SEARCH

SEARCH BY CITATION

Keywords:

  • institutional dynamics;
  • learning disabilities;
  • mental health settings;
  • rehabilitation

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References

Accessible summary

  • The findings from this study reveal a significantly higher prevalence of neurological and intellectual disabilities as well as epilepsy among adolescents residing in a social welfare/juvenile justice institution in Nigeria compared with a cohort of school going adolescents. Epilepsy and neurological deficits was particularly prevalent among adolescents admitted into the institution as victims of neglect compared with those brought in as offenders.
  • Stigmatization of and social prejudices against children with neuro-psychiatric disabilities and epilepsy as well as lack of support for their caregivers in Nigeria was speculated as the key factor promoting neglect of such children. The speculation was based on the findings from this study and extant literature. Consequently, efforts should be geared towards disengaging childhood epilepsy and neuro-psychiatric disabilities from myth and prejudices and to provide needed support for caregivers of children with such conditions. Meanwhile curative and restorative neuro-psychiatric services should be part of the service package for children within social welfare/juvenile justice institutions in Nigeria.

Abstract

A total of 67 adolescents from a juvenile remand home were matched with 67 other adolescents by age and gender, with a view to determine the prevalence and spectrum of neurological and intellectual disabilities. Intelligence quotient (IQ) was estimated using an adapted version of the Slosson's Intelligence Test and a full neurological evaluation was carried out. The mean IQ score for the remand home participants was significantly lower than the controls (77 ± 11 vs. 99 ± 14; t = 1.6, P = 0.001). Almost half (46.7%) of the participants in the remand home had intellectual disability of varying degrees, including borderline intellectual functioning, compared with only two (3.3%) of the comparison group (P < 0.001). Epilepsy and neurological deficits were significantly more prevalent among the remand home group, particularly those admitted as victims of neglect, compared with the comparison group (P ≤ 0.02). These findings and recent literature were used to speculate the possible underlying factors. Policy implications for child social welfare in Nigeria were suggested.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References

Nigeria is currently in a very difficult situation in terms of optimal childcare. This is not unconnected with the fact that current social indicators in the country are unlikely to be able to support optimal provision of the ingredients for physical, social and mental well-being of children. With a burgeoning 75 million children to cater for (Central Intelligence Agency 2011), widespread poverty and social inequalities in the country (Earth trends 2003, Omotola 2008) has denied many families the cohesion, stability and resources needed for proper childcare (Ebigbo 2003). Countries with adverse socio-economic indicators, as currently obtainable in Nigeria, are known to have a high proportion of dysfunctional families; an increased risk of situations of child abuse and neglect, and need for large number of children to access social welfare services (United Nations 2003). This situation has also been linked to a higher risk of juvenile delinquency and as a consequence, children and adolescents coming in contact with the juvenile justice system (Oloruntimehin 1970, Odejide & Toye 1976, Ozen et al. 2005).

There is documented evidence that a large and increasing number of children and adolescents in Nigeria have had or are at risk of having contact with the social welfare or juvenile justice systems. Figures from the official data of the Nigerian Prison Services in the year 2011 showed that in the preceding 5 years, there was a steady, almost geometric rise in the number of children and adolescents processed through the criminal section of the juvenile justice system (Ogundipe 2011). There are also reports that the streets of Nigeria are being inundated daily with hordes of different categories of neglected children and adolescents in need of social welfare services (Abdulmalik et al. 2009, Aransiola et al. 2009), many of whom end up in the social welfare or juvenile justice institutions.

Another expected repercussion of the adverse social indicators in Nigeria is poor early childhood care, especially ante and perinatal childcare. Recent reports showed that up to 12% of pregnant women in Nigeria were malnourished and that only 58% and 35% of a nationally representative sample of pregnant women in Nigeria had access to antenatal care and attendance of a skilled birth attendant respectively (National Population Commission and ICF Macro 2008). Reports like this are probably the most worrisome aspect of the socio-economic situation in Nigeria from child health perspectives. This is because many of the childhood mental and neurological disorders take their root from the quality of transition from ante-partum to postpartum life. In a study of a cohort of children and adolescents referred to a Child and Adolescent Mental Health (CAMH) clinic in Nigeria for sundry neurological and mental health problems, about a third had a history of obstetrics complications, the commonest of which was perinatal asphyxia (Omigbodun & Bella 2004). Perinatal asphyxia is the leading adverse birth outcome in the settings of poor maternal care (Costello 1994) and Nigeria currently has one of the highest rates in sub-Saharan Africa (UNICEF 2009).

