,
to
epidem iolog y of ADHD,
cted literatures which were relevant to Africa
in
area of
iology of ADHD and
ADHD
symptom s were also
AU
studies add ressing epidem iology of ADHD,
HD symptom s and co-morbidities in Africa and carrie d
he review. The last up date d search w as unde rtaken in
Ethical clearance for this study was obtained from the
itutional Review Board of Federal Neu ropsy chiatrie
9)
studie s relevant
to
aspects of
ADHD an d ADHD
ptom s in Africa.'''^ Whu e four of the stud ies w ere from
ricaä.'o.iz.is^ two st ud ies ea ch we re from N ig er ia' '
ocratic Republic
of
Congo^'''' respectively, and only
iology of ADHD among p opulation
of
school
dren in Africa'''2.i3,i4 on e study amo ng p opulation of
in the gen eral community.'^ Three stu dies^' '
addressed epidemiology of ADHD symptoms among
special populations
of
chü dre n with HIV infection,
tuberc ulosis meningitis, and intellectual disability in Africa,
whue one study dealt solely with co-morbid conditions.^
The detaüs of the reviewed literature
are
shown in Table
I.
iscussion
Epidemiology of ttention Deficit Hyperactivity Disorders
ADHD) among populations of school children in frica
The prevalence of ADHD amo ng school chü dren accordin g
to studies cond ucted in Africa ra nge s betw een 5.4% and
3 7o „ 7,12.13.14 The studies coming firom South Africa
documented a prevalence of abou t five percen t, which
concurred with the finding
of
a prevalence
of
abo ut five
percen t in the meta-analysis study of word-wide prevalence
of ADHD by Polanczyk et
al.^
The only epidemiolog ical
study among school chüdren co ming from the Dem ocratic
Republic of Congo docum ented a prevalence of 6.0%, wh ue
the only epidemiological study com ing from N igeria amo ng
school chüdren revealed
a
prevalence
of
8.7%.
There were m tütiple sourc es of information for making
the diagnosis of ADHD in the se studie s with all of the
studies making use of information from b oth the par ents
and the teachers albeit employing different diagnostic
instruments.'•'^•'^•'''
Epidemiology of ADHD among children n the general
population sample
The rate of primary school enrolment in African countries
had been noted to range from about thirty to ninety five
percent, with much lower rates in sub-Saharan African
countries.'8 Therefore the prev alenc e stu dies of ADHD
carrie d out among sub-Saharan African chü dren in primary
schools'''^''^''^ might not be representative of the actual
prevalence in the general population. Unfortunately, only
one study had looked at prevalence of ADHD am ong
chüdren selected from
a
general population sample
in
Africa.'5 Ashenafi
et
al'^ found the prevalence of ADHD
among chüdren from the general population in a district in
i
Country
of
Origin
and
Pop ulation
of
Children Studied
in the
Reviewed Literature
uthor s
et
al (2005)
et
al (2006)
Famuyiwa (2007)
et
al (2001)
ountries
o
Origin
South A frica
South A frica
Democratic R epublic
of
Congo
Democratic R epublic
of
Congo
Nigeria
Ethiopia
Population
o
hiidren Studied
School Children
School Children
School Children
School Children
School C hildren
Children from the General Population
8/19/2019 Attention Deficit Hyperactivity Symptoms and Disorder Among African Children
http://slidepdf.com/reader/full/attention-deficit-hyperactivity-symptoms-and-disorder-among-african-children 3/5
Ethiopia to be 1.5%. The pre vale nce of 1.5% ih this study 's
is by far lower than the range of 5.4% to 8.7% documented
in the studies conducted among primary school children in
South Africa, Nige ria an d Dem ocratic Repu blic of
The reasons for the apparent disparity in prevalence
betw een the community and school studies are not quite
de ar . There is however a possibility that sym ptoms of
ADHD, especially in-attentive sub-type are made more
noticeable and apparent by the school environment
compared to the home or community environment where
high levels of concentration might not be required in normal
routine tasks. Another possibility is the difference in
diagnostic instruments employed in assessment before
arriving at a d iagn osis of ADHD. However, this possibility is
more remote because the diagnostic instruments employed
in all the stud ies'''2''3'i'''5 factored in diagno stic criteria
specifled in the World Health Organization (WHC)
International Classiñcation of Dise ases, Tenth Edition (ICD-
10) and Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV).'«
Epidem iology of Attention Deficit Hypera ctivity Symp toms
in special pop ulation of children with possible organ ic
brain pathology in frica
• Three stud ies a dd resse d epidemio logy of Attention Deflcit
Hyperactivity Symptoms in special population of children.'-
Zeeg ers et aP asse ssed the epidemiolog y of ADHD
amo ng HIV infected South African ch ildren. They found a
com bined prevalence of ADHD to be 88% in the stud ied
population, with inattentive type accounting for 26%,
hyperactive type, 38% and com bined type, 24%.̂ In an other
study Wait et al'° explored the association betw een
tuber culos is men ingitis and Attention Deficit Hyperactivity
Symptoms. They found that one h und red p ercent (100%) of
children that had just recovered from tuberculosis
mening itis had Attention Deflcit Hyperactivity Sym ptoms.
