AWARENESS AND KNOWLEDGE OF AUTISM SPECTRUM DISORDERS AMONG MOTHERS IN UKWUANI LOCAL GOVERNMENT AREA, DELTA STATE

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1 .2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria AWARENESS AND KNOWLEDGE OF AUTISM SPECTRUM DISORDERS AMONG MOTHERS IN UKWUANI LOCAL GOVERNMENT AREA, DELTA STATE Okandeji-Barry, R. O., Agofure, O. and Garba A. Department of Public and Community Health, vena University Ogume, Nigeria ABSTRACT Autism Spectrum Disorders (ASD) is defined as a group of neurodevelopment disorders that are usually diagnosed in early childhood. A cross-sectional study was conducted among 192 women of reproductive age selected from three communities of Ukwuani Local Government Area. A semistructured questionnaire was administered to obtain information from respondents. Mean age of respondents was 57.9 ± 9.8 years, and 105 (54.70%) were married. More than half 108 (56.30%) of the respondents were aware of ASD. More than one third (34.40%) of the respondents had good knowledge of ASD. Predictors of good knowledge of ASD includes; marital status (OR= % CI= ), husbands occupation (OR= % CI= ) and husbands education (OR= % CI= ). In addition, most of the respondents demonstrated poor attitude towards autistic children. Majority, 156 (81.30%) concur to unusual behaviour towards autistic mothers and their children and 45 (34.10%) agreed that ignoring autistic children when they are in need is one of the ways of attending to them. The finding shows poor knowledge and attitude of respondents towards children with autism spectrum disorder. Therefore, more awareness of the disease especially in rural areas is hereby recommended. Keyword: Autism Spectrum Disorders, knowledge, attitude, autistic children, women INTRODUCTION Autism spectrum disorders, also known as pervasive developmental disorders, are a behaviourally defined group of neurodevelopment disorders that are usually diagnosed in early childhood (1). Autism spectrum disorders are characterized by early onset of impairments in social interaction and communication and the development of unusual stereotyped behaviours such as inability to learn from the natural environment as most children (1). Children diagnosed with autism spectrum disorders generally show little interest in the world or people around them, although few children with autism spectrum disorders develop normally and advance skills in particular areas; most exhibit a wide range of profound behavioural problems and delayed or undeveloped skills (1). According to the Center for Disease Control and Prevention, an average of 1 in 110 children has an autism spectrum disorder (2). The number of people in Western countries diagnosed with autism has increased dramatically since the 1980s (2). This increase can be attributed partly to changes in diagnostic practices, to an increased awareness among the general population, and to a new recognition of the broader autism spectrum (3, 4). However, according to Okey-Martins (5), about one hundred and ninety thousand (190,000) children in Nigeria may not have been diagnosed of autism because of the low level of awareness in Nigeria. Previous studies on knowledge of autism in Nigeria have been found to be low. For instance a study carried out among nurses working in tertiary health institutions in south - east and south south regions of Nigeria showed low levels of knowledge of childhood autism (6). Similar studies among undergraduate students, primary school pupils and their parents also found knowledge of autism to be low (7, 8). This observed low level of knowledge is probably due to the difficulty in diagnosing and recognizing autistic children among parents especially those in rural areas which have no access to medical facilities obtained in urban areas. In addition most of the previous studies carried out

2 .2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria focuses on institutions and medically inclined professionals in assessing the knowledge of autism leaving a gap among parents in a typical rural community where children develop the disorder and yet undiagnosed not until the child is already in late infanthood before it is finally diagnosed. Thus this study was designed to investigate the awareness and knowledge of autism spectrum disorders among mothers in Ukwuani Local Government Area, a local government with typical rural communities. METHODS AND PROCEDURES The study was a descriptive cross-sectional study carried out among women of reproductive age selected from three wards of Ukwuani Local Government Area. Ukwuani Local Government Area with its Headquarters in Obiaruku is made up of nine communities (Akoku, Amai, Ebedei, Eziokpo, Ezionum, Obiaruku, Umuebu, Umukwata and Umutu). The study involves a three stage sampling technique; firstly three communities of Amai, Ezionum and Obiaruku were randomly selected in a ballot out of the nine communities that make up the local government. The second stage involves stratification into the various clans that makes up each of the selected communities. Finally, women of child bearing age were randomly selected from each of the clans that make up the selected communities. A semi-structured questionnaire was administered to 192 women of child bearing age in the selected communities. The questionnaire consist of five sections which sought the respondents socio-demographic characteristics, prevalence of autism, awareness of autism, knowledge of autism and attitude of respondents towards autism spectrum disorder. Approval for the study was obtained from each of the okpola-uku (traditional ruler) that makes up each of the selected community. The validity and reliability of the instrument was determined. The level of knowledge of autism spectrum disorder was measured by a 14-point scale graded; poor (0-7) and good (>7). Data generated were analysed using SPSS version Descriptive statistics was used to evaluate frequency distribution, while Chi-square test and Logistic regression were performed to test for associations between variables of interest with level of significance set at p<0.05. RESULTS According to table 1, (n=64, 33.3%) are both in the age range of between years while (n=105, 54.70%) are married. Also predictors of good knowledge of autism spectrum disorders includes marital status (OR= % CI= ), husbands occupation (OR= % CI= ) and husbands education (OR= % CI= ). Table 1: Socio-demographic characteristics as predictors of good knowledge of Autism spectrum disorder Variables Frequency Percentage Sig Odds 95% CI Ratio Lower Upper Age >32 Marital Status Single Married Divorced Separated Widowed Occupation Housewife