Perinatal asphyxia has been reported to be associated with a wide range of chronic disabling neurological disorders ranging from cerebral palsy (Odding et al. 2006) through cognitive deficits (Frank-Briggs & Alikor 2011) to epilepsy (Ogunlesi et al. 2008). Epilepsy, neurological deficits and cognitive deficits either independently or in combination, are risk factors for being abused or neglected among children in different parts of the world (Sullivan & Knutson 2000, Spencer et al. 2005). The increased risk has been linked with the higher caregiver burden associated with such chronic disabling conditions (Maes et al. 2003). Other than delinquency and crime, child abuse and neglect is also a major reason for placing children and adolescents in institutional care in Nigeria.

Nigeria runs a ‘multipurpose’ juvenile justice system in which both child offenders and child victims are processed through the juvenile courts. These are then committed to a borstal or remand facility. Borstal institutions in Nigeria are mainly for young offenders while remand homes are like refuge centres for maltreated and abandoned children. This divisions are not however strict as a few offenders can be diverted to the remand system if the borstal systems get overwhelmed. Children in institutional care are living in a difficult circumstance and as such are expected to have higher social and health needs. The few health needs assessment studies conducted among adolescents in custodial care in Nigeria had focused on psychopathology and social needs (Ononye & Morakinyo 1994, Ajiboye et al. 2009, Bella et al. 2010). At least one of these studies had hinted that neurological and intellectual disabilities may also be an issue among these children (Bella et al. 2010). Children with neurological disorders and intellectual disabilities have been found to constitute a bigger management burden in custodial care (Smith et al. 1990) and place a higher demand on the often limited resources. Available neurological and mental health services in the best of climes hardly cover more than a small fraction of children and adolescents in need of such services (Burns et al. 2004).

Therefore, in a country like Nigeria where paediatric neurology, CAMH and special education services are limited; provision of such services for children in custodial care will require careful planning. This will include a well-designed assessment to determine the needs for neurological, neuro-physiotherapy, psychiatric and special education services to children in social welfare and juvenile justice institutions. Such services have a potential to improve quality of life and the success of social re-integration of these children and adolescents. As part of a multidisciplinary mental health outreach programme to a remand home in South-West Nigeria, the prevalence and spectrum of neurological and intellectual disabilities among adolescents in the facility was examined in a cross-sectional comparative study design.

Materials and methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References

Setting

This study was carried out at a juvenile remand home and a secondary school in Ibadan Nigeria. The remand home is one of the 24 of its type situated in the major cities in Nigeria. Remand homes in Nigeria serve as multipurpose institutions where adolescents and children who had suffered abuse and neglect and in need of care and protection mainly, and sometimes those on ‘criminal code’ (those described as ‘beyond parental control’ and ‘young offenders’) are temporarily kept for care, protection and reformation.

Procedures

All the 41 adolescents aged 10–17 years who were already admitted in the Home at the commencement of data collection and 26 subsequent consecutive admissions within the age range were recruited into the study. The comparison group was drawn from a neighbouring government-run school and matched for age and gender. All physical examinations were done with minimal bodily exposure and conducted in a screened corner.

The intelligence quotient (IQ) of the participants was estimated using the Slosson's Intelligence Test (SIT) (Slosson 2005). The SIT is a shorter modification of the Stanford-Binet test and has been found to correlate with other standard IQ instruments such as the Wechsler's Intelligence Scale for Children (Jeffery et al. 1984). The SIT has been validated for use in the Nigerian context and has been found to be reliable in assessing the IQ of Nigerian children (Oyundoyin 2003). To compensate for the fact that the SIT does not have a specific section that assesses adaptive functions, the Child Global Assessment Scale (CGAS) (Shaffer et al. 1983) was used to evaluate the participants further for level of social functioning. This was done with additional information from staff of the remand home or school teachers as the case may be. CGAS has been found to be a useful measure of overall severity of impairment in functioning and with good inter-rater reliability (Shaffer et al. 1983). Neurological evaluation included assessment of all the cranial nerves, cerebellar functions, muscle tone and reflexes in the four limbs. A history of epilepsy was also obtained. The neurological examinations were conducted by OA with active assistance and supervision by IL (a paediatric neurologist) while IQ tests were performed by OA and PI (PI is a specialist in the use of SIT and she trained OA on the use of the instrument). CGAS was assessed by OA.

