Prevalence of Child Mental Health Problems in Sub-Saharan Africa: A Systematic Review | Global Health | JAMA Pediatrics | JAMA Network
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Prince M, Patel V, Saxena S,  et al.  No health without mental health.  Lancet. 2007;370(9590):859-87717804063PubMedGoogle ScholarCrossref
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge.  Lancet. 2007;369(9569):1302-131317434406PubMedGoogle ScholarCrossref
UNICEF.  Annual Report 2006. New York, NY: UNICEF; 2007
Rutter M. Development and psychopathology. In: Rutter M, Taylor E, eds. Child and Adolescent Psychiatry. Oxford, UK: Blackwell Science Ltd; 2002:309-324
Roberts RE, Attkisson CC, Rosenblatt A. Prevalence of psychopathology among children and adolescents.  Am J Psychiatry. 1998;155(6):715-7259619142PubMedGoogle Scholar
Patel V, Sumathipala A. International representation in psychiatric literature: survey of six leading journals.  Br J Psychiatry. 2001;178:406-40911331553PubMedGoogle ScholarCrossref
Saxena S, Paraje G, Sharan P, Karam G, Sadana R. The 10/90 divide in mental health research: trends over a 10-year period.  Br J Psychiatry. 2006;188:81-8216388075PubMedGoogle ScholarCrossref
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.  Lancet. 2006;367(9524):1747-175716731270PubMedGoogle ScholarCrossref
Nolen-Hoeksema S, Girgus JS. The emergence of gender differences in depression during adolescence.  Psychol Bull. 1994;115(3):424-4438016286PubMedGoogle ScholarCrossref
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000
World Health Organization.  The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, Switzerland: World Health Organization; 2007
 Depression looms as global crisis. BBC News . 2009. Accessed November 11, 2009
Zisook S, Lesser I, Stewart JW,  et al.  Effect of age at onset on the course of major depressive disorder.  Am J Psychiatry. 2007;164(10):1539-154617898345PubMedGoogle ScholarCrossref
Murray C, Lopez A. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability, Injuries and Risk Factors 1990 and Projected to 2020. Cambridge, MA: Harvard University Press on behalf of the World Health Organization and the World Bank; 1996
Jamison DT, ed, Feachem RG, ed, Malegapuru WM, ed,  et al.  Disease and Mortality in Sub-Saharan Africa. 2nd ed. Washington, DC: International Bank for Reconstruction and Development/The World Bank; 2006
 DAC list of ODA recipients used for 2008, 2009, and 2010 flows. OECD Web site. Accessed 2008
UNAIDS.  Report on the Global AIDS Epidemic. Geneva, Switzerland: UNAIDS; 2008
Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B.International Child Development Steering Group.  Developmental potential in the first 5 years for children in developing countries.  Lancet. 2007;369(9555):60-7017208643PubMedGoogle ScholarCrossref
Grantham-McGregor S.International Child Development Committee.  Early child development in developing countries.  Lancet. 2007;369(9564):82417350449PubMedGoogle ScholarCrossref
Thabet AA, Vostanis P. Social adversities and anxiety disorders in the Gaza Strip.  Arch Dis Child. 1998;78(5):439-4429659090PubMedGoogle ScholarCrossref
Shaw DS, Vondra JI, Hommerding KD, Keenan K, Dunn M. Chronic family adversity and early child behavior problems: a longitudinal study of low-income families.  J Child Psychol Psychiatry. 1994;35(6):1109-11227995846PubMedGoogle ScholarCrossref
Rutter ML. Psychosocial adversity and child psychopathology.  Br J Psychiatry. 1999;174:480-49310616625PubMedGoogle ScholarCrossref
Rudolph KD, Flynn M. Childhood adversity and youth depression: influence of gender and pubertal status.  Dev Psychopathol. 2007;19(2):497-52117459181PubMedGoogle ScholarCrossref
Hackett R, Hackett L, Bhakta P, Gowers S. Life events in a South Indian population and their association with psychiatric disorder in children.  Int J Soc Psychiatry. 2000;46(3):201-20711075632PubMedGoogle ScholarCrossref
Barbarin OA, Richter L. Adversity and psychosocial competence of South African children.  Am J Orthopsychiatry. 1999;69(3):319-32710439846PubMedGoogle ScholarCrossref
Baingana FK, Alem A, Jenkins R. Mental health and the abuse of alcohol and controlled substances. In: Jamison DT, Feachem RG, Malegapuru WM, eds, et al. Disease and Mortality in Sub-Saharan Africa. Washington, DC: International Bank for Reconstruction and Development/The World Bank; 2006
Belfer ML. Child and adolescent mental disorders: the magnitude of the problem across the globe.  J Child Psychol Psychiatry. 2008;49(3):226-23618221350PubMedGoogle ScholarCrossref
World Health Organization.  World Health Report 2001: Mental Health: New Understanding, New Hope. Geneva, Switzerland: World Health Organization; 2001
Goodman R. The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden.  J Child Psychol Psychiatry. 1999;40(5):791-79910433412PubMedGoogle ScholarCrossref
Briere J. Trauma Symptom Checklist for Children (TSCC) Professional Manual. Odessa, FL: Psychological Assessment Resources; 1996
Sutton A, Abrams K, Jones D, Sheldon T, Song F. Random effects methods for combining study estimates. In: Sutton AJAK, Jones DR, Sheldon TA, Song F, eds. Methods for Meta-analysis in Medical Research. Chichester, UK: John Wiley & Sons; 2000:73-86
