Nigeria, India, and China have been identified as the top three leading contributors to the global prevalence of developmental disabilities in children, a new report shows.
A research sponsored by the Bill and Melinda Gates Foundation, and just published in the Lancet Global Health journal revealed that over 53 million children under the age of five worldwide had developmental disabilities in 2016.
The research sponsored by the Global Research on Developmental Disabilities Collaborators (GRDDC) was conducted by experts in child disability from different world regions, supported by the Institute of Health Metrics and Evaluation, United States of America.
The experts defined developmental disabilities as a group of life-long health conditions affecting the ability of a child to develop, grow and function optimally.
These conditions include hearing loss, vision loss, cerebral palsy, epilepsy, autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorders, intellectual disability and Down’s syndrome.
The report specifically noted the top three leading contributors to the global prevalence of developmental disabilities were India, China and Nigeria.
Besides, the report found that under-five mortality in sub-Saharan Africa declined by 20.8 per cent from 3.4 million in 1990 to 2.7 million in 2016.
However, the number of children with epilepsy, intellectual disability, hearing and visual impairments, autism spectrum disorder and attention-deficit/hyperactivity disorder alone rose by 71.3 per cent from 8.6 million in 1990 to 14.7 million in 2016.
In Nigeria, the report said, the number of children with developmental disabilities rose by two thirds (66.7 per cent) from 1.5 million in 1990 to 2.5 million in 2016.
This figure is considered grossly under-estimated as it excludes children with birth defects and other developmental disabilities such as learning and communication disorders.
In addition, children with cerebral palsy without intellectual disability and those with developmental disabilities that cannot be associated with specific medical causes are also excluded.
A global health expert and leader of GRDDC, Bolajoko Olusanya, in his reaction to the report describes the data as troubling.
She said when viewed against challenges usually encountered by children with disabilities and their families in developing countries like Nigeria, the report was worrisome.
According to Mrs Olusanya, who is the Executive Director, Centre for Healthy Start Initiative, these children often required more support daily to “communicate, play, learn, understand or use information than others”.
“They require a great deal of support to be as independent and successful compared to children without disabilities,” she noted
She said failure to provide necessary assistance to these children in the first five years of life, especially when the brain is most amenable to stimulation, has grave adverse consequences on their educational and vocational attainment.
Also, citing a follow-up publication by Lancet Child and Adolescent Health journal on developmental disabilities in Africa, Mrs Olusanya said a difficult future seems to await such children in many communities.
She said this was largely due to unfavourable cultural beliefs, discrimination and family stigma, which expose the children to higher risks of neglect.
Other disadvantages include maltreatment, violence, family disintegration, exclusion from formal education and full economic participation and even premature death compared to children without disabilities.
The medical expert noted that the direct impact on family as a result of the condition was diverse, including “frequent frictions among family members, threat to family cohesion, high risk of divorce or parental separation, and unavoidable intrusion by third parties”.
“It is not uncommon for disability to be attributed to an ‘evil force’, supernatural causes, or linked to some superstitious beliefs. On such occasions, often out of ignorance or frustration with available (or lack of) services, some mothers resort to either ‘spiritual healing or appeasement’ or traditional medicine that entails unorthodox and potentially harmful therapies.
“A child that is accepted is more likely to be hidden from public view or sent away to live with extended family members in villages because of the stigma and the stress of parenting.
“The very thought of these challenges frequently compels some families to consider disability as worse than death, and view infanticide (killing a child in the first year of life) as an escape route to freedom,” Mrs Olusanya said.
The expert said the overriding message from the research was that something needs to be done about the increasing number of beneficiaries of the globally sponsored child survival programmes in Nigeria and the rest of Africa since1990.
Proferring a number of measures that could be applied to manage children with such conditions, Mrs Olusanya said merely keeping these children alive was not enough.
“The Sustainable Development Goals (SDGs) mandates all countries to identify and monitor the proportion of children under-five years who are at risk of not attaining their developmental potential.
“The findings from this research should therefore challenge the relevant authorities, especially in the health and educational sectors to consider a three-pronged strategy.
“These include interventions to curtail the incidence of avoidable disabilities, community-based programmes for the early detection of children with disabilities from birth, and provision of support services for children with disabilities and their families,” she said.
Meanwhile, the report also emphasised the needs of these children and their families to be explicitly recognised in the country’s maternal and child health policy.
As a first step, the report called for an inter-ministerial technical team to be established to address this issue in greater detail in consultation with relevant stakeholders including developmental partners, like the United Nations Children Education Fund (UNICEF), World Health Organization (WHO) and the World Bank.
“This will facilitate a more effective platform for coordinating the activities of the diverse service providers within and outside the public sector for improved and qualitative outreach,” Mrs Olusanya added.