Ethical permission to conduct the study was obtained from the Ethical Committee of the Oyo state Ministry of Health, Ibadan, Nigeria. In view of the difficulty that was envisaged in tracing the parents or competent guardians of the adolescents in the Home, individual assent was obtained in lieu of parental consent. All the standard ethical principles like voluntariness, confidentiality, non-malfeasance, et cetera were however observed throughout the conduct of the study. The data collected were analysed using the Statistical Package for Social Sciences version 16 (spss – 16) software. Categorical variables were examined, analysed and compared using statistical tests of significance, while continuous variables were analysed using measures of central tendency and Student's t-test. Level of significance was set at P < 0.05.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References

A total of 134 adolescents comprising 67 participants from the Ibadan remand home and 67 controls from a nearby school completed the study.

Socio-demographic pattern

There were 82 (61%) boys and 52 girls (39%) with a boy : girl ratio of 2:1. Their mean age was 12.5 years (SD ± 2.1). There was no statistically significant difference in the mean age of the adolescents in custodial care and the comparison group. While the comparison group were all school-going adolescents, 51 (76%) of the remand home participants had either dropped out of school before coming in contact with the custodial facility or were never in school.

The admission categories of the adolescents who were resident in the Home were Care and Protection (n = 53; 78%) and Criminal Code (n = 14; 22%). The adolescents on ‘criminal code’ were those declared as ‘beyond parental control’ (n = 9) and ‘young offenders’ (n = 5). Participants admitted in the Home for care and protection were predominantly younger than those on ‘criminal code’ (9 ± 1.7 vs. 14 ± 1.8, P = 0.001). Among the 53 adolescents in need of care and protection, 39 (86.8%) were picked up by law enforcement agents having been found abandoned, wandering the streets or living as destitute. Others were brought in having been found engaged in dangerous child-labour situations like bus conducting (n = 6; 11.3%) while one (1.9%) adolescent girl was committed for living in a brothel.

Intellectual disabilities

The mean IQ score for the remand home participants was significantly lower compared with the comparison group (67 ± 11 vs. 99 ± 14; t = 1.6, P = 0.001). Figure 1 shows the distribution of IQ ratings among participants. Almost half (n = 28; 46.7%) of the participants in the remand home group had low intellectual ability of varying degrees, including borderline intellectual functioning as compared with only 2 (3.3%) of the controls (P < 0.001). When borderline intellectual functioning was excluded, the prevalence of intellectual disability among the remand home participants was 22.4% (n = 15) compared with none (0%) among the controls. This number included seven (10.4%) who could not comprehend any question on the SIT and were adjudged to have severe-profound intellectual disability. In this group of adolescents, hearing impairment was excluded with attestations from the staff of the Home and a good response to calls on their given names or sound from behind them.

figure

Figure 1. Intelligence quotient (IQ) ratings by Slosson's Intelligence Test among adolescents in Ibadan remand home, Nigeria (n = 67 per group). *P < 0.001

Download figure to PowerPoint

CGAS scores

The mean current CGAS score for the remand home group was 74 (SD ± 9) compared with 97 (SD ± 4) among the controls. This difference was statistically significant (t = −11.2, P < 0.001). The mean CGAS score among the remand home participants with intellectual disabilities (mild to profound) was 48 ± 4 while that of those with borderline intellectual functioning was 61 ± 2. These figures were significantly lower than 89 ± 3 for the remand home participants with normal intellectual abilities as measured by the SIT.