3 Percentage Proceedings of The International Academic Conference for Sub-Sahara African Transformation & Development Vol. 3.2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria Trading Artisan Civil Servant Unemployed Husband s educational Status Never attended school Primary school Secondary school Tertiary school Husband s Occupation Artisan Trading Farming Civil Servant Unemployed As shown in figure 1, (n=108, 56.30%) of the respondents are aware of autism spectrum disorder while (n=84, 43.80%) were not aware of the disorder Figure 1: Awareness of Autism Spectrum Disorder As shown in figure 2, (n=42, 38.90%) of the respondents sources of information about autism spectrum disorder was hospital/clinic while (n=22, 20.40%) and (n=13, 12.0%) sources of information are friends and Radio/TV respectively. Awareness of Autism Spectrum Disorder

4 Percentage of respondents Proceedings of The International Academic Conference for Sub-Sahara African Transformation & Development Vol. 3.2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria Radio/TV Hosp/ClinSem/WrkshpFriends Sources of Information of Autism Figure 2: Sources of information of autism spectrum disorder As shown in table 2, one hundred and twenty nine (67.20%), believes mothers age at conception is a factor in having autistic child, while majority of the respondents 158 (82.30%) affirmed unprescribed drugs during ANC as cause of autism and more than one third 77 (40.10%) identify incoherent speech as a symptom of autism. Furthermore, 80 (41.70%) believes autistic disorder affects the growth and development of children, while majority 143 (74.50%) asserted that eating of toxic substance does not cause autism and 129 (67.20%) believes autism disorder is curable. More information on mothers knowledge of autism spectrum disorders is shown in table 2. Table 2: Knowledge of Autism spectrum disorders among respondents Variables Frequency Percentage Mean Knowledge Score Mother s age at conception as a factor of having an Autistic child Unprescribed drugs during ANC as a cause of Autism Symptoms of Autism Incoherent Speech Difficulty in Speaking Uncoordinated movement Child easily gets annoyed Ritualistic Behaviour Burden of having an Autistic Child Autistic disorder affecting the growth and development of children Physical Development Psychological Development Emotional Development ± 1.17

5 .2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria Intellectual Development Eating of toxic substance as a cause of Autism Appropriate treatment of Autism Medical treatment Traditional Method Spiritual Method Autism disorder is curable Child appearing deaf and dumb may be suffering from Autism Child staring into open space may be suffering from Autism Child not smiling when playing with other children may be an Autistic child Delay in Spoken word is a symptom Autism Child playing alone and not interacting may be suffering from Autism Autism is common among male than female children Autism disorder being contagious

6 Percentage Proceedings of The International Academic Conference for Sub-Sahara African Transformation & Development Vol. 3.2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria As shown in figure 2, 65.60% had poor knowledge of autism spectrum disorders while 34.40% had good knowledge of autism spectrum disorders Figure 3: Knowledge of Autism Spectrum Disorder Majority of the respondents 156 (81.30%) behaves unusual towards autistic mothers and their children, while almost half 95 (49.50%) will feel bad if they had an autistic child and forty-five (34.10) believes ignoring autistic children is the best way to attend to an autistic child when they are in need. Table 3: Attitude of respondents towards children with Autism Variable Frequency Percentage Attitude towards Autistic mothers and their children rmal Unusual Feeling of having an Autistic child Bad rmal Ashamed Abandon that child Beat the child Others Way of attending to autistic children when they are in need Shout at them Ignore them Attend to them Beat them 0 Poor Know of ASD Good Know of ASD Level of Knowledge of Autism Spectrum Disorder DISCUSSION The prevalence of autism spectrum disorders have been shown to be increasing (2, 9). Consequently, more of the respondents demonstrated a greater awareness of autism spectrum