Based on this finding, they speculated that ADHD may be a
long term complication of tubercu losis mening itis.' Both
studies^'' further reinforce the possibility of organic brain
conditions as aetiological factors in ADHD amon g African
children. Bakare et al looked at prob lem behaviou r amon g
children with intellectual disability The study found a
prevalen ce of 45.5 % hyperactivity sym ptoms amon g
chüdren with intellectual disability '
One of the pr op os ed aetiological factors of ADHD is
brain damage resulting from circulatory toxic, metabolic,
mechanical or physical insults.'^ The high prevalence of
Attention Deflcit Hyperactivity Sym ptoms rang ing from
about forty five to one hundred percents as documented by
the aforementioned studies^ '' supp orts the notion that
possib le brain dam age is an important aetiological
explanation for ADHD am on g African children.s.'o. The
prevalence distribution of ADHD/ADHD Symptoms in
different population of children in Africa is shown in Table
Epidemiology of ADHD gender differences and co-
morbidities in frica
Regarding g ender, all the studies on epidem iology of
ADHD among African children reviewed agr eed on a hig
prevalence of ADHD or Hyperactivity symptoms among
boys compared to girls.'''9''0' ''2.'3.'4's
The most commonly reported co-morbid conditions
associated with ADHD among African children were
Oppositional Deflant Disorder (ODD) and Conduct
Disorder.•'•8.9 i.'s Anxiety and depressive symptoms may
also co-exist with ADHD among African C hildren .' How
frequently these co-morbid conditions co-exist with ADH
varied according to the population samp le of children
studied.
Limitations
It is important to emp has ize that the ex isting literature in
fleld of ADHD from A frica is relatively sp ars e w hich limits
the ability to realistically generalize the findings of this
review as the prevalent trend of ADHD and attention deflc
hyperactivity symptoms among African children. A furthe
limitation may be that the search approach did not identif
aU
relevant stu dies. Notw ithstanding th ese limitations, it i
imperative to examine the existing data to determ ine the
know ledge g aps related to the epidem iology of ADHD an
attention deflcit hyperactivity symptoms among African
chüd ren. It is bejieve d that the findings of this review will
guide future epidemiological studies of ADHD and
subse quen t p olicy making in Africa.
Conclusion
The prevalence of ADHD in Africa based on studies comi
from the continent range s betw een 5.4% and 8.7% amo ng
populations of school children''^''^^'i with the prevalence
bein g much lower amon g a population of chüdren from th
gene ral community where a prevalence of 1.5% was
documented. '5
In addition, studies from Africa affirmed that Attention
Deflcit Hyperactivity symptoms do complicate various
conditions, characterized by p ossible organic brain
pathology, in chüdren.^s.io^o The n ee d to prevent the se
conditions, which have the potential for damaging effects
the develop ing brain, amon g African chüdren is thus
imperative.
Tabie ii: Prevaience of AD HD ADHD Sym ptoms amongst different popuiations of African chüdren
Population o Children
Prevalence o ADHD ADHD Symptoms
8/19/2019 Attention Deficit Hyperactivity Symptoms and Disorder Among African Children
http://slidepdf.com/reader/full/attention-deficit-hyperactivity-symptoms-and-disorder-among-african-children 4/5
Afr Psychie
Limited research studies are avaüable from the continent
essing the epidemiology of ADHD
and
other chüdhood
Such studies
are
essential
on intervention and healthcare
is a
further reflection
of
less attention
of chüdhood neuro-developmental disorders
If adequate health service planning is to be put in place
the African continent further studies are required to
and
rden of ADHD and other chüdhood neuro-developmental
for
providing list of
in their study. The author is also
to Dr. Adewuya
for
his assistance
in
providing
a
of their study
e s
J C . Is childhood hyperactivity th e product of Western
culture?Lancet.
1 9 9 6 ; 3 4 8 : 7 3 - 7 4 .
H R . The diagnostic classification, epidemiology a nd cross-
cultural validity of ADHD, I n Attention Deficit Hyperactivity
Disorder:
State of the
Science;
Best P ractices. Edited by Jensen,
P C J , Kingston, NJ, Civic Research
Institute,
2002.