Neurological deficits and epilepsy

Neurological deficits were found in 12 (18%) of the remand home group compared with none in the control group. This difference was statistically significant using Fishers’ statistic (P = 0.02). The neurological deficits recorded among the remand home adolescents included slurred speech (n = 6), dyskinesia (n = 4), motor disabilities in the form of hemiparesis and quadriparesis (n = 5) and one participant had a waddling gait (some participants had more than one deficit). Epilepsy was reported in 13 (19.4%) of the adolescents in custodial care compared with 1 (1.7%) among the control group (P = 0.015). Seizures were mostly generalized seizures (n = 12) with only one participant reporting features suggestive of complex partial seizures. The mean age of onset of seizure disorder among remand home participants who could remember was 7 years (SD ± 1) and they were all on anticonvulsants with a mean of 2 ± 1 attacks per week. The sole participant who had seizure disorder among the comparison group had an age of onset of 10 years and was also on anticonvulsants. This participant had been seizure free for 2 years. None of the participants reported ever having had an electro-encephalography or other neurological investigations done.

Among the adolescents in the Ibadan juvenile remand home (IJRH), the prevalence rate of neurological deficits and epilepsy was significantly higher among those admitted for child abuse or neglect than those on ‘criminal code’. They also had a lower mean IQ as shown in Table 1.

Table 1. Comparison of prevalence of neurological disorders among the two categories of participants
VariableChild neglect/abuse (n = 53)‘Criminal code’ (n = 14)χbP
  1. a

    Student's t-test.

  2. b

    Fisher's exact statistic.

  3. IQ, intelligence quotient.

Mean IQ score58 ± 676 ± 80.46a0.04
Neurological (motor) deficits11 (20.8)1 (7.4)0.002b
Epilepsy12 (22.6)1 (7.4)0.001b

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References

Epilepsy, neurological deficits and intellectual disabilities were significantly higher among the child-neglect group compared with both the comparison group and the adolescents on ‘criminal code’. This is in line with earlier research findings, which show that chronic disabling conditions increase the chances of being maltreated or neglected as a child (Sobsey 1992, Sullivan & Knutson 2000, Spencer et al. 2005). Sullivan & Knutson (2000) reported that children with any type of disabling condition were more likely to be maltreated or neglected compared with children without disabilities. Sobsey (1992) also reported that children with intellectual disabilities were 4–10 times more likely to be victims of maltreatment and neglect than those without intellectual disabilities. The higher risk of neglect and maltreatment among children with chronic disabling conditions may not be unconnected with their higher dependence and needs for care. The social and economic disadvantage that may increase the risk of having children with disabilities in resource constrained countries like Nigeria in the first place may also increase the stress of parenting. Therefore, the burden of caregiving for children with disabling conditions is likely to be higher when coupled with other social challenges like poverty.

Aside this, one specific factor that can increase the burden of caring for and the risk of maltreatment or neglect of children with chronic neurological disorders in Nigeria include widespread wrong notions about the causation and outcomes of these conditions. Several studies in Nigeria and indeed, other West African countries have documented that a large number of mothers and school teachers attributed the cause of childhood epilepsy, neurological deficits and intellectual disability in children to possession by evil spirits, witchcraft or virulent contagion (Alikor & Essien 2005, Birbeck et al. 2006, Ofovwe & Ofovwe 2007, Frank-Briggs & Alikor 2011). Citing the ‘demonic’ or ‘contagion’ theory of causation of different types of chronic disabling neurological conditions as a rationale, 48% of a sample of teachers in a Nigerian community was of the opinion that children with epilepsy should be withdrawn from school (Alikor & Essien 2005). In another study, about 30% of mothers of children attending a neurological clinic in Nigeria reported that they maintain minimal social contact with their children with epilepsy, and were of the view that affected children would not achieve much in life (Frank-Briggs & Alikor 2011). Similarly, majority of mothers of children with chronic neurological deficits in some Nigerian communities were ashamed and embarrassed to be seen with their affected children in public (Ofovwe & Ofovwe 2007) and thought them as bearers of misfortune and evil powers (Ofovwe & Ofovwe 2007).

