Developing Standardized Care Pathways for management of autism spectrum disorders in the Ashanti Region

Abstract

Background
 According to the Ghana Multiple Indicator cluster survey 2011, 1 in 4 Ghanaian children aged 36-59 months is estimated to have a delay in their development (cognitive, learning, socioemotional and physical). Although the exact prevalence of autism spectrum disorder (ASD) in the country is unknown, these children are a particularly under-served population in Ghana, suffering from late identification and poor access to evaluation and treatment.Aim: 
 To establish standard care pathways in the public health sector for the management of ASD in the Ashanti Region of Ghana by August 2021.
 Method 
 A multidisciplinary guiding coalition was established to conduct a fish-bone root cause analysis via one-on-one interviews and focused group discussions with major stakeholders to understand the primary cause of the problem. A simple referral process map was then designed by the group. After an extensive literature search using google scholar and PubMed, the 23Q screening tool, originally designed in Uganda, for developmental assessment of children aged 2-9years was selected and locally validated. The tool was then piloted in 15 schools across 9 out of 43 districts assemblies in the Ashanti Region.
 Results
 23 out of 43 special needs coordinators in Ashanti Region were trained in the use of the screening tool. Across the 15 schools visited, the tool identified developmental disorders in a total of 427 children, aged 3-17years, with an average age of 9years. 18% (n=78) of these children aged between 3 and 17years, were flagged by ASD specific questions with 7% (32) aged between 3-9years.
 Conclusion
 Autism awareness is evolving in Ghana. This project seeks to ultimately establish the burden of ASD in Ghana and connect pediatricians, medical officers, special education teachers, therapists, and families in an all teach, all learn collaboration which would set the framework for a national system of coordinated care for children with ASD.