Symptoms of attention-deficit/hyperactivity disorder among child and adolescent psychiatric outpatients in Zanzibar

Introduction: Attention-deficit/hyperactivity disorder, ADHD, is a neurodevelopmental disorder that affects children and adolescents, however symptoms may continue through adulthood. People with ADHD show a constant pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development. The worldwide prevalence is 5.3%. Yet, to our knowledge, no studies on the prevalence of ADHD has been done in a Zanzibarian population.

Aim: The aim of this study was to determine the prevalence of symptoms of ADHD amongst children and adolescents attending the outpatient clinic at Kidongo Chekundu mental hospital in Zanzibar, Tanzania. Furthermore, to evaluate if the ADHD diagnosis was being used, and if the children or adolescents diagnosed received treatment.

Methods: A cross-sectional study in a Zanzibarian population using SNAP-IV, a teacher and parent screening tool, to screen for symptoms of ADHD or ODD in the patients attending the clinic during the period of time. Caretakers to the attending child were asked to answer the screening questions, as well as baseline characteristics of the child. The screening tool and baseline questionnaire was translated to swahili and two research assistants read the questions to the children’s caretakers in swahili and filled in the forms. Chronbach’s alpha was measured to analyze the internal consistency of the SNAP-IV screening tool. Furthermore, the patient’s medical file was used to confirm the child’s diagnosis and treatment.

Results: In total 153 patients were included for the screening of symptoms of ADHD or ODD, and 140 of these patients were also analyzed for diagnosis and treatment through the patients’ files. The screening showed that 27% of the children and adolescents attending Kidongo Chekundu mental hospital showed moderate or severe symptoms of ADHD. Moreover, from the 140 patients with medical files, 22 patients (16%) had a confirmed ADHD diagnosis and all received treatment. Out of the 22 patients with a verified ADHD diagnosis 12 were male and 10 were female. Most patients with an ADHD diagnosis were treated with antipsychotics, predominantly with Risperidone. Only 2 of the children with confirmed ADHD received treatment with central nervous system stimulants. It was shown that 64% of the children with ADHD still showed moderate or severe symptoms of ADHD through the screening, even though they received treatment. Furthermore, Chronbach’s alpha was 0,87 for SNAP-IV.

Conclusions: More than one fourth of the children attending the children and adolescent psychiatric outpatient clinic in Zanzibar showed moderate to severe symptoms of ADHD. Future studies are needed to investigate the underlying aetiology to these symptoms. Furthermore, 16% of the patients included in the study had an ADHD diagnosis and were receiving treatment, most commonly with antipsychotics. Unfortunately, 64% of these patients still showed moderate or severe symptoms of ADHD which implicates that the treatment is insufficient.

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