These widespread beliefs can engender social distance from and neglect of affected children and adolescents. Attempts at exorcizing such children from perceived evil-spirit possession may also lead to various forms of maltreatment. Physical punishments and maltreatment may also be used as a retribution for the perceived possession of evil powers. The perceived ‘evil’, ‘extra-terrestrial’ or ‘infectious’ nature of these neurological conditions may also lead to stigmatization and discrimination of both the child and their mothers. A lack of adequate social support for parents and lack of educational facilities for the care of children with chronic disabling neurological and intellectual disabilities in resource-poor countries like Nigeria can also add to the burden of care. Confronted with a combination of stigma and misconceptions, high caregiver burden and a lack of social support; caregivers of children with chronic disabling neurological conditions may get frustrated and consider abandoning or neglecting their affected children. Doing away with children by way of abandonment has been cited as a well-considered form of respite from the burden of care, shame and fears associated with caring for children with disabling conditions in Nigeria (Abasiubong et al. 2008). The foregoing may explain the much higher prevalence of neurological deficits and epilepsy among the adolescents admitted into the remand home haven being maltreated or abandoned.

Impaired intellectual functioning was found in almost half of the remand home participants in this study. Although the SIT is not designed to assess for deficiencies in adaptive functioning, the fact that the adolescents in this study who had scores that fell within the range of ‘intellectual disability’ also had significantly lower CGAS scores suggest some reliability of the SIT in detecting such. The mean CGAS scores of 48 for the remand home participants who had intellectual disabilities fell short of the normative score of 81, which corresponds with ‘good functioning’. This observation suggests actual impairments in the functioning of the remand home participants that were adjudged to have intellectual disabilities using the SIT IQ scores. The 22.4% prevalence of intellectual disability among the children and adolescents within the juvenile facility in this study is higher than the weighted average of 12.7% found in the results of a meta-analysis from developed countries (Casey & Keilhtz 1999). This is most likely due to the fact that the participants in this study were not exactly the typical ‘juvenile justice sample’. The majority were actually remanded in the Home for maltreatment and abandonment rather than juvenile crime or delinquency. Although lower levels of intellectual functioning have been found among incarcerated young offenders (Perske 1991), particularly high prevalence of intellectual disabilities has been found among abandoned, maltreated or children in other situations that may warrant protective custody (Sullivan & Knutson 2000, Spencer et al. 2005). It does appear from current study that social welfare institutions in this region may be fast becoming a dumping ground for children with unrecognized or unattended neurological or intellectual disabilities.

Being a cross-sectional study, this study cannot establish whether the lower intellectual abilities of the participants in the remand home were confounded by their stay in the Home. However, the finding of high prevalence of low intellectual functioning among the adolescents in the Home still raises serious concerns. This is because regular educational services in the facility where the present study was conducted, and in similar facilities across the country, are either skeletal or non-existent. The same goes for resources for special education. Although not usually classified as intellectual disability per se, the finding in this study that adolescents with borderline intellectual functioning also had significantly lower CGAS scores is a cause for much concern. Earlier research has shown that children with borderline intellectual functioning also suffer some degree of social and academic impairment (Karande et al. 2008).

The needed social and intellectual skills to help prepare for life after and outside the remand home will be lacking and the chances of successful reintegration into the community will be slim, if the educational needs (regular or special) of these children and adolescents are not addressed. Article 2 (1) of the United Nations Convention on the Rights of the Child (CRC) (United Nations 1989) guarantees that rights, including right to education, of any child should not be denied by reason of status or disability. Article 28 of same convention provides that all children should be given education on equal opportunity basis. Children and adolescents with intellectual disability within the juvenile justice and social welfare systems constitute a very vulnerable group whose needs can only be met with purposive efforts.

Young persons with intellectual disabilities will often require specialist interventions from appropriately skilled professionals. Therefore, educational services for young persons with intellectual disability within the juvenile justice and social welfare systems should be part of any national or regional CAMH service. This can best be provided in juvenile justice and social welfare settings, where co-morbid psychiatric disorders are usually very common (Teplin et al. 2002, Abram et al. 2004); by a well-coordinated multidisciplinary team (Chapman et al. 2006). Such teams should consist of child and adolescent psychiatrists, learning disability experts, psychologists, social workers, paediatricians, physiotherapists and experts in juvenile justice jurisprudence.