7 .2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria disorders, although many of the respondents are still ignorant of autism spectrum disorders. This awareness shows the increasing prevalence of autism spectrum disorders in Africa and Nigeria (10, 11). Thus there should be greater commitment in the diagnosis and treatment of autism especially at the primary health care level which is easily accessible to communities, because most of the mothers got their information about autism spectrum disorder from hospital/clinic. This shows that health facilities are a very good avenue for promoting awareness about autism spectrum disorders. Ironically, despite the awareness shown by the respondents most of them demonstrated poor knowledge of the signs and symptoms of autism and other characteristics of autism spectrum disorder. This finding is similar to previous findings which showed low level of knowledge of autism spectrum disorder among the general public, health care workers and students in Nigeria (6, 7, 12). The poor knowledge of autism spectrum disorders shown by respondents was further corroborated by their attitude towards autistic children and their mothers. This reveals some of the attitudinal challenges autistic mothers and their children are facing in communities in Nigeria. CONCLUSION The finding shows poor knowledge and attitude of mothers towards children with autism spectrum disorder. This finding is not surprising, because in most rural communities many of the primary health care centres are not properly equipped for diagnosis of the disorder and attitude of communities towards the disease is still poor. Therefore, more awareness of the disease especially in rural areas is hereby recommended. RECOMMENDATIONS 1. Health workers especially community health workers should educate nursing and expectant mothers on the causes and preventions of autism spectrum disorders by organising seminars and workshop in their practice areas. 2. The government at all levels should promote the awareness of autism spectrum disorders in order to educate the generality of the people. REFERENCES 1. Austin, D An epidemiological analysis of the autism as mercury poisoning hypothesis. International Journal of Risk Safety and Medicine 20: Centers for Disease Control and Prevention (CDC) Prevalence of autism spectrum disorders-autism and developmental disabilities monitoring network, 14 sites, United States. MMWR Morbidity Mortality Weekly Report 56(1): Bryson, S. E. and Smith, I. M Epidemiology of autism: Prevalence, associated characteristics, and implications for research and service delivery. Mental Retardation and Developmental Disabilities Research Reviews, 4, Dosreis, S., Weiner, C. L., Johnson, L. and Newschaffer, C. J Autism spectrumdisorder: Screening and management practices among general pediatric providers. Journal of Developmental and Behavioral Pediatrics, 27 (2), Okey-Martins, N Autism in Nigeria: A brief on current situation Lagos. 6. Bakare, M. O., Ebigbo, P. O., Agomoh, A. O. and Menkiti, N. C Knowledge about childhood autism among health workers (KCAHW) questionnaire: description, reliability and internal consistency. Clinical Practice and Epidemiology in Mental Health, 4: Igwe, M. N., Bakare, M. O., Agomoh, A. O., Onyeama, G. M. and Okonkwo, K. O Factors influencing knowledge about childhood autism among final year undergraduate medical, nursing and psychology students of University of Nigeria, Enugu State, Nigeria. Italian Journal of Pediatrics, 36:44.

8 .2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria 8. Audu, V. E. I. and Egbochuku, E. O Autism among primary school pupils in Benin metropolis: Implications for counseling, Edo Journal of Counselling, 3:2. 9. Fombonne, E Epidemiology of autistic disorder and other pervasive developmental disorders. Journal of Clinical Psychiatry; 66: Seif Eldin, A., Habib, D., ufal, A., Farrag, S., Bazaid, K., Al-Sharbati, M., Badr, H., Moussa, S., Essali, A., and Gaddour, N Use of M-CHAT for a multinational screening of young children with autism in the Arab countries; International Rev Psychiatry; 20(3): Bakare, M. O and Munir, K. M Epidemiology, diagnosis, etiology and knowledge about autism spectrum disorders (ASD) in Africa: perspectives from literatures cited in pubmed over the last decade ( ); African Journal of Psychiatry (In Press). 12. African Network for the Prevention and Protection against Child Abuse and Neglect (ANPPCAN), Nigeria Chapter Communique on a project to increase the level of awareness on autism and develop a mechanism for care and support of children with autism in Enugu State, South-Eastern Nigeria.

9 .2 March, University of Ilorin, 1000 Capacity Lecture Theatre Hall, Ilorin, Kwara State - Nigeria