Hedges LV, Olkin I. Statistical Methods for Meta-analysis. Orlando, FL: Academic Press; 1985
Fazel S, Danesh J. Serious mental disorder in 23,000 prisoners: a systematic review of 62 surveys.  Lancet. 2002;359(9306):545-55011867106PubMedGoogle ScholarCrossref
Mulatu MS. Prevalence and risk factors of psychopathology in Ethiopian children.  J Am Acad Child Adolesc Psychiatry. 1995;34(1):100-1097860449PubMedGoogle ScholarCrossref
Abiodun OA. Emotional illness in a paediatric population in Nigeria.  East Afr Med J. 1992;69(10):557-5591473508PubMedGoogle Scholar
Robertson BA, Ensink K, Parry CD, Chalton D. Performance of the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3) in an informal settlement area in South Africa.  J Am Acad Child Adolesc Psychiatry. 1999;38(9):1156-116410504815PubMedGoogle ScholarCrossref
Adelekan ML, Ndom RJ, Ekpo M, Oluboka O. Epidemiology of childhood behavioural disorders in Ilorin, Nigeria: findings from parental reports.  West Afr J Med. 1999;18(1):39-4810876731PubMedGoogle Scholar
Ashenafi Y, Kebede D, Desta M, Alem A. Prevalence of mental and behavioural disorders in Ethiopian children.  East Afr Med J. 2001;78(6):308-31112002109PubMedGoogle Scholar
Kashala E, Elgen I, Sommerfelt K, Tylleskar T. Teacher ratings of mental health among school children in Kinshasa, Democratic Republic of Congo.  Eur Child Adolesc Psychiatry. 2005;14(4):208-21515981132PubMedGoogle ScholarCrossref
Liang H, Flisher AJ, Chalton DO. Mental and physical health of out of school children in a South African township.  Eur Child Adolesc Psychiatry. 2002;11(6):257-26012541003PubMedGoogle ScholarCrossref
Minde KK. Children in Uganda: rates of behavioural deviations and psychiatric disorders in various school and clinic populations.  J Child Psychol Psychiatry. 1977;18(1):23-37838785PubMedGoogle ScholarCrossref
Peltzer KK. Posttraumatic stress symptoms in a population of rural children in South Africa.  Psychol Rep. 1999;85(2):646-65010611795PubMedGoogle ScholarCrossref
Tadesse B, Kebede D, Tegegne T, Alem A. Childhood behavioural disorders in Ambo district, western Ethiopia. I. Prevalence estimates.  Acta Psychiatr Scand Suppl. 1999;397:92-9710470361PubMedGoogle ScholarCrossref
Ndetei DM, Khasakhala L, Nyabola L,  et al.  The prevalence of anxiety and depression symptoms and syndromes in Kenyan children and adolescents.  J Child Adolesc Ment Health. 2008;20(1):33-51Google ScholarCrossref
Ndetei DM, Othieno CJ, Mutiso V,  et al.  Psychometric properties of an African symptoms check list scale: the Ndetei-Othieno-Kathuku scale.  East Afr Med J. 2006;83(5):280-28716866223PubMedGoogle Scholar
Achenbach TM, Edelbrock C. Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: Queen City Printers; 1983
Giel R, de Arango MV, Climent CE,  et al.  Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative Study on Strategies for Extending Mental Health Care.  Pediatrics. 1981;68(5):677-6837312471PubMedGoogle Scholar
Costello EJ, Angold A, Burns BJ,  et al.  The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders.  Arch Gen Psychiatry. 1996;53(12):1129-11368956679PubMedGoogle ScholarCrossref
 Office for National Statistics. Prevalence of mental disorders among children: by gross weekly household income and age of child, 1999. Office for National Statistics; 1999. Accessed March 16, 2011 
Eapen V, Swadi H, Sabri S, Abou-Saleir M. Childhood behavioural disturbance in a community sample in Al-Ain, United Arab Emirates.  East Mediterr Health J. 2001;7(3):428-43412690763PubMedGoogle Scholar
Rescorla LL, Achenbach TM, Ivanova MY,  et al.  Behavioral and emotional problems reported by parents of children ages 6 to 16 in 31 societies.  J Emot Behav Disord. 2007;15(3):130-142Google ScholarCrossref
Hickson J, Kriegler S. Childshock: the effects of apartheid on the mental health of South Africa's children.  Int J Adv Couns. 1991;14(2):141-154Google ScholarCrossref
Morrison JA. Protective factors associated with children's emotional responses to chronic community violence exposure.  Trauma Violence Abuse. 2000;1(4):299-320Google ScholarCrossref
Havenaar JM, Geerlings MI, Vivian L, Collinson M, Robertson B. Common mental health problems in historically disadvantaged urban and rural communities in South Africa: prevalence and risk factors.  Soc Psychiatry Psychiatr Epidemiol. 2008;43(3):209-21518058040PubMedGoogle ScholarCrossref
Mullick MS, Goodman R. The prevalence of psychiatric disorders among 5–10- year-olds in rural, urban and slum areas in Bangladesh: an exploratory study.  Soc Psychiatry Psychiatr Epidemiol. 2005;40(8):663-67116091858PubMedGoogle ScholarCrossref
Rutter M. The promotion of resilience in the face of adversity. In: Clarke-Stewart A, ed. Families Count. New York, NY: Cambridge University Press; 2004:26-52
Demyttenaere K, Bruffaerts R, Posada-Villa J,  et al; WHO World Mental Health Survey Consortium.  Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.  JAMA. 2004;291(21):2581-259015173149PubMedGoogle ScholarCrossref
Costello EJ, Keeler GP, Angold A. Poverty, race/ethnicity, and psychiatric disorder: a study of rural children.  Am J Public Health. 2001;91(9):1494-149811527787PubMedGoogle ScholarCrossref
Mar 2012

