Childhood autism spectrum disorder: insights from a tertiary hospital cohort in Kenya

Introduction: Autism Spectrum Disorder (ASD) is characterized by impairments in behavior, social communication and interaction. There have been little data on ASD from sub-Saharan Africa (SSA) describing clinical characteristics in large cohorts of patients. Preliminary studies reported a high male sex ratio, excess of non-verbal cases, possible infectious etiologies and comorbidities e.g. epilepsy. Objectives: To describe the clinical characteristics of children diagnosed with ASD in an African context. Methodology: This cohort study used a retrospective medical chart review which identified 116 (7%) children diagnosed with ASD according to DSM-5 criteria. From a total of 1,711 medical records consisting of physical files and electronic databases from Twenty-seven (23%) children self-referred while 89 (77%) referred by other medical practitioners and attended a pediatric neurology clinic at Aga Khan University Hospital in Nairobi, Kenya, between 2011 and 2016. Results: The median age at presentation was 3 years with speech delay as the most common reason for presentation enventhouh most of them were 6 years and below. Expressive language delay was observed in 90% of the respondents. (60%) who obtained imaging had normal MRI brain findings. Only 44% and 34% of the children had access to speech and occupational therapy respectively. 53% in the study were first-borns in their families. Epilepsy and ADHD were the most prevalent co-morbidities. Males (94, 81.1%) were more than females (22, 18.9%) at a ratio of 4.3:1. Conclusion And Recommendations: An early median age at presentation and preponderance of male gender was observed as lack of awareness and stigma identified as contributing factors for therapy. Access to speech therapy and other interventions to scale-up to cub intellectual disability and epilepsy. A prospective study would help determine outcomes following appropriate interventions from 1 to 23 years old