In the same vein, article 24 (d) of the CRC requires that state parties commit themselves to pre- and postnatal care at the primary care level as a means of reducing child morbidity and mortality and by extension the incidence of childhood disabilities. The absence of ancillary information on the course and onset of the neurological deficits found among the adolescents in this study made a definitive conclusion on the diagnosis difficult. However, the pattern of almost all the neurological deficits found were in keeping with the pattern earlier reported among children with neurological sequelae of perinatal asphyxia in Nigeria (Ogunlesi et al. 2008, Frank-Briggs & Alikor 2011). Studies from Nigeria have described slurred speech, hypertonia, hyper-reflexia, muscle atrophy, dyskinesia and epilepsy as among the most frequent neurological sequelae of perinatal asphyxia in this region (Ogunlesi et al. 2008, Frank-Briggs & Alikor 2011). If indeed the neurological deficits found among the abandoned or maltreated adolescents in this study arose from perinatal asphyxia as we strongly suspect, this study then provides another rationale for an urgent need to scale up availability and quality of child and maternal care in Nigeria as one way of ensuring child-right protection and reducing the rising cases of child neglect in the country.

Furthermore, study also makes a further case for a need for public enlightenment on the gains of accessing quality obstetric and neonatal care where possible. Enlightenment campaigns should also endeavour to dispel misperceptions about neurological disorders. Government and donor agencies must as a matter of urgency provide facilities for respite care, counselling and support for mothers of children with chronic neurological disorders. Such facilities can also serve as a community-based source of referral to, as well as a collaboration point with, other relevant service providers like paediatric neurologists, child psychiatrists, special education experts and paediatric physiotherapists. Such centres may also serve as a community-based meeting-point for group therapy among mothers of children with disabilities. In view of the popularity of the faith-based organizations among community dwellers in Nigeria, worship centres can also serve as a setting for public enlightenment in this case. These measures will reduce the burden of care and the feeling of despair among mothers of children with neurological disorders and can ultimately reduce the risk of abuse and neglect of such children.

Above all, a longer-term solution to adverse child outcome in Nigeria is a sincere and concerted effort to maximize the use of the nation's vast human and material resource. Official corruption must be tackled through a culture of transparency and accountability in governance. Child poverty must also be reduced through social protection schemes. Affordable, accessible and qualitative maternal and child preventive and restorative healthcare must be made available through re-awakening of the primary care driven system of healthcare.

This study was part of an initial needs assessment conducted by the ongoing multidisciplinary Mental Health Outreach Programme to the IJRH, a local model for service provision for children and adolescents in juvenile justice or social welfare custodian care. The ongoing multidisciplinary collaboration programme was designed for the provision of neuro-psychiatric, social, educational and legal services for children and adolescents within the ibadan juvenile remand home. The MacArthur-Foundation sponsored collaboration includes the Child and Adolescent Psychiatry unit, the Paediatric Neurology Unit, the Institute of Child Health, the Paediatric Dermatology unit, the Department of Special Education and the Department of Private and Business Law in the University of Ibadan. Other juvenile justice and social welfare establishments within the country have a lot to learn from this programme in their quest for a holistic service provision for adolescents within the juvenile justice system.

Strengths and limitation

A major strength of this study is the inclusion of a comparison group. This improves the level of evidence of a higher prevalence of neurological and intellectual disability among the adolescents in the Home. A major limitation however is the fact that the SIT, which was used to measure IQ, does not have an in-built section that addresses specific impairments in adaptive function. This may have limited the interpretation of the scores generated by the instrument as regards disabilities. Although the CGAS score was used to bridge this gap, it is still a subjective measure of adaptive abilities. The fact that SIT is a verbal test with no performance section may imply that participants with subtle communication difficulties may have been at a disadvantage and as such have had a spuriously low IQ scores.

The sample size is small and the results were generated from a single Home. This limits the ability to generalize the findings. Future studies may need to have a larger scale design, involving a higher number of participants and remand centres in the country. Such study may want to include an objective assessment of social skills, which can inform rehabilitation strategies. There is also a need for further in-depth study of the socio-economic and cultural factors that promotes child abandonment in Nigeria with a view to come up with appropriate interventions. In addition, in drawing inferences from this study, it must be acknowledged that this study did not actually study abuse and neglect of children with disabilities but rather drew some conclusions based on previously published literature. While we stronglybelieve that many of the children in the remand home were there because of abuse or neglect, we did not actually study the relationship between neglect/abuse and having intellectual or neurological disability. Future studies may want to build on these limitations in expanding the literature on the relationship between child abuse/neglect and disabilities in this region.

