A Survey of Health Workers in Ghana and Nigeria on the Potential Burden and Local Assessment of Executive Dysfunction Among Children

Early identification of executive dysfunction in children by non-specialist through task-shifting is imperative to attaining universal health coverage in sub-Saharan Africa. We assessed the potential burden of executive dysfunction seen by local health workers, and the potential for integrating them into assessment for cognitive functioning of children within the local healthcare system. This study was a cross-sectional in-person and online survey of 133 health workers in rural and urban Ghana and Nigeria from primary, secondary and tertiary tiers of the healthcare system. Adolescents (11 - 18 years) were the most seen age-category in primary and secondary care and by non-specialists, while school-age children (6 - 9 years) and pre-schoolers (1 - 5 years) were most seen by specialists. In decreasing order of frequency, the reported conditions likely to be associated with executive dysfunction and the cadres of workers who saw them were epilepsy and seizure-related (all workers), brain injury and neurodevelopmental delay-related complaints (secondary care workers), Attention Deficit Hyperactivity Disorder related complaints (specialists in referral centres), anxiety-related complaints (specialists in primary care) and school difficulties-related complaints (secondary care workers and non-specialists). Adolescents with Attention Deficit Hyperactivity Disorder may be going unrecognised. The Wechsler Intelligence Scale for Children/Wechsler Preschool and Primary Scale of Intelligence and the Kaufman Assessment Battery for Children (not ecologically validated) and clinical history with Mental State Exam were the most common means of assessing cognitive functioning. Potential burden of executive dysfunction among children in Ghana and Nigeria is high, and involvement of non-specialist health workers in cognitive functioning assessment is needed.