SV Sergeant
J ,
Gillberg
C ,
Biederman J The worldwide
prevalence of ADH D: is it a n American condition? World
Psychiatiry 2003; 2:104- 1 1 3 .
Timimi S , Taylor E . ADHD is best understood as a cultural
consti-uct.
B r
J
Psychiati-y 2004; 184:8-9.
M D .
Attention deficit-hyperactivity disorder NEnglJ
Med 2005; 352:165-173.
Polanczyk G ,
de
Lima M S , Horta B L , Biederman J , fihode L A . Th e
worldwide prevalence of ADH D: A systematic review and meia-
regression analysis. J i m J Psychiatry
2007;
6 ; 1 6 4 : 9 4 2 - 9 4 8 .
Adewuya
A O ,
Famuyiwa
O O .
Attention deficit hyperactivity
disorder among Nigerian primary school children: Prevalence
and co-morbid conditions. Eur Child Adolesc Psychiati-y 2007;
16:10-15.
Kashala E , Lundervold A , Sommerfelt K , Tylleskar T Eigen I C o-
existing symptoms and risk factors among African school
children with hyperactivity-inattention symptoms in
Kinshasa,
Congo. Eur Child Adolesc Psychiati-y
2006; 15(5):
2 9 2 - 2 9 9 .
9. Zeegers I , Rabie H , Swanevelder S , Edson C , Cotton M , vanToorn
R .
Attention deficit hyperactivity
an d
oppositional
defiance
disorder in HfV-infected South African children. J Trop Pediatr
2 0 1 0 ; 56(2): 97-102.
10 .
WaitJW,
Stanton L , Schoeman J F Tuberculosis meningitis and
attention deficit hyperactivity disorder in children. J Trop Pediat
2002; 48(5):
294-299.
1 1 . Bakare M O , Ubochi V N , Ebigbo P O , Orovwigho A O . Problem an d
pro-social behavior among Nigerian children with intellectual
disability:
th e implication for developing policy f o r school based
mental health programs. Italian Journal o f Pediatrics 2 0 1 0 ; 36:3
1 2 .
Meyer
A .
Attention DeficitlHyperactivity Disorder among North
Sotho speaking primary school children in South
Africa:
Prevalence and sex ratios. Journal of Psychology in Africa 1 9 9 8 ;
186-19S.
1 3 . Meyer A , Eilertsen D E , SundetJM, Tshifularo J G , Sagvolden T .
Cross cultural similarities
in
ADHD-like behavior amongst Sout
African primary school children. South African Journal
o f
Psychology 2004; 34:123 - 1 3 9 .
14 . Kashala E , Tylleskar
T
Eigen I , Kayembe K T , Sommerfelt K .
Attention deficit and hyperactivity disorder among school
children
in Kinshasa,
Democratic Republic
of Congo. Afr
Healt
Sei 2005; 5 ( 3 ) :
172-181.
1 5 . Ashenafi Y , Kebede D , Desta M , JUem A . Prevalence of mental an
behavioural disorders in Ethiopian children. East Afr MedJ 2 0 0
78(6): 308-311.
16 . ChildlnfolUnicef. Primary school enrolment and a ttendance in
Africa 2003 to
2008);
http:llwww.childinfo.orgleducation_primary.php
1
World Healtii Organization (WHO). The International
Classification of Diseases, Tentin Edition ( I C D - 1 0 ). W H O ,
Geneva, Switzerland; 1 9 9 2 .
18 . 7\merican Psychiatric 7\ssociation (APA). Diagnostic a nd
Statistical Manual o f Mental Disorders, Fourth Edition ( D S M -
American Psychiatric
Publishing,
Washington D C ; 1 9 9 4 .
19. Sadock B J , Sadock V A . Kaplan Sadock s Concise Textbook o f
Child a n d Adolescent Psychiatiry. Wolters KluwerlLippincott
Williams Wilkins,
2009;
C hapter 7:80.
20 . Idro R , Kakooza-Mwesige A , Balyejjussa S , Mirembe G , Mugasha
C , Tugumisirize J , et a l. Severe neurological sequelae and
behaviour problems after cerebral malaria in Ugandan children
B M C Res Notes 2 0 1 0 ; 3:104.
O p e n a c c e s s t o
f r i c a n J e n r n a l
e f
P s y c h i a t r y w e b s i t e
African
8/19/2019 Attention Deficit Hyperactivity Symptoms and Disorder Among African Children
http://slidepdf.com/reader/full/attention-deficit-hyperactivity-symptoms-and-disorder-among-african-children 5/5
Copyright of African Journal of Psychiatry (19948220) is the property of In House Publications and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
written permission. However, users may print, download, or email articles for individual use.