Conclusions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References

This study has established that chronic disabling conditions like epilepsy and intellectual disabilities and neurological impairments are common among children in the Ibadan remand home. There is an urgent need to support families with children living with chronic disabling conditions as well as to develop facilities where restorative and respite care can be provided for affected children and adolescents and their caregivers. The study justifies the inclusion of special education practitioners, physiotherapists and paediatric neurological services in outreach programmes to this kind of institution and calls for further research in the field.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References

The authors wish to acknowledge the funding support of the MacArthur Foundation for the University of Ibadan Mental Health Outreach Programme to the Ibadan remand home, from which the data reported in this study were obtained.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Acknowledgments
  9. References
  • Abasiubong F., Obembe A. & Ekpo E. (2008) The opinion of mothers to mental retardation in Lagos, Nigeria. Nigerian Journal of Psychiatry 6, 8085.
  • Abdulmalik J., Omigbodun O., Beida O., et al. (2009) Psychoactive substance use among children in informal religious schools (Almajiris) in northern Nigeria. Mental Health, Religion and Culture 12, 527542.
  • Abram K.M., Washburn J.J., Teplin L.A., et al. (2004) Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry 61, 403410.
  • Ajiboye P.O., Yusuff A.D., Issa B.A., et al. (2009) Current and lifetime prevalence of mental disorders in a juvenile Borstal Institution in Nigeria. Research Journal of Medical Science 3, 2630.
  • Alikor E.A. & Essien A.A. (2005) Childhood epilepsy: knowledge and attitude of primary school teachers in Port Harcourt, Nigeria. Nigerian Journal of Medicine 14, 299303.
  • Aransiola J.O., Bamiwuye O., Akinyemi A.I., et al. (2009) Proliferation of street children in Nigeria: issues and challenges. Journal of Social Work 9, 371385.
  • Bella T., Atilola O. & Omigbodun O. (2010) Children within the juvenile justice system in Nigeria: psychopathology and psychosocial needs. Annals of Ibadan Postgraduate Medicine 8, 3439.
  • Birbeck G.L., Chomba E., Atadzhanov M., et al. (2006) Zambian teachers: what do they know about epilepsy and how can we work with them to decrease stigma? Epilepsy and Behaviour 9, 275280.
  • Burns B.J., Phillips S.D., Wagner H.R., et al. (2004) Mental health need and access to mental health services by youths involved with child welfare: a national survey. Journal of American Academy of Child and Adolescent Psychiatry 43, 960970.
  • Casey P. & Keilhtz I. (1999) Estimating the prevalence of learning disabled and mentally retarded juvenile offenders: a meta analysis. In: Understanding Troubled and Troubling Youth (ed Leone, P.E. ), pp. 8491. Sage publications, Newbury Park, CA.
  • Central Intelligence Agency (2011) The world fact book, 2011.
  • Chapman J.F., Desai R.A. & Falzer P.R. (2006) Mental health service provision in juvenile justice facilities: pre- and post-release psychiatric care. Child and Adolescent Psychiatric Clinic of North America 15, 445458.
  • Costello M. (1994) Perinatal asphyxia in less developed countries. Archives of Disability in Childhood 71, F1F3.
  • Earth Trends (2003) Economic Indicators – Nigeria.
  • Ebigbo P. (2003) Street children: the core of child abuse and neglect in Nigeria. Children, Youth and Environment 13, 4557.
  • Frank-Briggs A.I. & Alikor E.A.D. (2011) Socio-cultural issues and causes of cerebral palsy in Port Harcourt, Nigeria. Nigerian Journal of Paediatrics 38, 115119.
  • Jeffery B.T., Jeffrey L.K. & Yetter J.G. (1984) The Slosson intelligence test and young learning-disabled children: a comparative study. Journal of Clinical Psychology 4, 12551256.
  • Karande S., Kanchan S. & Kulkarni M. (2008) Clinical and psychoeducational profile of children with borderline intellectual functioning. Indian Journal of Pediatrics 75, 795800.
