Stigma, explanatory models and unmet needs of caregivers of children with developmental disorders in a low-income African country: a cross-sectional facility-based survey.

Journal: BMC health services research

Volume: 16

Issue: 

Year of Publication: 2016

Affiliated Institutions:  Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia. Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia. charlotte.hanlon@kcl.ac.uk. The Open University, Department of Life, Health and Chemical Sciences, Milton Keynes, UK.

Abstract summary 

Understanding the perspectives of caregivers of children with developmental disorders living in low-income countries is important to inform intervention programmes. The purpose of this study was to examine the stigma experiences, explanatory models, unmet needs, preferred interventions and coping mechanisms of caregivers of children with developmental disorders in Ethiopia.Participants comprised caregivers (n = 102) of children with developmental disorders attending two child mental health clinics in Addis Ababa. The majority (66.7%; n = 68) had a diagnosis of intellectual disability (ID); 34 children (33.3%) had autism spectrum disorder (ASD) as their primary diagnosis. All caregivers were administered a structured questionnaire via a face-to-face interview, which included an adaptation of the Family Interview Schedule, closed questions about socio-demographic characteristics, explanatory models of illness, type of interventions used or desired and coping strategies, and an open ended question regarding the family's unmet needs.Most caregivers reported experience of stigma: 43.1% worried about being treated differently, 45.1% felt ashamed about their child's condition and 26.7% made an effort to keep their child's condition secret. Stigma did not depend on the type of developmental disorder, the child's age or gender, or on the age or level of education of the caregiver (all p > 0.05). Reported stigma was significantly higher in caregivers who had sought traditional help (p < 0.01), provided supernatural explanations for their child's condition (p = .02) and in caregivers of Orthodox Christian faith (p = .03). Caregivers gave a mixture of biomedical explanations (e.g. head injury (30.4%) or birth complications (25.5%)) and supernatural explanations (e.g. spirit possession (40.2%) or sinful act (27.5%)) for their child's condition. The biggest reported unmet need was educational provision for their child (74.5%), followed by treatment by a health professional (47.1%), financial support (30.4%) and expert help to support their child's development (27.5%). Most caregivers reported that talking to health professionals (86.3%) and family (85.3%) helped them to cope. Many caregivers also used support from friends (76.5%) and prayer (57.8%) as coping mechanisms.This study highlights the stigma experienced by families caring for a child with a developmental disorder. Designing interventions appropriate for low-income settings that improve awareness about developmental disorders, decrease stigma, improve access to appropriate education and strengthen caregivers' support are needed.

Authors & Co-authors:  Tilahun Dejene D Hanlon Charlotte C Fekadu Abebaw A Tekola Bethlehem B Baheretibeb Yonas Y Hoekstra Rosa A RA

Study Outcome 

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Statistics
Citations :  WHO, Mental Health Gap Action Program (mhGAP) Scaling up care for mental, neurological and substance use disorders. Geneva: World Health Organization; 2008.
Authors :  6
Identifiers
Doi : 152
SSN : 1472-6963
Study Population
Male,Female
Mesh Terms
Adaptation, Psychological
Other Terms
Autism Spectrum Disorder;Developing countries, Africa;Developmental disorder;Intellectual disability;Stigma
Study Design
Cross Sectional Study
Study Approach
Country of Study
Ethiopia
Publication Country
England