Intersectoral Collaboration in Autism Screening and Surveillance - a Four Year Trend from Lagos Nigeria.

Background:  There is a recurring reminder about the need for research to be carried out to determine the burden of Autism in Africa along with the need to address the service gap and related challenges in autism care in many African countries. The perennial non availability of trained personnel which are few and scattered all over the country, making them inaccessible in many regards. Non availability of resources, lack of awareness, and lack of political will to provide solutions continue to worsen these challenges. Collaboration in providing solutions for autism diagnosis for those in need along with the willingness to explore what available options to service provision in this setting, can an be important first step. It is important that health care providers also get trained to identify and appropriately manage cases of ASD and Policymakers are encouraged to focus on providing the necessary infrastructure to manage this condition. One anticipates that when all stakeholders play a roles at varying levels there will be a more sustainable solution evolovlving to address this challenge.

Objectives:  This report aims to describe the findings, processes and strengths of a community surveillance program over a period of 4 years (2013,2014, 2015 and 2016).

Methods:  The GTB-CMUL autism program is a collaboration run as part of the Orange Ribbon initiative of Guaranty trust bank. The annual exercise involves two broad approaches: firstly the organizing of seminars and secondly, conducting consultative sessions with clients with features suggestive of ASDs often undiagnosed formally. Mode of recruitment is directly from community ; via email invitation, letters to special schools, verbal invitation, print media and radio jingles. Clinical evaluation sessions held over 5 day periods each year. The clinical portion findings are reported here. Clinical evaluation was conducted multidisciplinary team of volunteers. Assessments were made based on the DSM 5 Criteria for Autism.

Results: The collaborative team drawn from the private sector, public sector and academia comprised multidisciplinary professionals involved in autism care. The 4 year experience in program execution reported here showed a total of 626 individuals with neurodevelopmental disorders seen in this time frame. A significant proportion of subjects screened each year met criteria for ASD. For Majority this consultation was their first contact with formal orthodox care. Most of the caregivers suffered significant distress and were enrolled to support groups. The program consistently required to provide appropriate referrals to local services and parental inclusion to much needed support groups.

Conclusions: This program highlights how much can be achieved through team work and commitment. In the face of scarce resources committed collaborative efforts is a useful recourse to ensuring service delivery in Africa where there are little or no ASD relevant services. Monitoring, evaluation and quality assurance processes need to be continually included and reviewed in such programs going forward.