COMPARISONS OF PATHWAYS TO CARE FOR CHILDHOOD EPILEPSY AND CHILDHOOD PSYCHIATRY DISORDERS AMONG CHILDREN AND ADOLESCENTS IN IBADAN, NIGERIA

Abstract

Epilepsy and child psychiatry disorders are very common in the developing world and contribute to the burden of diseases among young people in this region. It is estimated that 80% of children with epilepsy live in resource poor countries; likewise 10-20% of children and adolescents suffer from mental illness. Also these disorders often overlap and majority of the patients do not have access to the much needed specialist care. In Nigeria, studies have shown different pathways of mental health services which revealed that it is either majority of the subjects had not received any care prior to presentation at hospital or majority of the subject had initially received treatment from a traditional or religious healer. However not much is known about pathways to epilepsy health care services. This study therefore set out to determine the pathway to care for children presenting at a neurology clinic and to evaluate similarities and differences between pathways to child psychiatric services and neurology services. Methodology In this comparative cross-sectional study, data was collected over 13 weeks from 114 participants and their caregivers attending the Paediatrics Neurology Clinic; and the Child and Adolescent Mental Health Clinic of the University College Hospital, Ibadan and a private clinic (The New World Clinic). A comparative two proportional sampling size formula was used to derive my sample size. Participants who met the inclusion criteria were selected using a purposive sampling technique. A socio-demographic questionnaire was used to obtain background information from the participants, while a modified version of the WHO Encounter form and the Data Extraction form was used to collect data about participants’ visits to the various research sites. Data was cleaned and coded where appropriate. Data entry and analysis was done using the Statistical Package for the Social Sciences version 20 (S.P.S.S 20). Socio-demographic and clinical variables were analysed and presented in frequencies or percentages. The Chi-square test was used to determine the association between categorical sociodemographic analysis was applied for the analysis of time to the actual act of seeking help for medical services by the caregiver, and the exact time to seek help will be determined. Cox regression analysis was used to check whether the socio-demographic variables were related to the time taken to seek intervention. Computer-assisted theme generation from the qualitative data was conducted using ATLAS Ti software. The statistical level of significance was set at 5% (p<0.05). Results There were 34 (57.9%) males, and 24 (24.1%) females in the epilepsy group, while 31(54.4%) were males and 26 (45.6%) were females in the child psychiatry group. The participants’ ages ranged from 8 months to 18 years. Generalized tonic-clonic epilepsy, seen in 46 (80.7%) was the most common type of epilepsy in the epilepsy group while neurodevelopmental disorders 30 (52.6%) was the most common in the psychiatric group. The medical pathway was accessed by 41 (72.0%) of caregivers of children and adolescents with epilepsy as their first contact into help-seeking while 24 (42.1%) of caregivers of children and adolescents with psychiatric disorders sought help from non-medical pathway (religious leaders) as their first contact to care. This difference was statistically significant at p<0.001. The median time taken to seek any type of help after the onset of symptom was 29.42 weeks (IQR 30.86) for childhood epilepsy while it took 94.82 weeks (IQR 96.50) for childhood psychiatry disorders. The median time taken to seek at the tertiary facility was 52 weeks (IQR 124.00) for childhood epilepsy while it took 48 weeks (IQR 91.00) for childhood psychiatry disorders. The main barriers to care identified by the study participants were family issues, financial constraints, work-related issues. Hospital related themes included long distance to the clinic, hospital stress and delay at the hospital Conclusion analysis was applied for the analysis of time to the actual act of seeking help for medical services by the caregiver, and the exact time to seek help will be determined. Cox regression analysis was used to check whether the socio-demographic variables were related to the time taken to seek intervention. Computer-assisted theme generation from the qualitative data was conducted using ATLAS Ti software. The statistical level of significance was set at 5% (p<0.05). Results There were 34 (57.9%) males, and 24 (24.1%) females in the epilepsy group, while 31(54.4%) were males and 26 (45.6%) were females in the child psychiatry group. The participants’ ages ranged from 8 months to 18 years. Generalized tonic-clonic epilepsy, seen in 46 (80.7%) was the most common type of epilepsy in the epilepsy group while neurodevelopmental disorders 30 (52.6%) was the most common in the psychiatric group. The medical pathway was accessed by 41 (72.0%) of caregivers of children and adolescents with epilepsy as their first contact into help-seeking while 24 (42.1%) of caregivers of children and adolescents with psychiatric disorders sought help from non-medical pathway (religious leaders) as their first contact to care. This difference was statistically significant at p<0.001. The median time taken to seek any type of help after the onset of symptom was 29.42 weeks (IQR 30.86) for childhood epilepsy while it took 94.82 weeks (IQR 96.50) for childhood psychiatry disorders. The median time taken to seek at the tertiary facility was 52 weeks (IQR 124.00) for childhood epilepsy while it took 48 weeks (IQR 91.00) for childhood psychiatry disorders. The main barriers to care identified by the study participants were family issues, financial constraints, work-related issues. Hospital-related themes included long distances to the clinic, hospital stress and delay at the hospital Conclusion This study revealed various forms of pathways to care for both disorders. The most frequently used intervention for childhood epilepsy, was to access care in a hospital setting while for childhood psychiatric disorder, it was to access care in a non-medical pathway which is in keeping with most studies. The main barriers identified in this study were family issues, financial constraints and work-related issues. Adjusting clinic time and increasing mental health talk through advocacy would go a long way in improving access to the available child and adolescent mental health services