  • Maes B., Broekman T.G., Dosen A., et al. (2003) Caregiving burden of families looking after persons with intellectual disability and behavioural or psychiatric problems. Journal of Intellectual Disability Research 47, 447455.
  • National Population Commission and ICF Macro (2008) Nigeria Demographic and Health Survey 2008: Key Findings. NPC and ICF Macro, Calverton, MD.
  • Odding E., Roebroeck M.E. & Stam H.J. (2006) The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disability and Rehabilitation 28, 183191.
  • Odejide A. & Toye S. (1976) A survey of the inmates of a remand home in Ibadan. Nigerian Journal of Pediatrics 3, 5254.
  • Ofovwe G.E. & Ofovwe C.E. (2007) Knowledge, attitude and expectation of mothers of children with neurologic disorders attending the Paediatric Neurology Clinic, University Of Benin Teaching Hospital, Benin City, Nigeria. Journal of Medicine and Biomedical Research 6, 5965.
  • Ogundipe (2011) Management of juvenile delinquency in Nigeria. Paper presented at the International Conference on Special Needs Offenders organized by the International Institute for Special Needs Offenders and Policy Research (Canada) which held in Nairobi Kenya, 24th–26th Oct. 2011.
  • Ogunlesi T., Ogundeyi M., Adekanmbi F., et al. (2008) Socio-clinical issues in cerebral palsy in Sagamu, Nigeria. South African Journal of Child Health 2, 120124.
  • Oloruntimehin O. (1970) The role of family structure in the development of delinquent behaviour among juveniles in Lagos. Nigerian Journal of Economics and Social Sciences 12, 185203.
  • Omigbodun O. & Bella T. (2004) Obstetrics risk factors and subsequent mental health problems in a child psychiatry clinic population in Nigeria. Tropical Journal of Obstetrics and Gynaecology 21, 1520.
  • Omotola J.S. (2008) Combating poverty for sustainable human development in Nigeria: the continuing struggle. Journal of Poverty 12, 496517.
  • Ononye F. & Morakinyo O. (1994) Drug abuse, psychopathology and juvenile delinquency in south-west Nigeria. Journal of Forensic Psychiatry and Psychology 5, 527537.
  • Oyundoyin (2003) Environmental, gender and cognitive factors as correlates of creativity among senior secondary school students in Oyo state Nigeria. A PhD thesis submitted to the Department of Special Education, University of Ibadan Nigeria.
  • Ozen S., Aydın E., Remzi O., et al. (2005) Juvenile delinquency in developing country: a province example in Turkey. International Journal of Law and Psychiatry 28, 430441.
  • Perske R. (1991) Unequal Justice? What Can Happen When Persons with Retardation or Other Developmental Disabilities Encounter the Criminal Justice System. Abingdon Press, Nashville.
  • Shaffer D., Gould M.S., Brasic J., et al. (1983) A children's global assessment scale (CGAS). Archives of General Psychiatry 40, 12281231.
  • Slosson R.L. (2005) The Slosson's Intelligence Test Revised. Slosson Educational Publications Inc., New York, pp. 14.
  • Smith C., Algozzine B., Schmid R., et al. (1990) Prison adjustment of youthful inmates with mental retardation. Mental Retardation 28, 177181.
  • Sobsey D. (1992) Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance? Paul H. Brookes Publishing Co., Baltimore, MD.
  • Spencer N., Devereux E., Wallace A., et al. (2005) Disabling conditions and registration for child abuse and neglect: a population based study. Pediatrics 116, 609613.
  • Sullivan P.M. & Knutson J.F. (2000) Maltreatment and disabilities: a population-based epidemiological study. Child Abuse and Neglect 24, 12571273.
  • Teplin L., Abram K. & McClelland G. (2002) Psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry 59, 11331143.
  • UNICEF (2009) Federal Government of Nigeria and UNICEF Master Plan of Operations for a Country Program of Cooperation for Nigerian Children and Women – 2002–2007. United Nations Children's Fund, Lagos.
  • United Nations (1989) Convention of the Rights of the Child. United Nations, Geneva.
  • United Nations (2003) Juvenile Delinquency. World Youth Report 2003. p. 193. Available at: www.un.org/esa/socdev/unyin/documents/ch07.pdf (accessed 21 January 2012).