Prevalence of Child Mental Health Problems in Sub-Saharan Africa: A Systematic Review

Author Affiliations

Author Affiliations: Department of Psychiatry (Drs Cortina, Fazel, and Ramchandani) and Oxford University Hospitals NHS Trust (Dr Sodha), University of Oxford, Oxford, United Kingdom; and Medical Research Council/Wits Rural Public Health and Health Transitions Unit, University of the Witwatersrand, Johannesburg, South Africa (Dr Cortina). Dr Sodha is now with the Psychiatry Department, Norwick Park Hospital, Harrow, United Kingdom.

Arch Pediatr Adolesc Med. 2012;166(3):276-281. doi:10.1001/archpediatrics.2011.592

Objective To assess the prevalence of child mental health problems in community settings in sub-Saharan Africa.

Data Sources A systematic search of MEDLINE, EMBASE, and PsychInfo, supplemented by tracking of references from identified articles and personal communications with local researchers.

Study Selection Only community-based studies in sub-Saharan Africa that assessed the general psychopathology of children aged 0 to 16 years were included. For each eligible study, the following information was extracted: year of publication, country, population sampled, area type (rural or urban), sampling method and sample size (percentage boys), age range, assessment instrument, informant, diagnostic criteria, and prevalence rates of general psychopathology.

Main Outcome Measure Pooled prevalence rate of psychopathology in children, identified by questionnaire and, specifically, by clinical diagnostic instruments.

Results Eleven studies met the inclusion criteria, 10 of which were included in the meta-analysis. The 10 studies provided data for 9713 children from 6 countries, with substantial variation in assessment methods. Overall, 14.3% (95% CI, 13.6%-15.0%) of children were identified as having psychopathology. Studies using screening questionnaires reported higher prevalence rates (19.8%; 95% CI, 18.8%-20.7%) than did studies using clinical diagnostic instruments (9.5%; 8.4%-10.5%).

Conclusions Evidence suggests that considerable levels of mental health problems exist among children and adolescents in sub-Saharan Africa. One in 7 children and adolescents have significant difficulties, with 1 in 10 (9.5%) having a specific psychiatric disorder. There are clear sociodemographic correlates of psychopathology that may place children in areas of greatest deprivation at greatest risk.